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

Case No. MISSING
Regular Panel Decision

ESIS, Inc., Servicing Contractor v. Johnson

This is a workers’ compensation case involving Billy Carl Johnson, a jailer for the Tarrant County Sheriff’s Department, who sustained an accidental gunshot injury while cleaning his service revolver at home. The Texas Workers’ Compensation Appeals Panel determined that the injury occurred in the course and scope of his employment, a finding subsequently affirmed by a jury in the district court. ESIS, Inc., the servicing contractor for Tarrant County’s self-insured policy, appealed this decision, raising four points of error. These included claims that Johnson was not within the course and scope of his employment, challenges to the admission of the appeals panel opinion, the exclusion of evidence regarding Johnson's alcohol consumption, and the Texas Workers’ Compensation Commission's intervention in the case. The Chief Justice overruled all points of error, concluding that there was sufficient evidence to support the jury’s finding that Johnson’s injury was sustained in the course and scope of his employment, and affirmed the trial court's judgment.

Workers' CompensationCourse and Scope of EmploymentAccidental InjuryFirearmJailerAppellate ReviewAdministrative LawEvidence AdmissibilityStatutory InterpretationIntoxication Defense
References
34
Case No. 06-11-00016-CV
Regular Panel Decision
Aug 04, 2011

Christopher Castleberry v. Ace American Insurance/ESIS

Christopher Castleberry, a pro se appellant, sought workers' compensation benefits for a hearing loss allegedly sustained while employed by U.S. Steel Tubular Products, Inc. His claim was initially denied by a hearing officer and subsequently by the Texas Department of Insurance Division of Workers’ Compensation appeals panel. Castleberry then filed a petition for judicial review in the District Court of Morris County. Ace American Insurance/ESIS, the appellee, filed a plea to the jurisdiction, asserting that Castleberry's petition was not filed within the statutory forty-five-day deadline. The district court granted the plea, dismissing the case with prejudice. This appellate court affirmed the trial court's decision, concluding that the untimely filing deprived the district court of jurisdiction.

Workers' CompensationHearing LossJudicial ReviewTimely FilingJurisdictionStatutory DeadlinesTexas Labor CodeAppellate CourtPlea to JurisdictionPro Se Appeal
References
5
Case No. ADJ9527444
Regular
May 23, 2018

, REYES P. HERNANDEZ, vs. , QUALI RUN RANCH; STATE COMPENSATION INSURANCE FUND; OMA OJAI PACIFIC; ZENITH INSURANCE COMPANY; ACE USA INSURANCE COMPANY, Administered By ESIS; MICHAEL AND JODY CROMER, Homeowners; STATE FARM INSURANCE,

The Workers' Compensation Appeals Board granted ESIS's Petition for Removal because the WCJ's order denying ESIS a panel Qualified Medical Evaluator (PQME) evaluation was found to cause significant prejudice and irreparable harm. ESIS was not a party to the original Agreed Medical Examiner (AME) agreement between the applicant and SCIF, and the WCJ's decision unfairly bound ESIS to the AME's findings and effectively closed ESIS's discovery rights. The Board rescinded the WCJ's decision and ordered a PQME evaluation for ESIS, recognizing the denial violated ESIS's due process rights.

Petition for RemovalQualified Medical EvaluatorAgreed Medical ExaminerDue ProcessSignificant PrejudiceIrreparable HarmDiscoveryFindings and OrderWorkers' Compensation Appeals BoardCumulative Trauma
References
6
Case No. 05-21-00466-CV
Regular Panel Decision
May 11, 2022

NCH Corporation and RPG Innovations, LLC v. ESI/Employee Solutions, LP

This case involves an appeal regarding the enforceability of an indemnity agreement between NCH Corporation and RPG Innovations, LLC (appellants) and ESI/Employee Solutions, LP and Employee Solutions Arlington, LLC (appellees). The dispute arose after an employee, Timothy Price, assigned by ES Arlington to RPG, suffered severe injuries while operating a forklift without proper certification. Price sued ES Arlington for negligence. Appellees sought indemnification from appellants based on their staffing agreement. The trial court granted appellees' motion for summary judgment, ordering appellants to indemnify them. However, the appellate court reversed, finding that the indemnity provision did not meet the express negligence test because appellees were seeking indemnification for their own alleged negligence. The court rendered judgment for appellants regarding attorney's fees and costs incurred in Price's lawsuit and remanded the remaining indemnification claims to the trial court.

Indemnity AgreementExpress Negligence TestSummary JudgmentWorkers' Compensation PolicyForklift AccidentStaffing AgreementNegligence ClaimsAttorney's FeesContractual IndemnificationAppellate Review
References
10
Case No. ADJ1690383 (LAO 0818718) ADJ253066 (LAO 0811576) ADJ1849347 (LAO 0845486)
Regular
Dec 07, 2010

TRINI RIVERA vs. FREMONT COMPENSATION INSURANCE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, ESIS, INC., ARGONAUT INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, rescinding an arbitrator's decision that had determined specific injury dates binding for contribution proceedings. The Board ruled that ESIS, Inc. was not bound by its prior stipulation with the applicant regarding injury dates for the purpose of determining contribution from other defendants. The case is remanded for the arbitrator to independently determine the dates of injurious exposure, as required by Labor Code section 5500.5, to properly address ESIS's contribution claim.

Workers' Compensation Appeals BoardReconsiderationContribution ProceedingCumulative Trauma InjuryDates of InjuryStipulated AwardInjurious ExposureLabor Code Section 5500.5De Novo DeterminationApportionment of Liability
References
1
Case No. ADJ3668486 (SBA 0081243) ADJ2866077 (SBA 0073112) ADJ3676183 (SBA 0082815) ADJ3511801 (GOL 0090292) ADJ2318677 (GOL 0095094) ADJ658495 (SBR 0193676)
Regular
Jul 09, 2009

FRANCINE KOBLICK vs. PALM SPRINGS UNIFIED SCHOOL DISTRICT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, ACE/ESIS

This case concerns ACE/ESIS seeking reconsideration of a WCJ's decision that CIGA was not responsible for a Blue Cross lien. ACE/ESIS and CIGA had settled the applicant's multiple injury claims via a Compromise and Release agreement which included an addendum obligating both parties to pay 50% of adjusted liens. CIGA argued it was not liable for the Blue Cross lien due to Insurance Code § 1063.1(c) excluding "covered claims" related to insurers, similar to the *Gorgi* case. The Appeals Board granted reconsideration, finding the WCJ erred by distinguishing this case from *Gorgi* due to CIGA's voluntary contractual agreement to pay 50% of liens, making it analogous to the *Carter* case. The Board rescinded the WCJ's finding and returned the matter for further proceedings, holding that CIGA's contractual promise overrides the statutory exclusion for liens.

CIGAACE/ESISCompromise & ReleaseLienBlue CrossInsurance Code § 1063.1(c)Contractual ObligationCovered ClaimReconsiderationWorkers' Compensation Appeals Board
References
2
Case No. ADJ7110968
Regular
Apr 09, 2013

CLAUDIA LARA vs. NORTHGATE MARKET, ESIS

This case involves Claudia Lara, applicant, versus Northgate Market and ESIS, defendants. The Workers' Compensation Appeals Board issued an Order Dismissing Petition for Reconsideration. The dismissal is due to the petitioner having withdrawn their petition for reconsideration of the January 13, 2012 decision. Therefore, the petition has been formally dismissed by the Board.

Petition for ReconsiderationWithdrawn PetitionDismissed OrderWorkers' Compensation Appeals BoardApplicantDefendantNorthgate MarketESISPomona District OfficeJanuary 13 2012 decision
References
0
Case No. ADJ6413644
Regular
Apr 24, 2009

JANICE HOWELL vs. NATIONAL MENTOR HOLDINGS, dba COLE VOCATIONAL SERVICES, administered by ESIS

The Workers' Compensation Appeals Board dismissed the applicant's Petition for Reconsideration because it was not taken from a final order determining substantive rights or liabilities. The petition also sought removal, which was denied as the applicant failed to demonstrate substantial prejudice or irreparable harm. The underlying issues, such as an order compelling medical record production, are interlocutory procedural matters not subject to reconsideration. The Board adopted the WCJ's report and recommendation, denying both reconsideration and removal.

Petition for ReconsiderationFinal OrderInterlocutory OrderSubstantive RightRemovalWCJ Report and RecommendationStipulationsOrder Compelling Production of RecordsDiscovery ProcessPrivacy
References
11
Case No. ADJ10553566, ADJ10553567
Regular
Apr 04, 2017

HUGO FLOREZ vs. SUPERIOR INDUSTRIES INTERNATIONAL, INC.; ESIS

The Workers' Compensation Appeals Board (WCAB) denied Superior Industries International, Inc. and ESIS's Petition for Removal in the case of Hugo Florez. Removal is an extraordinary remedy granted only when substantial prejudice or irreparable harm would occur, and reconsideration is inadequate. The WCAB found that the defendants failed to demonstrate such prejudice or inadequacy. Therefore, the petition was denied.

Petition for RemovalWorkers' Compensation Appeals BoardDenying RemovalExtraordinary RemedySubstantial PrejudiceIrreparable HarmReconsiderationAdministrative Law JudgeWCJ ReportAdverse Decision
References
2
Case No. ADJ10168186 ADJ10168303
Regular
Mar 17, 2020

JOSEFINA VALDIVIA vs. KING MEAT, INC., ACE/ESIS

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior decision concerning Josefin Valdivia's claims against King Meat, Inc. and ACE/ESIS. While affirming the January 10, 2020 decision, the WCAB amended it to defer specific issues. The determination of whether the injury arose out of and occurred in the course of employment (AOE/COE) is deferred. Furthermore, issues regarding permanent disability and entitlement to future medical treatment are also deferred.

AOE/COEPetition for ReconsiderationWorkers' Compensation Appeals BoardPermanent DisabilityFuture Medical TreatmentWCJ ReportDecision After Reconsideration
References
0
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