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Case Summaries

Elder Law

[02/05] Villano v. Waterman Convalescent Hosp., Inc.
In plaintiff's action against a convalescent hospital claiming she was admitted without her consent, judgment of the trial court is affirmed where, although a stipulated judgment is appealable, plaintiff cannot show that allegedly erroneous rulings were prejudicial.

[12/22] Massey v. Mercy Med. Center Redding
In plaintiff's negligence action against a nurse and the hospital that employed the nurse alleging that he sustained injury after falling from a walker because the nurse placed the plaintiff on the walker and left him unattended, judgment of the trial court is reversed in part where: 1) the question of nurse's alleged negligence for the fall poses a question of common knowledge, and therefore does not require expert opinion testimony; and 2) trial court's judgment that denied plaintiff's attempt to amend his complaint to add causes of action for battery, fraud and elder abuse is affirmed.

[12/21] Grace Healthcare of Benton v. US Dept. of Health & Hum. Servs.
In a petition for review of a civil monetary penalty imposed by the Secretary of the Department of Health and Human Services on petitioner nursing home for an "immediate jeopardy" violation of 42 C.F.R. section 483.13(c), which required nursing homes to thoroughly investigate all allegations of resident neglect or abuse, including injuries of unknown sources, the petition is granted where the Secretary's finding of the likely harm necessary to warrant an immediate-jeopardy-level finding was based on pure speculation and not supported by substantial evidence in the administrative record as a whole.

[12/01] Yarick v. Pacificare of California
In plaintiff-estate's suit against defendant health care providers and health care benefits providers alleging that the events resulting in decedent's death happened because of the financial pressures and incentive that arose from the care providers' contracts with the defendants, trial court's order sustaining defendants' demurrer is affirmed as: 1) federal law expressly preempts applications of state laws where standards for Medicare Advantage plans are established pursuant to the Medicare law; and 2) to the extent the plaintiff seeks to allege causes of action based on state common law concepts of duty independent of the Health and Safety Code provisions cited, those common law causes of action are preempted.

[11/30] Holbert v. Fremont Inv. & Loan
In plaintiff's suit against a financial lender, dismissal of the complaint is affirmed where: 1) defendant was not required to comply with the Home Ownership and Equity Protection Act of 1994 (HOEPA), which applies when the finance charges imposed on a loan exceed a certain threshold; 2) two charges imposed on plaintiff, one to pay off a preexisting debt to another lender and another to satisfy a prepayment penalty on a prior home loan, were not finance charges within the meaning of HOEPA; 3) plaintiff has not established a claim against defendant for unfair business practices; and 4) while plaintiff may have a viable claim against her loan broker for financial elder abuse based on various misrepresentations made during the loan process, she failed to link that claim to defendant, who is as much a victim of the broker's misrepresentations as plaintiff.

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ERISA

[03/01] Jones v. Unum Provident Corp.
In an action under ERISA for wrongful denial of benefits, summary judgment for defendant is affirmed where: 1) defendant thoroughly investigated plaintiff's claim, both initially and when plaintiff appealed, and its initial and final decisions were carefully reasoned; and 2) coverage under the policy at issue lapsed more than six weeks prior to plaintiff's return to full-time work, and thus her later disability claim was not covered because of a pre-existing condition clause.

[02/26] Overby v. Nat'l Ass'n of Letter Carriers
In an action seeking a declaration that a purported amendment to a trust plan, which would have rendered plaintiff ineligible to receive benefits under the plan as a surviving spouse, was not properly adopted, judgment for plaintiffs is affirmed where the district court committed no reversible error in either its factual determinations or in its conclusions of law in finding that the trustees of the plan had not submitted the amendment to the fund's actuaries for an evaluation and estimate of its cost, as required by the governing provisions of the plan, and therefore the amendment was not properly adopted.

[02/25] Carpenters Dist. Council v. JNL Const. Co.
In an ERISA action on behalf of certain pension funds against a construction company claiming that defendants failed to contribute union employees' fringe benefits to the funds as required by collective bargaining agreements, summary judgment for plaintiffs is reversed where plaintiffs did not produce sufficient evidence to show the absence of trialworthy issues on the issue of whether defendant corporation was used to perpetrate a fraud.

[02/10] Green v. UPS Health & Welfare Package for Retired Employees
In a class action lawsuit brought by former employees of UPS claiming that defendants raised the amount of health insurance contributions required of union retirees in violation of the retirement plan and, consequently, ERISA, judgment of the district court is affirmed where: 1) district court correctly concluded that UPS violated the Summary Plan Description by collecting additional contributions from local union retirees without collecting from other IBT retirees covered by the plan; and 2) with respect to additional contributions UPS collected from the local union retirees during the term of the 2008 CBA, district court correctly concluded that UPS's determination was within the range of reasonable interpretations, and therefore, not arbitrary and capricious.

[02/05] Battoni v. IBEW Local Union No. 102 Employee Pension Plan
In plaintiffs' ERISA action challenging an amendment to their welfare plan as an unlawful cutback of their accrued benefits under their pension plan, the judgment of the district court in favor of the plaintiffs is affirmed as the amendment violated the ERISA's Anti-Cutback rule, 29 U.S.C. section 1054(g), by constructively amending the pension plan in a manner that decreased an accrued benefit under that plan.

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Workers' Comp

[03/05] Rhine v. Stevedoring Servs. of Am.
In a petition for review of a decision of the Benefits Review Board under 33 U.S.C. section 921(c) of the Longshore and Harbor Workers' Compensation Act, the petition is denied where: 1) a reasonable mind could have concluded that the Pacific Maritime Association Average adequately represented petitioner's annual earning capacity; and 2) the availability of alternative employment was determined by reference to two criteria: the claimant's physical abilities and the economic availability of particular jobs in the market.

[03/03] City of Laguna Beach v. California Ins. Guarantee Ass'n
In a city's action against an insurance company seeking reimbursement for incurring workers' compensation liability that exceeded its self-insured retention, grant of insurance company's motion for summary judgment is affirmed where: 1) the addition of subdivision (c)(13) to Ins. Code section 1063.1 did not abrogate Denny's Inc. v. Workers' Comp. Appeals Bd., 104 Cal.App.4th 1433 (2003); 2) the trial court properly invoked the Denny's rule when it granted summary judgment and concluded that the city cannot obtain reimbursement from defendant under section 1063.1(c)(13) as, although this provision renders the obligation of an insolvent excess workers' compensation insurer a "covered claim" that defendant must ordinarily reimburse, defendant need not reimburse a permissibly self-insured employer for benefits paid to an employee for cumulative injury if the employer's liability is based in part on a period of time when the employer was self-insured and chose not to buy excess insurance for the particular risk.

[02/26] Lara v. Workers' Comp. Appeals Bd.
Workers' Compensation Appeals Board's decision against the petitioner and in favor of the defendant is affirmed as, the petitioner, hired twice in the space of 12 months to prune bushes for a diner, was not an employee of the diner at the time he sustained injury, but rather, he was an independent contractor exempt from workers' compensation coverage.

[02/26] Elliott v. Workers' Comp. Appeals Bd.
Decision of the WCAB that plaintiff's employer was not obligated to provide the requested spinal surgery is reversed and remanded as, in light of its en banc decision in Cervantes v. El Aguila Food Products, Inc. (2009) 74 Cal.Comp.Cases 1336 explicitly denouncing the Brasher holding relied on by the WCAB in this case, the employer is ordered to authorize the requested surgery or object to the treating physician's recommendation under 4062(b) within 10 days of receipt of this order, thereby commencing the spinal surgery second opinion process.

[02/12] Conley v. Nat'l Mines Corp.
Order of the Benefits Review Board reversing an Administrative Law Judge's award of black lung benefits on a widow's claim filed by petitioner under the Black Lung Benefits Act after her husband died of metastatic lung cancer is affirmed as the Board did not err in concluding that the decedent's treating physician's opinion was insufficient to carry the widow's burden of proof, based on the standard previously articulated in Eastover Mining Co. v. Williams, 338 F.3d 501 (6th Cir. 2003).

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Government Benefits

[03/08] Wildman v. Astrue
In a petition for review of the denial of social security disability benefits, the petition is denied where: 1) the Administrative Law Judge (ALJ) did not err in discounting a physician's opinion because it was conclusory and failed to account for petitioner's unjustified noncompliance; 2) the ALJ did not err when he discounted petitioner's testimony regarding her limitations due to her noncompliance; and 3) the ALJ properly considered and weighed the available medical evidence and petitioner's testimony.

[03/05] Rhine v. Stevedoring Servs. of Am.
In a petition for review of a decision of the Benefits Review Board under 33 U.S.C. section 921(c) of the Longshore and Harbor Workers' Compensation Act, the petition is denied where: 1) a reasonable mind could have concluded that the Pacific Maritime Association Average adequately represented petitioner's annual earning capacity; and 2) the availability of alternative employment was determined by reference to two criteria: the claimant's physical abilities and the economic availability of particular jobs in the market.

[03/03] California Pharm. Ass'n v. Maxwell-Jolly
In an action to enjoin the California Department of Health Care Services Director from implementing state legislation reducing payments to certain medical service providers, a preliminary injunction in favor of plaintiffs is affirmed where the state failed to study the impact of a 5% percent rate reduction on the statutory factors of efficiency, economy, quality, and access to care prior to implementing the rate reductions.

[03/03] Dominguez v. Schwarzenegger
In an action to enjoin California legislation that reduces the state contribution to wages paid to In-Home Supportive Services (IHSS) providers as preempted by Section 30(A) of the Medicaid Act, a grant of the injunction is affirmed where: 1) both the legislature and the Department of Social Services recognized that reimbursement rates ? that is, providers' wages and benefits ? were directly correlated to ensuring that services were consistent with efficiency, economy, and quality of care, and sufficient to ensure access to services under the IHSS program; 2) the state should have studied the impact of its decreased contribution to providers' wages and benefits prior to passing Cal. Welf. & Inst. Code section 12306.1(d)(6), and the State was not ipso facto immunized from challenges to its actions because it had no system in place to make such an assessment; and 3) the district court did not abuse its discretion in concluding that plaintiffs established irreparable harm absent injunctive relief, as its finding regarding provider harm was not clearly erroneous.

[03/02] St. John's Well Child & Family Ctr. v. Schwarzenegger
In a petition for writ of mandate by a nonprofit network of five community health centers and six school-based clinics in medically underserved areas of the state, claiming that Governor Schwarzenegger's use of his line-item veto authority exceeded constitutional limits because individual budget cuts he further reduced were not items of appropriation that could be individually vetoed or reduced, the petition is denied as the particular Assembly Bill 4X 1 budget reductions at issue were "items of appropriation" within the meaning of article IV, section 10(e) of the state constitution and the governor's line-item vetoes reducing them, while approving other portions of the Bill, were constitutionally authorized.

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