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Case Summaries

ERISA

[06/06] Pruter v. Local 210's Pension Tr. Fund
In an action seeking damages for fraud, breach of contract and violation of an employee benefit plan, the district court's dismissal of the claims is: 1) affirmed in part where plaintiffs' state law claims arise under the Railway Labor Act (RLA) and are thus preempted; but 2) vacated in part as to dismissal of the RLA claims, as those claims bear a close resemblance to claims brought pursuant to the Employee Retirement Income Securities Act (ERISA), and it is appropriate to borrow and apply ERISA's three?year statute of limitations rather than the six?month limitations period the district court borrowed from Section 10(b) of the National Labor Relations Act (NLRA).

[06/05] Advocate Health Care Network v. Stapleton
In a class action under the Employee Retirement Income Security Act of 1974 (ERISA) against church-affiliated nonprofits that run hospitals and other healthcare facilities, brought by current and former employees of the hospitals, alleging that the hospitals' pension plans do not fall within ERISA's church-plan exemption because they were not established by a church, the Seventh Circuit's judgment affirming the District Court's decision that a plan must be established by a church to qualify as a church plan, is reversed where a plan maintained by a principal-purpose organization qualifies as a 'church plan,' regardless of who established it.

[05/18] McCulloch Orthopaedic Surgical Services, PLLC v. Aetna Inc.
In a suit brought by a surgeon against a health insurance company under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. sections1001 et seq., seeking reimbursement for a patient insured by defendant, the district court's dismissal of plaintiff's complaint is vacated where ERISA does not completely preempt an 'out?of?network' health care provider's promissory?estoppel claim against a health insurer in cases where the provider: 1) did not receive a valid assignment for payment under a health insurance plan; and 2) received an independent promise from the insurer that he would be paid for certain medical services provided to the insured.

[05/18] McCulloch Orthopaedic Surgical Services, PLLC v. Aetna Inc.
In a suit brought by a surgeon against a health insurance company under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. sections1001 et seq., seeking reimbursement for a patient insured by defendant, the district court's dismissal of plaintiff's complaint is vacated where ERISA does not completely preempt an 'out?of?network' health care provider's promissory?estoppel claim against a health insurer in cases where the provider: 1) did not receive a valid assignment for payment under a health insurance plan; and 2) received an independent promise from the insurer that he would be paid for certain medical services provided to the insured.

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Workers' Comp

[06/20] Zhu v. Workers' Comp. Appeals Bd.
In a case involving an in-home caretaker injured while traveling between worksites, the court annulled an earlier appeal dismissing the action and remanded for a new decision, where the facts of the case qualified for the required vehicle exception to the going and coming rule.

[05/22] Southern Ins. Co. v. WCAB
In an action involving a workers' compensation insurance policy that was issued based on the express representation that the covered employer's employees did not travel out of state, and after an employee was injured out of state, the insurer notified the employer that it was rescinding the policy because of the employer's misrepresentation and returned the premium, the Workers' Compensation Appeals Board's decision affirming an arbitrator's decision that, as a matter of law, the insurer could not rescind the policy and that the policy was in effect, is annulled where: 1) contrary to the arbitrator's ruling, a workers' compensation insurance policy may be rescinded; and 2) the arbitrator and the appeals board did not address and determine whether rescission was a meritorious defense to the employee's claim.

[04/26] City of Jackson v. WCAB
In a workers' compensation case, the Workers' Compensation Appeals Board's decision disregarding the apportionment determination of the qualified medical evaluator (QME) on the ground the determination was not substantial medical evidence and directing the workers' compensation administrative law judge (ALJ) to make an award of unapportioned disability, is annulled where: 1) apportionment may be properly based on genetics/hereditability; 2) the QME properly apportioned disability; and 3) the QME's opinion Is based on substantial medical evidence.

[03/29] Marin Community Services v. WCAB
In a writ proceeding seeking to set aside the decision of the Workers' Compensation Appeals Board (WCAB) holding that firefighter-petitioner was entitled to the benefit of the rebuttable presumption under Labor Code section 3212.1 that his cancer arose out of his employment, the WCAB's decision is affirmed where: 1) the WCAB's determination that petitioner was an employee of Marinwood was based on a reasonable interpretation of the relevant statutes; and 2) the WCAB's determination that the extension of the cancer presumption ran from the date petitioner last worked as a firefighter for any agency was based on a reasonable interpretation of the relevant statute.

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