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

Case No. E2003-00432-WC-R3-CV
Regular Panel Decision

Bryant v. BAPTIST HEALTH SYSTEM HOME CARE

Patricia Bryant, a home-health nursing assistant, suffered two work-related back injuries in 1997 while working for Baptist Health System Home Care of East Tennessee. After leaving employment, she filed for workers' compensation benefits. During a deposition in 1998, Bryant falsely testified she had not worked since leaving Baptist. Upon discovery, Baptist filed a counterclaim under the Workers’ Compensation Fraud Act. The trial court dismissed Baptist's counterclaim, finding no prejudice or fraudulent insurance act, and awarded Bryant 22.5% permanent partial disability benefits. The Supreme Court affirmed the trial court's dismissal of the counterclaim, ruling that Baptist, as a self-insured employer, did not fit the 'insurer' definition under the Fraud Act, and affirmed the disability award, deferring to the trial court's credibility assessment of Bryant despite her false testimony.

Workers' Compensation FraudFalse TestimonyPermanent Partial Disability BenefitsMedical Impairment RatingNeurosurgeon OpinionSelf-Insured Employer LiabilityStatutory InterpretationAppellate Court ReviewCredibility AssessmentBack Injury Claim
References
13
Case No. MISSING
Regular Panel Decision

Arndt v. Pinard Home Health, Inc.

Anne G. Arndt, an accounts examiner for the Texas Workforce Commission, was auditing Pinard Home Health, Inc. During the audit, Arndt requested personal financial records of Robert Pinard, an officer and owner of the company, which Pinard Home Health refused to provide. Pinard Home Health then filed an ultra vires suit against Arndt, alleging she exceeded her authority. Arndt filed a plea to the jurisdiction, arguing sovereign immunity barred the suit. The appellate court held that Arndt had the authority to request the information under the Texas Labor Code and that Pinard Home Health's suit was therefore barred by sovereign immunity, reversing the trial court's decision and dismissing the claims.

TexasSovereign ImmunityUltra ViresJurisdictionAccounts ExaminerTexas Workforce CommissionAuditPersonal RecordsLabor LawAppellate Review
References
5
Case No. M2007-02787-COA-R3-CV
Regular Panel Decision
Mar 19, 2009

Liberty Mutual Insurance Company v. Friendship Home Health Agency, LLC

This case involves an appeal from the Chancery Court for Davidson County concerning a dispute over workers' compensation insurance premiums. Liberty Mutual Insurance Company sued Friendship Home Health Agency, LLC for unpaid balances after audits revealed underreported payroll. Friendship Home Health Agency, LLC appealed the trial court's judgment, citing the denial of a continuance, the rejection of an accord and satisfaction defense, and a waived statute of frauds argument. The Court of Appeals of Tennessee affirmed the trial court's decision, finding no abuse of discretion in denying the continuance and no evidence to preponderate against the finding of no accord and satisfaction. The court also deemed the statute of frauds defense waived due to improper raising.

Workers' Compensation InsuranceInsurance PremiumsAudit DisputeContinuance MotionAccord and SatisfactionStatute of FraudsAbuse of DiscretionAppellate ReviewContract LawPayroll Underestimation
References
37
Case No. Docket No. 2015-05-0341, State File No. 69225-2015
Regular Panel Decision
Mar 16, 2016

Dugger, Paula v. Home Health Care of Middle Tennessee, LLC, et al.

Paula Dugger, a home health care nurse, was injured in a motor vehicle accident while returning home after abandoning a work trip due to inclement weather. She sought workers' compensation benefits, arguing her injuries arose from her employment. The trial court denied her claim, finding no exception to the 'going and coming' rule for injuries sustained during commutes. The Workers' Compensation Appeals Board affirmed this decision, concluding that Dugger was not a 'traveling employee' and that the employer did not control the risks of her commute, thus her journey was not a compensated part of her service or a special errand.

Going and Coming RuleMotor Vehicle AccidentHome Health Care NurseScope of EmploymentArising Out of EmploymentSpecial Errand ExceptionTraveling Employee ExceptionEmployer Furnished TransportationInclement WeatherCausal Connection
References
18
Case No. MISSING
Regular Panel Decision

League of Voluntary Hospitals & Homes v. Local 1199, Drug, Hospital & Health Care Workers Union

The court addresses an application for a preliminary injunction against Local 1199, a union planning a three-day strike. The League of Voluntary Hospitals and Homes of N. Y. sought the injunction following a previous temporary restraining order concerning a one-day strike. The union argued that each planned strike required a new legal proceeding, but the court deemed the strikes "episodic and organically connected." Citing concerns about blocked ingress/egress to hospitals and the union president's threats to "shut down" facilities, the judge found a preliminary injunction necessary under Labor Law § 807 to protect public health and safety. The injunction restrains the union from unlawfully interfering with hospital operations, blocking access, and picketing within certain distances of hospital entrances and emergency rooms.

Labor DisputePreliminary InjunctionStrike ActionUnion ActivityHospital AccessPicketing RegulationsCollective BargainingCivil Disobedience ThreatPublic Health and SafetyIngress Egress Interference
References
1
Case No. ADJ10954204
Regular
Sep 15, 2022

MARIA FLORES vs. PINNACLE HEALTH CORP., SUMMARY OF EVIDENCE INSURANCE COMPANY OF THE WEST, AFFINITY HOME HEALTH CARE SERVICES, FALLS LAKE FIRE & CASUALTY INSURANCE, SEDGWICK CMS, HOME HEALTH CARE SOLUTIONS, INC.

The Workers' Compensation Appeals Board denied a petition for reconsideration filed by Home Health Care Solutions. The applicant, an LVN, was injured in a car accident while traveling between patients for multiple agencies. The Board adopted the WCJ's report, which found the injury arose out of and occurred in the course of employment for Home Health Care Solutions. This decision was based on the fact that the applicant was required to use her own vehicle, which extended the employer-employee relationship beyond direct service. The WCJ also found the going and coming rule did not bar the claim due to the required use of transportation between patient locations.

Workers' Compensation Appeals BoardPetition for ReconsiderationGoing and Coming RuleAOE/COELVNCar AccidentAutomobile ExceptionTransitEmployment RelationshipRequired Vehicle Use
References
6
Case No. 2020 NY Slip Op 02696 [183 AD3d 983]
Regular Panel Decision
May 07, 2020

Matter of Zuniga v. Aliah Home Care Inc.

Zulma Zuniga, a home health care aide, filed a workers' compensation claim listing Aliah Home Care Inc. as her employer. A Workers' Compensation Law Judge (WCLJ) found Aliah to be Zuniga's employer and 100% liable for awards. Aliah later filed an application with the Workers' Compensation Board seeking review, asserting that Zuniga was actually employed by County Agency. The Board denied Aliah's application as untimely, as it was filed well beyond the 30-day window. Aliah's subsequent request for reconsideration was also denied. The Appellate Division, Third Department, affirmed the Board's decision, finding no abuse of discretion in denying the untimely application for review.

Workers' CompensationTimelinessApplication for ReviewAdministrative DiscretionEmployer LiabilityPermanent Partial DisabilityHome Health CareAppellate ReviewUntimely FilingBoard Decision
References
5
Case No. 08-18-00171-CV
Regular Panel Decision
Dec 12, 2019

APC Home Health Services Inc. v. Lucina Martinez

This case involves an interlocutory appeal from the denial of a motion to compel arbitration. Lucina Martinez, an employee of APC Home Health Services, Inc., sued her employer for negligence after sustaining a workplace injury. APC, a non-subscriber to workers' compensation, sought to enforce an arbitration agreement Martinez had signed. The appellate court found that APC successfully demonstrated the existence of a valid arbitration agreement and that the Federal Arbitration Act (FAA) applied. The court rejected Martinez's procedural unconscionability claims but remanded the issue of substantive unconscionability concerning a one-year time limit for claims to the trial court for further consideration. The case was reversed and remanded for arbitration under the agreement's terms, with the trial court to address the specific unconscionability point.

ArbitrationFederal Arbitration ActEmployment LawWorkplace InjuryNegligenceUnconscionabilityContract EnforcementInterlocutory AppealTexas LawWorker's Compensation Non-Subscriber
References
63
Case No. MISSING
Regular Panel Decision

Iron Workers Locals 40, 361 & 417 Health Fund v. Dinnigan

The case involves a dispute between the Iron Workers Locals 40, 361, & 417 Health Fund and Robert Dinnigan, Amanda C. Dinnigan Supplemental Needs Irrevocable Trust, and their attorney regarding reimbursement of medical expenses. The Health Fund sought nearly $1.7 million paid for Amanda Dinnigan's severe injuries from a third-party tortfeasor settlement. Defendants argued against reimbursement, citing state anti-subrogation laws and the "made-whole" doctrine. The court ruled that the Health Fund was self-insured, thus preempting state law, and that the 2008 SPD, which rejected the made-whole doctrine, applied to most expenses. Ultimately, the court ordered judgment for the Plaintiff in the amount of $1,292,278, having reduced the claim by 25% to account for the Defendants' attorneys' fees and expenses in securing the original settlement.

ERISAEmployee BenefitsHealth Fund ReimbursementSubrogationEquitable ReliefSelf-Insured PlanMade-Whole DoctrinePersonal Injury SettlementSupplemental Needs TrustAttorneys' Fees
References
32
Case No. 15-0025
Regular Panel Decision
Jun 24, 2016

Texas Department of Insurance, Division of Workers' Compensation v. Bonnie Jones and American Home Assurance Company

This case addresses the Texas workers’ compensation regime and the judicial review of agency determinations regarding supplemental income benefits (SIBs). Bonnie Jones, an injured worker, sought SIBs but was denied for the fourteenth quarter due to insufficient work search efforts, a decision affirmed by an appeals panel. The trial court, however, approved a settlement between Jones and American Home Assurance Company awarding partial SIBs. The Supreme Court of Texas held that settlements for SIBs must strictly adhere to the Labor Code's eligibility requirements and precise calculation formula, disallowing awards of partial SIBs without a finding of full eligibility. The Court reversed the court of appeals’ judgment and remanded the case for further proceedings consistent with its opinion, emphasizing the Legislature's intent to curb opportunistic suits and ensure administrative certainty in workers' compensation claims.

Workers' CompensationSupplemental Income BenefitsSIBsSettlementStatutory InterpretationJudicial ReviewAdministrative DeterminationsTexas Labor CodeWork Search RequirementsEligibility Criteria
References
4
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