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

Case No. 03-14-00726-CV
Regular Panel Decision
Oct 30, 2014

Texas San Marcos Treatment Center, L.P. D/B/A San Marcos Treatment Center v. Veronica Payton

Texas San Marcos Treatment Center appeals the trial court's denial of its motion to dismiss Veronica Payton's health care liability claim. Payton alleged negligence after being assaulted by a patient at the treatment center. The appellant argues that the expert report provided by Dr. William H. Reid is deficient, lacking factual support and specificity concerning the standard of care, its breach, and causation, as required by Chapter 74 of the Texas Civil Practices and Remedies Code. The appellant asserts the trial court abused its discretion by finding the report adequate and requests dismissal of the claims.

Medical MalpracticeExpert ReportMotion to DismissAbuse of DiscretionStandard of CareBreach of DutyCausationHealth Care Liability ClaimPsychiatric FacilityEmployee Assault
References
25
Case No. E2014-00302-COA-R3-CV
Regular Panel Decision
Jan 30, 2015

American Heritage Apartments, Inc. v. The Hamilton County Water and Wastewater Treatment Authority, Hamilton County, Tennessee

The plaintiff, American Heritage Apartments, Inc., challenged a monthly flat charge imposed by the Hamilton County Water and Wastewater Treatment Authority (County WWTA) for sewer lateral repairs. The trial court granted summary judgment to the County WWTA, finding no private right of action under the Utility District Law of 1937 (UDL). On appeal, the Court of Appeals reversed the summary judgment, concluding the UDL was inapplicable as the County WWTA was formed under the Tennessee Water and Wastewater Treatment Authority Act (WWTA Act). The appellate court held that the WWTA Act implicitly provides a private right of action for ultra vires and contract claims. The court also affirmed the trial court's alternative ruling that class action certification for affected customers was appropriate.

Water UtilityWastewater TreatmentFlat Rate ChargeClass Action CertificationSummary Judgment ReversalPrivate Right of ActionUltra Vires ClaimGovernmental ImmunityUtility District LawWater and Wastewater Treatment Authority Act
References
48
Case No. 08-11-00264-CV
Regular Panel Decision
Oct 08, 2014

Maria G. Thompson/Luis Marioni, D.C. v. Jaime Stolar, M.D., Alivio Medical Center, Alivio Treatment Centers, P.A. and Luis Marioni, D.C./Maria G. Thompson

This multi-party appeal originated from a medical and chiropractic malpractice lawsuit filed by Maria G. Thompson against Dr. Jaime Stolar, Dr. Luis Marioni, and Alivio Medical Center and Alivio Treatment Centers, P.A. Thompson alleged negligence resulting in severe knee injuries, including infection and fusions, following injections and treatment. A jury found Dr. Stolar and Dr. Marioni negligent, awarding damages. On appeal, the court reversed the judgment against Dr. Marioni due to insufficient evidence of causation but affirmed the judgment against Dr. Stolar. The court also upheld the denial of Thompson's claims regarding damages and apparent agency against Alivio.

Medical MalpracticeChiropractic MalpracticeKnee InjuryKnee InfectionSpontaneous FusionSurgical FusionNegligenceCausationDamages AssessmentApparent Agency
References
48
Case No. ADJ7062572
Regular
Apr 28, 2011

ANA LILIA RODRIGUEZ vs. COUNTRY VILLA HEALTH SERVICES, ZURICH AMERICAN INSURANCE CO. administered by TRISTAR RISK MANAGEMENT

The Workers' Compensation Appeals Board granted reconsideration of an award of temporary disability indemnity to an applicant who received treatment outside a valid Medical Provider Network (MPN). The Board overturned the original award, ruling that reports from physicians outside the MPN are inadmissible under current case law, *Valdez v. Warehouse Demo Services*. Consequently, the applicant is not entitled to temporary disability indemnity, reimbursement to the EDD, or attorney's fees based on those inadmissible reports. However, the applicant's unauthorized departure from the MPN was not deemed an unreasonable refusal of medical treatment.

Workers' Compensation Appeals BoardMedical Provider Network (MPN)Labor Code Section 4616.6Unauthorized Medical TreatmentAdmissibility of Medical ReportsTemporary Disability IndemnityEmployment Development Department (EDD)Attorney's FeesUnreasonable Refusal of Medical TreatmentLabor Code Section 4056
References
2
Case No. ADJ5096605
Regular
May 28, 2013

JACK ODAY vs. WICKES LUMBER CORP., TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior decision that deemed a defense medical report admissible but insufficient to justify denial of treatment and ordered treatment consistent with the applicant's treating physician. The WCAB found both Dr. Lipton's report inadmissible as substantial evidence due to its age and lack of examination, and Dr. Dayton's treatment recommendations deficient for not specifying industrial injury causation. Consequently, the WCAB rescinded the previous order, returning the case for further development of the record to determine necessary industrial injury treatment and to allow for a proper medical-legal evaluation. The Board denied removal but granted reconsideration to correct the procedural and substantive issues regarding medical evidence and treatment authorization.

Workers' Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationFindings and OrderAdministrative Law JudgeMedical TreatmentStipulated AwardPrimary Treating PhysicianQualified Medical EvaluatorMedical-Legal Evaluation
References
10
Case No. ADJ1144741
Regular
Nov 14, 2008

QUENTIN FORD vs. UNITED PARCEL SERVICE, LIBERTY MUTUAL INSURANCE COMPANY

The Appeals Board affirmed the WCJ's decision that applicant Quentin Ford is not entitled to treat outside of the defendant's Medical Provider Network (MPN). The Board found Dr. Joel's report inadmissible due to its timing and lack of explanation for its late submission. Furthermore, even if admitted, the report did not establish applicant's need to continue treatment with Dr. Joel outside the MPN, as the recommended treatment had been completed and no subsequent treatment plan was outlined.

Workers' Compensation Appeals BoardReconsiderationTemporary Disability IndemnityMedical Provider Network (MPN)Labor Code section 4616.2(d)(3)(b)Knight v. United Parcel ServiceSerious and Chronic ConditionContinuity of CareRadiofrequency AblationAgreed Medical Evaluator (AME)
References
1
Case No. SAL SJO 252436 (MF); SJO 246192
Regular
Jul 02, 2007

NIHAL HORDAGODA vs. State Compensation Insurance Fund

This case involves an employer's petition for reconsideration of an order authorizing medical treatment and admitting the Qualified Medical Examiner's (QME) reports. The employer argued the QME reports were inadmissible due to an alleged ex parte communication between the applicant and the QME, and that the awarded treatments were improper. The report recommends denying the petition, finding the communication was permissible under LC § 4062.3(h) and that the QME's opinions and awarded treatments for chronic pain were reasonable and not governed by ACOEM guidelines.

Workers' Compensation Appeals BoardPetition for ReconsiderationQualified Medical EvaluatorLabor Code Section 4062.3Ophthalmological evaluationFunctional capacity evaluationUtilization ReviewACOEM GuidelinesChronic spinal conditionTreating physician
References
0
Case No. ADJ6507434
Regular
Jun 07, 2013

GABINO DANIEL MARTINEZ MONTES vs. MURRAY'S IRON WORKS, COMPWEST INSURANCE COMPANY

This case involves a lien claimant, Frontline Medical Associates, seeking reconsideration of the denial of their lien for medical treatment provided to an applicant, Gabino Daniel Martinez Montes. The lien was denied because the claimant failed to prove membership in the defendant's Medical Provider Network (MPN) or demonstrate the necessity of treatment for denied body parts. The Appeals Board adopted the WCJ's report, which found the lien claimant's evidence inadmissible due to non-disclosure and upheld the denial of reconsideration. The claimant also failed to establish that treatment for denied body parts was medically necessary or that the MPN process was properly bypassed.

Workers' Compensation Appeals BoardPetition for ReconsiderationWorkers' Compensation Administrative Law JudgeFrontline Medical AssociatesLien ClaimantMedical Provider Network (MPN)Pre-Trial Conference StatementAdmissible EvidenceDue ProcessLabor Code Section 4062
References
2
Case No. ADJ7048296
Significant
Sep 27, 2011

Elayne Valdez, Applicant vs. Warehouse Demo Services, Zurich North America, Adjusted By ESIS

The Appeals Board affirmed its prior en banc decision, holding that where unauthorized medical treatment is obtained outside a validly established and properly noticed medical provider network (MPN), the resulting non-MPN treatment reports are inadmissible and may not be relied upon to award benefits.

MPNinadmissibilitynon-MPN treatmentLabor Code section 4616.6appeals boardreconsiderationen banc decisionPTPmedical provider networkutilization review
References
17
Case No. MISSING
Regular Panel Decision
Jan 22, 2004

Mete v. New York State Office of Mental Retardation

This class action alleged age discrimination in employment against the New York State Office of Mental Retardation and Development Disabilities (OMRDD). Plaintiffs, former Chiefs of Developmental Center Treatment Services, claimed disparate treatment and disparate impact arising from a 1989 reduction in force (RIF) that eliminated their positions. All 46 Chiefs, who were over 40, were either demoted or retired, and statistical evidence showed a disproportionate impact on employees over 40. The Supreme Court granted defendants’ motion for summary judgment, dismissing all causes of action. The appellate court affirmed, finding that while plaintiffs established a prima facie case, OMRDD provided a legitimate, nondiscriminatory reason for the RIF (economic conditions and long-standing concerns about the position's utility), which plaintiffs failed to adequately prove was a pretext for discrimination.

Age DiscriminationClass ActionSummary JudgmentDisparate TreatmentDisparate ImpactReduction in ForceEmployment LawPretextPrima Facie CaseStatistical Evidence
References
11
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