News

Case Summaries

Government Benefits

[08/31] Jones v. Astrue
In plaintiff's appeal from the district court's judgment upholding the Commissioner of Social Security's denial of her application for disability insurance benefits and supplemental security income, the order is affirmed where: 1) the ALJ had no need to contact plaintiff's treating physician because there was no ambiguity to resolve in her report, and the report contained all the necessary information, including the results of diagnostic testing; 2) the ALJ appropriately considered plaintiff's subjective complaints of pain under Polaski; and 3) substantial evidence on the record as a whole supported the ALJ's decision.

[08/30] Uhm v. Humana, Inc.
In an action against an insurer for nonpayment of Medicare benefits, the dismissal of the action is affirmed where 1) the district court lacked jurisdiction to consider plaintiffs' breach of contract and unjust enrichment claims because they were not properly exhausted under the Medicare Prescription Drug Improvement and Modernization Act; and 2) plaintiffs' fraud and consumer protection act claims, while not subject to the Act’s exhaustion provisions, were expressly preempted.

[08/30] California State Foster Parents' Ass'n v. Wagner
In an action against officials of the State of California under 42 U.S.C. section 1983 claiming a violation of plaintiffs' federal right to payments under the Child Welfare Act (CWA), and seeking declaratory and injunctive relief, judgment for plaintiffs is affirmed where the CWA, at 42 U.S.C. sections 672(a) and 675(4)(A), created an enforceable federal right.

[08/26] US v. Prince
Conviction of defendant for conspiracy to commit money laundering and multiple counts of money laundering, in connection with fraudulent claims for payment for physical therapy services provided to Medicare beneficiaries, is affirmed where: 1) the evidence at trial was sufficient to establish that the defendant committed, or conspired to commit, money laundering by conducting, or aiding and abetting another in conducting, the specified financial transactions knowing that they involved the proceeds of Medicare fraud; 2) a reasonable person would not question the judge's impartiality toward defendant because a government witness was represented by an attorney who previously represented the judge in a prior unrelated matter; and 3) district court did no abuse its discretion by refusing to require the government to provide a pretrial disclosure of its exhibit list.

Read More

Labor & Employment Law

[09/02] Weber v.Universities Research Ass'n, Inc.
In plaintiff's suit against her former employer for sex discrimination and retaliation in violation of Title VII, district court's grant of summary judgment in favor of the defendant is affirmed where: 1) plaintiff has waived her discrimination and retaliation arguments under the direct method of proof; and 2) plaintiff has failed to establish a prima facie case of sex discrimination, because even if she does not have to show that she was meeting defendant's legitimate business expectations, defendant is still entitled to summary judgment as she has failed to show that there were similarly situated men who were treated more favorably than she was.

[09/02] Branham v. Gannett Satellite Info. Network, Inc.
In plaintiff's suit under the Family Medical Leave Act (FMLA) against her former employer for being terminated from her job as a receptionist, district court's grant of summary judgment in favor of the employer is reversed and remanded where: 1) the district court erred when it granted summary judgment to defendant based on the submission of negative medical certification indicating that plaintiff could return to work; 2) plaintiff has produced sufficient evidence to create a genuine issue of material fact about her entitlement to FMLA leave, and defendant was not permitted to deny her leave based on the certification requirement when it never properly requested certification or informed her of the consequences of failing to provide the same, as required by Department of Labor regulations.

[09/01] Polycarpe v. E&S Landscaping Serv., Inc.
In consolidated Fair Labor Standards Act (FLSA) actions claiming that during plaintiffs' employment they worked more than forty hours per week and defendant employers failed to pay them either a federally mandated minimum wage, federally mandated overtime pay, or both, summary judgment for defendants is reversed where: 1) if a district court, ruling for a defendant, applied the "coming to rest" doctrine -- for instance, by looking at where defendant bought an item instead of where an item was produced, the court must vacate the judgment for the defendant if there was a question about where the "goods" or "materials" were produced or where they moved; and 2) for the purposes of the FLSA's handling clause, an item will count as "materials" if it accords with the definition of "materials" -- tools or other articles necessary for doing or making something -- in the context of its use and if the employer has employees "handling, selling, or otherwise working on" the item for the employer's commercial (not just any) purposes.

[09/01] Sprinkles v. Associated Indem. Corp.
In plaintiffs' bad faith action against Fireman's Fund Insurance Company, arising from an underlying suit against defendant and his employer for causing the death of plaintiffs' father in an automobile accident, trial court's judgment sustaining the insurer's demurrer is affirmed as, under the complaint and matters judicially noticed, the defendant-employee was an insured, rendering the automobile exclusion in the GCL policy applicable, and Fireman's Fund had no duty to defend the employer.

Read More

Workers' Comp

[08/31] Hayes Lemmerz Int'l, Inc. v. ACE Am. Ins. Co.
In an employer's suit against its insurer for refusing to tender defense in an underlying suit under its workers' compensation and employer liability policy, judgment of the district court in favor of the insurer is affirmed as, because defendant was, by virtue of Indiana law, a joint employer, insurer was contractually obligated to reimburse the reasonable expense of defendant's getting itself dismissed from the tort suit. However, because the defendant is not claiming that insurer refused to pay that amount, but rather, it is complaining that the insurer breached its duty to defend by failing to advise defendant that it's law firm was not defending the suit properly, the insurer had no duty to provide its insured's lawyers with legal advice.

[08/27] Transcon. Ins. Co. v. Crump
In plaintiff's suit against her deceased husband's insurer for workers' compensation death benefits, the judgment of the court of appeals is reversed and remanded where: 1) the treating physician's opinion was based on a reliable foundation and, therefore, legally sufficient evidence supports the jury's verdict; 2) the trial court's omission of the but-for component in the jury charge constitutes reversible error; and 3) an insurance carrier is entitled to have a jury determine the disputed amount of reasonable and necessary attorney's fees for which it is liable.

[08/19] Milpitas Unified Sch. Dist. v. Workers' Comp. Appeals Bd.
In a School District employee's suit for workers' compensation claims, the decision of the Workers' Compensation Appeals Board is affirmed as, the language of section 4660 permits reliance on the entire American Medical Association's Guides to the Evaluation of Permanent Impairment, including the instructions on the use of clinical judgment, in deriving an impairment rating in a particular case.

[08/12] Alvarez v. Workers' Comp. Appeals Bd.
In a claimant's objection to a panel qualified medical evaluator's ex parte communication with defense counsel, and a request for a new panel qualified medical evaluator under section 4062.3(f), in a workers' compensation proceeding for death benefits, the Workers' Compensation Appeals Board's (WCAB) denial of the petition is annulled and remanded as section 4062.3 expressly prohibits ex parte communications with a panel qualified evaluator, with no exception based on the initiator of the communication or for "administrative" matters. However, because a certain degree of informality in workers' compensation procedures has been recognized, not every conceivable ex parte communication permits a party to obtain a new evaluation from another panel qualified medical evaluator.

Read More