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

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. 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

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. 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
Case No. ADJ8742261
Regular
Apr 24, 2015

JOHN MURPHY vs. COUNTY OF FRESNO

The Workers' Compensation Appeals Board granted reconsideration, rescinding the prior order that awarded additional compensation to Cedars-Sinai Medical Center (CSMC). The Board determined that California Administrative Director Rule 9790, as amended, clarifies that regulations allowing payment in excess of the Official Medical Fee Schedule for extraordinary circumstances do not apply to services rendered after January 1, 2004. Therefore, CSMC is not entitled to additional payment beyond the $66,248.58 already paid, as this amount conforms to the 2004 Inpatient Official Medical Fee Schedule for services provided in 2011.

Workers' Compensation Appeals BoardCounty of FresnoCedars-Sinai Medical Center2004 Inpatient Official Medical Fee SchedulePetition for ReconsiderationAdministrative Director Rule 9790Labor Code section 5307.1Senate Bill 228extraordinary circumstanceslien claimant
References
3
Case No. NO. 14-17-00084-CV
Regular Panel Decision
Jul 03, 2018

Elizabeth Protas v. University of Texas Medical Branch at Galveston, David Callender, M.D. Individually and in His Official Capacity, and Danny Jacobs, M.D., Individually and in His Official Capacity

Dr. Elizabeth Protas, a tenured professor at The University of Texas Medical Branch at Galveston (UTMB), filed suit against UTMB and two individual doctors after being ordered to attend a course, suspended without pay, and deemed ineligible for an incentive plan. The trial court dismissed claims against the individual doctors and granted a plea to the jurisdiction for all claims, citing sovereign immunity. Protas appealed, raising issues regarding discovery denial, election of remedies under the Texas Tort Claims Act, due process violations, discrimination claims under the TCHRA, and a claim for declaratory judgment. The appellate court affirmed the dismissal of individual claims and the plea to the jurisdiction for due process and declaratory judgment claims but reversed and remanded the discrimination claims, allowing Protas an opportunity to amend her pleadings.

Employment DiscriminationSovereign ImmunityPlea to the JurisdictionDue ProcessDeclaratory JudgmentTexas Tort Claims ActUltra Vires ClaimTexas Commission on Human Rights ActAppellate ReviewGovernmental Immunity
References
42
Case No. 03-14-00774-CV
Regular Panel Decision
Aug 28, 2015

Texas State Board of Veterinary Medical Examiners, and Nicole Oria, in Her Official Capacity as Executive Director// Ellen Jefferson, D.V.M. v. Ellen Jefferson, D.V.M.// Texas State Board of Veterinary Medical Examiners, and Nicole Oria, in Her Official Capacity as Executive Director

This Amicus Curiae Brief is filed on behalf of Best Friends Animal Society, a national nonprofit animal welfare organization. It opposes the Texas Board of Veterinary Medical Examiners' (the 'Board') enforcement actions against Ellen Jefferson, D.V.M., alleging these actions illegally expand the Board's jurisdiction beyond statutory limits and usurp animal welfare responsibilities delegated to the Texas Board of Health and municipalities. The brief argues the Board's actions violate both unambiguous statutory language and the Board's own rules, attempting to regulate animal welfare instead of merely licensing veterinarians. Best Friends contends that if unchecked, the Board's overreach will debilitate no-kill shelters and lead to an exponential increase in animal euthanasia in Texas.

Veterinary Licensing ActAnimal WelfareTexas Board of Veterinary Medical ExaminersJurisdiction DisputeNo-Kill SheltersRegulatory OverreachStatutory InterpretationAmicus CuriaeProperty RightsTexas Occupations Code
References
59
Case No. SBR 0320298
Regular
Jun 13, 2008

DANILO DeGUZMAN vs. LOMA LINDA UNIVERSITY MEDICAL CLINIC, LOMA LINDA RISK MANAGEMENT

This case concerns a dispute over the reasonable value of medical services provided by West Coast Spine Restoration Center. The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior decision, finding that the defendant properly paid the lien claimant's fees according to the Official Medical Fee Schedule. The Board determined that the lien claimant failed to meet its burden of proof to justify charges exceeding the OMFS for work hardening and functional capacity evaluations.

Workers' Compensation Appeals BoardLoma Linda University Medical CenterLoma Linda Risk ManagementDanilo DeGuzmanIndustrial InjuryRegistered NurseWork HardeningFunctional Capacity EvaluationOfficial Medical Fee ScheduleOMFS
References
1
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