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

Case No. 14-12-00174-CV
Regular Panel Decision
Mar 22, 2012

in Re New Hampshire Insurance Company, Gallagher Bassett Services,Inc and Manuel Aragon

Relators New Hampshire Insurance Company, Gallagher Bassett Services, Inc., and Manuel Aragon sought a writ of mandamus against Judge Jaclanel McFarland after she denied their plea to the jurisdiction in a bad faith lawsuit filed by Catherine Penarugia. Penarugia's lawsuit stemmed from an alleged delay in handling her workers' compensation claim, despite an administrative decision extending her compensable injury. The relators argued Penarugia failed to exhaust administrative remedies. The Fourteenth Court of Appeals denied the petition, finding that the relators did not demonstrate the trial court abused its discretion. The court noted that a claimant is not required to seek review of undisputed issues, and the record lacked sufficient information to confirm if all issues were fully decided by the administrative body.

Workers' CompensationMandamusPlea to the JurisdictionAdministrative RemediesInsurance Bad FaithTexas Court of AppealsAbuse of DiscretionExhaustion of RemediesDWC DecisionExtent of Injury
References
10
Case No. 2-07-296-CV
Regular Panel Decision
Apr 03, 2008

Valean Childers v. Gallagher Bassett Services, Inc., Myrtis Lacy and Zurich American Insurance Company

This case involves an appeal by Valean Childers against Gallagher Bassett Services, Inc., Myrtis Lacy, and Zurich American Insurance Company, challenging a summary judgment granted based on the statute of limitations in a bad-faith lawsuit. Childers filed a bad-faith claim stemming from a workers' compensation dispute. The core issue was when the two-year statute of limitations began to run: upon the initial denial of her claim in March 2003, or a subsequent denial in June/July 2004, after the first dispute was resolved. The court affirmed the trial court's ruling that the statute of limitations had run on the claim related to the March 2003 denial. However, it reversed and remanded the part of the judgment related to the June/July 2004 denials, holding that a new denial of benefits after a prior one has been fully and finally resolved can restart the statute of limitations for a new bad-faith claim.

Workers' CompensationStatute of LimitationsBad Faith ClaimSummary JudgmentAppellate ReviewInsurance DenialCause of Action AccrualAdministrative RemediesTexas LawInsurance Carrier
References
11
Case No. MISSING
Regular Panel Decision

Deluca v. Arch Insurance Group

This case involves an appeal from an order and judgment concerning an arbitration award. The Supreme Court, Suffolk County, confirmed an arbitration award dated December 12, 2011, in favor of the petitioner, and denied a cross-petition by Arch Insurance Group and Gallagher Bassett Services to vacate the award. Arch Insurance Group and Gallagher Bassett Services appealed this decision. The appellate court dismissed the appeal from the intermediate order dated June 5, 2012, as the right of direct appeal terminated with the entry of judgment. The court affirmed the judgment, finding the petitioner's service of the demand for arbitration proper and noting that insufficiencies did not warrant vacatur. The arbitrator's award was found to have evidentiary support and a rational basis, and was not duplicative of any worker’s compensation benefits. One bill of costs was awarded to the petitioner.

Arbitration ConfirmationArbitration Award VacaturCPLR Article 75Appellate ReviewInsurance ArbitrationUninsured MotoristUnderinsured MotoristEvidentiary SupportArbitrary and Capricious StandardSufficiency of Arbitration Demand
References
9
Case No. 01-07-00193-CV
Regular Panel Decision
Oct 23, 2008

Rosa Schwartz v. the Insurance Company of the State of Pennsylvania, Gallagher Bassett Services, Inc., and Belinda Ybarra

Rosa Schwartz sued The Insurance Company of the State of Pennsylvania, Gallagher Basset Services, Inc., and Belinda Ybarra (collectively, “Gallagher”) for damages stemming from alleged unreasonable delay and denial in authorizing her requested foot surgery. The trial court granted Gallagher's plea to the jurisdiction, ruling Schwartz failed to exhaust administrative remedies and dismissing her claims. Schwartz appealed, contending the trial court erred in its exhaustion of remedies ruling and in granting the plea regarding claims for a neuroma deformity. The appellate court affirmed the trial court's decision, finding that Schwartz failed to exhaust administrative remedies regarding the foot surgery preauthorization dispute and that her petition did not adequately allege claims related to the neuroma deformity denial. The court concluded that the impediment to jurisdiction regarding the foot surgery could not be cured due to untimely requests for reconsideration.

Workers' CompensationJurisdictionAdministrative RemediesMedical NecessityFoot SurgeryNeuroma DeformityInsurance DenialPlea to the JurisdictionAppellate ReviewTexas Law
References
15
Case No. ADJ478277 (LAO 0857795)
Regular
Jul 23, 2015

LUIS OSUNA vs. COLOR GRAPHICS, INC., GALLAGHER BASSETT SERVICES

Defendant Gallagher Bassett Services sought reconsideration of a Compromise and Release (C&R) approval, alleging an error in permanent disability advances due to oversight of attorney fees. The Board dismissed the petition as untimely because it was filed more than 20 days after the C&R was issued, and the defendant failed to provide proof of actual receipt after asserting defective service. Even if considered on its merits, the Board would have denied the petition, as the calculation error was a unilateral mistake by the defendant and not grounds for setting aside the C&R.

Workers Compensation Appeals BoardCompromise and ReleasePetition for ReconsiderationAdministrative Law JudgeUntimely PetitionDefective ServiceJurisdictionPermanent Disability AdvancesUnilateral MistakeService of Process
References
11
Case No. ADJ2329061
Regular
Jun 24, 2014

Irene Cota vs. C.R. Courier Services, Gallagher Bassett Services, Inc.

Gallagher Bassett's untimely and unverified petition for removal was dismissed. The Appeals Board granted removal on its own motion to address a lack of clarity regarding Gallagher's party status and the case's disposition. Due to missing or incomplete electronic and paper files, the Board could not determine Gallagher's involvement or the case's procedural history. The Order continuing the case for sanctions was rescinded, and the matter was returned to the trial level to identify the correct employer/administrator before proceeding.

Petition for RemovalDismissalRemoval on Board MotionDecision After RemovalUntimely PetitionUnverified PetitionOrder dated April 252014Mandatory Settlement ConferenceWCJ
References
0
Case No. ADJ526691, ADJ3636578
Regular
Mar 28, 2013

Jitka Van Dyne vs. United Airlines, Gallagher Bassett Services, Inc.

The Workers' Compensation Appeals Board (WCAB) denied the applicant's petition for removal. The WCAB adopted the Judge's report, stating removal is an extraordinary remedy not warranted here. The applicant failed to object to the declaration of readiness and has an adequate remedy at trial for evidentiary disputes. Therefore, the petition was denied.

Petition for RemovalWorkers' Compensation Appeals BoardIrreparable HarmSignificant PrejudiceDeclaration of ReadinessAdmissibility of EvidenceDue DiligenceAneurysmIndustrial InjuryLay Opinion
References
3
Case No. ADJ7671717
Regular
Sep 06, 2012

CARLOS RODRIGUEZ vs. MICHAELS STORES, INC.; ARCH INSURANCE COMPANY, GALLAGHER BASSETT SERVICES

The Workers' Compensation Appeals Board denied reconsideration of its prior order. The Board adopted the WCJ's report, which found the applicant's testimony lacked credibility due to inconsistencies and omissions regarding prior shoulder injuries. The WCJ determined the applicant failed to meet their burden of proving the injury was industrial, citing a lack of credible medical evidence supporting the claim.

WCABPetition for ReconsiderationWorkers' Compensation Administrative Law Judgecredibilityindustrial injurymedical evidenceprior injuriesshoulder injurymotor vehicle accidentsevasive testimony
References
2
Case No. ADJ10261356
Regular
Jun 03, 2017

MICHELE GONSALVES vs. LIVE NATION, GALLAGHER BASSETT SERVICES, INC.

This case concerns a petition for reconsideration and removal filed by Applicant Michele Gonsalves against Live Nation and Gallagher Bassett Services, Inc. The Workers' Compensation Appeals Board dismissed the petition for reconsideration because it was not filed from a "final" order as defined by law. The Board also denied the petition for removal, finding no evidence of substantial prejudice or irreparable harm to warrant this extraordinary remedy. The WCJ's report, which the Board adopted, supported both decisions.

Petition for ReconsiderationPetition for RemovalFinal OrderSubstantive Right or LiabilityThreshold IssueInterlocutory OrderProcedural DecisionEvidentiary IssueExtraordinary RemedySubstantial Prejudice
References
6
Case No. ADJ6680842
Regular
Jan 31, 2013

BRUNO VARGAS vs. SELECT BUILD INTEGRATED CONSTRUCTION SERVICES, GALLAGHER BASSETT

This case involves Applicant Bruno Vargas and Defendants Select Build Integrated Construction Services and Gallagher Bassett. The Workers' Compensation Appeals Board granted reconsideration of a previous WCJ decision. The Board rescinded that decision and returned the matter to the trial level for further proceedings and a new decision by the WCJ. This order is not a final decision on the merits of the case.

WCABReconsiderationRescindedFurther ProceedingsWCJ DecisionAdministrative Law JudgeApplicantDefendantsIntegrated Construction ServicesGallagher Bassett
References
0
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