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

Case No. 03-17-00707-CV
Regular Panel Decision
Nov 21, 2018

What Happened in Felix vs. Weber Metals Reconsideration?

CoreALM, LLC appealed a trial court's judgment that awarded Keen Fusion, Inc. damages for tortious interference with contract and business disparagement. CoreALM contended that the economic loss rule barred the award and that the evidence was legally insufficient to support the jury's findings. The appellate court affirmed the trial court's judgment. It determined that the economic loss rule did not preclude Keen Fusion's recovery on its tort claims because the duty not to interfere with contractual relationships arises from common law, independent of any contractual agreement between the interfering party and the party whose contract was interfered with. The court also found factually sufficient evidence to support the jury's finding that CoreALM tortiously interfered with Keen Fusion’s contract with eCommQuest, which proximately caused Keen Fusion to lose an engagement with Johnson Controls. Given the valid finding on tortious interference, the court did not address the challenge to the business disparagement claim.

Tortious Interference with ContractEconomic Loss RuleBusiness DisparagementContract BreachAppellate ReviewFactual Sufficiency of EvidenceProximate CauseCommon Law DutyIndependent Contractor DisputeSubcontractor Agreement
References
17
Case No. 03-03-00435-CV
Regular Panel Decision
Jul 29, 2004

How Did the WCAB Rule in Hardgrove vs. Intercon Security?

This case involves the Texas Workers’ Compensation Commission's failure to establish fee guidelines for ambulatory surgical centers under the Texas Workers’ Compensation Act. East Side Surgical Center, Clinic for Special Surgery, and intervenor Surgical and Diagnostic Center, L.P. (collectively "East Side") sued the Commission to invalidate certain default rules that applied when specific guidelines were absent. The district court declared one rule (133.304(i)) invalid and enjoined its enforcement, citing unlawful delegation of authority. On appeal, the Court of Appeals reversed the district court's judgment regarding the rule's invalidity and dissolved the injunction, citing a Texas Supreme Court decision finding no unlawful delegation. The court affirmed that East Side was not entitled to its usual and customary fee in the absence of specific guidelines.

Workers' CompensationAdministrative LawDelegation of AuthorityRulemakingAmbulatory Surgical CentersJudicial ReviewInsurance CarrierFee GuidelinesFair and Reasonable RatesStatutory Interpretation
References
38
Case No. 08-06-00071-CV
Regular Panel Decision
Aug 30, 2007

What Did the WCAB Decide in Cuadra vs. Community Home Care?

Vincent and Cynthia Maes and The Insurance Company of the State of Pennsylvania appealed the dismissal of a health care liability suit against El Paso Orthopaedic Surgery Group (EPOSG). The Maeses alleged negligence and vicarious liability against EPOSG after Vincent Maes suffered severe complications following back surgery by Dr. Paul Cho, an EPOSG neurosurgeon. The trial court dismissed all claims against EPOSG, finding the expert reports insufficient to address EPOSG's breach of the standard of care, even for vicarious liability claims. On appeal, the Court reviewed whether an expert report was necessary for vicarious liability claims and if the severance of claims against EPOSG was proper. The appellate court ultimately affirmed the trial court's judgment, upholding the dismissal of all claims against EPOSG and the severance.

Health Care LiabilityMedical MalpracticeExpert Report SufficiencyVicarious LiabilityRespondeat SuperiorDismissal with PrejudiceSeverance of ClaimsSpinal Surgery ComplicationsNeuroscienceOrthopedic Surgery Group Liability
References
17
Case No. MISSING
Regular Panel Decision

How Were Death Benefits Handled in Bocanegra vs. Sun-Gro Commodities?

Vincent and Cynthia Maes, as next friend of their minor daughter Isabel, and The Insurance Company of the State of Pennsylvania (ICTSP), appealed a summary judgment granted in favor of El Paso Orthopaedic Surgery Group, P.A. (EPOSG). Isabel's claim was for loss of parental consortium due to her father Vincent Maes's alleged disabling injury following surgery performed by an EPOSG employee, Dr. Paul Cho, in 2001. Vincent Maes's initial lawsuit against EPOSG was dismissed with prejudice in 2004, and the two-year statute of limitations for his underlying claim expired in 2003. EPOSG moved for summary judgment, arguing Isabel's claims were time-barred and barred by the prior dismissal of her father's underlying claim. The appellate court affirmed the summary judgment, concluding that Isabel's derivative loss of parental consortium claims were extinguished by both the running of the statute of limitations on her father's claim and its prior dismissal with prejudice.

medical malpracticeloss of parental consortiumstatute of limitationssummary judgmentderivative claimshealthcare liabilityminor's claimsprior litigationdismissal with prejudiceTexas Civil Practice and Remedies Code
References
26
Case No. 08-11-00331-CV
Regular Panel Decision
Oct 31, 2012

Can a WCJ Be Disqualified for Appearance of Bias?

Vincent Maes sustained a spinal injury in 2000 from a motor vehicle accident, leading to a lumbar laminectomy in 2001 by Dr. Paul Cho, an employee of El Paso Orthopaedic Surgery Group, P.A. (EPOSG). Following the surgery, Mr. Maes allegedly experienced severe neurological issues. In 2010, Vincent and Cynthia Maes, acting as next friend for their minor daughter Isabel, along with The Insurance Company of the State of Pennsylvania (ICTSP), filed a lawsuit against EPOSG, asserting claims for Isabel's loss of parental consortium and alleging vicarious liability for Dr. Cho's negligence. EPOSG sought summary judgment, contending that Isabel's claims were time-barred by the two-year statute of limitations applicable to Mr. Maes's original claim and also by the prior dismissal of Mr. Maes's claim with prejudice in 2004. The trial court granted summary judgment in favor of EPOSG. The appellate court affirmed the trial court's decision, ruling that claims for loss of parental consortium are derivative in nature and are consequently extinguished when the statute of limitations on the injured parent's underlying claim expires or when that underlying claim is dismissed with prejudice.

Medical MalpracticeParental ConsortiumSummary JudgmentStatute of LimitationsDerivative ClaimsDismissal with PrejudiceTexas Civil Practice and Remedies CodeHealth Care LiabilityMinor's ClaimsAppellate Review
References
28
Case No. 08-06-00170-CV
Regular Panel Decision
Jun 30, 2008

What Were the Key Rulings in Torrez vs. SuperShuttle?

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. ADJ6619207 ADJ6736606
Regular
May 24, 2010

Why Was Removal Denied in Rush vs. California Correctional Institution?

The Workers' Compensation Appeals Board granted reconsideration of a decision awarding lumbar fusion surgery, finding the WCJ erred by solely relying on the *Cervantes* decision regarding timely utilization review. The Board determined that the defendant's utilization review timeliness was unclear, and the parties had agreed to an Agreed Medical Examiner (AME) to resolve the surgery dispute before *Cervantes* was issued. Furthermore, the Board held that the treating physician's recommendation for surgery must constitute substantial evidence, which was not definitively established here. Therefore, the matter was returned for further development of the record, requiring the treating physician to address the AME's concerns regarding the necessity of fusion surgery.

Workers' Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationJoint Findings Award and OrderIndustrial InjuryLumbar FusionUtilization ReviewCervantes v. El Aguila Food ProductsSubstantial Medical EvidenceExpedited Hearing
References
3
Case No. MISSING
Regular Panel Decision

What Did the WCAB Clarify in Ontiveros vs. Savers Stores?

Demica Hawkins, a Black former Accounts Payable Coordinator, sued her employer, The Center for Spinal Surgery (CSS), alleging race discrimination, retaliation, and FMLA interference. The lawsuit stemmed from denied pay raises, disciplinary actions, and ultimately her termination while on pregnancy leave, which Hawkins claims was discriminatory and retaliatory. CSS filed a renewed motion for summary judgment, and Hawkins filed a partial motion for summary judgment. The court granted in part and denied in part CSS's motion, dismissing Hawkins' pregnancy discrimination and certain retaliation claims. However, Hawkins' retaliatory discharge and FMLA interference claims related to her 2013 termination will proceed to trial due to genuine disputes of material fact regarding CSS's motivations.

Race DiscriminationRetaliationFMLA InterferenceSummary JudgmentEmployment LawTitle VIIPregnancy Discrimination ActMcDonnell Douglas FrameworkHonest Belief RulePretext
References
64
Case No. 2022-06-0596
Regular Panel Decision
Dec 05, 2022

Why Was Reconsideration Denied in Gomez vs. Dorothy Stevens?

Lynn Freeman, an employee of Kirby Pines Estates, sought an expedited hearing to compel her employer to provide a recommended lumbar fusion surgery by her authorized treating physician, Dr. Glenn Crosby, for a back injury sustained in July 2021. The proposed surgery, a transforaminal lumbar interbody fusion (TLIF), was initially denied through utilization review and upheld on appeal, with medical experts citing Official Disability Guidelines (ODG) and a lack of significant spinal instability. While Dr. Crosby supported the surgery and dismissed the guidelines, the Court found the employer successfully rebutted the presumption of medical necessity using the opinions of Drs. Samuel Murrell and Maria Sumas. Their assessments, which aligned with ODG and noted the resolution of Ms. Freeman's radicular complaints, were deemed more persuasive. Consequently, the Court denied Ms. Freeman’s request for the TLIF procedure, setting a status conference for future proceedings.

Lumbar FusionTLIFHerniated DiscRadiculopathyUtilization ReviewMedical NecessityOfficial Disability GuidelinesWorkers' Compensation ClaimsExpedited HearingSpine Surgery
References
4
Case No. 03A01-9804-CH-00120
Regular Panel Decision
Mar 24, 1999

Why Was Reconsideration Dismissed in Sabino vs. Johnson Pump Company?

Two private health care providers, Cleveland Surgery Center and Ocoee Physical Therapy, Inc., sought a declaratory judgment against Bradley County Memorial Hospital and its partners, alleging ultra vires acts and violations of the Tennessee Constitution. The providers challenged the hospital's business ventures with private entities, specifically the Ocoee Health Alliance. The trial court found the hospital had exceeded its authority by lending the county's credit and engaging in unconstitutional business dealings. On appeal, the Court of Appeals affirmed the trial court's judgment regarding the specific business ventures, concluding that the hospital acted as an agent of Bradley County and its partnerships with the private Alliance violated Article II, § 29 of the Tennessee Constitution. The appellate court modified the permanent injunction, narrowing its scope to prohibit transactions with private businesses that obligate County Funds without a public referendum.

Hospital AuthorityUltra Vires ActsConstitutional LawPublic-Private PartnershipsDeclaratory JudgmentInjunctionCounty LiabilityTaxation PowerReferendumHealthcare Law
References
24
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