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Case Law Database

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

Case No. 03-95-00464-CV
Regular Panel Decision
Jun 12, 1996

Robert Schorovsky v. SIR Lloyds Insurance Company and Standard Financial Indemnity Corporation

Robert Schorovsky sued SIR Lloyds Insurance Company and Standard Financial Indemnity Corporation (SFIC) for alleged failure to timely pay workers' compensation benefits after an on-the-job injury. SFIC, Schorovsky's workers' compensation carrier, was placed into temporary and then permanent receivership, leading to suspensions of benefit payments. Schorovsky appealed the trial court's grant of summary judgment in favor of the appellees. The Court of Appeals affirmed the trial court's judgment, concluding that Schorovsky failed to preserve his constitutional challenge to Article 21.28, § 4(f) of the Texas Insurance Code and did not successfully challenge all independent grounds for summary judgment against SFIC. Furthermore, the court found SIR Lloyds was not liable as it was not the carrier at the time of the injury.

Workers' CompensationSummary JudgmentReceivershipInsurance LawAppellate ProcedureConstitutional LawTexas Insurance CodeBenefit ReviewExhaustion of Administrative RemediesOpen Courts Doctrine
References
12
Case No. M1996-00003-COA-R3-CV
Regular Panel Decision
Nov 05, 1999

Christine Spann v. Barry Abraham, Individually, and D/B/A Sir Pizza

This case involves Christine Spann's pregnancy discrimination claim against her employer, Barry Abraham, operating as Sir Pizza, under the Tennessee Human Rights Act. Spann quit her job after refusing a temporary reassignment during her pregnancy, which she alleged was discriminatory. The Chancery Court for Davidson County granted a directed verdict for the employer, finding Spann failed to establish a prima facie case. The Tennessee Court of Appeals affirmed, concluding that neither direct nor circumstantial evidence supported discriminatory intent or disparate treatment compared to similarly situated non-pregnant employees. The appellate court also upheld the trial court's procedural decisions regarding post-trial motions.

Pregnancy DiscriminationEmployment DiscriminationTennessee Human Rights ActDirected VerdictAppellate ReviewDisparate TreatmentPrima Facie CaseConstructive DischargeTemporary ReassignmentMcDonnell Douglas Burden-Shifting
References
73
Case No. ADJ3533713
Regular
Nov 07, 2011

JUANA LOPEZ vs. THE MERCHANT OF TENNIS, HARTFORD INSURANCE

The Workers' Compensation Appeals Board (WCAB) removed this matter for the purpose of imposing sanctions. The WCAB found that the petition for reconsideration filed by SIR Practice Solutions, LLC on behalf of several lien claimants was skeletal, unintelligible, and violated multiple WCAB rules regarding evidentiary and legal support. The lien claimants and SIR Practice Solutions, LLC failed to object to the Notice of Intention to Impose Sanctions within the allotted time. Therefore, the WCAB imposed sanctions of $250.00 against each individual lien claimant and found SIR Practice Solutions, LLC jointly and severally liable for these sanctions.

Workers' Compensation Appeals BoardRemovalSanctionsLien ClaimantsSIR Practice SolutionsPetition for ReconsiderationSkeletal PetitionAppeals Board Rule 10846Labor Code Section 5813Notice of Intention to Impose Sanctions
References
6
Case No. 03-13-00300-CV
Regular Panel Decision
Feb 26, 2015

Adrian Tijerina v. Texas Property Casualty Insurance Guaranty Association as Receiver for SIR Lloyd's Insurance Company and the Texas Department of Insurance, Division of Workers' Compensation

Adrian Tijerina appealed the dismissal of his case against the Texas Property Casualty Insurance Guaranty Association (Association) and the Texas Department of Insurance, Division of Workers’ Compensation (Division). Tijerina, who sustained a back injury in 1987, sought to enforce a 1989 judgment for future medical benefits, alleging the Association refused to pay for back surgery and the Division improperly refused jurisdiction. The Ector County court transferred the case to Travis County, and the Travis County district court dismissed it for lack of jurisdiction. The appellate court affirmed the trial court's order, ruling that the venue transfer was proper, Tijerina's claim against the Division was barred by sovereign immunity and failure to exhaust administrative remedies, and his claim against the Association was not ripe because the compensability of the desired surgery had not been determined by the Division.

Workers' CompensationJurisdictionPlea to the JurisdictionVenue TransferAdministrative RemediesRipeness DoctrineSovereign ImmunityDeclaratory JudgmentMedical BenefitsBack Surgery
References
17
Case No. SBR 0315782
Regular
Jul 30, 2007

GORDON ADAMS vs. SOUTHLAND DRYWALL COMPANY, STATE COMPENSATION INSURANCE FUND

This case concerns a lien claimant, Premier Outpatient Surgery Center, Inc., whose lien was denied because it allegedly did not use its full corporate name or have a fictitious business name permit. The Appeals Board rescinded the denial and returned the case for further proceedings, finding that Premier was properly licensed as an outpatient facility and that the defendant did not timely raise the fictitious business name statement issue. The Board clarified that a facility fee lien claimant is not required to have a Medical Board fictitious-name permit, but may need to file a fictitious business name statement if operating under a name other than its legal corporate name.

Workers Compensation Appeals BoardLien ClaimantFictitious Business Name StatementFictitious-Name PermitBusiness & Professions Code Section 17910Business & Professions Code Section 2415(a)Medical Board of CaliforniaOutpatient SettingFacility FeeCompromise and Release
References
13
Case No. LAO 0878674
Regular
Mar 06, 2008

KARLA BUENO vs. PLAZA DEFENDANT LA RAZA, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision that barred a lien claim due to the alleged lack of a fictitious business name permit. The WCAB found that while the lien claimant presented a surgical clinic license, the record was unclear about its actual business name and compliance with fictitious name filing requirements. The case is remanded for further proceedings to determine the lien claimant's true name and establish its compliance with fictitious business name laws.

Fictitious Business Name StatementSurgical Clinic LicenseHealth ServicesBusiness and Professions CodeMedical BoardLien ClaimantOutpatient SettingAdministrative Law JudgeReconsiderationReasonableness of Fees
References
14
Case No. STK 0189570
Regular
Jul 30, 2007

JOSEPH BUENO vs. AMERICAN FIRE SYSTEMS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed the administrative law judge's decision, allowing a lien claim of $10,838.43 for facility fees. The defendant argued the lien should be disallowed due to the lien claimant's alleged lack of a fictitious name permit. However, the Board found the lien claimant met its burden of proof by demonstrating proper licensure and that it was not operating under a fictitious name, thus not requiring a fictitious name permit from the Medical Board.

Workers Compensation Appeals BoardLien claimantFictitious name permitMedical Board of CaliforniaFacility feesArthroscopic surgeryStipulated awardPermanent disabilityFuture medical treatmentAmbulatory surgical centers
References
2
Case No. RIV 0037205, RIV 0070473
Regular
Jul 24, 2007

LORRIE AVERETTE vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed a prior ruling that Premier Outpatient Surgery Center was properly licensed and not required to have a fictitious name permit for services rendered. The defendant argued Premier lacked proper licensure and a fictitious name permit, but the Board found Premier met its burden of proof by submitting evidence of its licensure and accreditation. Premier was determined to be an "outpatient setting" rather than a "clinic," thus not requiring a fictitious name permit from the Medical Board.

Workers' Compensation Appeals BoardLien claimantFictitious name permitMedical Board of CaliforniaOutpatient surgery servicesLicensureAccreditationAmbulatory surgical centersZenith Ins. Co. v. Workers' Comp. Appeals Bd. (Capi)Stokes v. Patton State Hospital
References
2
Case No. 01-10-00711-CV
Regular Panel Decision
May 12, 2011

Lexington Insurance Company v. National Oil Well Varco, Inc. and Fiber Glass Systems, L. P.

Lexington Insurance Company (Lexington) brought a suit seeking a declaration of rights and duties under an insurance policy regarding an underlying lawsuit where Albemarle Corporation sued National Oilwell NOV, Inc. (National) for defective fiberglass downhole tubing. Lexington had initially acknowledged a duty to defend National after its self-insured retention (SIR) was exhausted. However, after the underlying case settled, Lexington contested its duty to defend and indemnify, and also claimed National failed to provide timely notice of SIR exhaustion. The trial court granted summary judgment in National's favor, finding Lexington had a duty to defend and was liable for defense costs. On appeal, the court affirmed the trial court's judgment, concluding that Albemarle's claims potentially encompassed covered property damage beyond the defective product itself and that Lexington's unilateral request for SIR exhaustion notice did not create an additional duty for National.

Insurance DisputeDuty to DefendProducts LiabilitySelf-Insured RetentionCommercial General Liability PolicyPolicy ExclusionsProperty DamageSummary Judgment ReviewContract InterpretationTexas Insurance Law
References
37
Case No. RIV 0047694, RIV 0063415 RIV 0063416, RIV 0063417
Regular
Jul 19, 2007

DEADRA FRANKLIN vs. STATE OF CALIFORNIA / DEPARTMENT OF MENTAL HEALTH / PATTON STATE HOSPITAL, legally uninsured, adjusted by STATE COMPENSATION INSURANCE FUND

This case concerns a lien claim by Premier Outpatient Surgery Center for unpaid services. The WCAB rescinded a previous order disallowing the lien due to Premier's lack of a fictitious-name permit, finding that the distinction between providing medical treatment versus an "outpatient setting" was not adequately addressed. The matter is returned to the trial level to determine if Premier, as an outpatient facility, was required to obtain a fictitious-name permit from the Medical Board.

Workers' Compensation Appeals BoardPremier Outpatient Surgery Centerfictitious-name permitBusiness and Professions CodeMedical Boardlien claimantoutpatient facilitycliniclicensureaccreditation
References
2
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