CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

Case Law Database

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

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
Case No. 2-06-016-CV
Regular Panel Decision
Mar 15, 2007

Shioleno Industries, Inc. AND Columbia Medical Center of Arlington Subsidiary, L.P. and Columbia North Texas Subsidiary, GP, LLC D/B/A Medical Center of Arlington v. Columbia Medical Center of Arlington Subsidiary, L.P. and Columbia North Texas Subsidiary, GP, LLC D/B/A Medical Center of Arlington AND Shioleno Industries, Inc.

Shioleno Industries, Inc. appealed a summary judgment granted in favor of Columbia Medical Center of Arlington Subsidiary, L.P. and Columbia North Texas Subsidiary, GP, LLC d/b/a Medical Center of Arlington (the Hospital). The case originated from the Hospital's alleged failure to disclose an employee's positive drug and alcohol test results to Shioleno after an on-the-job injury. Shioleno contended that this omission led to increased workers' compensation premiums and expenses in unemployment benefit disputes. The appellate court affirmed the trial court's judgment, ruling that Shioleno failed to provide a valid authorization for the disclosure of medical information. Consequently, the Hospital had no legal duty to disclose the results and could not be held liable for negligence, breach of contract, or Deceptive Trade Practices Act (DTPA) violations.

Summary JudgmentMedical RecordsDisclosure AuthorizationHealth & Safety CodeNegligenceBreach of ContractDTPADrug TestingAlcohol TestingEmployer Liability
References
13
Case No. 03-17-00357-CV
Regular Panel Decision
Nov 21, 2017

George Allibone, M.D. v. Scott Freshour, in His Official Capacity as the Interim Executive Director of the Texas Medical Board Juanita Garner, Investigator of the Texas Medical Board And the Texas Medical Board

George Allibone, M.D., appealed the denial of his petition for a protective order against an administrative subpoena issued by the Texas Medical Board. The subpoena sought patient medical and billing records for an investigation into complaints against Allibone. He contended the trial court erred by failing to issue findings of fact and conclusions of law and by abusing its discretion in finding the subpoena reasonable and relevant. The appellate court found Allibone waived his complaint regarding missing findings. It also concluded the trial court did not abuse its discretion, citing the Board's need for complete records for investigation and Allibone's failure to prove the unconstitutionality of the statute requiring compliance. The trial court's order was affirmed.

Medical Board InvestigationAdministrative SubpoenaPhysician RecordsConstitutional RightsDue ProcessJudicial Review of Agency ActionAbuse of DiscretionFourth AmendmentTexas LawProfessional Licensing
References
50
Case No. 2022-08-0195
Regular Panel Decision
Sep 02, 2022

Evans, Antron v. Family Dollar Stores, Inc.

Mr. Antron Evans requested a panel of psychiatrists, attorney's fees, and payment of a medical bill following a store robbery where he sustained a head injury. Family Dollar, the employer, contended he was not entitled to a psychiatric panel without a referral from an authorized physician, disputed the medical bill, and denied wrongfully denying the claim for attorney's fees. The Court denied Mr. Evans's requests for a psychiatric panel and payment of the emergency room bill, citing the statutory requirement of a panel physician's referral for psychiatric services and lack of proof for the medical bill. However, the Court granted his request for attorney's fees due to Family Dollar's five-month delay in timely initiating medical benefits. Additionally, Family Dollar was referred to the Compliance Program for potential penalties concerning the late filing of the First Report of Injury and the untimely provision of a panel of physicians.

Workers' CompensationMedical Benefits DenialAttorney's Fees GrantEmployer PenaltiesExpedited HearingPsychiatric ReferralStatutory InterpretationLate Claim ProcessingFirst Report of Injury DelayPost-Traumatic Stress
References
6
Case No. 11-03-00346-CV
Regular Panel Decision
Mar 03, 2005

Ray Warren, M.D. and Texas Medical Images, Inc. v. KPH-Consolidation, Inc., D/B/A Columbia Kingwood Medical Center

Ray Warren, M.D. and Texas Medical Images, Inc. (Warren) appealed the trial court's order granting summary judgment to KPH-Consolidation, Inc. d/b/a Columbia Kingwood Medical Center (Kingwood). The dispute arose from Warren's failure to pay rent on two lease agreements, leading Kingwood to sue for breach of contract. The trial court granted Kingwood's motion for summary judgment and ruled against Warren on his counterclaim regarding a breach of an Expense Sharing Agreement and breach of warranty. The Eleventh Court of Appeals affirmed the trial court's judgment, finding Kingwood had proven its breach-of-contract claim and that Warren's counterclaim failed as a matter of law, partly due to an 'as is' clause in the Equipment Lease. The appellate court also upheld the denial of Warren's motion for a new trial, finding no abuse of discretion.

summary judgmentbreach of contractlease agreementequipment leasecounterclaimbreach of warranty"as is" clauseappellate reviewabuse of discretionTexas law
References
8
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. 03-18-00663-CV
Regular Panel Decision
Dec 05, 2019

Facility Insurance Company v. Vista Hospital of Dallas, Vista Medical Center Hospital and Surgery Specialty Hospitals of America

This case involves an appeal from a suit for judicial review of an administrative decision concerning workers’ compensation medical benefits. Multiple insurance carriers (Appellants) disputed the reimbursement amounts sought by Vista Hospital entities (Appellees) for outpatient medical services provided between 2002 and 2008. Vista initially claimed 70%-100% of billed charges but later revised its calculations to 200% of the Medicare allowable reimbursement, following a 2008 regulatory change and a clarifying court opinion. The State Office of Administrative Hearings (SOAH) and the trial court affirmed Vista's revised calculations as 'fair and reasonable.' The Court of Appeals affirmed the trial court's judgment, finding substantial evidence to support SOAH's decision regarding the reimbursement methodology and the accrual of interest.

Medical Reimbursement DisputesAdministrative Agency ReviewAppellate Court DecisionTexas Labor CodeFee Guideline InterpretationHospital Billing PracticesWorkers' Compensation InsuranceState Office of Administrative Hearings (SOAH)Due Process RightsStatutory Interpretation
References
18
Case No. MISSING
Regular Panel Decision

Yklik Medical Supply, Inc. v. Allstate Insurance

Plaintiff Yklik Medical Supply, Inc., a medical supply provider, sued Allstate Insurance Company to recover $317 in unpaid medical bills for equipment supplied to its assignor, Tammy Agosto. Yklik moved for summary judgment, asserting proper bill submission and Allstate's failure to timely pay or deny the claim. Allstate argued that the charges exceeded the Workers' Compensation fee schedule and that a partial payment had been made. The court found that Yklik established a prima facie case. The central issue was whether Allstate's fee schedule defense was precluded due to its failure to issue a timely denial within 30 days as mandated by Insurance Law § 5106 (a) and 11 NYCRR 65-3.5. The court ruled that since Allstate waited 56 days to send its denial, it was precluded from raising the fee schedule defense, and therefore, summary judgment was granted to the plaintiff.

No-fault insurancesummary judgmenttimely denialfee schedulepreclusion ruleinsurance lawmedical supplybilling practicespersonal injury protectionassignor
References
19
Case No. 02-22-00072-CV
Regular Panel Decision
Jul 27, 2023

BioTE Medical, LLC v. John Carrozzella, MD, JCMD Medical Services, Inc., Dan Deneui, and Terri Deneui

This case addresses whether a contractual "residual benefit" clause, requiring a post-termination fee for using a competing treatment method, constitutes a covenant not to compete under Texas law. Appellant BioTE Medical, LLC, licensed a pellet-based bioidentical hormone replacement therapy (BHRT) method. Appellee JCMD Medical Services, Inc., a former customer, terminated its agreement and began using a competitor's BHRT without paying the residual-benefit fee. BioTE Medical sued JCMD for breach of contract. The trial court granted summary judgment to JCMD, finding the clause unenforceable either as a noncompete or a violation of public policy. The appellate court reversed, holding that the residual-benefit clause is not a covenant not to compete as it does not restrict JCMD from competing with BioTE Medical, but rather from using a competitor's product. The court also declined to invalidate the clause on uncodified public policy grounds, deferring to the Legislature's policy determinations.

Contract lawCovenants Not to Compete ActResidual benefit clausePublic policyBioidentical hormone replacement therapy (BHRT)Breach of contractSummary judgmentAppellate reviewTexas lawBusiness and Commerce Code
References
33
Case No. MISSING
Regular Panel Decision

Healthsouth Medical Center v. Employers Insurance Co.

HealthSouth Medical Center appealed a trial court's decision that granted Employers Insurance Company of Wausau's plea to the jurisdiction, dismissing HealthSouth's breach of contract claim related to workers' compensation insurance payments. HealthSouth argued the trial court erred in concluding it lacked jurisdiction and in refusing to compel Wausau to produce contracts. The court determined that the Texas Workers’ Compensation Commission (now the Division of Workers' Compensation) has exclusive jurisdiction over medical fee disputes between healthcare providers and insurers. Because HealthSouth did not exhaust its administrative remedies after the Division dismissed its claims, the trial court correctly lacked subject matter jurisdiction. The appellate court affirmed the trial court's order, concluding that the Division has the sole authority to determine the amount to be paid in such disputes.

Workers' CompensationJurisdictionBreach of ContractAdministrative RemediesMedical Fee DisputePlea to the JurisdictionAppellate ReviewInsurance BenefitsHealthcare ProviderPreferred Provider Organization
References
8
Showing 1-10 of 16,047 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational