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Case Law Database

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

Case No. MISSING
Regular Panel Decision

Henneberry v. ING Capital Advisors

Virginia Henneberry was terminated from her employment with ING Furman Selz Asset Management, LLC and ING Capital Advisors, LLC. She initiated arbitration, challenging the burden of proof and arguing arbitrator misconduct after the arbitrator reversed his initial ruling on the burden of proof. Both the Supreme Court and the Appellate Division upheld the arbitration award. This court affirmed those decisions, finding that the arbitrator's procedural error in shifting the burden of proof did not deprive Henneberry of a fundamentally fair arbitration or exceed his authority, especially since he concluded the employer would have prevailed regardless of who bore the burden.

ArbitrationEmployment AgreementTerminationBurden of ProofArbitrator MisconductDue ProcessFundamental FairnessCPLR 7511Judicial ReviewAppellate Practice
References
4
Case No. ADJ6929350, ADJ7133107, ADJ8881791
Regular
Aug 16, 2019

TIMOTHY RODRIGUEZ vs. DEPARTMENT OF CORRECTIONS, CALIFORNIA MEN'S COLONY, STATE COMPENSATION INSURANCE FUND

The Appeals Board rescinded the WCJ's decision, finding legal error in requiring proof of conspiracy for workers' compensation claims. The WCJ incorrectly applied the burden of proof and failed to adequately consider medical opinions regarding applicant's claims of physical and psychiatric injuries. The case is remanded for further proceedings and a new decision, requiring the WCJ to analyze each claimed injury and body part separately under the correct burden of proof and to further develop the medical record as necessary.

AOE-COEAgreed Medical Evaluatorhostile work environmentconspiracy theoryburden of proofpreponderance of the evidencespecific injurycumulative traumapsychiatric injurygood faith personnel action
References
11
Case No. ADJ10257811
Regular
Dec 18, 2020

JORGE ANDRADE vs. CECILIO ARREDONDO TERREZAS, STAR INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed the judge's decision finding the applicant was not an employee at the time of injury, concluding he failed to meet his burden of proof. The applicant did not provide evidence establishing an employment relationship with the labor contractor or its associated individuals, and evidence indicated he paid for his own transportation. A dissenting opinion argued the board and judge incorrectly shifted the burden of proof, stating the applicant is presumed an employee and the employer must prove otherwise. The dissent would have rescinded the decision for failure to meet the employer's burden.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and OrderEmployee StatusLabor ContractorBurden of ProofEmployment RelationshipPresumption of EmployeeLabor CodeRebuttal of Presumption
References
5
Case No. ADJ10341378, ADJ10341435
Regular
Mar 23, 2018

MARIA AKA MARTHA PUGA AKA GONZALEZ vs. UNITED ONE STAFFING, TRAVELERS PROPERTY AND CASUALTY COMPANY OF AMERICA

This case involves an interpreter service provider petitioning for reconsideration after an administrative law judge denied their request for costs and sanctions against the defendant. The judge found the interpreter service failed to meet their burden of proof regarding the defendant's liability. The Appeals Board granted reconsideration, finding the judge misapplied the burden of proof. Specifically, the Board determined that the defendant's failure to pay an interpreter's invoice within 60 days, without objection, violated a regulation and shifted the burden to the defendant to prove their delay was due to excusable neglect, which they failed to do. The matter was returned to the trial level for further proceedings.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of FactAdministrative Law JudgePetition for SanctionsLabor Code Section 5811Interpreter FeesMandatory Settlement ConferenceCompromise and ReleaseAdministrative Director Rule 9795.4
References
2
Case No. 19-0533
Regular Panel Decision
Jan 29, 2021

Patients Medical Center v. Facility Insurance Corporation

This case is an administrative appeal stemming from a medical fee dispute between Patients Medical Center, a healthcare provider, and Facility Insurance Corporation, a worker's compensation insurance carrier. The core issue revolves around the proper allocation of the burden of proof in a contested case hearing before the State Office of Administrative Hearings (SOAH) following an initial decision by the Texas Department of Insurance, Division of Workers’ Compensation. While the Division and the ALJ initially placed the burden on the carrier, the court of appeals reversed. The Texas Supreme Court, however, reversed the court of appeals, holding that the burden of proof lies with the party seeking relief from the Division's initial decision, which in this case was the carrier. The Supreme Court remanded the case for the court of appeals to address other unaddressed issues.

Worker's CompensationMedical Fee DisputeAdministrative LawBurden of ProofTexas Supreme CourtAppellate ReviewInsurance LawHealthcare ReimbursementSOAHALJ Decision
References
10
Case No. MISSING
Regular Panel Decision

Texas Employers' Insurance Ass'n v. Olivarez

This workers' compensation case involves an appeal by Texas Employers’ Insurance Association (TEIA) against Antonio Olivarez. TEIA challenged a judgment favorable to Olivarez, arguing that the trial court's jury charge failed to place the burden of proving the duration of total incapacity on Olivarez. The court found that TEIA's timely objection to the special issue preserved the point of error, making it unnecessary to submit a requested explanatory instruction. It concluded that Rule 277 specifically addresses the fixing of the burden of proof, distinguishing it from general provisions for explanatory instructions. The court determined that failing to assign the burden of proof on the duration of total incapacity constituted reversible error, despite medical testimony suggesting the permanence of Olivarez's disability. Consequently, the judgment was reversed, and the case was remanded to the trial court.

Workers' CompensationBurden of ProofJury ChargeTrial Court ErrorReversible ErrorTotal IncapacityDuration of IncapacityAppealTexas LawCivil Procedure
References
2
Case No. ADJ7800258 ADJ7800270
Regular
Jun 03, 2013

DEBRA NICKELL vs. PKB INVESTMENTS, INC., dba HOME INSTEAD, CARE WEST INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and amended a prior finding. The amended decision clarifies that the applicant met her burden of proof for reaching maximum medical improvement on July 19, 2011, and for a 15% whole person impairment rating based on an Agreed Medical Evaluator's opinion. However, the applicant did not meet her burden of proof for injury to other claimed body parts. The case is returned to the trial level for further proceedings.

WORKERS' COMPENSATION APPEALS BOARDPKB INVESTMENTSINC.HOME INSTEADCARE WEST INSURANCE COMPANYPEGASUS RISK MANAGEMENTDEBRA NICKELLPetition for ReconsiderationFindings of FactOrder
References
7
Case No. ADJ194128 (SBR 0298661)
Regular
Apr 04, 2011

MICHELLE ASTLEY vs. REDLANDS UNIFIED SCHOOL DISTRICT, COREGA aka WESTPOINT INSURANCE COMPANY c/o YORK INSURANCE SERVICE

The Workers' Compensation Appeals Board granted reconsideration to address the defendant's petition challenging a prior finding that Rancho Specialty Hospital's $223,400.28 bill was reasonable. The Board found the trial judge incorrectly placed the burden of proof on the defendant to prove the charges were unreasonable, rather than on the lien claimant to prove their charges were reasonable. Consequently, the case was returned to the trial level for a new decision with the correct burden of proof applied.

Workers' Compensation Appeals BoardLien ClaimantRancho Specialty HospitalRedlands Unified School DistrictReconsiderationFindings and OrderWCJLabor Code section 4603(b)Penalties and InterestLong Term Acute Care Hospital
References
2
Case No. 13-03-038-CV
Regular Panel Decision
Dec 16, 2004

Tina Bruno v. Trinity Universal Ins. Co. of Kansas

This workers' compensation case involved an appeal by Tina Bruno, individually and as natural guardian of Charles Bruno, deceased, and Jasime Bruno, a minor, against Trinity Universal Insurance Company of Kansas. The appellants contested the trial court's finding that Charles Bruno was not in the course and scope of his employment at the time of his death. They argued the evidence was legally and factually insufficient and that the trial court improperly shifted the burden of proof. The Court of Appeals, Thirteenth District of Texas, affirmed the trial court's judgment, concluding that there was sufficient evidence to support the finding regarding Charles Bruno's employment status at the time of the incident and that the burden of proof was not impermissibly shifted.

Workers' CompensationCourse of EmploymentScope of EmploymentDeath BenefitsLegal SufficiencyFactual SufficiencyBurden of ProofAppellate ReviewTexas LawInsurance Liability
References
0
Case No. ADJ7546371
Regular
Aug 13, 2018

PEGGY BREWER, vs. COUNTY OF SAN BERNARDINO,

This case involved a lien claimant, Physical Rehabilitation Services, seeking payment for medical treatment provided to applicant Peggy Brewer. The original decision denied the lien claimant's claim, finding they failed to meet their burden of proof regarding the necessity of the treatment and proper appeal procedures. The lien claimant petitioned for reconsideration, arguing that Independent Medical Review (IMR) was not required for services rendered in 2011 and that the WCJ exceeded their authority. The Appeals Board granted reconsideration solely to correct a clerical error referencing IMR procedures, which were not applicable to the services. The original decision, that the lien claimant did not meet their burden of proof for the treatment provided, was otherwise affirmed.

Lien claimantUtilization review denialIndependent Medical Review (IMR)Petition for ReconsiderationFindings and Order (F&O)Workers' Compensation Appeals Board (WCAB)Administrative law judge (WCJ)Burden of proofSubstantial medical evidenceExhaustion of remedies
References
2
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