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

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. 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. 2022 NY Slip Op 06531
Regular Panel Decision
Nov 17, 2022

Matter of Jennings v. Stop & Shop

Claimant, Hope J. Jennings, a supermarket clerk, suffered a work-related shoulder injury in 2007, leading to a classification of nonschedule permanent partial disability with a 50% loss of wage-earning capacity in 2012, subject to a 300-week durational cap for benefits. Following further causally-related surgeries in 2017 (shoulder) and 2019 (cervical fusion), claimant sought temporary total disability benefits after the durational cap on her permanent partial disability benefits had expired. The Workers' Compensation Board (WCB) ultimately ruled that the expiration of the durational cap on permanent partial disability benefits does not preclude a claimant from seeking temporary total disability benefits following a causally-related surgery. The Appellate Division, Third Department, affirmed the Board's decision, emphasizing that Workers' Compensation Law § 15 (2) (temporary total disability) and § 15 (3) (w) (permanent partial disability) operate under distinct statutory provisions, and the durational cap applies only to benefits payable under the latter paragraph.

Workers' Compensation Law § 15Temporary Total DisabilityPermanent Partial DisabilityDurational CapWage Loss BenefitsCervical Fusion SurgeryShoulder InjuryReclassification of DisabilityStatutory InterpretationAppellate Review
References
4
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. 2017-06-1187
Regular Panel Decision
Mar 13, 2018

Sweeney, Howard v. Jerry Carter, dba Carter Roofing

This case concerns Howard Swenney, an employee who suffered rib, lung, and spinal injuries after falling from scaffolding while working for Jerry Carter, an uninsured employer. Swenney was not immediately taken to a hospital but later sought medical attention for severe pain. After Carter failed to provide medical care or temporary disability benefits, Swenney filed a petition which led to the Bureau of Workers’ Compensation investigating Carter's lack of insurance. The Court granted Swenney's request for additional medical treatment to be provided by Mr. Carter and declared him eligible to seek benefits from the Uninsured Employers Fund. However, his request for temporary disability benefits was denied at this time due to a lack of expert medical proof regarding the duration of his disability.

Expedited HearingUninsured EmployerScaffolding AccidentSpinal InjuryRib InjuryLung InjuryTemporary DisabilityMedical BenefitsUninsured Employers FundWork-related Injury
References
2
Case No. 2015-08-0310
Regular Panel Decision
Dec 21, 2015

Boyd, Barbara v. Randstad North America

Employee Barbara Boyd sought temporary disability benefits following a left ankle injury on June 23, 2015, while employed by Randstad North America. Randstad accepted the injury as compensable but disputed the duration of benefits, asserting Ms. Boyd resigned and failed to allow accommodation for work restrictions. The Workers' Compensation Judge found Ms. Boyd's testimony credible, stating she did not resign and attempted to return to work, and ruled against Randstad's contention. The Court granted temporary total disability benefits from November 5, 2015, and temporary partial disability benefits for the period from July 21, 2015, to November 4, 2015. However, benefits were denied for the period prior to July 21, 2015, citing late notice to the employer and a lack of medical restrictions during that time, while also recalculating the claimant's average weekly wage.

Temporary DisabilityExpedited HearingAnkle InjuryStress FractureMedical RestrictionsAverage Weekly Wage CalculationNotice of Injury DisputeEmployer AccommodationDisability BenefitsOrthopedic Care
References
6
Case No. 2019-07-0058
Regular Panel Decision
Jul 16, 2019

Cornelison, Jeanette v. JTN Lodging, LLC

Ms. Cornelison sought additional medical and temporary disability benefits for injuries to her right knee and back, which JTN Lodging, LLC contested. An Expedited Hearing found her likely to prevail on medical benefits but not temporary disability. The Court accepted Dr. Michael Smigielski's opinion, who linked both the knee and sciatica to the work injury, over Dr. John Masterson's conflicting views. Consequently, Dr. Smigielski was designated the authorized treating physician for both conditions. Temporary disability benefits were denied due to insufficient evidence regarding the duration of her inability to work.

Workers' CompensationMedical BenefitsTemporary DisabilityKnee InjuryBack InjurySciaticaMeniscus TearCausationAuthorized Treating PhysicianExpedited Hearing
References
7
Case No. 535144
Regular Panel Decision
Nov 17, 2022

In the Matter of the Claim of Hope Jennings

Hope J. Jennings, a supermarket clerk, sustained a work-related shoulder injury in 2007, leading to established workers' compensation benefits. She was classified with a nonschedule permanent partial disability in 2012, subject to a durational cap for wage loss benefits, which expired in November 2018. Following a causally-related cervical fusion surgery in July 2019, claimant sought temporary total disability benefits, arguing these should not count towards the permanent partial disability cap. The Workers' Compensation Board, on full Board review, rescinded an earlier decision and ruled that the expiration of the durational cap did not preclude claimant from seeking temporary total disability benefits after subsequent surgeries. The Appellate Division affirmed the Board's decision, clarifying that temporary total disability benefits under Workers' Compensation Law § 15 (2) are distinct from permanent partial disability benefits under § 15 (3) (w) and are not subject to the latter's durational caps.

Workers' CompensationTemporary Total DisabilityPermanent Partial DisabilityDurational CapWage Loss BenefitsCervical Fusion SurgeryShoulder InjuryAppellate ReviewStatutory InterpretationWorkers' Compensation Law § 15
References
4
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
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