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

Case No. 2023 NY Slip Op 00140 [212 AD3d 974]
Regular Panel Decision
Jan 12, 2023

Matter of Molnar v. JRL S. Hampton, LLC

Claimant John Molnar appealed a Workers' Compensation Board decision which disallowed his claim for occupational bilateral wrists and hands injury. The Board affirmed a Workers' Compensation Law Judge's decision, finding the claim was precluded by collateral estoppel. Molnar had a prior established claim for occupational bilateral carpal tunnel syndrome and a second claim for repetitive-use wrist injury that was disallowed by the Board in August 2020 for lack of causal relationship to employment. The Board determined that the issue of causal link between employment and repetitive-use wrist injury in the instant claim was identical to the issue previously litigated and decided against Molnar, thus applying the doctrine of collateral estoppel to preclude relitigation.

Collateral EstoppelRes JudicataOccupational DiseaseCarpal Tunnel SyndromeRepetitive-Use InjuryWorkers' Compensation BenefitsAppellate ReviewCausal RelationshipBoard DecisionClaim Disallowed
References
7
Case No. 14-19-00539-CV
Regular Panel Decision
Dec 22, 2020

Hand & Wrist Center of Houston, P.A. v. Lowery Masonry, LLC

Appellant Hand & Wrist Center of Houston, P.A. (HWC) appealed a summary judgment that denied it recovery from Appellee Lowery Masonry, LLC, on a guaranty agreement. Lowery's president had signed a "Letter of Guarantee" to ensure prompt medical treatment for an injured employee, Sandro Tovar, and to pay HWC's usual and customary fees. Lowery later argued an exception applied because it had workers' compensation insurance with Texas Mutual Insurance Company, leading the trial court to grant summary judgment. The appellate court determined that Lowery's interpretation of the exception was unreasonable as it would render the phrase "additional payment" meaningless within the contract. Consequently, the appellate court reversed the trial court's judgment and remanded the cause for further proceedings, concluding that Lowery had not conclusively established its entitlement to summary judgment.

Contract LawGuaranty AgreementSummary JudgmentWorker's Compensation InsuranceMedical BillingAppellate ReviewContract InterpretationTexas LawHarris CountyFourteenth Court of Appeals
References
25
Case No. MISSING
Regular Panel Decision

Hand & Wrist Center of Houston, P.A. v. SGS Control Services, Inc.

Charles Reagan was injured at work and treated by Hand & Wrist Center. SGS North America, his employer, signed a "Letter of Guarantee" promising to pay for treatment if workers' compensation insurance didn't cover it. SGS failed to pay, leading Hand & Wrist to sue for breach of contract. SGS filed a plea to the jurisdiction, arguing Hand & Wrist failed to exhaust administrative remedies under the Workers' Compensation Act. The trial court granted the plea, and Hand & Wrist appealed, contending SGS did not invoke its workers' compensation coverage and that exclusive remedies provisions do not apply to healthcare providers. The appellate court affirmed the trial court's decision, holding that SGS invoked its workers' compensation coverage when it obtained it, and Hand & Wrist was required to exhaust administrative remedies with the Texas Department of Insurance-Workers’ Compensation Division before filing suit, as the Division has exclusive jurisdiction over medical fee disputes.

Workers' CompensationAdministrative RemediesSubject Matter JurisdictionPlea to the JurisdictionBreach of ContractHealthcare Provider ReimbursementExclusive RemediesTexas Labor CodeMedical Fee DisputeAppellate Review
References
17
Case No. 01-12-00216-CV
Regular Panel Decision
Feb 04, 2014

Hand & Wrist Center of Houston, P.A. and SCA Houston Hospital for Specialized Surgery L.P. v. Maintenance Supply Headquarters, LP

Appellants Hand & Wrist Center, P.A. and SCA Houston Hospital for Specialized Surgery, L.P. appealed the trial court's summary judgment in favor of Maintenance Supply Headquarters, L.P., concerning a breach of contract claim. The dispute arose from a "Letter of Guarantee" signed by Maintenance Supply for medical services provided to an injured employee, Daniel Contreras, whose workers' compensation claim was denied. Maintenance Supply argued estoppel and the applicability of the Labor Code's exclusive remedies provision. The Court of Appeals found the estoppel defense inapplicable and, crucially, ruled that Labor Code section 408.001(a)'s exclusive remedies provision applies only to employees and their beneficiaries, not to health care providers. Consequently, the appellate court reversed the summary judgment and remanded the case for further proceedings.

Breach of contractSummary judgmentWorkers' compensationExclusive remedyHealth care providersStatutory interpretationTexas Labor CodeEstoppelLetter of GuaranteeAppellate review
References
10
Case No. 2022-02-0210
Regular Panel Decision
Feb 17, 2023

Bassham, Stephen v. Lowe's Home Centers, Inc.

Stephen Bassham, an employee of Lowe's, sought a second medical opinion for wrist injuries sustained while building and dismantling shelving. He noticed pain while golfing, leading to diagnoses of bilateral ligament tears and later bilateral wrist arthritis with traumatic ligament ruptures by various physicians. Lowe's denied his request for a second opinion, arguing his authorized doctor did not recommend surgery or a referral for one. The Court, citing Tennessee Code Annotated sections, denied Mr. Bassham's request. It found that no physician had recommended surgery, which is a prerequisite for a second opinion on that issue under Tennessee law.

Workers CompensationMedical Treatment DisputeSecond Opinion RequestWrist InjuryBilateral Ligament TearsWrist ArthritisTraumatic Ligament RupturesMaximum Medical ImprovementPre-existing ConditionExpedited Hearing
References
1
Case No. 534670
Regular Panel Decision
Jan 12, 2023

In the Matter of the Claim of John Molnar

Claimant John Molnar appealed a decision by the Workers' Compensation Board which disallowed his claim for workers' compensation benefits, alleging an occupational disease of the bilateral wrists and hands. The Board affirmed a Workers' Compensation Law Judge's finding that the instant claim was an attempt to relitigate a previously disallowed claim from August 2020. This prior claim also involved a repetitive-use injury to his bilateral wrists, where the Board found a lack of evidence for a causal link to his employment. The Appellate Division, Third Judicial Department, affirmed the Board's decision, ruling that the doctrine of collateral estoppel precluded relitigation of the identical issue concerning the causal relationship between Molnar's employment and his alleged repetitive-use injury.

Occupational DiseaseBilateral Wrist InjuriesCarpal Tunnel SyndromeRepetitive Use InjuryCollateral EstoppelRes JudicataClaim DisallowanceWorkers' Compensation AppealCausal RelationshipPrior Litigation
References
6
Case No. ADJ1806235 (OAK 0229406) ADJ3677836 (OAK 0279846) ADJ3058455 (OAK 0347422)
Regular
Jun 03, 2013

THEODORE FERNANDEZ vs. TENET HEALTHCARE dba SAN RAMON REGIONAL MEDICAL CENTER, SEDGWICK CMS, VALLEYCARE HEALTH SYSTEM, LUMBERMEN'S UNDERWRITING ALLIANCE, TRAVELERS PROPERTY AND CASUALTY INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, returning the case to the trial level for further proceedings. The Board found insufficient medical evidence to definitively link the applicant's wrist condition to his 1993 injury. It noted the applicant's wrist symptoms emerged and worsened years after his employment with the original employer, suggesting a potential cumulative trauma injury with a subsequent employer. The Board ordered further development of the medical record to clarify the nature and causation of the applicant's bilateral wrist issues.

WCABReconsiderationCumulative TraumaBilateral Upper ExtremitiesCarpal Tunnel SyndromeUlnar NeuritisCubital Tunnel SyndromeAgreed Medical EvaluatorApportionmentSubstantial Medical Evidence
References
0
Case No. ADJ12582828
Regular
Jan 03, 2023

TERRY KELLY vs. SAFEWAY

This case involves a workers' compensation claim where the defendant sought reconsideration of an award finding injury AOE/COE to multiple body parts. The primary dispute centers on the applicant's occupational group number, with the applicant claiming "butcher" (420) and the defendant arguing "meat cutter" (322), impacting permanent disability ratings. The Board granted reconsideration, finding insufficient evidence to determine the occupational group number and therefore deferring permanent disability for all affected body parts pending further development of the record. The finding of injury AOE/COE to the applicant's cervical spine, thoracic spine, lumbar spine, bilateral knees, bilateral elbows, and bilateral wrists was upheld.

Occupational Group NumberMeat CutterButcherCumulative TraumaPermanent DisabilityQualified Medical EvaluatorSubstantial EvidenceFurther DevelopmentBody PartsWPI Ratings
References
11
Case No. MISSING
Regular Panel Decision

Onley v. National Union Fire Insurance Co. of Pittsburgh

This workers' compensation case addresses the appropriate scheduled member for a compensable injury and the extent of disability. The employee suffered a severe comminuted fracture to the first metacarpal bone in his left hand and a laceration on June 8, 1988. An orthopedic surgeon assessed a 63% permanent partial disability to the left thumb, which could also translate to hand or arm impairment, noting the fracture extended slightly into the wrist joint. The trial court awarded 60% permanent partial disability to the left thumb. On appeal, the court determined the injury was more appropriately classified as a disability to the left hand due to the fracture's location at the base of the thumb extending into the hand. Consequently, the judgment was modified to award 50% permanent partial disability to the left hand, affirming the trial court in all other respects.

Workers' CompensationScheduled InjuryPermanent Partial DisabilityLeft Hand InjuryThumb FractureMetacarpal BoneMedical TestimonyOrthopedic SurgeonAppellate ReviewTrial Court Modification
References
6
Case No. MISSING
Regular Panel Decision

Claim of Rathbun v. D'Ella Pontiac Buick GMC, Inc.

In February 1999, claimant experienced work-related wrist and elbow pain, later diagnosed as bilateral carpal tunnel syndrome. The employer's workers’ compensation carrier initially accepted the claim and authorized medical treatment. In 2006, claimant sought authorization for left wrist surgery, which the carrier denied, asserting that liability shifted to the Special Fund for Reopened Cases under Workers’ Compensation Law § 25-a. This was based on the lapse of seven years from the injury date and three years from the last compensation payment. The Workers’ Compensation Board deemed § 25-a inapplicable. However, the Appellate Division reversed, finding that the case was "truly closed" in July 2003 when right wrist surgery was authorized, as no further proceedings were contemplated. Consequently, the court held that Workers’ Compensation Law § 25-a indeed applies, shifting liability to the Special Fund, and remitted the matter for further proceedings.

Workers' Compensation Law § 25-aSpecial Fund for Reopened CasesCarpal Tunnel SyndromeOccupational InjuryMedical Authorization DenialCase ReopeningStatute of LimitationsLapse of TimeTruly Closed Case DoctrineAppellate Division
References
5
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