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Case Law Database

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

Case No. 2019-07-0058
Regular Panel Decision
Jul 16, 2019

Cornelison, Jeanette v. JTN Lodging, LLC

Ms. Cornelison sought additional medical and temporary disability benefits for injuries to her right knee and back, which JTN Lodging, LLC contested. An Expedited Hearing found her likely to prevail on medical benefits but not temporary disability. The Court accepted Dr. Michael Smigielski's opinion, who linked both the knee and sciatica to the work injury, over Dr. John Masterson's conflicting views. Consequently, Dr. Smigielski was designated the authorized treating physician for both conditions. Temporary disability benefits were denied due to insufficient evidence regarding the duration of her inability to work.

Workers' CompensationMedical BenefitsTemporary DisabilityKnee InjuryBack InjurySciaticaMeniscus TearCausationAuthorized Treating PhysicianExpedited Hearing
References
7
Case No. 2016-03-1099
Regular Panel Decision
Apr 25, 2017

Lindsay, Angie v, CVS Distribution Center

Angie Lindsay, an employee of CVS Distribution Center, filed for an expedited hearing regarding a right knee injury sustained on October 29, 2015. The central legal issue was whether the injury arose primarily out of and in the course and scope of her employment and if she was entitled to medical and temporary disability benefits. The Court found that Ms. Lindsay's injury, occurring when she twisted in a narrow aisle to avoid a co-worker, was compensable as the narrow aisles created a peculiar hazard. The Court granted Ms. Lindsay's request for ongoing medical treatment, including surgery recommended by Dr. Paul Becker, as CVS did not provide a contrary medical opinion. However, the Court denied temporary disability benefits, concluding Ms. Lindsay had not provided sufficient evidence to establish her likelihood to prevail on that claim at a hearing on the merits, noting that no physician had taken her completely off work and she did not provide duration of restrictions or employment status.

Workers' CompensationKnee InjuryMedical BenefitsTemporary Disability BenefitsExpedited HearingIdiopathic InjuryCausationMeniscus TearArthroscopic SurgeryUtilization Review
References
5
Case No. MISSING
Regular Panel Decision
Jun 16, 2006

Fortis Benefits v. Cantu

Vanessa Cantu suffered severe injuries in a car accident and sued multiple parties. Her medical insurer, Fortis Benefits, intervened, seeking subrogation for medical benefits paid under the policy. After Cantu settled with the defendants, Fortis pursued recovery from Cantu. Cantu argued that the equitable "made whole" doctrine barred Fortis's claim because her total losses exceeded the settlement amount plus the benefits Fortis paid. The trial court and court of appeals sided with Cantu. The Texas Supreme Court reversed, holding that the "made whole" doctrine does not override an insurer's clear contractual subrogation rights. The Court affirmed the dismissal of Fortis's claims against Ford due to a pretrial agreement.

Insurance SubrogationMade Whole DoctrineContractual SubrogationEquitable SubrogationERISATexas LawInsurance Policy InterpretationPersonal InjuryAutomobile AccidentSettlement Proceeds
References
28
Case No. 2015-08-0310
Regular Panel Decision
Dec 21, 2015

Boyd, Barbara v. Randstad North America

Employee Barbara Boyd sought temporary disability benefits following a left ankle injury on June 23, 2015, while employed by Randstad North America. Randstad accepted the injury as compensable but disputed the duration of benefits, asserting Ms. Boyd resigned and failed to allow accommodation for work restrictions. The Workers' Compensation Judge found Ms. Boyd's testimony credible, stating she did not resign and attempted to return to work, and ruled against Randstad's contention. The Court granted temporary total disability benefits from November 5, 2015, and temporary partial disability benefits for the period from July 21, 2015, to November 4, 2015. However, benefits were denied for the period prior to July 21, 2015, citing late notice to the employer and a lack of medical restrictions during that time, while also recalculating the claimant's average weekly wage.

Temporary DisabilityExpedited HearingAnkle InjuryStress FractureMedical RestrictionsAverage Weekly Wage CalculationNotice of Injury DisputeEmployer AccommodationDisability BenefitsOrthopedic Care
References
6
Case No. MISSING
Regular Panel Decision
Feb 22, 1984

Barnhardt v. Hudson Valley District Council of Carpenters Benefit Funds

The plaintiff, injured in May 1978 during maintenance work, was denied workers' compensation due to the absence of an employer-employee relationship. Subsequently, he sought reimbursement for medical expenses from the Hudson Valley District Council of Carpenters Benefit Funds (Benefit Funds) through a union insurance policy. Continental Assurance Company (Continental), Benefit Funds' insurer, rejected the claim, citing an employment-related injury exclusion in the policy. The plaintiff then initiated an action against Benefit Funds, which in turn filed a third-party action against Continental seeking indemnification. Continental's motion for summary judgment, asserting the exclusion, was denied by the County Court. The appellate court affirmed this denial, ruling that the exclusionary language was ambiguous and applied only in cases where a clear employer-employee relationship existed, a fact still to be determined.

Insurance Policy InterpretationEmployment StatusWorkers' Compensation ExclusionSummary Judgment MotionContractual AmbiguityGroup Health InsuranceMedical Expense ReimbursementThird-Party ActionAppellate ReviewEmployer-Employee Relationship
References
10
Case No. 2018-03-0071
Regular Panel Decision
Jul 20, 2018

Shetterly, Patricia v. Campbell County

Patricia Shetterly, an employee of Campbell County, sustained a hip injury after a fall at work on June 16, 2017. Campbell County did not provide medical or temporary disability benefits. Ms. Shetterly sought an expedited hearing, presenting evidence that she is likely to prevail on entitlement to medical benefits, based on Dr. Paul Naylor's confirmation of the work-related injury. The Court granted the requested medical benefits, ordering Campbell County to provide treatment with Dr. Naylor, but denied temporary disability benefits due to insufficient evidence regarding total disability and its duration. A status conference is scheduled for September 17, 2018.

Workers' CompensationHip InjurySlip and FallMedical BenefitsTemporary Disability BenefitsExpedited HearingEmployer ResponsibilityCausal ConnectionPhysician ReportCourt Order
References
2
Case No. 2017-06-0405
Regular Panel Decision
Dec 06, 2017

Castillo, David Valle v. The Hotel Group Holdings, LLC

David Valle Castillo, an employee of The Hotel Group Holdings, LLC, filed a request for expedited hearing seeking additional medical and temporary benefits for a compensable injury. Mr. Castillo, a dishwasher, slipped and fell on October 7, 2016, and the claim was accepted. He sought treatment from Dr. Edward Mackey, who recommended spinal fusion surgery due to symptomatic spinal stenosis. The employer denied further medical benefits based on an independent medical examination by Dr. Tarek Elalayli, who concluded the work injury was less than 50% related. The Court found that Dr. Mackey's opinion, affirmed by a causation letter, was presumed correct and that the employer failed to rebut this presumption. The Court granted Mr. Castillo's request for medical benefits, ordering The Hotel Group to authorize continued treatment with Dr. Mackey, including the recommended surgery. However, the request for temporary disability benefits was denied due to incomplete records regarding the duration of disability.

Expedited HearingMedical BenefitsTemporary BenefitsSpinal StenosisSpinal FusionCausation OpinionTreating PhysicianIndependent Medical ExaminationPresumption of CorrectnessBurden of Proof
References
3
Case No. MISSING
Regular Panel Decision

Cook v. Pension Benefit Guarantee Corp.

The Trustees of the Local 852 General Warehouseman’s Union Pension Fund sued the Pension Benefit Guarantee Corporation (PBGC) seeking reimbursement for pension benefits paid to retirees of two closed warehouses. The Fund argued for recovery based on equitable estoppel, asserting detrimental reliance on an initial PBGC determination that it would guarantee these benefits. The PBGC moved for summary judgment, contending that estoppel against a federal agency requires a showing of affirmative misconduct or manifest injustice. The Court found no evidence of affirmative misconduct by the PBGC and concluded that its change in determination, made to conform with Congressional intent, did not constitute manifest injustice. Consequently, the Court granted the PBGC's motion for summary judgment, ruling that equitable estoppel was inapplicable.

Equitable EstoppelFederal Agency EstoppelSummary JudgmentERISAPension BenefitsMulti-employer PlanPension Benefit Guarantee Corporation (PBGC)Affirmative MisconductManifest InjusticeDetrimental Reliance
References
10
Case No. 2016-05-0775
Regular Panel Decision
Apr 18, 2017

Brown, Rickie A. v. Goodman Global

Rickie Brown filed for an Expedited Hearing seeking medical and temporary disability benefits for a skin condition developed from fiberglass exposure at Goodman Global in June 2015. Although Goodman initially accepted the claim and provided benefits, they were later terminated. The court found Mr. Brown failed to present sufficient medical evidence establishing a causal connection for future treatment or the duration of his temporary disability. Specifically, no medical opinion linked his current medical needs to the work injury, nor was evidence provided that he was completely off work. Therefore, the Court denied his request, concluding he was unlikely to prevail on the merits for either medical or temporary disability benefits at this time.

Workers' CompensationSkin ConditionFiberglass ExposureTemporary Disability BenefitsMedical BenefitsExpedited HearingMaximum Medical ImprovementCausationMedical CertaintyTennessee Law
References
3
Case No. 2017-08-1148
Regular Panel Decision
May 02, 2018

Oglesby, Edward v. United Parcel Serices, Inc.

Mr. Edward Oglesby, a plant engineering mechanic for UPS, sought medical and temporary disability benefits following a workplace injury on September 4, 2017, sustained while repairing a conveyor belt. UPS denied the claim, arguing Mr. Oglesby violated a safety rule by not powering off the machine. The Court determined UPS failed to prove it would likely prevail on its defense, finding Mr. Oglesby's actions aligned with accepted "live conveyor repair" procedures and training. As a result, the Court awarded Mr. Oglesby medical benefits but postponed a decision on temporary disability benefits, citing insufficient evidence regarding the duration of his disability at the time of the hearing.

Expedited HearingMedical BenefitsTemporary Disability DenialSafety Rule Violation DefenseLive Conveyor RepairEmployer PolicyWorkplace InjuryCausal ConnectionBurden of ProofTennessee Workers' Compensation Claims
References
4
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