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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. 03-00-00449-CV
Regular Panel Decision
Apr 12, 2001

Donald Fulton v. Association Indemnity Corporation

Donald Fulton, an injured worker, disputed an impairment rating and Maximum Medical Improvement (MMI) certification after his condition deteriorated six months post-initial assessment. The Workers' Compensation Commission and district court affirmed the initial rating, citing Commission Rule 130.5(e) (the 90-day Rule), which states that an impairment rating is final if not disputed within 90 days. Fulton challenged the rule's validity, arguing it contravenes the Workers' Compensation Act. The appellate court held that the 90-day Rule is invalid because it impermissibly shortens the statutory 104-week period for a claimant to achieve MMI, thereby imposing a restriction in excess of the Act. Consequently, the court reversed the district court's order and granted summary judgment in favor of Fulton.

Workers' CompensationMaximum Medical ImprovementImpairment RatingAdministrative LawStatutory InterpretationJudicial ReviewAgency AuthorityRule ValidityTexas Court of AppealsSummary Judgment
References
21
Case No. MISSING
Regular Panel Decision

Fulton v. Associated Indemnity Corp.

Donald Fulton sustained a back injury and was initially assessed at maximum medical improvement (MMI) with a seven percent impairment rating. His condition later deteriorated, leading his doctors to request an amendment to his MMI date and impairment rating. The Workers’ Compensation Commission deemed the initial rating final due to Fulton's failure to dispute it within 90 days, as per Commission Rule 130.5(e). Fulton challenged this rule's validity, arguing it contravenes the Workers’ Compensation Act by prematurely finalizing MMI certification. The district court affirmed the Commission’s decision. This appellate court ruled the 90-day Rule invalid for impermissibly shortening the statutory 104-week period for a worker to achieve MMI, thereby reversing the lower court's judgment and granting summary judgment to Fulton.

Maximum Medical Improvement (MMI)Impairment Rating90-day Rule InvalidityStatutory AuthorityAdministrative Rule ChallengeJudicial Review of Agency DecisionSummary Judgment GrantTexas Labor Code § 401.011(30)Claimant RightsMedical Condition Deterioration
References
19
Case No. 13-13-00463-CV
Regular Panel Decision
Oct 10, 2013

the Corporation of the President of the Church of Jesus Christ of Latter-Day Saints, the Church of Jesus Christ of Latter-Day Saints, and the Corporation of the Presiding Bishop of the Church of Jesus Christ of Latter-Day Saints v. John Doe

John Doe sued the Church of Jesus Christ of Latter-day Saints, alleging sexual assault by Eustacio Munioz and seeking damages based on vicarious and direct liability theories. The Church moved for summary judgment, asserting the claims were time-barred. The trial court denied the motion without stating its reasons. The Church petitioned the Court of Appeals for a permissive interlocutory appeal, arguing controlling questions of law regarding the statute of limitations and tolling doctrines like duress and continuing tort. The appellate court denied the petition, finding that the absence of a substantive ruling by the trial court prevented the identification of a clear controlling question of law, thus failing to meet the requirements for a permissive appeal.

Permissive appealInterlocutory orderSummary judgmentStatute of limitationsTollingDuressContinuing tort doctrineControlling question of lawAppellate procedureTexas law
References
12
Case No. 13-97-428-CV
Regular Panel Decision
May 27, 1999

Trevino, Dora v. Transportation Insurance Company

Dora Trevino injured her arm while working, leading to a workers' compensation claim against Transportation Insurance Co. An initial medical examination resulted in an eight percent impairment rating, which Trevino did not appeal within 90 days. After further treatment, a second doctor assigned an eighteen percent impairment rating. The Texas Workers' Compensation Commission appeals panel ruled the initial rating invalid due to inadequate medical treatment, negating the 90-day appeal rule. However, the district court granted summary judgment to the insurance company, upholding the finality of the initial rating. Citing the recent Texas Supreme Court decision in Lumbermen's Mutual Casualty Co. v. Manasco, the Court of Appeals dismissed the case for want of jurisdiction and remanded it to the trial court.

Workers' CompensationImpairment RatingMaximum Medical ImprovementSummary JudgmentAppellate JurisdictionStatutory InterpretationAgency PowerTexas Law90-Day RuleMedical Treatment Adequacy
References
2
Case No. 08-01-00329-CV
Regular Panel Decision
Jul 25, 2002

Albertson's, Inc. v. Lara, Eyna

Albertson's, Inc. appealed a trial court's finding that notice regarding an injured former employee's impairment rating was insufficient. Eyna Lara, the injured employee, received a report from Dr. Hollander certifying maximum medical improvement (MMI) and a 5 percent impairment rating (IR), along with a Form TWCC-69 containing a handwritten 'not valid' notation, and Form EES-19. Lara did not dispute the rating within the 90-day period stipulated by Texas Workers' Compensation Commission Rule 130.5(e). The trial court concluded that the notice was insufficient to trigger the 90-day rule, thus preventing the rating from becoming final. The Court of Appeals affirmed this decision, agreeing that the misleading nature of the forms, particularly the 'not valid' notation, rendered the notice inadequate to inform Lara of her rights and obligations, and thus did not trigger the 90-day dispute period.

Impairment RatingWorkers' CompensationMaximum Medical ImprovementNotice RequirementsTexas Administrative CodeAppellate ReviewStatutory ConstructionDue ProcessStipulated FactsTimeliness of Dispute
References
6
Case No. MISSING
Regular Panel Decision

Trevino v. Transportation Insurance Co.

Dora Trevino, an employee, sustained a right arm injury while working for National Health Labs, Inc., whose workers' compensation carrier was Transportation Insurance Co. After surgery, Dr. Moldovan assigned an eight percent impairment rating (IR) and certified maximum medical improvement (MMI) in 1994, which Trevino did not appeal. Later, another doctor assigned an eighteen percent IR. The appellee contested this new rating, citing the 90-day appeal rule under 28 Tex. Adm.Code Sec. 130.5(e) for initial impairment ratings. While an appeals panel initially negated the 90-day rule due to inadequate medical treatment, the Harris County District Court granted summary judgment to the appellee, ruling that Trevino's failure to dispute the initial rating made it final. Citing *Lumbermens Mutual Casualty Co. v. Manasco* (1998), the court affirmed the summary judgment, holding that a claimant cannot reopen an impairment rating after the appeal period has lapsed.

Workers' CompensationImpairment RatingMaximum Medical ImprovementSummary JudgmentAppeal ProcessMedical TreatmentTexas LawAgency InterpretationStatutory ConstructionJudicial Review
References
2
Case No. 13-06-471-CV
Regular Panel Decision
Apr 17, 2008

Day Cruises Maritime, L.L.C. and Corpus Christi Day Cruise, L.L.C. v. Christus Spohn Health System D/B/A Christus Spohn Hospital Memorial

This case involves an appeal from summary judgments. Appellants (Day Cruises Maritime, L.L.C. and Corpus Christi Day Cruise, L.L.C., collectively "Texas Treasure") contested the trial court's decision in favor of appellee (Christus Spohn Health System d/b/a Christus Spohn Hospital Memorial, "Christus"). The dispute arose from medical expenses incurred by a seaman, Judy Ann Lanado, employed by Texas Treasure, who suffered severe brain damage after surgery at Christus. Texas Treasure sought to avoid liability for the entire hospital bill and claimed equitable subrogation. The appellate court affirmed the denial of Texas Treasure's motion for summary judgment on its plea in intervention but reversed the granting of Christus's motions for summary judgment on its counterclaim and Texas Treasure's plea in intervention, remanding for further proceedings to determine negligence and attributable expenses.

Summary JudgmentAppellate ReviewSworn AccountVerified DenialDue ProcessEquitable SubrogationMaintenance and CureMaritime LawAlien CrewmanHospital Expenses
References
52
Case No. MISSING
Regular Panel Decision

Local 205, Community and Social Agency Employees'union v. Day Care Council of Ny Inc.

Local 205, Community and Social Agency Employees’ Union petitioned for confirmation and enforcement of an arbitration award against the Day Care Council of New York, Inc. (DCC). The award arose from employee grievances against the now-closed Georgia-Livonia Day Care Center. The Union argued that the award should be interpreted as binding upon DCC, a multi-employer bargaining association, despite not explicitly naming DCC for relief. DCC contended it was not a party to the arbitration agreement in the collective bargaining agreement (CBA) and therefore not obligated to arbitrate disputes involving itself. The court, after reviewing the CBA's language and the parties' past conduct, found no agreement by DCC to arbitrate. It also ruled that DCC's defenses were not time-barred by either the Federal Arbitration Act or New York C.P.L.R. § 7511, as these limitations do not apply to arguments challenging the existence of an arbitration agreement itself. Consequently, the Union's petition for confirmation and enforcement of the award against DCC was denied.

Arbitration AwardCollective Bargaining AgreementGrievance ProcedureMulti-Employer AssociationAgreement to ArbitrateFederal Arbitration ActLabor Management Relations ActConfirmation of AwardEnforcement of AwardSouthern District of New York
References
25
Case No. MISSING
Regular Panel Decision
Oct 31, 1988

Moreno v. Roberts

The plaintiff appealed a Supreme Court judgment favoring the defendants in a personal injury case stemming from a 1985 automobile accident. The plaintiff contested the court's failure to charge the "90/180 day" serious injury rule under Insurance Law § 5102 (d) and the admission of defendants' expert medical testimony on causation. The Appellate Division affirmed the judgment, concluding that insufficient medical evidence supported the 90/180 day rule charge and that the issue of causation, raised in pretrial reports, meant the expert testimony was not a surprise.

Serious InjuryAutomobile AccidentInsurance LawCausationExpert Testimony90/180 Day RuleAppellate ReviewPersonal InjuryMedical EvidenceDirected Verdict
References
6
Case No. 03-23-00077-CV
Regular Panel Decision
Jul 17, 2024

Norman Engel v. Texas Department of Insurance-Division of Workers' Compensation and Commissioner Cassie Brown, in Her Official Capacity The State of Texas and the Attorney General of the State of Texas by and Through Ken Paxton in His Official Capacity as Attorney General of the State of Texas And Illinois National Insurance Company

Norman Engel, an injured worker, sued his workers’ compensation carrier and several Texas State entities after an administrative law judge upheld his Maximum Medical Improvement (MMI) certification. Engel challenged the administrative ruling, asserting constitutional, statutory-conflict, and delegation issues related to the 90-day deadline for disputing MMI. The trial court granted pleas to the jurisdiction for the State parties and summary judgment for the insurance carrier. On appeal, the Third District Court of Appeals affirmed the trial court's judgment. The appellate court found no errors in the dismissals and upheld the constitutionality of the challenged statutes and rules, rejecting arguments against the 90-day MMI dispute law and the delegation of rulemaking authority.

Workers' CompensationMaximum Medical ImprovementImpairment Rating90-day ruleTexas Labor CodeOpen Courts ProvisionDue Course of LawSovereign ImmunityDeclaratory Judgment ActAdministrative Procedure Act
References
41
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