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Case Summaries

Labor & Employment Law

[05/26] Fernandez v. Zoni Language Ctrs., Inc.
In an employment suit brought by English language teachers, alleging minimum wage and overtime claims under the Fair Labor Standards Act (FLSA), 29 U.S.C. sections 201 et seq., the district court's dismissal is affirmed over plaintiffs' arguments that it was error to afford defendants the FLSA's exemption for bona fide professional employees, section 213(a)(1), because defendants are not 'educational establishment[s],' as required by law, 29 C.F.R. sections 541.303(a), 541.204(b).

[05/24] US EEOC v. McClane Co., Inc.
On remand from the U.S. Supreme Court, in an action challenging the EEOC's issuance of an administrative subpoena requesting 'pedigree information' (name, Social Security number, last known address, and telephone number) for employees or prospective employees who took an employer's physical capability strength test, as part of an investigation of a sex discrimination claim, the district court's order denying the enforcement of the subpoena is vacated where the district court abused its discretion because the information was relevant to the EEOC's investigation.

[05/22] Water Splash, Inc. v. Menon
In an employer's Texas state court action against a former employee who resided in Canada, alleging that defendant had begun working for a competitor while still employed by plaintiff, the Texas Court of Appeals' decision reversing the trial court's denial of defendant's motion to set aside the default judgment on the ground that she had not been properly served, is vacated where the Hague Service Convention does not prohibit service of process by mail.

[05/22] Demetrius v. Transport Workers Union of Am.
In two consolidated actions brought under the Railway Labor Act, alleging a union's breach of the duty of fair representation in the decision to distribute the proceeds of a bankruptcy settlement to all of its members unevenly, the district court's dismissal of the actions is affirmed where there was no breach of duty because the union's conduct was not arbitrary, discriminatory, or in bad faith.

[05/22] Makinen v. City of New York
In an employment case involving a provision of the New York City Human Rights Law (NYCHRL) that defines only 'recovering' or 'recovered' alcoholics as having a 'disability', the Court certifies the following question to the New York Court of Appeals: Do sections 8?102(16)(c) and 8?107(1)(a) of the New York City Administrative Code preclude a plaintiff from bringing a disability discrimination claim based solely on a perception of untreated alcoholism?

[05/18] Jones v. SCO Silver Care Operations LLC
In an action brought by certified nursing assistants against their employer for violations of the Fair Labor Standards Act (FLSA) and related New Jersey state wage and hour laws, the District Court denial of defendant's motion to dismiss or to stay pending arbitration is affirmed over defendant's claim that both overtime claims must first be submitted to arbitration to resolve disputed interpretation of the collective bargaining agreement (CBA), including the definition of the wage differentials and policies concerning the meal breaks.

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ERISA

[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.

[05/11] Orzechowski v. The Boeing Company Non-Union Long-Term Disability Plan
In an ERISA action challenging a decision to terminate the plaintiff's long-term disability benefits, the district court's judgment after bench trial in favor of defendants is reversed where: 1) de novo review was required under California Insurance Code section 10110.6, which voided the discretionary clause contained in the plan; 2) section 10110.6 is not preempted by ERISA because it falls within the savings clause set forth in 29 U.S.C. section 1144(b)(2)(A); and 3) section 10110.6 applied to the plaintiff's claim because the relevant insurance policy renewed after the statute's effective date.

[04/05] Sec'y US Dep't of Labor v. Kwasny
In a case brought under the Employee Retirement and Income Security Act of 1974 (ERISA), the district court's grant of summary judgment is affirmed where the record shows no genuine issue of disputed fact, but remanded for a determination of whether the judgment against defendant should be offset by a previous Pennsylvania state court judgment entered against defendant for the same misdirected employee contributions.

[03/27] Stephanie C. v. Blue Cross Blue Shield of Mass
In an action brought pursuant to the Employee Retirement Income Security Act (ERISA), 29 U.S.C. section 1132(a)(1)(B), seeking reimbursement for certain expenses connected with the treatment of plaintiff's teenage son, the district court's judgment affirming the denial of her claim is affirmed where: 1) because an ERISA plan is a form of contract, and contract-law principles inform the construction of an ERISA plan, the plain language of the plan provisions should normally be given effect; and 2) applying the plain language of the plan, the clear weight of the evidence dictates a finding that the disputed charges were not medically necessary and, thus, were not covered.

[03/27] Doe v. Standard Ins. Co.
In an ERISA benefits suit for long term disability (LTD) payments brought by an environmental lawyer against his insurer, the district court's judgment in favor of the insurer is reversed where: 1) in assessing whether and when Doe became disabled, defendant chose not to use the material duties of an environmental lawyer, but rather those of a lawyer; 2) in doing so, defendant's evaluation as to Doe's disability onset date was based on the wrong standards; and 3) defendants denial of benefits from its determined onset date was arbitrary and capricious.

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Immigration Law

[05/25] Int'l Refugee Assistance v. Trump
In an action challenging the President's Executive Order No. 13780, 'Protecting the Nation from Foreign Terrorist Entry Into the United States,' the district court's issuance of a nationwide preliminary injunction as to Section 2(c) of the challenged Executive Order is affirmed in part and vacated in part where: 1) the Constitution, as the Supreme Court declared in Ex parte Milligan, 71 U.S. (4 Wall.) 2, 120 (1866), remains 'a law for rulers and people, equally in war and in peace'; and 2) the Establishment Clause of the First Amendment protects plaintiffs' right to challenge an Executive Order that in text speaks with vague words of national security, but in context drips with religious intolerance, animus, and discrimination.

[05/08] Flores v. Attorney General US
In a petition for review of a Board of Immigration Appeals (BIA) decision finding a Guatemalan petitioner ineligible for withholding of removal because she had been convicted of a 'particularly serious crime' -- namely a conviction of accessory after the fact in South Carolina for witnessing but failing to report a murder -- the petition is granted in part where the South Carolina accessory-after-the-fact conviction is not an offense 'relating to obstruction of justice,' and it cannot be considered either an 'aggravated felony' or a 'particularly serious crime' under the Immigration and Nationality Act (INA).

[05/03] Garcia-Garcia v. Sessions
In consolidated petitions for review of the IJ's and the BIA's denial of petitioner's asylum application on the ground that a key provision of Illegal Immigration Reform and Immigrant Responsibility Act of 1996, Pub. L. 104-208, 110 Stat. 3009-546 (IIRIRA) plainly entitles him to seek asylum, the petitions are denied where aliens who are subject to reinstated orders of removal may not apply for asylum.

[05/02] US v. Garcia
Conviction of unlawful procurement of naturalization, in violation of 18 U.S.C. section 1425(a), is affirmed over defendant's claims that the district court erred by denying his post-trial motions for judgment of acquittal and a new trial, and taking judicial notice of a portion of the U.S. Citizenship and Immigration Services' (USCIS) website.

[05/02] Cazun v. Attorney General US
In an action involving a native and citizen of Guatemala involving the issue of whether an alien subject to a reinstated removal order may apply for asylum, the Board of Immigration Appeals (BIA) decision, that she was statutorily ineligible to apply because her previous order of removal had been reinstated, is affirmed where although Congress has not spoken clearly on the issue in the relevant statute, the Court gives Chevron deference to the BIA's reasonable statutory interpretation that aliens subject to reinstated removal orders are ineligible to apply for asylum.

[05/01] Ayala v. Sessions
In a petition for review of the Board of Immigration Appeals (BIA) denial of a motion to reconsider or reopen a negative reasonable fear determination in reinstatement removal proceedings, the petition is granted where: 1) the Board's decision constituted the final order of removal and the petition is timely; and 2) the Immigration Judge (IJ) abused his discretion in denying the motion to reconsider or reopen.

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Workers' Comp

[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.

[03/29] Ramirez v. WCAB
In a workers' compensation writ proceeding, seeking review of worker-petitioner's independent medical review on the ground the underlying utilization review was based on an incorrect standard, the order of the administrative law judge (ALJ) taking the matter off calendar is reversed and remanded for further proceedings where: 1) this is not a proper ground for appeal of a utilization review determination because it goes to the heart of the determination of medical necessity; 2) the independent medical reviewer is in the best position to determine whether the proper standard was used to evaluate the medical necessity of the requested treatment, and the statutory scheme requires the independent medical reviewer to use the proper standard in determining medical necessity; and 3) the Legislature's plenary power over the workers' compensation system precludes any separation of powers violation, and the process afforded workers under the system affords sufficient opportunity to present evidence and be heard.

[03/24] Co. of Riverside v. WCAB
In a workers' compensation case involving a sheriff, the findings by the Workers' Compensation Appeals Board are affirmed over a County's challenge where: 1) plaintiff's the application for adjudication of claim was timely filed; and 2) Labor Code section 5500.5(a), did not bar liability on the County?s part.

[03/23] People v. Riddles
Conviction of workers' compensation insurance fraud in violation of Insurance Code section 11760(a) and restitution order are affirmed where: 1) a workers' compensation insurer may recover, as restitution under Penal Code section 1202.4, the premiums it would have earned in the absence of misrepresentations by an insurance applicant; and 2) the court did not err in imposing a fine.

[01/20] Metro Machine Corporation v. DOWCP
In a petition for review of an order of the Benefits Review Board affirming decisions of an ALJ granting a claim for medical benefits under the Longshore and Harbor Workers' Compensation Act, 33 U.S.C. section 907, the petition is denied where: 1) the only error the ALJ committed was in failing to apply the 'naturally or unavoidably results' standard to the fracture claim; and 2) remand for application of that standard would be a futile exercise, given that there was no issue presented regarding avoidability.

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Insurance Law

[05/03] Friedman v. AARP, Inc.
In an action brought by a plaintiff Medicare beneficiary who purchased private supplemental health insurance through a group Medigap policy, alleging that AARP Insurance Plan transacted insurance without a license in violation of the California Insurance Code, the district court's Fed. R. Civ. P. 12(b)(6) dismissal of the complaint is reversed where plaintiff stated a plausible claim at the motion to dismiss stage that AARP 'solicits' insurance without a license, and, as a consequence, committed an 'unlawful' act in violation of the California's Unfair Competition Law (UCL),Cal. Bus. & Prof. Code section 17200.

[05/02] People v. International Fidelity Ins. Co.
In a bail bond forfeiture case, the trial court's denial of surety-defendant's motion to vacate the forfeiture under Penal Code section 1305 and grant of summary judgment against defendant are affirmed over defendant's contention that, without its knowledge or consent, the trial court added conditions to defendant's bail that materially increased its risk under the bond.

[05/02] In re: The Trustees of Conneaut Lake PArk, Inc.
In a bankruptcy case involving 40 Pa. Stat. section 638, which prohibits insurance companies from paying fire insurance proceeds to a 'named insured' unless the local municipality certifies that no delinquent taxes are owed on the property where the insured structure was located, the District Court's judgment reversing the Bankruptcy Court grant of summary judgment to the Taxing Authorities and holding that 'named insured' as used in Section 638 includes only those who own the structure at issue and are responsible for the delinquent taxes, is reversed where this interpretation contravenes the text of the statute.

[05/01] Gerasimos Petratos v. Genentech Inc.
In a qui tam action under the False Claims Act involving a multi-billion dollar cancer drug, Avastin, which was developed by defendant, flied by the former head of healthcare data analytics for defendant, alleging that defendant suppressed data that caused doctors to certify incorrectly that Avastin was 'reasonable and necessary' for certain at-risk Medicare patients, the district court's dismissal of the suit for failure to state a claim is affirmed on alternate grounds where plaintiff failed to satisfy the False Claims Act's materiality requirement.

[04/27] Cuevas v. Contra Costa County
In an action brought by plaintiff's guardian ad litem for medical malpractice against defendant the County of Contra Costa arising out of injuries he sustained at birth, the trial court's entry of a jury verdict awarding plaintiff the present cash value of his future medical and rehabilitation care expense is reversed where the trial court erred in excluding evidence that health insurance benefits under the Patient Protection and Affordable Care Act (ACA) (Pub.L. No. 111-148 (Mar. 23, 2010) 124 Stat. 119) would be available to mitigate plaintiff's future medical costs.

[04/26] Salvati v. The American Ins. Co.
In an insurance dispute involving the issue of whether the plaintiff in a wrongful death action, who reached a settlement with the defendants and their primary insurance carrier, can recover the amount exceeding the primary policy limits from the defendants' excess insurer, the district court's grant of defendant's motion to dismiss, on grounds that the settlement agreement did not trigger the excess policy because the agreement was not accompanied by a court judgment, is affirmed on alternate grounds, where plaintiff has not presented a plausible argument that the settlement agreement triggered the excess insurer's duty to indemnify.

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