Justia U.S. 6th Circuit Court of Appeals Opinion Summaries

Banks worked as a coal miner for 17 years and smoked about one pack of cigarettes per day for 38 years. His employment ended in 1991. After two unsuccessful attempts, in 2003, Banks filed a claim for benefits under the Black Lung Benefits Act, which provides benefits to coal miners who become disabled due to pneumoconiosis, 30 U.S.C. 901. An ALJ found that Banks had shown a change in his condition and that he suffered from legal pneumoconiosis which substantially contributed to his total disability. Banks was awarded benefits and the Benefits Review Board affirmed. The Sixth Circuit affirmed, adopting the regulatory interpretation urged by the Director of the Office of Workers’ Compensation Programs. The ALJ relied on reasoned medical opinions. View "Cumberland River Coal Co. v. Banks" on Justia Law

Stryker, a manufacturer of medical devices, sued its umbrella insurer XL, seeking coverage for claims stemming from the implantation of expired artificial knees. The dispute concerned the precise "defect" that triggers batch coverage under the Medical Products Endorsement. The district court held that XL was liable under the policy for the entirety of Stryker’s losses on both direct claims brought against Stryker, as well as claims brought against Pfizer that Stryker was obligated to reimburse under an asset purchase agreement. The court found that the items were defective if they were available in Stryker’s inventory for implantation by physicians beyond their shelf-life of five years. The Sixth Circuit affirmed XL’s liability for the full amount of Stryker’s losses and pre-judgment interest. XL’s payment to Pfizer applies to exhaust the policy with respect to the direct claims. The court reversed the holding that the aggregate limit of liability of the XL policy does not apply to the judgments on the direct claims and remanded for determination of what portion, if any, of the total liability for those judgments beyond $15 million represents consequential damages as defined under Michigan contract law. View "Howmedica Osteonics, Corp. v. Nat'l Union Fire Ins. Co." on Justia Law

TIG issued a $25 million excess policy to Stryker, a manufacturer of medical devices. Coverage attached above the underlying (XL) umbrella policy, with a limit of $15 million. Stryker sued XL, seeking defense and indemnification for claims related to replacement knees (first suit). Pfizer then sued Stryker, seeking indemnification with respect to claims based on Uni-Knees; the companies had an asset purchase agreement. The court ruled in favor of Pfizer. When XL denied coverage, Stryker sued both insurers. In 2008, the district court held that XL was liable for all of Stryker's liabilities with respect to both suits and also granted declaratory judgment against TIG. XL settled directly with Pfizer, and obtained a ruling that this satisfied its obligations. TIG moved to remove the declaratory judgment ruling, arguing that the ruling that XL was responsible with respect to both suits made it impossible to subject TIG to liability. The district court denied this motion. The Sixth Circuit affirmed that the case is not moot, noting that the claims may exhaust the XL policy; reversed a ruling that TIG is precluded from raising coverage defenses on remand, noting that TIG was not a party to the first suit; and remanded. View "Stryker Corp. v. Nat'l Union Fire Ins. Co." on Justia Law

In 2004, plaintiff had arthroscopic surgery to treat pain and instability in his shoulder joint. The doctor implanted a pain-pump catheter and, over the next two days, a Stryker pain pump delivered a regular dose of a local anesthetic, bupivicaine, to the joint. Plaintiff’s condition improved after surgery but worsened over time, and in 2008 he learned he no longer had any cartilage remaining in his shoulder, a condition called chondrolysis. He sued, alleging strict liability, negligence and breach of warranty. The district court concluded that Stryker could not reasonably have known about the risk of chondrolysis in 2004 and thus had no duty to warn of the risk and held that Plaintiff failed as a matter of law to prove causation. The Sixth Circuit affirmed. Plaintiff did not present any evidence that Stryker knew or should have known that the use was dangerous or that a warning on Stryker's pain pump would have caused the doctor not to use the device in his joint space.

Plaintiffs, manufacturers and sellers of tobacco products, alleged that provisions of the 2009 Family Smoking Prevention and Tobacco Control Act violated their First Amendment rights. The district court granted partial summary judgment upholding the law and partial summary judgment to plaintiffs. The Seventh Circuit affirmed and ruled in favor of the government on most issues, declining to apply strict scrutiny and finding that warnings required by the Act reasonably related to the government's interest in preventing deception of consumers. The court upheld bans on event sponsorship, branding non- tobacco merchandise, and free sampling (loyalty and continuity programs); a requirement that tobacco manufacturers reserve significant packaging space for textual health warnings; the restriction of tobacco advertising to black and white text; and the constitutionality of the Act's color graphic and non-graphic warning label requirement. Reversing the district court, the court upheld the Act's restriction on claims that tobacco products are "safe or less harmful by virtue of” FDA regulation, inspection or compliance" 21 U.S.C. 331(tt)(4).

The company granted plaintiff leave under the Family and Medical Leave Act, listing a June 27 return date. The doctor cleared plaintiff for light work beginning on May 31 and set June 13 as the probable date for unrestricted work. On May 31, plaintiff was sent home because the company did not permit employees with non-work-related injuries to perform light duty work after leave. Plaintiff did not return on June 13 and told the company that he was experiencing pain and would return on June 27. He obtained a doctor's note, but the company counted June 13 to 17 as unexcused absence and terminated his employment. The district court ruled for plaintiff on a claim of FLMA interference (29 U.S.C. 2612(a)(1)(D)); awarded $99,960 in attorney fees, $2,732.90 in costs, and $104,354.85 in back pay; and ordered the company to change the termination date, for purposes of pension and retiree health benefits. The court denied statutory liquidated damages because it found that the company acted with reasonable grounds. The Sixth Circuit affirmed on the interference claim and reversed on the liquidated damages claim, noting the company's "obdurate refusal to correct an obvious mistake that constituted a wrongful discharge of a 36-year employee."

Plaintiff, a pipefitter, worked with asbestos-containing gaskets made by defendant from 1962 until 1970. From 1962 until 1975, he also sustained significant exposure to asbestos insulation. He died in 2008, of mesothelioma, a cancer of the lining of the lung. Before his death, plaintiff sued under theories including strict liability and negligence. Defendant does not dispute that asbestos-containing products likely caused the mesothelioma, but argues that the mesothelioma was caused by exposure to asbestos insulation, and that its own gaskets were not a substantial factor. A jury awarded plaintiff $516,094. The Sixth Circuit reversed. Given that plaintiff failed to quantify the exposure to asbestos from defendant's gaskets and concedes that plaintiff sustained massive exposure to asbestos from non-defendant sources, there was insufficient evidence to infer that defendant's gaskets probably, as opposed to possibly, were a substantial cause of plaintiff's mesothelioma.

Following a 2007 train derailment and three-day fire that allegedly exposed a small Ohio town to cancer-causing agents, plaintiffs sought damages on behalf of a putative class. Plaintiffs' expert testified that the normal background level of dioxin is four parts per trillion and that the range within area homes was from 11.7 to 274 ppt. A doctor testified about increased risk of cancer. The district court granted summary judgment for the train company, finding that plaintiffs had not established general or specific causation and, as a matter of law, any increased risk of cancer or other diseases was too insignificant to warrant the court's ordering a lengthy period of medical monitoring. The Sixth Circuit affirmed, noting the absence of conclusive medical evidence that plaintiffs faced even a one-in-a-million increased risk of cancer.

Patient, insured by defendant, diagnosed with end-stage renal disease, and received dialysis at plaintiff's center. Three months after diagnosis, she became entitled to Medicare benefits (42 U.S.C. 426-1). Her plan provided that coverage ceased at that time, because of her entitlement to Medicare, but the insurer continued to pay for two months. Under the 1980 Medicare Secondary Payer Act, a group health plan may not take into account that an individual is entitled to Medicare benefits due to end-stage renal disease during the first 30 months (42 U.S.C. 1395y(b)(1)(C)(i)), but the insurer terminated coverage. Plaintiff continued to treat and bill. The insurer declared that termination was retroactive and attempted to offset "overpayment" against amounts due on other patients' accounts. The outstanding balance after patient's death was $210,000. Medicare paid less than would have been received from the insurer. The center brought an ERISA claim, 29 U.S.C. 1132(a)(1)(B), and a claim for double damages under the 1980 Act. The district court granted plaintiff summary judgment on its ERISA claim but dismissed the other. The Sixth Circuit affirmed on the ERISA claim and reversed dismissal. A healthcare provider need not previously "demonstrate" a private insurer's responsibility to pay before bringing a lawsuit under the 1980 Act's private cause of action.

A 66-year -old arrived at petitioner's center with complex ailments, but oriented, able to feed herself and able to speak. During her 18 days at the center, she was sent to the hospital twice with serious medical complications. Upon investigation, the center was found to have failed to maintain substantial compliance with federal regulations for facilities that participate in Medicare and Medicaid (42 U.S.C. § 1395) in its treatment of the resident and appealed the resulting civil money penalty. An administrative law judge, the Departmental Appeals Board, and the Sixth Circuit affirmed. The ALJ acted properly in requiring submission of written testimony, properly weighed the evidence, and found violation of the federal hydration standard, laboratory services requirement, and mandate of a care plan, resulting in "immediate jeopardy."