Justia Health Law Opinion Summaries

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The primary issue in consolidated appeals was the scope of an automobile insurance policy’s arbitration provision. Two insureds with identical Allstate Insurance Company medical payments and uninsured/underinsured motorist (UIM) insurance coverage settled with their respective at-fault drivers for applicable liability insurance policy limits and then made medical payments and UIM benefits claims to Allstate. Allstate and the insureds were unable to resolve the UIM claims and went to arbitration as the policy required. The arbitration panels initially answered specific questions submitted about the insureds’ accident-related damages. At the insureds’ requests but over Allstate’s objections, the panels later calculated what the panels believed Allstate ultimately owed the insureds under their medical payments and UIM coverages and issued final awards. Allstate filed superior court suits to confirm the initial damages calculations, reject the final awards as outside the arbitration panels’ authority, and have the court determine the total amounts payable to the insureds under their policies. The judge assigned to both suits affirmed the final arbitration awards; Allstate appealed both decisions. The Alaska Supreme Court determined the arbitration panels had no authority to determine anything beyond the insureds’ damages arising from their accidents and because Allstate withheld its consent for the panels to determine anything else, the Court reversed the superior court’s decisions and judgments. The Supreme Court also reversed some aspects of the superior court’s separate analysis and rulings on legal issues that the panels improperly decided. Given (1) the arbitration panels’ damages calculations and (2) the Supreme Court's clarification of legal issues presented, the cases were remanded for the superior court to determine the amount, if any, Allstate had to pay each insured under their medical payments and UIM coverages. View "Allstate Insurance Company v. Harbour" on Justia Law

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Saunders worked as a bus attendant for the Washington, D.C., school system, helping students with special needs and those in wheelchairs on and off the bus. On January 7, 2014, she slipped and fell on ice at work, suffering a hip contusion and back pain. Saunders never returned to work but filed a disability claim with the Social Security Administration six months after her fall. She obtained multiple opinions from Dr. Williams, her generalist, and Dr. Liberman, her neurologist. Saunders received disability benefits from the Washington, D.C., workers’ compensation board.After Saunders’s federal disability claims were denied an ALJ held a hearing and concluded that she was not disabled. The ALJ gave “some” weight to certain medical opinions but “no weight” to others, including Dr. Lieberman’s opinion that Saunders was permanently disabled. The ALJ placed considerable weight on the vocational expert’s testimony and found that someone with Saunders’s functional capacity could perform her past work as generally performed in the national economy. The district court affirmed. The D.C. Circuit remanded. The ALJ erroneously failed to consider certain medical opinions, particularly those of Saunders’s treating physician. View "Saunders v. Kijakazi" on Justia Law

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Indian Health Services (IHS) previously provided health care to the federally recognized Tribe through a clinic in McDermitt, Nevada, and an emergency medical services program. Federal law entitles members of other tribes also to receive care at the clinic. In 2016, the Tribe notified IHS of its intent to assume responsibility for the clinic and part of the EMS program. The Tribe requested about $603,000 annually to provide medical care at the clinic. IHS awarded only about $53,000. The parties disputed whether the Tribe was entitled to all the funds that IHS previously had spent on the clinic or whether the agency could withhold the portion of those funds to benefit members of another tribe. IHS allocates generally funding among health care programs according to the number of eligible users living in the tribe's assigned. IHS funded the clinic to benefit the Tribe and the nearby Winnemucca Tribe. IHS argued that it could not include Winnemucca’s “tribal share” of clinic funding without that tribe’s consent. The parties disputed the treatment of third-party income from Medicare and Medicaid, which the Tribe now collects directly. The Tribe assumed full control of the clinic, filed suit, and obtained summary judgment.The D.C. Circuit reversed. The Indian Self-Determination and Education Assistance Act, 25 U.S.C. 5321(a), did not permit withholding of the amount budgeted as benefitting members of the second tribe but did permit withholding an amount equal to the Medicare and Medicaid reimbursements. View "Fort McDermitt Paiute and Shoshone Tribe v. Becerra" on Justia Law

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The Supreme Court affirmed in part and vacated in part the judgment of the circuit court rejecting Plaintiffs' claims challenging the refusal by the Department of Social Services (DSS) to provide MO HealthNet coverage, holding that the circuit court erred in declaring Mo. Const. art. IV, 36(c) constitutionally invalid.Plaintiffs, three Missourians eligible for MO HealthNet coverage under article IV, section 36(c), brought this action challenging the DSS's refusal to provide coverage on the grounds that the General Assembly failed to appropriate adequate funding. The circuit court rejected the claims, finding that the ballot initiative that enacted article IV, section 36(c) violated Mo. Const. art. III, 51, which prohibits initiatives from appropriating money without creating revenue to fund the initiative. The Supreme Court affirmed in part and vacated in part the circuit court's judgment, holding (1) article IV, section 36(c) does not appropriate money and does not remove the General Assembly's discretion in appropriating money to MO HealthNet; and (2) therefore, the circuit court erred in concluding that article IV, section 36(c) violates article III, section 51. View "Doyle v. Tidball" on Justia Law

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After a Tessier's employee was modifying a hole cover on the roof of an unfinished building when the cover collapsed and he fell 22 feet to the floor below, OSHA issued a citation against Tessier's under 29 C.F.R. 1926.501(b)(4)(i), for failing to protect its employees from falling through holes.The Eighth Circuit denied the petition for review filed by Tessier's, concluding that substantial evidence supported the ALJ's conclusion that the employees had removed a one-foot-by-three-foot section of the cover before it collapsed and, in doing so, exposed a hole. Because this hole was not covered and was more than six feet above the second floor, Tessier's was required to protect its employees from falling by means of an alternative form of fall protection, which it had not done. Therefore, the ALJ did not err in concluding that Tessier's had committed the violation. View "Tessier's, Inc. v. Secretary of Labor" on Justia Law

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Antonia Nyman was renting a backyard cottage to Dan Hanley when the COVID-19 pandemic began. She sought to evict Hanley and gave him 60 days’ notice of her intention to move into the unit herself. Due to this unprecedented pandemic, Washington Governor Jay Inslee temporarily halted most evictions, but not for landlords seeking to occupy the unit personally. A federal eviction moratorium imposed by the United States Centers for Disease Control and Prevention (CDC) also temporarily halted some evictions, but not for tenants who have violated a contractual obligation (with certain specified exceptions). The issue this case presented for the Washington Supreme Court's review centered on whether Hanley violated a contractual obligation by holding over in his unit after his lease expired by its terms. Based on undisputed facts before us, the Court held that he did. "While the CDC order may be more protective than Washington’s eviction proclamation in some instances, it does not apply here. Accordingly, we affirm the trial court and lift the stay of the writ of restitution." View "Nyman v. Hanley" on Justia Law

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The Family Smoking Prevention and Tobacco Control Act amended the Federal Food, Drug, and Cosmetic Act to establish a comprehensive regulatory scheme for tobacco products, defined as “any product made or derived from tobacco that is intended for human consumption, including any component, part, or accessory of a tobacco product,” 21 U.S.C. 321(rr)(1). The 2016 FDA "Deeming Rule" deemed all products that meet the Act’s definition of “tobacco product,” including any “component” and “part” but excluding any “accessory” of those products, to be subject to the Act. Premarket review by FDA was required before the introduction into interstate commerce of any “new tobacco product.” FDA adopted “staggered compliance periods” for premarket review requirements of newly deemed products that were being marketed as of the Rule’s effective date. FDA also promulgated a separate rule addressing the assessment of user fees for manufacturers and importers of cigars and pipe tobacco.The D.C. Circuit affirmed summary judgment in favor of FDA on five Administrative Procedure Act challenges to the Deeming Rule concerning its implementation of the premarket review requirements, underlying cost-benefit analysis, and classification of a pipe as a “component or part” of a tobacco product subject to regulation, and an APA challenge to the User Fees Rule. View "Cigar Association of America v. United States Food and Drug Administration" on Justia Law

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The issue this case presented for the New Jersey Supreme Court's consideration was whether, under the facts of this case, plaintiff Leah Coleman, the victim of a violent assault by social worker Sonia Martinez’s patient, could bring a negligence claim against Martinez. Martinez’s patient, T.E., suffered two violent episodes prior to her treatment with Martinez. Coleman worked for the Division of Child Protection and Permanency (DCPP) and was tasked with ensuring the welfare of T.E.’s children when the children were removed from T.E.'s care after her hospitalization following her second violent incident. In a letter to Coleman dated October 1, 2014, Martinez stated that T.E. had been compliant during her sessions and with her medication and was ready and able to begin having unsupervised visits with her children with the goal of reunification. At her deposition, Martinez acknowledged the inaccuracy of representing that T.E. did not exhibit psychotic symptoms in light of what she and the group counselor had seen. During a November 7 appointment, Martinez disclosed to T.E. Coleman’s report of T.E.’s hallucinations. T.E. “became upset” and “tearful,” denied any psychotic symptoms, and reiterated her goal of regaining custody of her children. Later that day, T.E. called DCPP and spoke with Coleman. During their conversation, T.E. referenced her session with Martinez, denied that she was experiencing auditory hallucinations, and stated she did not understand why such a claim would be fabricated. Coleman advised T.E. to seek advice from an attorney as DCPP would “maintain that she [was] not capable of parenting independently due to her mental health issues.” Six days later, T.E. made an unscheduled visit to DCPP offices, where she stabbed Coleman twenty-two times in the face, chest, arms, shoulders, and back. Coleman filed a complaint against Martinez, alleging that Martinez was negligent in identifying her to T.E. as the source of information about T.E.’s hallucinations, and that T.E.’s attack was a direct and proximate result of Martinez’s negligence. The trial court granted summary judgment in favor of Martinez, finding no legal duty owed to Coleman under the particularized foreseeability standard set forth in J.S. v. R.T.H., 155 N.J. 330 (1998). The Supreme Court disagreed, finding that Martinez had a duty to Coleman under the circumstances here. The trial court's judgment was reversed and the matter remanded for further proceedings. View "Coleman v. Martinez" on Justia Law

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The Ninth Circuit reversed the district court's grant of summary judgment in favor of Agendia in an action alleging that the HHS wrongfully denied its claims for reimbursement for diagnostic tests under the Medicare health insurance program. Agendia contends that the denial was improper because the local coverage determination was issued without notice and opportunity for comment in violation of a provision of the Medicare Act—specifically, 42 U.S.C. 1395hh.The panel held that section 1395hh's notice-and-comment requirement does not apply to local coverage determinations, and that the district court erred in interpreting the statute otherwise. The panel rejected Agendia's alternative argument that the Medicare Act and its implementing regulations have unconstitutionally delegated regulatory authority to Medicare contractors by permitting them to issue local coverage determinations. The panel held that, because those contractors act subordinately to the HHS officials implementing Medicare, there is no unconstitutional delegation. View "Agendia, Inc. v. Becerra" on Justia Law

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Allstate Insurance Company et al. (Allstate) filed a complaint on behalf of itself and the People of California (qui tam) against Dr. Sonny Rubin and related medical providers (Rubin). Allstate generally alleged Rubin prepared fraudulent patient medical reports and billing statements in support of insurance claims. Rubin filed an anti-SLAPP motion, arguing the preparation and submission of its medical reports and bills were protected litigation activities. The trial court denied Rubin’s motion. "Litigation is not 'under [serious] consideration' - and thereby protected activity under the anti-SLAPP statute - if the ligation is merely a 'possibility.'" The Court of Appeal found that Rubin failed to show its medical reports and bills were prepared outside of its usual course of business in anticipation of litigation that was “under [serious] consideration.” Thus, the Court affirmed the trial court’s order denying Rubin’s anti-SLAPP motion. View "California ex rel. Allstate Ins. Co. v. Rubin" on Justia Law