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Case Law Database

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

Case No. 03-15-00401-CV
Regular Panel Decision
Aug 13, 2015

in Re Xerox Corporation and Xerox State Healthcare, LLC F/K/A ACS State Healthcare, LLC

Relators Xerox Corporation and Xerox State Healthcare, LLC seek a writ of mandamus to overturn trial court orders that struck their third-party claims and denied leave to designate responsible third parties. The underlying suit is a Texas Medicaid Fraud Prevention Act (TMFPA) enforcement action by the State of Texas against Xerox for misrepresenting its prior authorization review process for orthodontia services, leading to unauthorized Medicaid payments. The State argues the TMFPA is a remedial public welfare statute, not tort-based, and therefore Chapter 33 of the Civil Practice & Remedies Code (CPRC) on proportionate responsibility does not apply. The State asserts it seeks civil remedies and penalties from Xerox for its independent unlawful acts, not apportionable damages, and that Xerox has an adequate remedy on appeal.

Medicaid FraudTexas LawMandamusCivil ProcedureStatutory InterpretationState EnforcementPrior AuthorizationHealthcare LitigationTort LawProportionate Responsibility
References
98
Case No. ADJ4394929
Regular
Jan 27, 2011

Brenda Dulac vs. Sunnyside Rehab & Nursing Center, Gambro Healthcare, ESIS, CIGA

The Workers' Compensation Appeals Board (WCAB) rescinded a prior decision that denied the applicant's claim for industrial injury. The applicant alleges exposure to Hepatitis C during employment at Sunnyside Rehabilitation Center and Gambro Healthcare. The WCAB found that the medical record was not adequately developed, particularly concerning exposures at Sunnyside. Therefore, the case is returned to the trial level for further development of the medical record and a new decision.

Workers' Compensation Appeals BoardBrenda DulacSunnyside Rehab & Nursing CenterGambro HealthcareESISCIGAindustrial injuryhepatitis Coccupational diseasemedical evidence
References
6
Case No. MISSING
Regular Panel Decision

Classen v. Irving Healthcare System

Carol Classen sued her former employer, Irving Healthcare System, alleging retaliatory discharge for pursuing workers’ compensation benefits, a claim prohibited by Texas law. Irving Healthcare System, a municipal hospital authority and governmental entity, asserted immunity from suit. The trial court and court of appeals sided with Irving Healthcare, concluding that governmental immunity had not been waived for such claims under article 8307c. However, citing a recent precedent set in *City of La Porte v. Barfield*, the Supreme Court of Texas determined that governmental immunity had been partially waived in wrongful discharge cases. Consequently, the Supreme Court reversed the lower court's judgment and remanded the case for further proceedings consistent with *Barfield*.

Retaliatory DischargeWorkers' Compensation BenefitsGovernmental ImmunityWaiver of ImmunityMunicipal Hospital AuthoritySummary JudgmentRemandTexas LawEmployer-Employee DisputeLabor Code
References
2
Case No. CA 13-01105
Regular Panel Decision
Feb 14, 2014

KALEIDA HEALTH v. UNIVERA HEALTHCARE

This case concerns an appeal by Utica Mutual Insurance Company from a judgment that denied its motion for summary judgment and granted summary judgment to Kaleida Health and Univera Healthcare. The judgment declared Utica obligated to pay an outstanding hospital bill to Kaleida Health. Utica argued that collateral estoppel applied due to a Workers' Compensation Board determination, but the court found Kaleida Health and Univera Healthcare were not parties to that proceeding. Utica also contended the action was barred by arbitration, which was rejected as not compulsory. The Appellate Division affirmed the Supreme Court's decision, concluding Utica was responsible for the hospital bill as the patient's admission was a continuation of treatment for a work-related injury.

Workers' CompensationHospital BillCollateral EstoppelSummary JudgmentArbitrationPublic Health LawAppellate PracticeInsurance ObligationWork-Related InjuryHealth Care Provider
References
3
Case No. 2015-06-0977
Regular Panel Decision
May 21, 2019

Clay, Sharee v. Signature Healthcare

Ms. Clay, a CNA for Signature Healthcare, sustained neck and shoulder injuries while assisting a patient. Signature initially denied her workers' compensation claim, asserting her injuries were due to a prior car accident or pre-existing degenerative conditions. The Court found Ms. Clay's injuries were primarily work-related, crediting the testimony of Dr. Lanford and Dr. West. The Court ordered Signature Healthcare to provide ongoing medical treatment for her work-related injuries and pay her $20,731.50 in permanent partial disability benefits and $580.71 in temporary total disability benefits, totaling $21,312.21.

Workers' CompensationShoulder InjuryNeck InjuryCausationMedical TestimonyImpairment RatingDisability BenefitsTreating PhysicianIndependent Medical ExaminationCar Accident
References
6
Case No. 2021-08-0034
Regular Panel Decision
Apr 29, 2022

Williams, Lawrence v. Methodist LeBonheur Healthcare

This case concerns an appeal by Methodist LeBonheur Healthcare regarding the calculation of death benefits for Lawrence Williams, the surviving spouse of Linda Williams, a healthcare worker who died from COVID-19. The parties initially agreed on a settlement, but the trial court, presided over by Judge Deana C. Seymour, rejected it due to an inconsistent calculation of the 'maximum total benefit.' The trial court concluded that the maximum total benefit should be calculated by multiplying the state’s average weekly wage by 450 weeks, as per Tennessee Code Annotated section 50-6-102(15)(D). The Appeals Board, led by Presiding Judge Timothy W. Conner, affirmed the trial court’s decision, clarifying that while the weekly benefit rate is tied to the deceased employee's wages, the overall duration of payments is capped by an across-the-board limitation based on the state’s average weekly wage.

Workers' CompensationDeath BenefitsCOVID-19Maximum Total BenefitStatutory InterpretationState Average Weekly WageSurviving SpouseAppellate ReviewSettlement RejectionHealthcare Worker
References
5
Case No. M2005-01818-COA-R3-CV
Regular Panel Decision
Apr 30, 2008

Bridgett Hill v. NHC Healthcare/Nashville, LLC

The administrators of Barbara Hill's estate, Bridgett Hill and Janece Wilson, filed a wrongful death suit against NHC Healthcare/Nashville, LLC, and Medic One after Ms. Hill died following her transfer from the nursing home to a hospital. NHC Healthcare sought to compel arbitration based on a clause in Ms. Hill's admission agreement, which also included a waiver of the right to a jury trial. The trial court denied this motion, finding the arbitration clause unconscionable. The Court of Appeals affirmed the trial court's decision, determining that the arbitration agreement was an unconscionable contract of adhesion due to Ms. Hill's vulnerable state, lack of clear explanation of terms, its 'take-it-or-leave-it' nature, ambiguous provisions, and the potentially prohibitive upfront costs for arbitration, which would effectively deter claimants from seeking legal redress.

Wrongful DeathArbitration AgreementUnconscionabilityNursing Home NegligenceContract of AdhesionWaiver of Jury TrialMedical MalpracticeAppellate ReviewContract EnforcementCost Prohibitiveness
References
34
Case No. 2019 NY Slip Op 02599 [171 AD3d 1277]
Regular Panel Decision
Apr 04, 2019

New York State Workers' Compensation Bd. v. A&T Healthcare, Inc.

The New York State Workers' Compensation Board assumed administration of the insolvent Healthcare Providers Self-Insurance Trust, which had a deficit of $132.5 million. The Board initiated an action to recover the deficit from former employer-members, including Motherly Love Home Care Services Inc., who were jointly and severally liable. Motherly Love Home Care Services Inc. executed two settlement agreements but subsequently moved to vacate them, claiming a unilateral mistake by believing they had only signed duplicate copies of one agreement. The Supreme Court denied this motion. The Appellate Division, Third Department, affirmed the Supreme Court's decision, finding no basis for vacating the agreements given their distinct terms and the clear clarifications provided by the Board's counsel.

Workers' Compensation TrustInsolvencySettlement AgreementVacate AgreementUnilateral MistakeJoint and Several LiabilityAppellate ReviewContract PrinciplesHome Health CareEmployer Liability
References
5
Case No. 13-15-00118-CV
Regular Panel Decision
Nov 19, 2015

Bay Area Healthcare Group, Ltd., D/B/A Corpus Christi Medical Center v. Brenda Martinez

Brenda Martinez, a housekeeper for Bay Area Healthcare Group, Ltd. (dba Corpus Christi Medical Center), sued her employer after sustaining a shoulder injury during "trash and linen duty," which involved heavy lifting. She alleged negligence, claiming BAHG failed to provide a safe work environment and proper assistance. BAHG moved to dismiss, arguing her claim was a "health care liability claim" (HCLC) under the Texas Medical Liability Act (TMLA) requiring an expert report. The trial court denied the motion. The Court of Appeals affirmed, concluding Martinez's claim was not an HCLC as it lacked a substantive relationship with the provision of medical care and instead concerned general workplace safety, not duties specific to a healthcare provider.

Texas Medical Liability ActHealth Care Liability ClaimWorkplace Safety StandardsEmployer NegligenceExpert Report RuleAppellate ProcedureStatutory InterpretationRoss factorsMedical Professional DutiesNon-subscriber Employer
References
5
Case No. MISSING
Regular Panel Decision

In Re Odyssey Healthcare, Inc.

This negligence case addresses whether a trial court erred by refusing to compel arbitration. Guadalupe Morales sued her employer, Odyssey Healthcare, Inc., and a supervisor for workplace injuries. Odyssey, a non-subscriber to workers' compensation, had an Occupational Injury Benefit Plan requiring arbitration. The trial court denied Odyssey's motion, citing unconscionability of the arbitration location. The higher court found no abuse of discretion in compelling arbitration, rejecting Morales's defenses related to unconscionability, the Texas Workers’ Compensation Act, the Tenth Amendment, and illusory promises. The writ of mandamus is conditionally granted, ordering the trial court to compel arbitration.

Arbitration AgreementMandamus ReliefSubstantive UnconscionabilityFederal Arbitration Act (FAA)Tenth AmendmentWorkers' Compensation Non-subscriberEmployment LawContractual ConsiderationIllusory PromiseJudicial Discretion
References
11
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