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

Case No. 03-17-00352-CV
Regular Panel Decision
Aug 22, 2018

Vista Medical Center Hospital Vista Healthcare, Inc. And Surgery Specialty Hospital, Inc.// State Office of Risk Management v. State Office of Risk Management// Vista Medical Center Hospital Vista Healthcare, Inc. And Surgery Specialty Hospital, Inc.

This case involves cross-appeals stemming from a dispute over the appropriate reimbursement for medical services provided by Vista Medical Center Hospital and its affiliates to injured employees covered by the State Office of Risk Management (SORM) under Texas workers’ compensation statutes. The district court had affirmed 23 administrative orders that required SORM to make additional payments to Vista, a decision which SORM challenged on appeal citing insufficient evidence. Vista, in turn, cross-appealed the district court's denial of prejudgment interest. The appellate court found substantial evidence supported the administrative law judges' conclusion that SORM's original reimbursement model was unfair and unreasonable, and that Vista's proposed methodology was valid. Consequently, the court affirmed the district court's judgment but modified it to include the prejudgment interest that Vista was statutorily entitled to.

Workers' CompensationMedical ReimbursementAdministrative LawAppellate ReviewSubstantial EvidencePrejudgment InterestTexas LawHealthcare ProvidersInsurance DisputesFee Guidelines
References
23
Case No. ADJ6722110
Regular
Oct 11, 2013

SERGIO RODRIGUEZ vs. AIR COASTAL FLEET SERVICES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed an administrative law judge's order dismissing a lien claim for failure to pay the required activation fee. The lien claimant, Advance Care Specialist Medical Clinic, and its representatives, Innovative Medical Management and Louis Heard, sought reconsideration, which was granted. However, the Board found no good cause to overturn the dismissal. Subsequently, the Board imposed a $1,000 sanction against Innovative Medical Management and Louis Heard for their failure to respond to a notice of intent to impose sanctions.

Lien activation feeSanctionLabor Code section 5813Appeals Board Rule 10561ReconsiderationWCJ Order Dismissing Lien ClaimNotice of Intention to Impose SanctionsWorkers' Compensation Appeals BoardHearing RepresentativeMedical Clinic
References
0
Case No. 13-08-00351-CV
Regular Panel Decision
Aug 31, 2009

Mitch Burkhart and Christine Burkhart v. Sedgwick Claim Management Services, Inc. and Concentra Integrated Services, and rgv/nueces Rehabilitation D/B/A Innovative Physical and Occupational Therapy

Mitch Burkhart sustained a foot and ankle injury while training for his employer, Verizon Communications. Verizon's workers' compensation claims were administered by Sedgwick Claim Management Services, Inc., who, along with Concentra Integrated Services, arranged a Functional Capacity Evaluation (FCE) for Burkhart with RGV/Nueces Rehabilitation d/b/a Innovative Physical and Occupational Therapy. The Burkharts alleged that the FCE aggravated Mitch's injury, causing permanent damage. They sued Sedgwick, Concentra, and Innovative, claiming negligence, civil conspiracy, assault, fraud, and breach of the duty of good faith and fair dealing. The trial court dismissed the case against Innovative for an inadequate expert report and granted summary judgment to Sedgwick and Concentra, citing the exclusive remedy provision of the Texas Workers' Compensation Act. The appellate court affirmed the trial court's judgment, concluding that Mitch's aggravation injury was an 'extension injury' covered by the exclusive remedy provision of the TWCA.

Workers' CompensationFunctional Capacity EvaluationExclusive RemedyAggravation InjurySummary JudgmentMedical Expert ReportHealth Care LiabilityCivil ConspiracyBreach of Duty of Good Faith and Fair DealingTexas Court of Appeals
References
23
Case No. ADJ8094646
Regular
Jan 17, 2014

ALEJANDRINA BARRETO vs. OUT OF THE SHELL, SOUTHERN INSURANCE COMPANY, REPUBLIC INDEMNITY COMPANY, PHARMAFINANCE, LLC, HEALTHCARE FINANCE MANAGEMENT, LLC

This case involves lien claimants PharmaFinance and Healthcare Finance Management, and their representatives Landmark Medical Management and Brian Hall, who sought reconsideration of a decision disallowing their liens for medical treatment. The Appeals Board granted reconsideration solely to notice its intention to impose sanctions of up to $2,500 against the lien claimants and their representatives. This action is due to a pattern of allegedly filing petitions containing false statements about not receiving notices, which violates the Board's Rules of Practice and Procedure and Labor Code Section 5813. The Board found these claims not persuasive and indicative of a tactic to avoid responsibility.

Workers' Compensation Appeals BoardPetition for ReconsiderationSanctionsLien ClaimantsHearing RepresentativesIndustrial InjuryFindings and OrderCompromise and ReleaseNotice of IntentionLabor Code section 5813
References
0
Case No. NUMBER 13-18-00236-CV
Regular Panel Decision
Mar 05, 2020

Michael A. Garza v. Well Med Medical Management, Inc.

Appellant Michael A. Garza sued Well Med Medical Management, Inc. (Well Med) for personal injuries, alleging negligence under the doctrine of respondeat superior after a collision with Well Med employee Joanne Garcia. Garza claimed Garcia was reviewing work-related papers while driving, contending this fell within the course and scope of her employment due to Well Med's flexible work policies. The trial court granted Well Med's motion for summary judgment, finding Garcia was not acting within the scope of her employment. The Court of Appeals affirmed, concluding there was no evidence that reviewing documents while driving was a specifically assigned duty or that Well Med had impliedly approved such conduct, distinguishing it from situations where employees are on special missions for their employer.

Respondeat SuperiorSummary JudgmentCourse and Scope of EmploymentNegligenceVicarious LiabilityCommuting RuleSpecial Mission ExceptionEmployee ConductEmployer LiabilityTexas Law
References
18
Case No. MISSING
Regular Panel Decision

ABC Medical Management, Inc. v. GEICO General Insurance

The case addresses whether a plaintiff-assignee medical equipment supplier can recover no-fault first-party benefits when a chiropractor, rather than a physician, issued the prescription. Defendant GEICO General Insurance Company moved for summary judgment, arguing that Education Law § 6551 prohibits chiropractors from prescribing such items. The court denied GEICO's motion, ruling that chiropractors are permitted to prescribe TENS units, thermophore devices, and similar medical supplies, as these do not constitute 'drugs or medicines' under the Education Law. Furthermore, the court found that GEICO failed to properly present its medical necessity defense and that the contested issues should be determined by a trier of fact.

No-Fault BenefitsChiropractic PrescriptionMedical EquipmentEducation Law § 6551Summary JudgmentMedical NecessityTENS UnitThermophoreCervical CollarLumbar Support
References
29
Case No. 03-02-00502-CV
Regular Panel Decision
Aug 29, 2003

Robert S. Howell, D.C. and First Rio Valley Medical, P.A. v. Texas Workers' Compensation Commission Envoy Medical Systems, L.L.C. Texas Mutual Insurance Company Continental Casualty Company Brownsville I.S.D. Edwards Risk Management D/B/A Edwards Claims Administration State Office of Risk Management

This is an interlocutory appeal of a temporary injunction, where a final judgment has already been rendered in the underlying cause. The appellees requested dismissal of this appeal as moot. Additionally, appellees moved for damages and sanctions due to the appellants' allegedly frivolous petition for emergency writ of prohibition, which the court overruled. The appeal was ultimately dismissed as moot.

Interlocutory AppealTemporary InjunctionMootnessFrivolous PetitionEmergency Writ of ProhibitionSanctionsAppellate ProcedureTexas Court of AppealsWorkers’ Compensation
References
1
Case No. ADJ7048560
Regular
Nov 28, 2011

PARVEENA PRASAD vs. SACRAMENTO BEE/McCLATCHY NEWSPAPERS, INC.

This case involves sanctions imposed against lien claimant Accident Injury & Family Therapy (AIFT), its representative Innovative Medical Management (IMM), and Louis Heard for failing to attend two mandatory settlement conferences. The Workers' Compensation Appeals Board (WCAB) reversed a prior decision that allowed AIFT's lien, finding the lien claimant's excuses for non-appearance unpersuasive despite the loss of the lien itself. The WCAB sanctioned AIFT, IMM, and Heard jointly and severally $800 and awarded defendant its reasonable costs and fees incurred due to the missed appearances.

Workers' Compensation Appeals BoardDecision After RemovalSanctionsCosts and FeesAccident Injury & Family TherapyInnovative Medical ManagementLouis HeardLabor Code Section 5813Utilization ReviewCompromise and Release
References
1
Case No. ADJ3413739 (SAL 0120295)
Regular
Nov 26, 2013

YOLANDA OSUNA vs. MARRIOTT HOTEL, ARCHIE MAYS, M.D., RUBY LEYNES, M.D., SCOTT ROSENZWEIG, M.D., EDWARD KOMBERG, D.C.; INNOVATIVE MEDICAL MANAGEMENT and LOUIS HEARD

This case involves a sanction against Innovative Medical Management and Louis Heard for reasons outlined in a prior Notice of Intention. The Appeals Board received a $2,500 payment from them, which they deemed an acknowledgment of the undisputed reasons for the proposed sanction. Consequently, the Board ordered a $2,500 sanction, crediting the payment already made, thus settling the matter.

Workers' Compensation Appeals BoardRemovalSanctionNotice of Intention to Impose SanctionHearing RepresentativesInnovative Medical ManagementLouis HeardMedical ManagementAppeals BoardOpinion and Decision
References
0
Case No. 03-03-00381-CV
Regular Panel Decision
Aug 12, 2004

Robert S. Howell, D.C. First Rio Valley Medical, P.A. Keith Gilbert William Maxwell And Gilbert & Maxwell, P.L.L.C. v. Texas Workers' Compensation Commission Envoy Medical Systems, L.L.C. Texas Mutual Insurance Company State Office of Risk Management and Continental Casualty Insurance Company

This case addresses whether a healthcare provider must exhaust administrative remedies within the workers' compensation system before pursuing payment disputes in court, and the district court's jurisdiction to issue an anti-suit injunction. Appellants, including Robert S. Howell, D.C., and First Rio Valley Medical, P.A., challenged the constitutionality of IRO fees and an injunction preventing them from filing numerous billing dispute lawsuits in Cameron County. The Court of Appeals affirmed that administrative remedies must be exhausted and upheld the constitutionality of the IRO fees. It also upheld the anti-suit injunction to prevent vexatious litigation. The court reversed and remanded the $13,000 sanctions against the law firm in part for recalculation, but affirmed the $3,200 sua sponte sanctions.

Administrative RemediesExhaustion DoctrineWorkers' CompensationMedical Payment DisputesIRO FeesDeclaratory JudgmentAnti-Suit InjunctionVexatious LitigationSanctionsJury Trial Right
References
115
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