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

Case No. 2017-06-1778
Regular Panel Decision
Apr 11, 2018

Demotte, Julie v. UPS

Julie Demotte sustained a workplace injury involving a broken hip and leg in November 2016 while working for UPS. UPS initially accepted the claim and provided temporary disability benefits. Dr. Jason Evans, the authorized treating physician, placed Ms. Demotte at maximum medical improvement and assigned a three-percent whole-person impairment rating. A compensation hearing was held to determine Ms. Demotte's entitlement to permanent disability, temporary disability, and future medical benefits. The Court ordered UPS to provide lifetime medical benefits for Ms. Demotte's workplace injury, but denied her claims for both temporary and permanent disability benefits. The denial of permanent disability was based on the inadmissibility of Form C-30A as proof of impairment, as Ms. Demotte failed to present admissible evidence. Additionally, the claim for further temporary disability benefits was denied due to an earlier overpayment by UPS that exceeded any subsequent amounts due.

Workplace InjuryFuture Medical BenefitsTemporary Disability BenefitsPermanent Disability BenefitsAdmissibility of Medical ReportsForm C-30AForm C-32Impairment RatingHearsayMaximum Medical Improvement
References
2
Case No. MISSING
Regular Panel Decision

Claim of VanDermark v. Frontier Insurance

In this workers' compensation appeal, the employer and its carrier challenged two decisions by the Workers’ Compensation Board concerning a claimant's permanent total disability. The claimant sustained a back injury in 1998 and was initially found to have a permanent partial disability. However, the Board later modified the award, concluding the claimant had a permanent total disability after August 2004, a finding supported by the testimony of her treating orthopedic surgeon despite conflicting medical evidence. The employer also contested the denial of their applications for reconsideration and/or full Board review, arguing insufficient evidence and an abuse of discretion. The appellate court affirmed the Board's decisions, deferring to its resolution of conflicting medical evidence and finding no arbitrary or capricious action in denying reconsideration, as no new evidence was presented.

Workers' Compensation LawPermanent Total DisabilityPermanent Partial DisabilityMedical EvidenceConflicting Medical OpinionsBoard's DiscretionReconsideration ApplicationFull Board ReviewAppellate ReviewSufficiency of Evidence
References
6
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. MISSING
Regular Panel Decision

Matter of Wohlfeil v. Sharel Ventures, LLC

The claimant, injured in October 2007, was initially found by a Workers’ Compensation Law Judge and affirmed by the Workers’ Compensation Board to have a permanent partial disability and a 75% loss of wage-earning capacity. The claimant subsequently appealed this decision. Medical experts, including the claimant's treating physician, Clifford Ameduri, and an independent medical examiner, Guy Corkhill, consistently testified that the claimant was totally disabled and incapable of any gainful employment. Despite this overwhelming medical evidence, the Board concluded that the claimant could perform sedentary work. The appellate court reversed the Board's findings, determining that they were not supported by substantial evidence in the record. The court concluded that the evidence actually warranted a finding of a permanent total disability for the claimant.

Permanent Partial DisabilityLoss of Wage-Earning CapacitySpinal FusionSpinal Cord StimulatorMedical TestimonyIndependent Medical ExaminationSedentary WorkTotal DisabilitySubstantial EvidenceAppellate Review
References
3
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. MISSING
Regular Panel Decision

Claim of Martone v. Niagara Frontier Transportation Authority-Metro

In 2005 and 2007, a bus driver (claimant) suffered work-related neck and back injuries. Initially, a Workers’ Compensation Law Judge found him permanently totally disabled. However, the Workers’ Compensation Board modified this, determining he had a permanent partial disability with a 75% loss of wage-earning capacity based on medical evidence and other factors. The claimant appealed this decision, arguing a lack of substantial evidence for the partial disability finding. The Appellate Division affirmed the Board's decision, noting medical reports indicating submaximal efforts, high medication dosages, symptom magnification, and the ability to ambulate, which supported the finding of partial disability. The court also upheld the 75% loss of wage-earning capacity, finding it supported by substantial evidence after considering the claimant's impairment, work restrictions, age, education, and work experience.

Permanent Partial DisabilityWage-Earning CapacityChronic Pain SyndromeLumbar Spine SurgeryMedical EvidenceSubmaximal EffortsSymptom MagnificationAppellate ReviewBoard DecisionMedical Treatment Guidelines
References
2
Case No. 2019-01-0630
Regular Panel Decision
Oct 28, 2020

Ferguson, Anne Michelle v. Amazon.com, Inc.

Anne Michelle Ferguson, an Amazon employee, sought permanent total disability and medical benefits for complex regional pain syndrome (CRPS) after injuring her left foot at work in October 2017. Amazon contended that benefits should be limited to a foot contusion and sought a credit for overpayment of temporary partial disability benefits. The Court weighed competing medical expert opinions, ultimately giving greater weight to Dr. Dreskin's diagnosis of compensable CRPS. Consequently, the Court awarded Ms. Ferguson permanent partial disability benefits of $8,858.13 and ongoing medical benefits, including access to a panel of CRPS specialists. However, her claim for permanent total disability was denied as she was deemed capable of sedentary work, and Amazon received a credit for previously overpaid temporary benefits.

Workers' CompensationPermanent Partial DisabilityComplex Regional Pain Syndrome (CRPS)Medical BenefitsVocational DisabilityMaximum Medical Improvement (MMI)Temporary Partial DisabilityPain ManagementMedical Expert TestimonyFoot Injury
References
5
Case No. MISSING
Regular Panel Decision

Matter of Williams v. Preferred Meal Systems

Claimant, a driver, suffered injuries to his right knee and back in 2009 while making a delivery, leading to an established workers' compensation claim. The claim was later amended to include consequential adjustment disorder, and the Workers' Compensation Board ultimately found that claimant had sustained a permanent total disability from May 2012 onward. The employer, workers’ compensation carrier, and policy administrator appealed this decision, arguing that further proof was needed regarding claimant's vocational and functional capacity. The court affirmed the Board's decision, holding that extensive evidence of vocational and functional capacity is not required when medical proof demonstrates a permanent total disability and inability to engage in any gainful employment, as benefits continue for life in such cases. The court found substantial evidence in the opinions of treating and independent medical examination orthopedists to support the finding of permanent total disability.

Workers' CompensationPermanent Total DisabilityWage-Earning CapacityMedical ProofVocational CapacityFunctional CapacityAppellate ReviewNew York LawDisability BenefitsClaimant Rights
References
4
Case No. 12-15-00014-CV
Regular Panel Decision
Jun 03, 2015

East Texas Medical Center D/B/A East Texas Medical Center Emergency Medical Services v. Jody Delaune Individually and as Personal Representative of the Estate of Crystal Delaune, and as Next Friend of D. D., D. D. and D. A. D., Minors

The appellant, East Texas Medical Center (ETMC), appeals a judgment finding it negligent for failing to train its EMS providers. The core issue revolves around whether ETMC adequately trained its employees on patient restraint protocols in a behavioral emergency, which allegedly led to the death of Crystal Delaune. ETMC argues that there is legally insufficient evidence to establish proximate cause because the EMS providers were previously found not negligent. Additionally, ETMC contends the appellee's expert testimony on the standard of care and breach was conclusory and based on improper inference-stacking. The appellant seeks a reversal of the verdict and a take-nothing judgment.

Negligent TrainingProximate CauseLegal Sufficiency of EvidenceStandard of CareEmergency Medical ServicesAppellate ReviewSummary JudgmentEmployee MisconductMedical Negligence DefenseExpert Witness Testimony
References
51
Case No. ADJ3156337 (FRE 0209931) ADJ4199467 (FRE 0209932)
Regular
Nov 20, 2008

FRANK FLORES vs. NICKEL'S PAYLESS STORES, WAUSAU INSURANCE COMPANIES, EVEREST NATIONAL INSURANCE COMPANY, AMERICAN COMMERCIAL CLAIMS ADMINSITRATORS

The Workers' Compensation Appeals Board granted reconsideration of an award for a 1999 right foot and ankle injury, specifically addressing the defendant's claims of error in permanent disability calculation without apportionment and the exclusion of medical evidence. The Board intends to admit the Agreed Medical Evaluator's reports into evidence, which the WCJ had previously excluded. This decision will allow the Board to review all relevant medical evidence before making a final determination on apportionment and the applicant's claimed injuries.

Workers Compensation Appeals BoardIndustrial InjuryPermanent Partial DisabilityApportionmentAgreed Medical EvaluatorSubstantial Medical EvidenceAdmissibility of EvidencePetition for ReconsiderationAmended Findings Award and OrderMinutes of Hearing
References
0
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