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

Case No. ADJ10243412
Regular
Jun 10, 2019

DEBRA LUX vs. COUNTY OF SANTA BARBARA

This case involves an injured firefighter seeking workers' compensation for a right knee injury. The defendant sought reconsideration of a finding of 17% permanent disability, arguing the administrative law judge erred by combining range of motion and diagnosis-based impairments, and by not apportioning the diagnosis-based impairment. The Appeals Board denied reconsideration, finding the medical evaluator adequately explained the departure from standard AMA Guides methodology for rating the combined impairments. The Board also affirmed no apportionment of the diagnosis-based impairment as no substantial evidence showed non-industrial factors contributed to the need for surgery.

Workers' Compensation Appeals BoardApplicantDefendantPermissibly Self-InsuredAdministered by CORVELFirefighterIndustrial InjuryRight KneePermanent DisabilityWhole Person Impairment
References
5
Case No. 03-08-00532-CV
Regular Panel Decision
Jan 27, 2010

Severiano DeLeon v. Royal Indemnity Company

This is a workers’ compensation case where the insurance carrier, Royal Indemnity Company, contested the impairment rating assigned to the claimant, Severiano DeLeon, by the Texas Department of Insurance, Division of Workers’ Compensation. The impairment rating was based on advisories issued by the Division, which were subsequently determined by the Court of Appeals to be invalid. The district court held that the assigned impairment rating was invalid, and the Court of Appeals affirmed this judgment. The court concluded that the 20% impairment rating assigned to DeLeon was invalid because it was improperly based on the invalid and withdrawn Division Advisories.

Workers' CompensationImpairment RatingSpinal FusionAMA GuidesMaximum Medical ImprovementAdministrative LawJudicial ReviewUltra Vires ActMedical EvaluationTexas Labor Code
References
9
Case No. NO. 03-06-00631-CV
Regular Panel Decision
Mar 26, 2009

Samuel Campos v. Texas Property & Casualty Insurance Guaranty Association for Reliance National Indemnity Company, an Impaired Carrier

Samuel Campos, an employee, was injured on the job, leading to disputes over his impairment rating and reimbursement for travel expenses. The Texas Workers’ Compensation Commission affirmed a designated doctor's 6% impairment rating and denied travel expenses, which Campos challenged in court. The case involved the Texas Property & Casualty Insurance Guaranty Association (TPCIGA) because Campos's employer's insurer became impaired. Initially filed in Winkler County, the case was transferred to Travis County, where TPCIGA was granted summary judgment. The Third District Court of Appeals reversed the summary judgment, ruling that the Workers' Compensation Act's specific mandatory venue provision, which places venue in the county of the employee's residence at the time of injury (Winkler County), overrides the Guaranty Act's general venue provision, which would place it in Travis County. The court remanded the case with instructions to transfer it to Winkler County.

Workers' CompensationVenue DisputeMandatory VenueStatutory ConstructionTexas Labor CodeTexas Insurance CodeImpairment RatingTravel Expenses ReimbursementJudicial ReviewAppellate Procedure
References
12
Case No. 2022-07-0416
Regular Panel Decision
Aug 04, 2023

Wigdor, Brad v. ELECTRIC RESEARCH & MFG. COOPERATIVE, INC

Mr. Brad Wigdor sustained a dislocated patella and subsequently developed Complex Regional Pain Syndrome Type-1 following a workplace injury on May 7, 2021. The central dispute concerned the appropriate permanent impairment rating. Mr. Wigdor challenged the five percent whole body impairment assigned by Dr. Michael Calfee of the Medical Impairment Rating Registry (MIRR), presenting evidence from Dr. Samuel Chung who assessed a nine percent impairment based on additional findings like hair loss and skin inelasticity. The Court, however, found that Mr. Wigdor did not present clear and convincing evidence sufficient to overcome the statutory presumption of accuracy afforded to Dr. Calfee’s MIRR rating. Consequently, the Court ordered the employer, Electric Research & Mfg. Cooperative, Inc., to pay permanent partial disability benefits based on Dr. Calfee’s five percent impairment.

Workers' CompensationPermanent Partial DisabilityImpairment RatingComplex Regional Pain Syndrome (CRPS)MIRR EvaluationMedical Expert TestimonyClear and Convincing EvidenceVocational ImpairmentKnee InjuryPatella Dislocation
References
4
Case No. 2020-08-0198
Regular Panel Decision
Jun 03, 2020

Gray, Katie v. Conagra Foods Packaged Foods Co., Inc.

The case involves an employee, Katie Gray, who suffered a work-related hand injury and was diagnosed with complex regional pain syndrome. After her authorized treating physician, Dr. Dan Fletcher, assigned a 13% permanent medical impairment rating based on a therapist's report using the range-of-motion model, her employer, Conagra Foods, retained Dr. David West for a medical records review. Dr. West disagreed with the methodology, concluding a 4% impairment rating for complex regional pain syndrome. Due to this discrepancy, the employer requested an evaluation through the Medical Impairment Rating Registry (MIRR), which the employee moved to quash, arguing that a medical records review was an insufficient basis for a dispute. The trial court denied the motion, and the Appeals Board affirmed, holding that the statute and regulations allow either party to obtain a second opinion, even based on a medical records review, to establish a dispute for an MIRR evaluation.

Workers' CompensationMedical Impairment Rating Registry (MIRR)Permanent Medical ImpairmentComplex Regional Pain SyndromeMedical Records ReviewSecond Medical OpinionDispute ResolutionAppeals Board DecisionTennessee LawTrial Court Affirmation
References
1
Case No. 03-08-00483-CV
Regular Panel Decision
Mar 19, 2010

Texas Property and Casualty Insurance Guaranty Association for Reliance National Insurance Company, an Impaired Company v. Doris J. Toberny

Doris J. Toberny, an exhibit decorator, injured her back on the job in May 2000, leading to spinal-fusion surgery that also corrected pre-existing scoliosis. Initially, her employer's insurer, Texas Property and Casualty Insurance Guaranty Association for Reliance National Insurance Company ('the Company'), paid for the surgery. However, in December 2001, the Company disputed the claim, asserting the injury was only a lower back strain and not the cause of her scoliosis. After a designated doctor assigned Toberny a 25-percent impairment rating in 2002, the Company paid supplemental income benefits for eight quarters. Three years later, in September 2005, the Company sought to dispute her impairment rating and discontinue benefits, claiming her pre-existing conditions were not compensable. The Division of Workers’ Compensation and the district court found that the Company had waived its right to contest the impairment rating under former rule 130.102(g) due to late dispute filing, and affirmed Toberny's 25-percent impairment rating and entitlement to benefits. The Texas Court of Appeals affirmed the trial court's judgment, upholding the validity of rule 130.102(g) and the finding of waiver, thus confirming Toberny's impairment rating and attorney's fees.

Workers' CompensationImpairment Rating DisputeSupplemental Income BenefitsWaiver DoctrineCompensability of InjuryExtent of InjuryJudicial Review of Agency DecisionTexas Appeals CourtAdministrative Rule ValidityMaximum Medical Improvement
References
12
Case No. 13-99-746-CV
Regular Panel Decision
Aug 31, 2001

Colonial Casualty Insurance Company v. Garcia, Osler G.

Osler G. Garcia, an employee, sustained a compensable injury to his cervical spine and back while working. His workers' compensation claim resulted in a dispute over his impairment rating. The hearing officer and TWCC Appeals Panel found his impairment rating to be seventeen percent as determined by the designated doctor, Dr. Rodney Simonsen. Colonial Casualty Insurance Company, the employer's insurer, sought judicial review, challenging the finding of a cervical spine injury and the seventeen percent impairment rating. The trial court affirmed the commission's findings, and on appeal, the Court of Appeals affirmed the trial court's judgment, finding sufficient evidence to support both the cervical injury and the impairment rating based on Dr. Simonsen's reports.

Workers' CompensationImpairment RatingCervical Spine InjuryBench TrialMedical EvidenceAMA GuidesAppellate ReviewSubstantial EvidenceTrial Court AffirmanceDesignated Doctor
References
7
Case No. MISSING
Regular Panel Decision

Bell v. Zurich American Insurance Co.

Bettie Bell appealed a partial summary judgment granted to Zurich American Insurance Company in a workers' compensation case concerning her impairment rating. Bell sustained a back injury and her treating physician, Dr. Bernie McCaskill, rated her impairment at 10 percent, while a designated doctor, Dr. Stuart Small, rated it at 20 percent based on an invalid Division Advisory. The trial court set aside Dr. Small's rating and ordered him to re-evaluate, but this court found that the labor code does not permit such reconsideration. The court affirmed the invalidity of the 20 percent rating and, finding Dr. McCaskill's 10 percent rating to be the only valid evidence, reversed the trial court's judgment in part and rendered judgment assigning Bell a 10 percent impairment rating. A motion for rehearing raising jurisdictional and other arguments was denied.

Impairment RatingAMA GuidesSummary JudgmentJudicial ReviewAppellate ProcedureAdministrative LawStatutory InterpretationMedical Expert TestimonyTexas Labor CodeInsurance Law
References
17
Case No. 08-06-00170-CV
Regular Panel Decision
Jun 30, 2008

Fireman's Fund Insurance Co. v. Weldon W. Weeks

This case concerns an appeal by Fireman’s Fund Insurance Company against a district court's judgment favoring workers' compensation claimant, Weldon Weeks. The core dispute revolved around the legal sufficiency of evidence for Weeks' impairment rating and maximum medical improvement (MMI) date, following an on-the-job spinal injury and subsequent fusion surgery. The district court had adopted a 25 percent impairment rating and April 17, 2002 MMI date, based on Dr. Chapman's report, which considered the spinal fusion surgery in violation of AMA Guides for impairment ratings. The Court of Appeals, affirming that surgery is not a permissible factor under the AMA Guides' Injury Model, found Dr. Chapman's reliance on the spinal fusion legally insufficient. Consequently, the appellate court reversed the district court’s judgment and rendered judgment for Fireman’s Fund, effectively upholding the Division's original decision of a 10 percent impairment rating and January 28, 2002 MMI date.

Impairment RatingMaximum Medical Improvement (MMI)Spinal Fusion SurgeryAMA GuidesLegal SufficiencyAppellate ReviewTrial Court JudgmentDesignated DoctorTexas Labor CodeDiagnosis-Related Estimate (DRE)
References
13
Case No. MISSING
Regular Panel Decision

Pacific Employers Insurance Co. v. Brown

This case involves Pacific Employers Insurance Company appealing a trial court's judgment awarding indemnity benefits to injured worker Jimmy I. Brown, based on a seventeen percent impairment rating. The dispute arose from conflicting impairment ratings by various doctors: Dr. Green's initial thirteen percent, Dr. Greenspan's initial seventeen percent which he later revised to thirteen percent, and the Texas Workers’ Compensation Commission’s appeals panel's sixteen percent finding. Pacific contended the trial court erred in assigning seventeen percent, arguing the evidence supported thirteen percent and that the trial court must adopt one of the doctors' specific ratings. The appellate court found a conflict between the judgment's seventeen percent rating and the trial court's later findings of fact stating thirteen percent. Ultimately, the court reversed and remanded the case for a new trial, clarifying that a trial court can correct clerical errors in doctors' impairment ratings, but must generally adopt one of the specific ratings provided by the medical examiners in the case.

Workers' CompensationImpairment RatingJudicial ReviewMedical ExaminationDesignated DoctorTreating PhysicianMaximum Medical ImprovementTexas Labor CodeTexas Rules of Civil ProcedureAppellate Procedure
References
25
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