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

Case No. 03-03-00436-CV
Regular Panel Decision
May 20, 2004

Texas Medical Association Texas AFL-CLO Patient Advocates of Texas Allen J. Meril, M.D. And L. E. Richey v. Texas Workers Compensation Commission Richard F. Reynolds, Executive Director And Texas Association of Business

The Texas Court of Appeals, Third District, at Austin, affirmed a district court's judgment upholding the validity of the 2002 medical fee guidelines promulgated by the Texas Workers' Compensation Commission. Appellants, including the Texas Medical Association and Texas AFL-CIO, challenged the guidelines on substantive grounds (unlawful delegation of power to CMS and arbitrary/capricious rulemaking) and procedural grounds (failure to consult the Medical Advisory Committee and inadequate reasoned justification/public notice). The appellate court found no unlawful delegation of power, that the Commission's decision was not arbitrary and capricious, and that the Commission substantially complied with the reasoned-justification requirement of the APA. The court also found no requirement to consult the Medical Advisory Committee for initial fee guidelines and that a new public notice and comment period was not required.

Workers' Compensation LawMedical ReimbursementFee GuidelinesAdministrative Procedure ActAgency RulemakingDelegation DoctrineArbitrary and CapriciousJudicial ReviewTexas LawHealth Policy
References
43
Case No. MISSING
Regular Panel Decision

Claim of Cummins v. North Medical Family Physicians

A claimant sustained a work-related back injury and sought continued medical treatment, which was initially authorized. Disputes over authorization led the claimant to retain an attorney. A Workers’ Compensation Law Judge authorized continued medical treatment but denied counsel fees, stating no "money passing" occurred. The Workers' Compensation Board upheld this decision. The claimant appealed, arguing the Board unconstitutionally applied Workers’ Compensation Law § 24, misinterpreted the statute regarding fee payment from medical benefits, and abused its discretion. The appellate court affirmed the Board's decision, ruling that counsel fees must be paid from "compensation," defined as a money allowance, and medical benefits are not considered "compensation" for this purpose, thus finding no abuse of discretion.

Workers' CompensationCounsel FeesAttorney FeesMedical TreatmentStatutory InterpretationConstitutional LawLienCompensation DefinitionAppellate ReviewBoard Decision
References
3
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

Texas Medical Ass'n v. Texas Workers Compensation Commission

The Texas Medical Association, Texas AFL-CIO, Patient Advocates of Texas, and Doctors Meril and Richey challenged the Texas Workers Compensation Commission's 2002 medical fee guidelines (Rule 134.202). Appellants argued the Commission unlawfully delegated its authority to a federal agency (CMS), acted arbitrarily and capriciously, and violated procedural requirements regarding the Medical Advisory Committee and public notice. The district court upheld the guidelines' validity. This appellate court affirmed, finding no unlawful delegation or arbitrary action, and concluded that the Commission substantially complied with the Administrative Procedure Act's requirements for reasoned justification and public comment, thereby validating the fee guidelines and denying a permanent injunction.

Workers' CompensationMedical Fee GuidelinesAdministrative LawRulemaking ValidityDelegation of PowerArbitrary and Capricious ReviewReasoned JustificationPublic Notice RequirementsTexas Labor CodeCMS Reimbursement
References
40
Case No. MISSING
Regular Panel Decision
Feb 03, 1992

Medical Designs, Inc. v. Medical Technology, Inc.

This case involves a patent infringement lawsuit filed by Medical Designs, Inc. (MDI) against Medical Technology, Inc. (MTI) and Gary Bledsoe, asserting infringement of two patents: U.S. Patent No. 4,407,276 and U.S. Patent Des. 269,379. The defendants counterclaimed, arguing patent invalidity and unenforceability. The court found that claims 1-7 of the ’276 patent were anticipated under 35 U.S.C. § 102 by prior art, and claims 1-8 were obvious under 35 U.S.C. § 103. Furthermore, the entire ’276 patent was deemed unenforceable due to inequitable conduct by MDI's patent attorney for intentionally omitting material prior art from the Patent and Trademark Office. While the ’379 design patent was found valid and enforceable, MDI failed to prove infringement. Consequently, the court awarded attorneys' fees and damages to MTI and Bledsoe against MDI and Floyd Hutson.

Patent infringementUtility patentDesign patentPatent invalidityPatent unenforceabilityPrior artObviousnessAnticipationInequitable conductAttorney's fees
References
20
Case No. 13-09-00350-CV
Regular Panel Decision
Jan 21, 2010

Gulf Coast Medical Center, LLC, Tony Todd, Crna, Dan Madsen, M.D. and South Texas Medical Clinics, P.A. v. Jacqueline Temple and Marcus Banks, Individually and as Representatives of the Estate of Markasia Banks, a Minor Child

Appellants, Gulf Coast Medical Center, LLC, Tony Todd, CRNA, Dan Madsen, M.D., and South Texas Medical Clinics, P.A., appealed the trial court's denial of their motions to dismiss. The underlying suit was filed by appellees Jacqueline Temple and Marcus Banks, alleging negligence in the care and treatment of their deceased minor child, Markasia Banks. The core issue on appeal was the appellees' failure to timely serve an expert medical report as required by the Texas Civil Practice and Remedies Code. The Court of Appeals determined that the appellees' claims were 'health care liability claims' and that the expert report was indeed untimely, and that an abatement due to a failure to provide medical authorization did not extend the deadline. The court also affirmed the constitutionality of the expert report requirement. Consequently, the appellate court reversed the trial court's judgment, granted the appellants' motions to dismiss, and remanded the case for the award of attorney's fees and costs to the appellants.

Health Care Liability ClaimExpert Medical ReportMotion to DismissTimeliness of ReportAbatementMedical MalpracticeNegligenceDue ProcessTexas ConstitutionAppellate Review
References
32
Case No. 03-05-00032-CV
Regular Panel Decision
May 04, 2007

Board of Medical Examiners for the State of Texas and Donald W. Patrick, M.D., J.D., as Executive Director of the Board of Medical Examiners for the State of Texas v. Vivian Adaobi O. Nzedu, M.D.

The Texas State Board of Medical Examiners denied Dr. Vivian Nzedu's medical license application, citing her failure to pass the USMLE within the statutorily permitted attempts. The Board included an examination attempt made prior to the effective date of the 'three-attempts statute' (September 1, 1993). The trial court initially sided with Dr. Nzedu, ruling that pre-1993 attempts should not be counted. However, the appellate court reversed this decision, concluding that counting pre-statute examination attempts is not an unconstitutional retroactive application of the Medical Practice Act, as it merely draws upon antecedent facts and does not impair a vested right. The court deferred to the Board's reasonable interpretation of the statute. The case was remanded for a determination of attorneys' fees.

Medical LicensingUSMLEStatutory InterpretationRetroactivityVested RightsAdministrative LawTexas Medical Practice ActPhysician LicensureExamination RequirementsAppellate Review
References
24
Case No. NUMBER 13-08-00200-CV
Regular Panel Decision
Aug 28, 2009

Valley Baptist Medical Center v. Noe Morales, Jr., as Administrator of the Estate of Paulina Morales

This is a statutory construction case concerning the production of medical records and associated fees. Appellant Valley Baptist Medical Center (VBMC) appealed a district court order compelling it to provide medical records to Appellee Noe Morales, Jr., as administrator of an estate, without charge. Morales sought records under the Texas Civil Practices and Remedies Code, while VBMC asserted its right to charge a reasonable fee under the Texas Health and Safety Code. The appellate court concluded that the statutes could be harmonized, affirming Morales's entitlement to the records but also VBMC's right to charge the statutory fee. The court reversed the trial court's judgment, requiring Morales to pay the $1,143.00 fee.

Statutory ConstructionMedical RecordsFees for RecordsTexas Civil Practices and Remedies CodeTexas Health and Safety CodeHospital LiabilityMandamusAppellate ReviewStatutory InterpretationHealthcare Law
References
15
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. 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
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