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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

Carlucci v. Omnibus Printing Co.

The claimant, a pressman, developed various respiratory, pulmonary, and cardiac disorders during his employment. A Workers' Compensation Law Judge initially found a permanent partial disability. The Workers' Compensation Board later determined a permanent moderate partial disability and reduced the compensation award, which the claimant appealed. The appellate court reversed the Board's decision, concluding that the Board had incorrectly relied on inapplicable medical guidelines for low back total disability when assessing the claimant's condition. The case was subsequently remitted to the Workers’ Compensation Board for a proper re-assessment of the medical evidence.

Workers' CompensationPermanent Partial DisabilityMedical GuidelinesAppellate ReviewRemittalDisability AssessmentRespiratory DisordersCardiac DisordersPulmonary DisordersNew York Law
References
4
Case No. No. 13
Regular Panel Decision

Fagg v. Hutch Manufacturing Co.

This workers' compensation case involved an appeal by Hutch Manufacturing Company and its insurance carrier concerning an employee, Mrs. Fagg, who sustained a compensable injury. The appeal raised issues regarding the duration of temporary total disability (TTD) benefits, the extent of permanent partial disability (PPD), a 6% penalty for unpaid installments, and medical expenses. The Court dismissed a preliminary appeal as interlocutory. It found the trial court erred in determining the termination date of TTD, concluding that Mrs. Fagg's TTD benefits should cease on October 9, 1984, the latest date for maximum medical recovery according to Dr. Coughlin's evaluations. The Court affirmed the trial court's award of 65% PPD to the body as a whole, emphasizing the consideration of non-medical factors in assessing disability. Furthermore, the Court upheld the 6% penalty on unpaid compensation installments due to the employer's demonstrated bad faith. The case was remanded for a more explicit allocation of medical expenses.

Temporary Total DisabilityPermanent Partial DisabilityMedical Impairment RatingJudicial ReviewRemandPenalty for Non-PaymentMedical EvidenceObjective SymptomsSubjective ComplaintsWorkers' Compensation Appeal
References
12
Case No. 2019-01-0122
Regular Panel Decision
Jun 27, 2019

Lowder, William v. XPO Logistics Freight, Inc.

William Lowder, a driver for XPO Logistics, developed hernias on January 2, 2019, after delivering solar panels. XPO Logistics initially denied the claim but later accepted it as part of an ongoing mediation process. Mr. Lowder then requested a 25% penalty for the late payment of temporary disability benefits, specifically temporary partial disability benefits. The Court assessed a $1,098.71 penalty against XPO Logistics under Tennessee Code Annotated section 50-6-205(b)(3)(A) for failing to pay temporary disability benefits within twenty days of having knowledge of Mr. Lowder's disability, rejecting XPO's arguments that the penalty only applied to temporary total disability benefits or required a finding of 'bad faith'.

Workers' CompensationPenalty AssessmentTemporary Disability BenefitsLate PaymentHernia ClaimStatutory InterpretationBad FaithTennessee LawEmployer LiabilityDisability Benefits
References
5
Case No. MISSING
Regular Panel Decision

Donaldson v. Texas Department of Aging & Disability Services

David Donaldson appealed a trial court's summary judgment in favor of the Texas Department of Aging and Disability Services (DADS) on claims of race and disability discrimination, retaliation, and hostile work environment under the TCHRA and Title VII. Donaldson, an African-American employee diagnosed with multiple conditions including prostate cancer and PTSD, alleged DADS failed to accommodate his disabilities and discriminated against him through various adverse actions, culminating in his termination. The appellate court affirmed the summary judgment for DADS on the race discrimination, retaliation, and hostile work environment claims, finding insufficient evidence of discriminatory intent or materially adverse actions in those areas. However, the court reversed and remanded the reasonable accommodation claim, concluding that Donaldson presented a fact issue regarding DADS's failure to provide continued assistance for his disabilities despite initial accommodations. This decision partially reverses the trial court's judgment, necessitating further proceedings on the reasonable accommodation aspect of the disability discrimination claim.

DiscriminationRetaliationHostile Work EnvironmentDisability DiscriminationRace DiscriminationReasonable AccommodationSummary JudgmentTexas Commission on Human Rights ActTitle VIIEmployment Law
References
83
Case No. MISSING
Regular Panel Decision
Oct 14, 1999

Claim of Williams v. New York State Department of Transportation

The claimant, who suffered a work-related injury in 1988, initially received permanent partial disability benefits at a mild rate in May 1996. Dissatisfied with this assessment, the claimant appealed, presenting medical evidence suggesting a more severe disability. This led the Workers’ Compensation Board to restore the case to the trial calendar for further development of the record concerning the degree of disability post-May 6, 1996. Although two physicians testified, with one indicating a moderate disability and another a total disability, the Workers’ Compensation Law Judge (WCLJ) ultimately awarded benefits at a moderate partial disability rate. Upon the claimant's subsequent appeal, the Board ruled that the claimant was precluded from raising the issue of their degree of disability, citing regulatory provisions. The appellate court found that the Board had abused its discretion, as the issue was explicitly remanded by the Board previously, and the claimant was still aggrieved by the WCLJ's award despite an increase in benefits. Consequently, the court reversed the Board's decision and remitted the matter for further proceedings.

Workers' CompensationDisability AssessmentAppellate ReviewAbuse of DiscretionProcedural ErrorMedical EvidenceDegree of DisabilityRemittalNew York LawAdministrative Appeal
References
0
Case No. 2016-06-0910
Regular Panel Decision
Jul 24, 2018

Fegan, Mark v. CSI Medical, Inc.

The case involved Mark Fegan seeking temporary disability benefits from his employer, CSI Medical, Inc., and its carrier, Am Trust, following a back injury in October 2015. Initially, Dr. Sullivan declared Fegan at maximum medical improvement (MMI) in March 2016, leading to a cessation of benefits. However, Fegan later sought treatment from Dr. Ronald Lakatos in Ohio, who performed surgery in May 2017 and provided a medical opinion contradicting Dr. Sullivan's MMI assessment. Dr. Lakatos stated that Fegan was not at MMI as of March 2016 and remained disabled through May 2017. The Court weighed the medical opinions, giving more weight to Dr. Lakatos's in-depth analysis, and found that Mr. Fegan was likely to prevail in demonstrating his entitlement to temporary disability benefits for the period from April 1, 2016, through May 30, 2017. Consequently, the Court ordered CSI to pay lump-sum temporary total disability benefits totaling $19,389.52.

Temporary DisabilityMedical ImprovementSpinal InjurySurgeryMMI DisputeMedical EvidenceExpedited HearingBenefit DeterminationCausationDisability Duration
References
2
Case No. 08-23-00177-CV
Regular Panel Decision
Aug 30, 2024

Texas Department of Aging and Disability Services v. Claudia Gomez

The Texas Department of Aging and Disability Services (DADS) terminated Claudia Gomez, alleging she physically assaulted a coworker; Gomez contended the termination was discriminatory based on age, gender, and disability. The trial court denied DADS's plea to the jurisdiction regarding Gomez's discrimination claims. On appeal, the court found Gomez failed to present evidence of a similarly situated comparator, thus not establishing a prima facie case for age, gender, or disability discrimination. Furthermore, Gomez did not demonstrate that DADS's stated reason for termination was a pretext for discrimination. Consequently, the appellate court reversed the trial court's decision and dismissed Gomez's claims for lack of jurisdiction.

DiscriminationAge DiscriminationGender DiscriminationDisability DiscriminationEmployment LawTerminationPretextPrima Facie CaseSovereign ImmunityTexas Labor Code
References
30
Case No. MISSING
Regular Panel Decision

Smith v. Bayer Corp. Long Term Disability Plan

Plaintiff Terry Smith, a former Diabetes Sales Specialist for Bayer Corporation, filed an action under ERISA to recover long-term disability benefits, claiming wrongful denial due to psychiatric impairments including depression, panic disorder, and bi-polar disorder. The Plan administrator, Bayer, upheld the denial based on reviews by non-examining physicians. However, Smith's treating psychiatrists, Dr. LeBuffe and Dr. McCool, consistently found him disabled. The court found the Plan's reliance on non-examining doctors, who 'cherry-picked' medical records and distorted findings, to be arbitrary and capricious. Consequently, the court granted Smith's motion for benefits, denying Bayer's, and also awarded partial disability benefits, ruling that Smith's failure to seek rehabilitation approval was excused by the prior wrongful denial.

ERISALong-term disabilityDisability benefits denialPsychiatric impairmentDepressionPanic disorderBi-polar disorderAttention Deficit Disorder (ADD)Treating physician ruleArbitrary and capricious standard
References
26
Case No. MISSING
Regular Panel Decision

Smith v. New York State & Local Retirement Systems

Petitioner, a taxpayer services representative, sustained a back injury in March 1981 while lifting forms, leading to a decline in attendance and eventual termination in November 1989. She applied for accidental and ordinary disability retirement benefits, both of which were denied by the Comptroller. The accidental disability claim was denied because the incident was not deemed an 'accident' under Retirement and Security Law § 63. The ordinary disability claim was denied as untimely, having been filed approximately six months after her termination, exceeding the 90-day limit stipulated by Retirement and Social Security Law § 62. The Supreme Court dismissed the challenge to the ordinary disability denial due to untimeliness and transferred the accidental disability challenge to this Court. This Court confirmed the Comptroller's determination on both counts, rejecting the petitioner's estoppel argument regarding the untimely ordinary disability application and finding substantial evidence to support the finding that the injury did not constitute an 'accident' within the meaning of the relevant law, as it resulted from ordinary employment duties without an unexpected event.

Disability Retirement BenefitsAccidental DisabilityOrdinary DisabilityUntimely ApplicationEstoppel Against GovernmentWork-Related InjuryBack InjuryDefinition of AccidentOrdinary Employment DutiesSubstantial Evidence Review
References
16
Case No. MISSING
Regular Panel Decision

Cowley v. Berryhill

Plaintiff appeals the Commissioner of Social Security's denial of disability benefits. The District Court affirmed the Commissioner's decision, upholding the Administrative Law Judge's (ALJ) finding that the plaintiff was not disabled under the Social Security Act. The court found that the ALJ properly assessed medical opinions from a treating therapist and a consulting psychologist, giving appropriate weight and providing sufficient explanations. The ALJ's determination of the plaintiff's residual functional capacity (RFC) and the vocational expert's testimony regarding suitable alternative employment were also supported by substantial evidence. Consequently, the plaintiff's motion for judgment on the pleadings was denied, and the Commissioner's cross-motion was granted.

Disability BenefitsSocial Security ActAdministrative Law JudgeMedical Opinion AssessmentResidual Functional CapacityVocational Expert TestimonyMental Health ImpairmentsAsthmaBipolar DisorderMajor Depressive Disorder
References
13
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