Justia Injury Law Opinion SummariesArticles Posted in U.S. 6th Circuit Court of Appeals
Brown v. Ajax Paving Indus., Inc.
Brown claimed that he injured his shoulder while paving a road for his employer Ajax Paving, and sought workers’ compensation. Ajax introduced medical testimony suggesting that the injury occurred outside of work. While the case remained pending before the Michigan administrative agency, Brown and Ajax settled. Brown, however, thought that Ajax had introduced false medical testimony and that it had done the same to other employees, and sued Ajax and its insurers, claims administrators and the doctor, under the Racketeer Influenced and Corrupt Organizations Act, 18 U.S.C. 1964(c). The district court dismissed. The Sixth Circuit affirmed. Under the Act, Brown must show that illegal racketeering activities have “injured [him] in his business or property.” The Sixth Circuit has held that “loss or diminution of benefits the plaintiff expects to receive under a workers’ compensation scheme does not constitute an injury to ‘business or property’ under RICO.” View "Brown v. Ajax Paving Indus., Inc." on Justia Law
Jackson v. United States
On January 13, 2009, Jackson was in a car accident with an agent of the Immigration and Customs Enforcement Agency (ICE) within the U.S. Department of Homeland Security (DHS). Jackson suffered damage to her head and spinal cord. Jackson retained the services of Shaffer, an attorney with the firm “Michigan Autolaw.” On March 5, 2009, Shaffer erroneously submitted Jackson’s administrative claim for Damage, Injury, or Death, to DHS, which forwarded Jackson’s claim to ICE. On June 17, ICE received Jackson’s claim. The cover letter listed Shaffer’s address in Southfield, Michigan. The claim form included Jackson’s mailing address. On July 7, ICE confirmed receipt of Jackson’s claim in correspondence, sent to the Southfield address, stating that ICE would process Jackson’s claim pursuant to the Federal Tort Claim Act, which allows an agency “up to six months to adjudicate a damage claim, beginning from the date the agency receives the claim.” On March 8, 2011, ICE sent to the Southfield address a “final determination” denying Jackson’s claim, stating that Jackson could file suit no later than six months after the date of mailing. On March 23, the Postal Service returned the denial as “Not Deliverable…Unable to Forward.” Autolaw had changed locations in May, 2010. Jackson contends that Autolaw had a one-year forwarding order for its mail. The parties also disagree whether the information about changing locations was conveyed to ICE. Despite receiving the undelivered mail, ICE took no further action. On January 11, 2012, Jackson filed suit. The district court dismissed, finding that the mailing of the denial letter triggered the six-month limitation and declining to apply equitable tolling. The Sixth Circuit affirmed. View "Jackson v. United States" on Justia Law
Anestis v. United States
Cameron returned to Kentucky after serving as a Marine in Iraq and applied for VA Medical Benefits, but did not include verification of service (DD-214). Four months later, the VA verified his service, but its record did not reflect combat service or other eligibility; his status was “Rejected.” A week later, Cameron’s records were updated and he was retroactively enrolled. Cameron had been involved in killing a civilian family. His parents had contacted the Lexington VA mental health department and urged their son to seek help. Tiffany, his wife, told him that she and their baby would not continue to live with him unless he sought help. Days before his enrollment was corrected Cameron went to the Leestown VA. The intake clerk recognized that Cameron was in urgent need of help and talked to him for 40 minutes, despite not finding his enrollment. She concluded that Cameron was suicidal. No mental health professional was available at Leestown. She sent him to Cooper Drive VA. Cameron called his father later, stating that he had been turned away from Cooper Drive because he did not have his DD-214. Cameron drove home. He and Tiffany searched for the form. Cameron became frustrated and threatened Tiffany, who called 911. While on the phone, she heard a shot. Her husband had committed suicide. His family asserted claims under the Federal Tort Claims Act. The district court dismissed, holding that it did not have jurisdiction over a “benefits determination,” Veterans’ Judicial Review Act, 38 U.S.C. 511.The Sixth Circuit reversed. Whether the clinics had a duty to care for Cameron is an improper question for this stage. The government failed to show that the actions of the VA employees satisfied the test of the FTCA’s discretionary function exception. View "Anestis v. United States" on Justia Law
Cultrona v. Nationwide Life Ins. Co.
Nicole discovered Shawn’s body in their Ohio home. Shawn had gone out drinking the night before, while Nicole spent the night at a friend’s house. The Medical Examiner’s Office reported the cause of death as “[a]sphyxia by extreme and restricted position (positional asphyxia)” and the manner of death as “[a]cute ethanol intoxication ... ACCIDENT: Prolonged and extreme hypertension of neck and torso while intoxicated.” Shawn’s blood-alcohol level at the time of autopsy was .22%. Nicole filed a $212,000 claim for accidental-death benefits with the Plan, which covers “injury” as a result of an “accident,” defined as “an unintended or unforeseeable event or occurrence which happens suddenly and violently.” No benefits will be paid if the “Covered Person [is] deemed and presumed, under the law of the locale … to be under the influence of alcohol or intoxicating liquors.” Nationwide directed denial of Nicole’s claim, citing Exclusion 12, but quoting an earlier version that provided: “The Covered Person being deemed and presumed … to be driving or operating a motor vehicle while under the influence…” Later, based on amended Exclusion 12, Nationwide upheld the denial; its appeals panel affirmed. Nicole filed suit, asserting claims under the Employee Retirement Income Security Act and a common-law breach-of-fiduciary-duty claim. The district court entered judgment in favor of the defendants, but agreed with Nicole that the appeals panel had breached its statutory duty to provide her with Plan-related documents upon written request, and imposed a penalty of $55 per day ($8,910). The Sixth Circuit affirmed. View "Cultrona v. Nationwide Life Ins. Co." on Justia Law
Rorrer v. City of Stow
Rorrer worked as a Stow firefighter from 1999 until July, 2008. On July 4, 2008, Rorrer lost all vision in one eye in a bottle-rocket accident unrelated to his work. The city terminated Rorrer because of his monocular vision. In September, 2008, the surgeon who operated on Rorrer’s eye cleared Rorrer to return to work without restriction. Rorrer arranged a return-to-work physical with Dr. Moten, the Department physician. After examining Rorrer, Moten’s colleague, Dr. Henderson, told Rorrer he should be able to return to duty without restriction, but qualified this statement by written cautions about using a self-contained breathing apparatus and driving at high speeds. Fire Chief Kalbaugh took the position that Rorrer was unfit to return to work and told Rorrer to call Moten, who told Rorrer that he “was sorry” for the “confusion” but that Rorrer could not return to work because “fire regs” would not allow it. National Fire Protection Association guidelines state that monocular vision compromises the firefighter’s ability to safely perform an essential Job Task. Rorrer claimed that the city had never adopted or applied those guidelines. The district court granted the city summary judgment on claims of disability discrimination and impermissible retaliation (for Rorrer’s opposition to discipline of another firefighter) under the Americans with Disabilities Act, Ohio law, and the First Amendment. The Sixth Circuit affirmed dismissal of First Amendment and ADA retaliation claims, but reversed as to the other ADA and Ohio discrimination claims.View "Rorrer v. City of Stow" on Justia Law
Shuler v. Garrett
Pauline and her doctors were aware of Pauline’s allergy to heparin, an anti-coagulant; she wore a medical bracelet listing her heparin allergy and her medical records noted the allergy. Her estate alleges that on several occasions, the hospital’s medical staff injected Pauline with heparin “in direct contradiction to her specific directive,” which proximately caused her death. The district court dismissed, for failure to comply with the notice and heightened pleading requirements of the Tennessee Medical Malpractice Act. The court concluded that under Tennessee law the injections were not “procedures” or “treatments” for the purposes of medical battery, but were only component parts of her treatment process, which did not require consent and could form the basis for medical malpractice but not medical battery. The Sixth Circuit reversed, holding that the complaint plausibly alleged medical battery, which is not subject to the Act. View "Shuler v. Garrett" on Justia Law
McClain v. Eaton Corp. Disability Plan
As an assembler with Eaton Corporation, McClain purchased the highest level of long-term disability insurance, which was “designed to replace ... 70 percent of [her] monthly base pay.” She stopped working in January 2008, due to a back injury she suffered on the job in June 2007. She received benefits during the first 24 months under the First Tier of the Plan’s coverage, which defined disability as being “totally and continuously unable to perform the essential duties of your regular position with the Company, or the duties of any suitable alternative position with the Company.” After 24 months, the Plan to an “any occupation” standard, providing Second Tier coverage if “you are totally and continuously unable to engage in any occupation or perform any work for compensation or profit for which you are, or may become, reasonably well fit by reason of education, training or experience--at Eaton or elsewhere.” The Plan denied her claim for benefits because her treating physician opined McClain could work part-time, and a market study identified various part-time positions in the area for which she was qualified. The district court rejected her suit under the Employee Retirement Income Security Act, 29 U.S.C. 1001. The Seventh Circuit affirmed, finding that the determination was not arbitrary.View "McClain v. Eaton Corp. Disability Plan" on Justia Law
Miller v. Mylan, Inc.
Mylan manufactures generic Duragesic, a drug to treat pain. It consists of fentanyl (active ingredient) and a “transdermal system” (patch that delivers the drug). Kelly’s estate claimed that the patch caused Kelly’s death by delivering an excessive amount of fentanyl, alleging strict products liability, negligence, misrepresentation, fraud, warranty, and violation of the Michigan Consumer Protection Act. The district court dismissed, based on Mich. Comp. Laws 600.2946(5), which provides that “drug” manufacturers are immune from suit. The Sixth Circuit reversed and remanded. Michigan defines “drug” using the federal definition, 21 U.S.C. 321: (A) articles recognized in the official United States Pharmacopoeia, official Homoeopathic Pharmacopoeia of the United States, or official National Formulary, or any supplement to any of them; and (B) articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or other animals; and (C) articles (other than food) intended to affect the structure or any function of the body of man or other animals; and (D) articles intended for use as a component of any article specified in clause (A), (B), or (C). Michigan’s definition provides that a “drug” is not a “medical appliance or device.” Immunity might not apply to a product, like the patch, that has mechanical (rather than chemical) effect on the body. Under the federal definition a product might be neither “drug” nor “device” but a “combination product.” Whether a combination product is regulated as a drug or a device is left to the Secretary’s discretion. View "Miller v. Mylan, Inc." on Justia Law
State Farm Auto. Ins. Co. v. Newburg Chiropractic
Plambeck owned two Kentucky chiropractic clinics that treated patients injured in car accidents, including some State Farm customers. All of the treating chiropractors were licensed to practice in Kentucky. Plambeck was not, although he was licensed elsewhere, and did not treat any patients in Kentucky. State Farm assumed that Plambeck had a license because Kentucky law requires chiropractic practitioners and owners of chiropractic clinics to hold one. When State Farm discovered that Plambeck lacked a state license, it stopped paying the clinics and sued Plambeck to recover all payments since 2000. The district court granted summary judgment to State Farm and awarded $557,124.78 in damages. The Sixth Circuit reversed. Kentucky common law claims for recovery of funds mistakenly paid are based on unjust enrichment. Because State Farm and the clinics never had a contractual relationship, the only applicable theory would require State Farm to show that it paid money to the clinics not due “either in law or conscience.” State Farm did not offer such proof. View "State Farm Auto. Ins. Co. v. Newburg Chiropractic" on Justia Law
Big Branch Res., Inc. v. Ogle
Ogle, born in 1954, worked in underground coal mines for 21 years, most recently in 1996 in Kentucky. Ogle smoked since age 12. He sought black lung benefits in 2007. After the record closed but before the ALJ issued a decision, Congress revived a rebuttable statutory presumption that a coal miner who worked in an underground mine for at least 15 years and suffers from a total respiratory or pulmonary disability is presumed to be totally disabled due to pneumoconiosis, 30 U.S.C. 921(c)(4). The ALJ awarded benefits, finding that Ogle suffered from totally disabling respiratory impairment, a conclusion with which all medical opinions agreed. The ALJ stated that the presumption shifts the burden to demonstrate by a preponderance of the evidence that either the miner’s disability does not, or did not, arise out of coal mine employment or the miner did not, suffer from pneumoconiosis. The Fund demonstrated that Ogle did not suffer from clinical pneumoconiosis, but failed to rebut the presumption that Ogle suffers from legal pneumoconiosis. The Board affirmed. The Sixth Circuit denied a petition for review, finding no evidence that the ALJ improperly restricted the Fund’s ability to rebut the 15-year presumption or that the ALJ applied the wrong standard. View "Big Branch Res., Inc. v. Ogle" on Justia Law