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

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. 03-05-00189-CV
Regular Panel Decision
Mar 21, 2008

Texas Department of Insurance, Division of Workers' Compensation v. Insurance Council of Texas, Texas Mutual Insurance Company, Texas Property and Casualty Insurance Guaranty Association, and Envoy Medical Systems, Inc.

The Texas Department of Insurance, Division of Workers' Compensation (the "Division") promulgated a rule (28 Tex. Admin. Code § 133.309) to create a less expensive alternative review procedure for workers' compensation claims concerning the necessity of medical treatment. The Insurance Council of Texas, Texas Mutual Insurance Company, Texas Property and Casualty Insurance Guaranty Association, and Envoy Medical Systems, L.P. (the "Joint Appellees") challenged the rule's validity in a declaratory judgment action. The district court granted the Joint Appellees' motion for summary judgment, declaring the rule invalid. The appellate court affirmed the district court's judgment, concluding that the rule was not in harmony with relevant governing statutes that allowed for judicial review of medical necessity disputes.

Workers' Compensation LawAdministrative LawJudicial ReviewStatutory InterpretationDeclaratory JudgmentSummary JudgmentMedical Necessity DisputesAlternative Dispute ResolutionAgency Rule ValidityTexas Court of Appeals
References
15
Case No. MISSING
Regular Panel Decision

Queens Blvd. Medical, P.C. v. Travelers Indemnity Co.

The plaintiff, Queens Blvd. Medical, P.C., sought $950 in first-party no-fault benefits for biofeedback medical services provided to its assignor for lower back and chronic pain syndrome. The central issue at trial was the medical necessity of these services under Insurance Law § 5102 (a) (1). The plaintiff established a prima facie case with expert testimony from a board-certified neurologist affirming the medical appropriateness of biofeedback. The defendant insurance company failed to present admissible evidence to disprove medical necessity, as its expert was deemed incompetent to testify on biofeedback for back pain. Consequently, the court granted the plaintiff's motion for a directed verdict, awarding judgment for $950 along with statutory costs, interest, and attorney's fees.

No-fault benefitsMedical necessityBiofeedback treatmentExpert testimonyDirected verdictInsurance lawChronic pain syndromeBack injuryCPT codesBurden of proof
References
9
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. 03-03-00381-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. 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. MISSING
Regular Panel Decision

In Re Texas Mutual Insurance Co.

Texas Mutual Insurance Company filed a petition for writ of mandamus to compel Judge Robert E. May to set aside an order denying its plea to the jurisdiction. The underlying dispute involves Adrian Harding's workers' compensation claim, specifically the interplay between disputes over the extent of injury and the necessity of medical treatment. Texas Mutual argued that Harding failed to exhaust administrative remedies regarding medical necessity before the Division of Workers’ Compensation (DWC). The court found that Harding's claims for delay in treatment required a prior DWC determination of medical necessity for the disputed period (January 2007 - February 2008), which was lacking. Consequently, the trial court abused its discretion in denying the plea to the jurisdiction, and the writ of mandamus is conditionally granted, directing the trial court to dismiss the case.

Workers' CompensationMandamusAdministrative RemediesExhaustion DoctrineMedical NecessityExtent of InjuryPreauthorizationJurisdictionPlea to JurisdictionTexas Law
References
18
Case No. 15-0092
Regular Panel Decision

Texas Medical Board and Scott Freshour, in His Official Capacity as General Counsel of the Texas Medical Board v. Teladoc, Inc.

Teladoc, Inc. argues against the Texas Medical Board's (TMB) petition for review, asserting that the Court of Appeals correctly ruled a June 2011 TMB letter constituted an invalid 'rule' under the Administrative Procedure Act (APA). The letter mandated a 'face-to-face' physical examination for establishing a physician-patient relationship, effectively amending an existing rule (22 Tex. Admin. Code § 190.8(1)(L)) without proper notice-and-comment rulemaking. Teladoc contends the letter's departure from the rule's plain text (using 'such as' versus 'including') justified the appellate court's finding. Teladoc further highlights TMB's subsequent initiation of formal rulemaking to amend the rule, implicitly acknowledging the procedural necessity.

Administrative LawRulemaking ProceduresAPADeclaratory JudgmentJudicial ReviewPhysician-Patient RelationshipTelemedicineMedical BoardRegulatory AuthorityFace-to-face Examination
References
25
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
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