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

Case No. 03-02-00089-CV
Regular Panel Decision
Mar 27, 2003

Envoy Medical Systems, L.L.C. and Independent Review Incorporated v. State of Texas Greg Abbott, Attorney General of Texas And Jose Montemayor, Insurance Commissioner of Texas

Appellants Envoy Medical Systems, L.L.C. and Independent Review Incorporated appealed a trial court's judgment concerning the disclosure of certain records under the Public Information Act. The case originated from a request for information made to the Texas Department of Insurance related to appellants' applications for certification as Independent Review Organizations (IROs). The Attorney General had previously ruled that the requested information, including reviewer lists, contracts, and compensation, could not be withheld. Appellants argued that the information was 'confidential by law' and also excepted from disclosure under the commercial or financial information clause of the PIA. The appellate court reviewed for abuse of discretion and affirmed the trial court's judgment, concluding that appellants failed to meet their burden to prove an exception to disclosure applied.

Public Information ActDisclosure of RecordsIndependent Review OrganizationsConfidentialityCommercial InformationFinancial InformationAbuse of DiscretionAppellate ReviewInjunctive ReliefAdministrative Law
References
12
Case No. MISSING
Regular Panel Decision

McKelvy v. Columbia Medical Center of McKinney Subsidiary, L.P.

Jeannie McKelvy, an employee of Columbia Medical Center of McKinney Subsidiary, L.P., d/b/a McKinney Medical Center (the Hospital), sustained injuries from a slip and fall at work due to leaking lab equipment. She filed a negligence claim against the Hospital, which is a non-subscriber to workers' compensation insurance. The Hospital moved to dismiss her claims under the Texas Medical Liability Act (Chapter 74) for failure to file an expert report, arguing her claims were health care liability claims. The trial court granted the Hospital's motion. On appeal, McKelvy argued her claims were ordinary negligence claims, not subject to Chapter 74. The appellate court reviewed the definition of a 'health care liability claim' under section 74.001(a)(13) of the Texas Civil Practices and Remedies Code. The court concluded that McKelvy's claims, stemming from a hazardous floor caused by leaking lab equipment, did not have an indirect relationship to the provision of health care and did not involve a patient-physician relationship. Therefore, her claims were not health care liability claims, and the trial court erred in dismissing her case. The appellate court reversed the trial court's order and remanded the case for further proceedings.

References
5
Case No. MISSING
Regular Panel Decision

Claim of Coratti v. Jon Josef Hair & Colour Group

The Workers' Compensation Board denied a claimant's motion to preclude a workers’ compensation carrier’s consultant report, which was based solely on a review of medical records, not an independent medical examination (IME). The claimant argued non-compliance with Workers’ Compensation Law § 137 (1) (b), a provision requiring notice if an IME is performed. The Board concluded the statute does not apply to records-review-only reports. An appellate court affirmed, holding that the plain language of § 137 (1) (b) explicitly refers to practitioners who have performed or will perform an IME, thereby excluding those who solely review records. The court emphasized that statutory interpretation must adhere to plain language, leaving policy arguments to the Legislature.

IME reportsrecords reviewWorkers' Compensation Lawstatutory interpretationpreclusion motioncausationoccupational illnessdue processlegislative intent
References
3
Case No. 2015-08-0509
Regular Panel Decision
Feb 12, 2016

Kelly, Thomas v. Catmur Development Co.

This expedited hearing addressed employee Thomas Kelly's claim for medical benefits for emergency air transport and attorney fees against employer Catmur Development Co. and its insurer, Builders Mutual Insurance Co. Mr. Kelly suffered a severe workplace injury, severing his left thumb, which necessitated an air ambulance transfer for attempted replantation surgery. Catmur denied payment for the air transport based on a utilization review, despite the Bureau's Medical Director overturning this denial. The Court, asserting its authority to independently review medical necessity, found Mr. Kelly was likely to prevail. Consequently, the Court ordered Catmur to cover the $52,900 air ambulance bill and granted a 20% attorney's fee lien on this payment.

Medical BenefitsAttorney FeesExpedited HearingAir Ambulance TransportUtilization Review DenialMedical Necessity DisputeThumb InjuryReplantation SurgeryShelby CountyJudge Jim Umsted
References
4
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. 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. 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. 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. 03-18-00232-CV
Regular Panel Decision
Aug 28, 2018

Joseph Cotropia M.D. v. Texas Medical Board and in His Official Capacity Only, Sherif Zaafran, President of the Texas Medical Board

Appellant Joseph Cotropia, M.D., challenged the Texas Medical Board's revocation of his license to practice medicine. The Board's decision stemmed from his failure to adequately supervise advanced practice nurses at two pain management clinics, resulting in substandard patient care and operation of an uncertified clinic. Dr. Cotropia argued against being held strictly liable for the APNs' actions, the clinic's certification status, the admissibility of expert testimony, and alleged due process violations. The appeals court reviewed the Board's findings under a substantial-evidence standard. Ultimately, the court found no error in the district court's judgment and affirmed the revocation of his license.

Medical License RevocationPhysician SupervisionAdvanced Practice NursesPain Management ClinicStandard of CareMedical Practice ActAdministrative LawDue ProcessExpert TestimonyTexas Medical Board
References
15
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