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

Case No. 2015 NY Slip Op 06776 [131 AD3d 1002]
Regular Panel Decision
Sep 16, 2015

Emanuel v. MMI Mechanical, Inc.

The Appellate Division, Second Department, reviewed an appeal concerning an action for personal injuries. The court dismissed the appeal from an intermediate order, as it merged into the final judgment. The main issue was whether the Supreme Court correctly granted summary judgment to defendants MMI Mechanical, Inc., Lester Starr, Wartburg Lutheran Home for the Aging, and Wartburg Nursing Home, Inc., based on collateral estoppel. The Appellate Division affirmed the judgment, concluding that the defendants had established their entitlement to summary judgment by demonstrating that the issue of whether the plaintiff sustained a work-related injury had already been decided in a Workers' Compensation Board proceeding and was identical to the issue in the current action. The plaintiffs failed to raise a triable issue of fact or show lack of a full and fair opportunity to litigate the issue previously.

collateral estoppelsummary judgmentpersonal injuryworkers' compensation boardappellate reviewjudgment affirmeddismissalwork-related injuryissue preclusionappellate procedure
References
5
Case No. MISSING
Regular Panel Decision

Smith v. Travelers Casualty & Surety Co.

Melba Smith filed a workers' compensation dispute against Travelers Casualty and Surety Company, challenging her impairment rating and the date she reached maximum medical improvement (MMI) after an on-the-job injury and two cervical fusion surgeries. After administrative proceedings where her impairment rating was set at eleven percent and her MMI date was ratified as February 15, 2007, Smith appealed to the trial court in Midland County regarding her MMI date. Travelers filed a plea to the jurisdiction, arguing Smith failed to file an original petition within the statutory deadline and that the issue of collateral estoppel regarding MMI did not concern compensability, thus requiring suit in Travis County. The trial court granted Travelers' plea. On appeal, the court reversed the trial court's order, ruling that Smith's amended petition satisfied statutory requirements and that the determination of collateral estoppel regarding MMI directly affects workers' compensation benefits, thus constituting an issue of compensability properly filed in Midland County.

Workers' Compensation DisputeImpairment RatingMaximum Medical ImprovementMMIPlea to the JurisdictionCollateral EstoppelJudicial ReviewStatutory InterpretationTexas Labor CodeCompensability
References
3
Case No. 08-07-00200-CV
Regular Panel Decision
Oct 30, 2009

Texas Builders Insurance Co. v. Calvin Molder

Calvin Molder sustained a work-related shoulder injury in 2001, leading to a workers' compensation claim against Texas Builders Insurance Company (TBI). Despite initial surgeries and an impairment rating (IR) by Dr. Erwin, Molder experienced further complications and required a third surgery. A Hearing Officer determined Molder's subsequent shoulder issues were related to the original injury. Following a dispute over MMI and IR, Dr. Foster was appointed as a new designated doctor, certifying Molder's MMI in March 2003 with a 16% IR. TBI appealed the trial court's summary judgment affirming Dr. Foster's findings. The Court of Appeals affirmed the proper appointment of Dr. Foster and the MMI date, but reversed the 16% IR due to its inclusion of post-MMI surgery, remanding the case for reassessment.

Workers' CompensationImpairment RatingMaximum Medical ImprovementDesignated DoctorShoulder InjuryRotator Cuff TearMedical ExaminationAppellate ReviewSummary JudgmentTexas Labor Code
References
18
Case No. MISSING
Regular Panel Decision

Texas Builders Insurance Co. v. Molder

Calvin Molder suffered a work-related shoulder injury in 2001, leading to multiple surgeries and a workers' compensation claim against Texas Builders Insurance Company (TBI). Initially, Dr. Erwin assigned a 2% impairment rating (IR) and Maximum Medical Improvement (MMI) date of May 13, 2002. However, Molder's condition worsened, necessitating a third surgery and the appointment of a new designated doctor, Dr. Foster, who certified a 16% IR and MMI on March 17, 2003. TBI challenged Dr. Foster's appointment and findings, leading to judicial review. The appellate court affirmed Dr. Foster's proper appointment and Molder's MMI date but reversed the 16% IR, finding it improperly considered post-MMI surgery. The case was remanded for reassessment of Molder's impairment rating.

Workers' CompensationImpairment RatingMaximum Medical ImprovementShoulder InjurySurgical ComplicationsDesignated Doctor AppointmentJudicial ReviewSupplemental Income BenefitsTexas Labor CodeMedical Evaluation
References
18
Case No. MISSING
Regular Panel Decision

Fulton v. Associated Indemnity Corp.

Donald Fulton sustained a back injury and was initially assessed at maximum medical improvement (MMI) with a seven percent impairment rating. His condition later deteriorated, leading his doctors to request an amendment to his MMI date and impairment rating. The Workers’ Compensation Commission deemed the initial rating final due to Fulton's failure to dispute it within 90 days, as per Commission Rule 130.5(e). Fulton challenged this rule's validity, arguing it contravenes the Workers’ Compensation Act by prematurely finalizing MMI certification. The district court affirmed the Commission’s decision. This appellate court ruled the 90-day Rule invalid for impermissibly shortening the statutory 104-week period for a worker to achieve MMI, thereby reversing the lower court's judgment and granting summary judgment to Fulton.

Maximum Medical Improvement (MMI)Impairment Rating90-day Rule InvalidityStatutory AuthorityAdministrative Rule ChallengeJudicial Review of Agency DecisionSummary Judgment GrantTexas Labor Code § 401.011(30)Claimant RightsMedical Condition Deterioration
References
19
Case No. 04-09-00541-CV
Regular Panel Decision
Jun 30, 2010

State Office of Risk Management v. Ruben C. Ramirez

This workers' compensation appeal addresses the reliability of a medical evaluation report. Ruben Ramirez sustained a lumbar spine injury in 1998, undergoing subsequent surgeries. The Division of Workers' Compensation appointed Dr. William W. Smith to determine Maximum Medical Improvement (MMI) and impairment rating. Dr. Smith's report, which set statutory MMI on June 27, 2000, with a 22% impairment, was contested by the State Office of Risk Management (SORM). SORM argued the report was unreliable for considering post-MMI conditions and lacking access to earlier medical records. The appellate court found Dr. Smith's opinion unreliable and reversed the trial court's judgment. The court rendered judgment that Ramirez reached MMI on April 9, 1999, with an 8% impairment, as certified by his treating physician, Dr. Michael Earle.

Workers' CompensationImpairment RatingMaximum Medical ImprovementMedical Evaluation ReportReport ReliabilityJudicial ReviewSpinal InjuryLaminectomyDiscectomyDesignated Doctor
References
6
Case No. 11-09-00227-CV
Regular Panel Decision
Oct 07, 2010

Melba Smith v. Travelers Casualty and Surety Company

Melba Smith filed a workers' compensation dispute against Travelers Casualty and Surety Company after an on-the-job injury, challenging her impairment rating and the date of maximum medical improvement (MMI). After administrative proceedings, where the Division of Workers' Compensation upheld an 11% impairment rating and the MMI date, Smith filed suit in Midland County. Travelers responded with a plea to the jurisdiction, arguing that Smith failed to file an original petition within the statutory deadline and that the MMI issue was not an issue of compensability, thus requiring the suit to be filed in Travis County. The trial court granted Travelers' plea. The Eleventh Court of Appeals reversed the trial court's decision, finding that Smith's amended petition satisfied statutory requirements and that the MMI determination, and thus the collateral estoppel issue related to it, directly affected her workers' compensation benefits, making it an issue regarding compensability properly filed in Midland County.

workers' compensationimpairment ratingmaximum medical improvementplea to the jurisdictionjudicial reviewcollateral estoppelcompensabilityappellate procedurestatutory interpretationTexas law
References
3
Case No. ADJ926004 (MON 0350313)
Regular
Nov 26, 2012

PAULENE THOMSON vs. SOUTHERN KERN UNIFIED SCHOOL DISTRICT, SELF-INSURED SCHOOLS OF CALIFORNIA

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration of a prior award. The original award found the applicant reached maximum medical improvement (MMI) on January 7, 2008, entitling her to increased benefits. The defendant argued this MMI date was incorrect and contradicted by Agreed Medical Evaluator reports. The Board amended the award to defer the MMI date issue, allowing parties to adjust it, and returned the case for further proceedings.

Workers Compensation Appeals BoardPetition for ReconsiderationFindings and AwardMaximum Medical Improvement (MMI)Labor Code Section 4658Agreed Medical Evaluator (AME)Permanent Disability IndemnityTemporary Disability IndemnityStipulationsPermanent and Stationary Date
References
1
Case No. ADJ17092437
Regular
Jul 01, 2025

Vince Miller vs. Automobile Club of Southern California, Old Republic Insurance

Defendant sought reconsideration of an Amended Findings of Fact and Order (F&O) that found the applicant had not reached maximum medical improvement (MMI) and was entitled to retroactive temporary disability benefits. The defendant contended a lack of substantial medical evidence for the MMI status and temporary disability, arguing for reliance on the qualified medical evaluator's (QME) report. The Workers' Compensation Appeals Board reviewed the petition and the WCJ's report. The Board ultimately granted the Petition for Reconsideration, rescinded the F&O, and returned the matter to the WCJ for further proceedings to determine if disputed body parts were due to industrial injury before reassessing MMI or temporary disability.

Workers' Compensation Appeals BoardMaximum Medical ImprovementTemporary Total DisabilityPetition for ReconsiderationQualified Medical EvaluatorSubstantial Medical EvidenceFindings of Fact and OrderRescindedReturned to Trial LevelLabor Code Section 5909
References
5
Case No. 03-23-00077-CV
Regular Panel Decision
Jul 17, 2024

Norman Engel v. Texas Department of Insurance-Division of Workers' Compensation and Commissioner Cassie Brown, in Her Official Capacity The State of Texas and the Attorney General of the State of Texas by and Through Ken Paxton in His Official Capacity as Attorney General of the State of Texas And Illinois National Insurance Company

Norman Engel, an injured worker, sued his workers’ compensation carrier and several Texas State entities after an administrative law judge upheld his Maximum Medical Improvement (MMI) certification. Engel challenged the administrative ruling, asserting constitutional, statutory-conflict, and delegation issues related to the 90-day deadline for disputing MMI. The trial court granted pleas to the jurisdiction for the State parties and summary judgment for the insurance carrier. On appeal, the Third District Court of Appeals affirmed the trial court's judgment. The appellate court found no errors in the dismissals and upheld the constitutionality of the challenged statutes and rules, rejecting arguments against the 90-day MMI dispute law and the delegation of rulemaking authority.

Workers' CompensationMaximum Medical ImprovementImpairment Rating90-day ruleTexas Labor CodeOpen Courts ProvisionDue Course of LawSovereign ImmunityDeclaratory Judgment ActAdministrative Procedure Act
References
41
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