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

Case No. 2016-02-0027
Regular Panel Decision
Mar 09, 2016

Gray, Kimberly v. Fresenius Medical Care

Kimberly Gray, an employee, sought an expedited hearing regarding her entitlement to medical treatment and a second opinion for her right elbow injury sustained while working for Fresenius Medical Care. She had been treating with Dr. Michael Bratton, who placed her at maximum medical improvement (MMI) on August 17, 2015, and determined a 1% permanent partial impairment. Ms. Gray requested a second opinion due to continued pain, but Fresenius Medical Care refused, stating there was no statutory basis requiring them to provide it without a physician's referral. The Court found that Ms. Gray was not entitled to the requested relief as she did not present sufficient evidence to likely prevail at a hearing on the merits, and her request for additional medical benefits was denied.

Workers' CompensationExpedited HearingMedical BenefitsSecond OpinionMMIPermanent Partial ImpairmentRight Elbow InjuryOrthopedic SurgeonStatutory InterpretationBurden of Proof
References
3
Case No. 2016-06-0910
Regular Panel Decision
Jul 24, 2018

Fegan, Mark v. CSI Medical, Inc.

The case involved Mark Fegan seeking temporary disability benefits from his employer, CSI Medical, Inc., and its carrier, Am Trust, following a back injury in October 2015. Initially, Dr. Sullivan declared Fegan at maximum medical improvement (MMI) in March 2016, leading to a cessation of benefits. However, Fegan later sought treatment from Dr. Ronald Lakatos in Ohio, who performed surgery in May 2017 and provided a medical opinion contradicting Dr. Sullivan's MMI assessment. Dr. Lakatos stated that Fegan was not at MMI as of March 2016 and remained disabled through May 2017. The Court weighed the medical opinions, giving more weight to Dr. Lakatos's in-depth analysis, and found that Mr. Fegan was likely to prevail in demonstrating his entitlement to temporary disability benefits for the period from April 1, 2016, through May 30, 2017. Consequently, the Court ordered CSI to pay lump-sum temporary total disability benefits totaling $19,389.52.

Temporary DisabilityMedical ImprovementSpinal InjurySurgeryMMI DisputeMedical EvidenceExpedited HearingBenefit DeterminationCausationDisability Duration
References
2
Case No. 2015-07-0040
Regular Panel Decision
Mar 11, 2016

Choate, Jerry v. Revel Logging, LLC

Jerry Choate, a truck driver, sustained neck, back, and head injuries in an August 2014 work accident. He sought permanent partial disability, additional temporary total disability (TTD), and mileage reimbursement. The employer, Revel Logging, LLC, disputed these claims and requested reimbursement for a TTD overpayment. Medical evaluations indicated no permanent impairment and set the maximum medical improvement (MMI) date at December 9, 2014. The Court denied Mr. Choate's claims for permanent partial disability, additional TTD, and mileage reimbursement, concluding his injuries did not result in permanent disability and his legal residence was within the qualifying mileage for providers. However, the Court granted Mr. Choate future medical benefits and denied Revel's request for TTD overpayment reimbursement, citing employer oversight and potential hardship to Mr. Choate.

Workers' CompensationDisability BenefitsMedical BenefitsPermanent Partial DisabilityTemporary Total DisabilityMileage ReimbursementOverpayment ReimbursementPost-traumatic HeadachesMaximum Medical Improvement (MMI)Neurosurgeon Evaluation
References
9
Case No. 2020-03-0080
Regular Panel Decision
Sep 10, 2020

Juboori, Mohammed v. PRESBYTERIAN HOMES OF TENNESSEE

Mohammed Juboori, a dietary aide for Presbyterian Homes of Tennessee (PHT), injured his left foot on February 28, 2018, and reinjured it on November 24, 2018. He received authorized treatment from Dr. William McPeake, who placed him at maximum medical improvement (MMI) on July 11, 2019, assigned a three-percent impairment rating, and released him to full-duty work, anticipating no further treatment. Mr. Juboori, dissatisfied with the care, sought additional medical benefits and temporary disability benefits, arguing he was unable to work. The Court, at an Expedited Hearing on September 2, 2020, denied his requests, finding that he failed to provide a medical opinion to rebut Dr. McPeake's assessments or establish a current need for medical treatment or work restrictions, thus making it unlikely he would prevail at trial.

Workers' CompensationExpedited HearingMedical BenefitsTemporary Disability BenefitsMaximum Medical Improvement (MMI)Impairment RatingAuthorized PhysicianReinjuryFoot InjuryLack of Medical Opinion
References
3
Case No. MISSING
Regular Panel Decision

American Cas. Co. of Reading, PA v. Hill

Donald E. Hill suffered a compensable injury on July 26, 2002. Dr. Samuel Bierner initially certified Hill's maximum medical improvement (MMI) date as November 6, 2002, with a five percent impairment rating. Hill challenged this, leading to administrative hearings and a lawsuit. The trial court ultimately changed Hill's MMI date to June 30, 2004, based on a later report from Dr. Bierner. American Casualty Company appealed this judgment, arguing that the evidence was inadmissible and that the Texas Labor Code prohibited new evidence without a substantial change in condition. The appellate court affirmed the trial court's judgment, concluding that the statutes did not bar new evidence for the date of maximum medical improvement and that other arguments regarding evidence admission were waived.

Workers' Compensation LawMaximum Medical ImprovementImpairment RatingJudicial ReviewAdministrative AppealAdmissibility of EvidenceHearsay EvidenceAuthentication of DocumentsDirected VerdictTexas Labor Code
References
13
Case No. 2018-08-1011
Regular Panel Decision
Mar 20, 2019

Appleton, Danny v, Kellogg Company

Danny Appleton requested additional medical and temporary disability benefits for a back injury, but Kellogg Company insisted all entitled benefits had been paid. The court considered the issues at an Expedited Hearing on March 6, 2019. Mr. Appleton injured his low back on February 16, 2018. The treating physician, Dr. John Brophy, selected from Kellogg's panel, concluded Mr. Appleton reached maximum medical improvement (MMI) on May 25, 2018, with no permanent impairment, attributing ongoing symptoms to a pre-existing condition. Mr. Appleton then treated on his own with Dr. Ashley Park, who linked the low back pain directly to the workplace injury. The Court found both medical opinions reasonable but upheld Dr. Brophy's opinion, which held a statutory presumption of correctness, finding it was not rebutted by a preponderance of the evidence. Consequently, the Court denied Mr. Appleton's claim for additional medical and temporary disability benefits.

Back injuryLow back painSpondylolisthesisPars defectsPre-existing conditionMaximum Medical Improvement (MMI)Expedited HearingCausation (medical)Medical benefitsTemporary disability benefits
References
4
Case No. 2014-01-0002
Regular Panel Decision
Oct 16, 2015

Howard, Denita v. US Xpress Enterprises

Denita Howard, a trainee truck driver for USXpress Enterprises, Inc., filed for an expedited hearing seeking medical benefits for emergency treatment after a work injury and temporary partial disability benefits. The alleged injury occurred when her tractor-trailer overturned near Acadia, Louisiana. The Court found Ms. Howard entitled to the requested medical benefits for charges from Jefferson Davis Emergency Group, LLC, as the employer's carrier, Liberty Mutual, had already paid the bill. However, her claim for temporary partial disability benefits from January 7, 2015, to February 18, 2015, was denied, as she was deemed to have reached maximum medical improvement as of December 18, 2014, by Dr. Venugopal Gadipudi. The employer's request for reimbursement of temporary partial disability benefits paid after the MMI date was deferred.

Workers' CompensationExpedited HearingMedical BenefitsTemporary Partial DisabilityMaximum Medical Improvement (MMI)Emergency TreatmentTruck Driver InjuryMotor Vehicle AccidentNeurological CareInsurance Carrier Liability
References
4
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. 2016-08-1288
Regular Panel Decision
Jun 05, 2017

Limberakis, George v. Pro-Tech Security, Inc.

George Limberakis, an employee of Pro-Tech Security, Inc., filed a Request for Expedited Hearing seeking a new authorized treating physician (ATP) for his work-related back injury. His initial ATP, Dr. Ashley Park, placed him at maximum medical improvement (MMI) and discharged him from care, despite Limberakis experiencing ongoing symptoms. Pro-Tech argued it had complied with statutory requirements and provided necessary treatment. The Court found sufficient evidence that Mr. Limberakis would likely prevail on the merits and ordered Pro-Tech to provide a substitute physician for Dr. Park on the panel from which Limberakis could select a new ATP for additional medical benefits related to his July 23, 2014 injury.

Workers' CompensationMedical BenefitsAuthorized Treating PhysicianExpedited HearingMMIPermanent ImpairmentWork InjuryBack InjuryTreatment RefusalStatutory Compliance
References
2
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
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