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

Case No. 2017 NY Slip Op 04184 [150 AD3d 1589]
Regular Panel Decision
May 25, 2017

New York State Workers' Compensation Board v. Program Risk Management, Inc.

The New York State Workers' Compensation Board, acting as administrator and successor to the Community Residence Insurance Savings Plan, initiated legal action against various entities and individuals after the trust became severely underfunded. Defendants include Program Risk Management, Inc. (administrator), PRM Claims Services, Inc. (claims administrator), individual officers of PRM, the Board of Trustees, and Thomas Gosdeck (trust counsel). The plaintiff sought damages for claims such as breach of contract, breach of fiduciary duty, and legal malpractice. The Supreme Court's order partially dismissed some claims and denied others. On cross-appeal, the Appellate Division, Third Department, modified the Supreme Court's order, notably reversing the dismissal of several breach of fiduciary duty claims and common-law indemnification against PRMCS, while affirming denials of motions to dismiss breach of contract, legal malpractice, and unjust enrichment claims. The court's decision was influenced by recent rulings in State of N.Y. Workers' Compensation Bd. v Wang.

Workers' Compensation LawGroup Self-Insured TrustBreach of ContractBreach of Fiduciary DutyLegal MalpracticeUnjust EnrichmentStatute of LimitationsEquitable EstoppelAlter Ego LiabilityCommon-Law Indemnification
References
20
Case No. 03-17-00352-CV
Regular Panel Decision
Aug 22, 2018

Vista Medical Center Hospital Vista Healthcare, Inc. And Surgery Specialty Hospital, Inc.// State Office of Risk Management v. State Office of Risk Management// Vista Medical Center Hospital Vista Healthcare, Inc. And Surgery Specialty Hospital, Inc.

This case involves cross-appeals stemming from a dispute over the appropriate reimbursement for medical services provided by Vista Medical Center Hospital and its affiliates to injured employees covered by the State Office of Risk Management (SORM) under Texas workers’ compensation statutes. The district court had affirmed 23 administrative orders that required SORM to make additional payments to Vista, a decision which SORM challenged on appeal citing insufficient evidence. Vista, in turn, cross-appealed the district court's denial of prejudgment interest. The appellate court found substantial evidence supported the administrative law judges' conclusion that SORM's original reimbursement model was unfair and unreasonable, and that Vista's proposed methodology was valid. Consequently, the court affirmed the district court's judgment but modified it to include the prejudgment interest that Vista was statutorily entitled to.

Workers' CompensationMedical ReimbursementAdministrative LawAppellate ReviewSubstantial EvidencePrejudgment InterestTexas LawHealthcare ProvidersInsurance DisputesFee Guidelines
References
23
Case No. M2024-01239-COA-R3-CV
Regular Panel Decision
Mar 18, 2025

Applied Underwriters Captive Risk Assurance Company, Inc. v. Tennessee Department of Commerce and Insurance

This appeal concerns a chancery court's dismissal of a petition for interlocutory judicial review. The Petitioners, Applied Underwriters Captive Risk Assurance Company, Inc., and others, sought review of an administrative law judge's denial of a motion to dismiss within a contested case before the Tennessee Department of Commerce and Insurance. The chancery court granted the Department's motion to dismiss the petition, citing a lack of subject matter jurisdiction because an adequate remedy would be available through subsequent judicial review of a final administrative decision. The Court of Appeals affirmed this decision, ruling that the challenge to jurisdiction was factual and that the Petitioners failed to demonstrate that a final administrative review would be inadequate, specifically rejecting arguments concerning procedural due process and the risk of retrial.

Administrative LawJudicial ReviewInterlocutory AppealSubject Matter JurisdictionMotion to DismissAdequate RemedyDue ProcessRisk of RetrialTennessee Court of AppealsInsurance Law
References
19
Case No. 03-02-00502-CV
Regular Panel Decision
Aug 29, 2003

Robert S. Howell, D.C. and First Rio Valley Medical, P.A. v. Texas Workers' Compensation Commission Envoy Medical Systems, L.L.C. Texas Mutual Insurance Company Continental Casualty Company Brownsville I.S.D. Edwards Risk Management D/B/A Edwards Claims Administration State Office of Risk Management

This is an interlocutory appeal of a temporary injunction, where a final judgment has already been rendered in the underlying cause. The appellees requested dismissal of this appeal as moot. Additionally, appellees moved for damages and sanctions due to the appellants' allegedly frivolous petition for emergency writ of prohibition, which the court overruled. The appeal was ultimately dismissed as moot.

Interlocutory AppealTemporary InjunctionMootnessFrivolous PetitionEmergency Writ of ProhibitionSanctionsAppellate ProcedureTexas Court of AppealsWorkers’ Compensation
References
1
Case No. MISSING
Regular Panel Decision

Texas Municipal League Intergovernmental Risk Pool v. Texas Workers' Compensation Commission

The Texas Municipal League Intergovernmental Risk Pool, representing numerous self-insured political subdivisions, challenged specific sections of the Texas Labor Code and associated administrative rules. These provisions require workers' compensation insurance carriers, including the Risk Pool, to pay death benefits (in cases where no legal beneficiary exists) into the Subsequent Injury Fund. This fund is then used to compensate workers who sustain second injuries and to reimburse other insurance carriers. The Risk Pool contended that these mandates violate Article III, Section 52(a) of the Texas Constitution, which restricts political subdivisions from lending credit or granting public money to individuals or private corporations without a pre-existing legal obligation. While the trial court initially agreed with the Risk Pool, the court of appeals reversed this decision, and the Supreme Court subsequently affirmed that reversal. Justice Owen dissents from this judgment, arguing that the challenged funding mechanism is unconstitutional, as it compels political subdivisions to fund compensation for non-employees and to reimburse private carriers, citing the precedent set in *City of Tyler v. Texas Employers’ Insurance Association*.

Texas ConstitutionPolitical SubdivisionsWorkers' CompensationSubsequent Injury FundSelf-InsuranceDeath BenefitsConstitutional LawPublic FundsIntergovernmental Risk PoolStatutory Interpretation
References
4
Case No. 13-07-00057-CV
Regular Panel Decision
Jul 29, 2008

State Office of Risk Management v. Irma Trujillo

The State Office of Risk Management (SORM) appealed a jury verdict in favor of Irma Trujillo, stemming from her workers’ compensation claim for bilateral carpal tunnel syndrome. SORM contended the trial court erred by excluding its expert witness, Dr. Martin R. Steiner, who was designated at the district court level but not at the prior administrative hearing. The trial court excluded Dr. Steiner's testimony, citing SORM’s failure to establish "good cause" for non-disclosure at the administrative level. The Court of Appeals reversed, finding that SORM was not required to disclose Dr. Steiner at the administrative level, as his opinion was formulated for the district court proceedings and he was timely designated there. The court ruled that Dr. Steiner's testimony was central to the case's material issue of compensable injury and its exclusion constituted reversible error, remanding the case for further proceedings.

Workers' CompensationExpert Witness ExclusionCarpal Tunnel SyndromeTexas Labor CodeAbuse of DiscretionJudicial ReviewDe Novo ReviewCompensable InjuryMedical TestimonyAppellate Procedure
References
18
Case No. 08-06-00257-CV
Regular Panel Decision
Apr 03, 2008

Mae Davis v. State Office of Risk Management

Mae Davis appealed a no-evidence summary judgment in favor of the State Office of Risk Management (SORM) concerning lifetime income benefits. Davis sought benefits for the total loss of use of both feet due to a workplace injury suffered in 1999. Following denials by a hearing officer and the Appeals Panel, the trial court granted SORM's summary judgment motion. The Court of Appeals reversed the judgment, concluding that Davis presented sufficient evidence to raise a genuine issue of material fact regarding her entitlement to lifetime income benefits for the permanent loss of use of both feet at or above the ankle. The case was remanded to the trial court for further proceedings.

Workers' CompensationLifetime Income BenefitsSummary JudgmentNo-Evidence Summary JudgmentTotal and Permanent Loss of UseBilateral Knee ReplacementTexas Labor CodeAppellate ReviewNotice RequirementDue Process
References
10
Case No. 13-14-00725-cv
Regular Panel Decision
Jul 23, 2015

Dos Republicas Coal Partnership v. David Saucedo, as Floodplain Administrator and County Judge of the Maverick County Commissioners Court, and the Maverick County Commissioners Court

Dos Republicas Coal Partnership (DRCP) appeals the Floodplain Administrator's denial of its permit for mining operations in a floodplain. DRCP argues the Administrator's decision, based on an over-expansive view of the ordinance and personal experience, renders the ordinance unconstitutionally vague and is preempted by state law. They contend their permit application met all conditions, as expert testimony showed the mining plan would decrease existing flood risks, making the permit grant a ministerial duty, not discretionary. DRCP also challenges the lack of a written explanation for the denial, arguing it signifies arbitrary and capricious action. The brief requests the Court to reverse the trial court's judgment and issue a writ of mandamus for the permit.

Floodplain ManagementCoal MiningPermit DenialAdministrative DiscretionStatutory PreemptionWater Quality RegulationTexas LawAppellate ReviewMandamusEnvironmental Law
References
26
Case No. 07-12-00232-CV
Regular Panel Decision
Jan 08, 2013

Wendell H. Taylor v. Lubbock Regional MHMR & JI Texas Risk Management and Texas Department of Insurance Division of Workers' Compensation

Wendell H. Taylor, an employee of Lubbock Regional MHMR, sustained a compensable injury in 2009. His subsequent claim for chronic pain and related conditions was denied by the Workers' Compensation Division's appeals panel. Taylor filed suit in district court seeking judicial review and alleging intentional torts, bad faith, and other claims against MHMR, JI Specialty Services, Texas Council Risk Management Fund, and the Division. The trial court dismissed most of Taylor's claims against all defendants based on a lack of jurisdiction and governmental immunity. On appeal, the court affirmed the dismissals for MHMR, the Risk Management Fund, and the Division, citing failure to exhaust administrative remedies and sovereign/governmental immunity for tort claims. However, the court reversed the dismissal against JI Specialty Services, Inc., concluding it had not established its claim to governmental immunity. The case was remanded for further proceedings regarding JI Specialty Services.

Interlocutory AppealPlea to the JurisdictionSovereign ImmunityGovernmental ImmunityTort ClaimsAdministrative Remedies ExhaustionSelf-insured EntityThird-Party Administrator LiabilityWorkers' Compensation BenefitsTexas Appeals Court
References
28
Case No. 14-18-00274-CV
Regular Panel Decision
Mar 17, 2020

Dr. Louis Patino, D.C. Dr. Stephen Wilson, M.D. And Dr. Gary Craighead, D.C. v. Texas Department of Insurance-Division of Workers' Compensation Commissioner Cassandra J. Brown and Dr. Donald Patrick, in Their Official and Individual Capacities State Office of Administrative Hearings, Texas Chief Administrative Law Judge Cathleen Parsley in Her Official Capacity Tommy Broyles, in His Official Capacity The State of Texas And the Attorney General of the State of Texas

Three doctors, Patino, Wilson, and Craighead, appealed the dismissal of their claims against the Texas Department of Insurance-Division of Workers’ Compensation and other state entities. The doctors were excluded from the state's workers' compensation approved doctor list between 2004 and 2007, leading to administrative penalties and a subsequent lawsuit. The trial court dismissed their claims for lack of jurisdiction, asserting immunity. The appellate court affirmed the dismissal of claims challenging final agency orders due to unexhausted administrative remedies and collateral attack immunity. However, the court reversed the dismissal of the doctors' constitutional challenges to the Workers’ Compensation Act and ultra vires claims against the Commissioner, concluding these claims were properly pleaded and not barred by sovereign immunity.

Physician ExclusionAdministrative LawJudicial ReviewSovereign ImmunityUltra Vires ClaimsConstitutional ChallengeDue Process RightsProfessional LicensingGovernment RegulationTexas Labor Code
References
24
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