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

Case No. 03-03-00176-CV
Regular Panel Decision
Dec 04, 2003

Texas Workers' Compensation Insurance Fund/Texas Workers' Compensation Commission and Leonard D. Watts v. Texas Workers' Compensation Commission and Leonard D. Watts/Texas Workers' Compensation Insurance Fund

This case involves a cross-appeal stemming from a workers' compensation claim by Leonard D. Watts, who sought lifetime income benefits for injuries sustained as a truck driver. The Texas Workers' Compensation Commission (appeals panel) initially reversed a hearing officer's decision and awarded Watts benefits, but this decision was later set aside by a Travis County district court. In this appeal, the Texas Workers' Compensation Insurance Fund (Texas Mutual) and the Commission challenged the district court's ruling. The Court of Appeals addressed arguments regarding the appeals panel's statutory authority for factual-sufficiency review and the interpretation of "issue" under the labor code, including legal doctrines of res judicata and collateral estoppel. The court ultimately reversed the judgment of the district court, thereby affirming the decision of the Commission's appeals panel which granted Watts lifetime income benefits.

Workers' CompensationLifetime Income BenefitsAppeals Panel ReviewFactual SufficiencyStatutory AuthorityCross-AppealRes JudicataCollateral EstoppelCausationMaximum Medical Improvement
References
17
Case No. MISSING
Regular Panel Decision

Nuara v. State of New York Workers' Compensation Board

Petitioners, two terminated group self-insured trusts (GSITs), challenged monetary assessments levied against them by the New York State Workers' Compensation Board and its chairman. The assessments were imposed pursuant to various sections of the Workers’ Compensation Law, utilizing a "pure premium calculation" method established by 2007 amendments. The court considered new 2008 legislation that further amended the calculation method for ceased self-insurers but declined to apply it retroactively. Ultimately, the court found the Board's interpretation of "the preceding year" in its pure premium calculation for terminated GSITs to be unreasonable and contrary to the clear statutory language. Consequently, the levied assessments were annulled and vacated.

Group Self-Insured TrustsMonetary AssessmentsStatutory InterpretationRetroactive ApplicationPure Premium CalculationAdministrative LawCPLR Article 78Legislative IntentStatutory ConstructionSelf-Insurance Liabilities
References
19
Case No. 07-02-0169-CV
Regular Panel Decision
Jan 14, 2003

Texas Workers' Compensation Commission v. Texas Workers' Compensation Insurance Fund

The Texas Workers' Compensation Commission (Commission) appealed a summary judgment that relieved the Texas Worker's Compensation Insurance Fund (Insurance Fund) of liability for workers' compensation benefits to Glenn Everett, the real party of interest. The Commission contended that the Texas Workers' Compensation Act abrogates the common law defense of election of remedies and that Everett did not make an election. Everett had previously settled a personal injury suit for $37,500 and later pursued a worker's compensation claim. The Court of Appeals affirmed the trial court's decision, finding that the Act does not abrogate the election of remedies defense and that Everett made an informed choice to elect remedies by settling his claim after consulting with attorneys, thus barring his right to workers' compensation benefits.

Workers' CompensationElection of RemediesSummary JudgmentTexas Appellate CourtStatutory InterpretationCommon Law DefenseIndemnificationSettlement AgreementEmployee StatusInsurance Fund Liability
References
18
Case No. 03-03-00435-CV
Regular Panel Decision
Jul 29, 2004

Texas Workers' Compensation Commission Richard Reynolds, in His Official Capacity as Executive Director of the Texas Workers' Compensation Commission/East Side Surgical Center Clinic for Special Surgery And Surgical and Diagnostic Center, L.P. v. East Side Surgical Center Clinic for Special Surgery/Texas Workers' Compensation Commission Richard Reynolds, in His Official Capacity as Executive Director of the Texas Workers' Compensation Commission

This case involves the Texas Workers’ Compensation Commission's failure to establish fee guidelines for ambulatory surgical centers under the Texas Workers’ Compensation Act. East Side Surgical Center, Clinic for Special Surgery, and intervenor Surgical and Diagnostic Center, L.P. (collectively "East Side") sued the Commission to invalidate certain default rules that applied when specific guidelines were absent. The district court declared one rule (133.304(i)) invalid and enjoined its enforcement, citing unlawful delegation of authority. On appeal, the Court of Appeals reversed the district court's judgment regarding the rule's invalidity and dissolved the injunction, citing a Texas Supreme Court decision finding no unlawful delegation. The court affirmed that East Side was not entitled to its usual and customary fee in the absence of specific guidelines.

Workers' CompensationAdministrative LawDelegation of AuthorityRulemakingAmbulatory Surgical CentersJudicial ReviewInsurance CarrierFee GuidelinesFair and Reasonable RatesStatutory Interpretation
References
38
Case No. MISSING
Regular Panel Decision
Mar 20, 2000

Claim of Hamm v. USF Red Star

A truck driver, referred to as 'claimant', was injured while crossing a street to get a meal before starting a new assignment. The Workers’ Compensation Board found the injury compensable, categorizing the claimant as an 'outside employee' entitled to expanded coverage. The employer and its insurance carrier appealed, arguing the accident occurred during a deviation from employment. The court affirmed the Board's decision, ruling that the activity was reasonable and within the course of employment. The court also dismissed an appeal concerning the calculation of benefits due to abandonment by the claimant.

Traveling EmployeePortal-to-Portal CoverageCourse of EmploymentDeviation from EmploymentCompensable InjuryAccidentTruck DriverMeal BreakOff-Duty InjuryBoard Resolution
References
7
Case No. 2017 NY Slip Op 27428
Regular Panel Decision
Dec 14, 2017

New York State Workers' Compensation Bd. v. Compensation Risk Mgrs., LLC

This action was brought by the New York State Workers' Compensation Board (WCB), as an assignee of former members of the Healthcare Industry Trust of New York (HITNY), against Compensation Risk Managers, LLC (CRM), HITNY trustees, and auditing firm UHY LLP. The WCB alleged mismanagement, breach of fiduciary duty, and negligent auditing, leading to the Trust's insolvency. Defendants moved to dismiss on grounds of standing, statute of limitations, and pleading particularity. The court dismissed certain derivative claims and negligent misrepresentation claims against some trustees due to standing issues and statute of limitations. All claims against UHY LLP were dismissed for lack of a near-privity relationship or prior precedent. An implied indemnity claim against the trustees was sustained. The WCB's cross-motion to consolidate related actions was denied.

Workers' Compensation LawGroup Self-Insured Trust (GSIT)Fiduciary DutyNegligenceNegligent MisrepresentationStatute of LimitationsStandingDerivative ActionImplied IndemnityAuditing Firm Liability
References
46
Case No. MISSING
Regular Panel Decision
Feb 19, 1997

Till v. Chautauqua Opportunities, Inc.

The claimant, a private preschool teacher, suffered a compensable injury. The Workers’ Compensation Board calculated her average weekly wage based on Workers’ Compensation Law § 14 (1), asserting she worked “substantially the whole of the year” despite her 41-week annual employment. The employer contended this was irrational, arguing that predictable seasonal layoffs should be factored into the annual earnings calculation, preventing her from receiving benefits equivalent to a full-time, full-year employee. The court agreed, holding that the formula in Workers’ Compensation Law § 14 (1) was inapplicable when seasonal layoffs are a known incident of employment. Therefore, the average weekly wage should be calculated under subdivisions (3) and (4) of Workers’ Compensation Law § 14. The Board's decision was reversed, and the matter remitted for further proceedings consistent with the court's ruling.

Workers' CompensationAverage Weekly WageSeasonal EmploymentRemittiturStatutory InterpretationSection 14Appellate DivisionWage CalculationEmployment DurationBoard Decision Reversal
References
6
Case No. 03-11-00009-CV
Regular Panel Decision
May 26, 2011

Rod Bordelon, Commissioner of the Texas Department of Insurance, Division of Workers' Compensation And the Texas Department of Insurance, Division of Workers' Compensation v. Brian Fanette

The appellants, Rod Bordelon, Commissioner of the Texas Department of Insurance, Division of Workers' Compensation, and the Texas Department of Insurance, Division of Workers' Compensation, filed a motion requesting the dismissal of their appeal. The Texas Court of Appeals, Third District, at Austin, granted this motion and consequently dismissed the appeal. This decision was made in the case against Appellee Brian Fanette.

Texas Court of AppealsWorkers' Compensation DivisionAppeal DismissalAppellant MotionJudicial DistrictTravis CountyMemorandum OpinionAdministrative AgencyState GovernmentAppellate Procedure
References
0
Case No. MISSING
Regular Panel Decision

Claim of Hope v. Warren County Board of Elections

This case involves an appeal by a workers' compensation carrier regarding the calculation of a claimant's average weekly wage based on concurrent employment. The claimant, injured on November 3, 2009, had employment as a polling inspector and concurrently with a retail store. A Workers’ Compensation Law Judge (WCLJ) and subsequently the Workers’ Compensation Board calculated the claimant's average weekly wage based on both employments, totaling $80.69, and directed the carrier to continue awards. The carrier appealed, arguing that awards should only be based on the primary employment wage of $3.56 due to the inability to seek reimbursement from the Special Disability Fund for concurrent employment amounts following 2007 amendments to Workers’ Compensation Law § 14 (6). The Appellate Court affirmed the Board's decision, interpreting the statutory language to mean that primary employers are liable for benefits calculated on combined average weekly wages, and the 2007 amendments did not intend to reduce benefits for injured workers.

Concurrent Employment BenefitsAverage Weekly Wage CalculationSpecial Disability Fund ClosureWorkers' Compensation Law § 14(6)Statutory Amendment ImpactEmployer Liability LimitsTemporary Total DisabilityTemporary Partial DisabilityAppellate Review of WCABLegislative Purpose Analysis
References
5
Case No. MISSING
Regular Panel Decision

Freeman v. Texas Compensation Insurance Co.

This case involves a claim for worker's compensation death benefits by Martha Freeman, widow of Jimmy Bolding, who died in a car accident while allegedly in the course of his employment with Southwestern Bell Telephone Company. The Supreme Court of Texas considered two main issues: whether Bolding's death resulted from an injury received in the course of his employment, and the correct calculation of death benefits upon Freeman's remarriage, particularly concerning the redistribution of benefits to the minor children. The Court affirmed the jury's finding that Bolding was in the course of employment, overturning the trial court's judgment non obstante veredicto. Regarding benefits, the Court held that the widow's lump sum payment upon remarriage should be based on her individual share of weekly benefits ($35), not the total ($70). Furthermore, the redistribution of the widow's former share of weekly benefits to the children does not occur immediately upon remarriage but rather two years thereafter, to ensure the statutory maximum weekly benefit is not exceeded. The case was remanded for recalculation of benefits consistent with this interpretation of Article 8306, section 8 of the Worker's Compensation Act.

worker's compensationdeath benefitscourse of employmentremarriage benefitsstatutory interpretationbenefit redistributionspecial mission doctrinepolygraph evidenceevidentiary exclusionTexas law
References
14
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