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Case Law Database

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

Case No. 04-09-00148-CV
Regular Panel Decision
Dec 09, 2009

Central Texas Orthopedic Products, Inc. v. Andrew Espinoza and Howmedica Osteronics Corp. D/B/A Stryker Orthopedics

Central Texas Orthopedic Products, Inc. (CTOP) sued Andrew Espinoza for breach of contract and fiduciary duty, and Howmedica Osteonics Corp. d/b/a Stryker Orthopedics (Stryker) for tortious interference. The trial court granted partial summary judgment for Espinoza and Stryker, and a jury found Espinoza breached fiduciary duty but awarded no damages. On appeal, CTOP challenged the summary judgments and attorney's fees awarded to Espinoza. The appellate court found the trial court erred in applying the unclean hands doctrine to CTOP's claims as the alleged misconduct was separate from the disputed contract. The court also found a genuine issue of material fact regarding Espinoza's entitlement to compensation due to his alleged breach of fiduciary duty. Therefore, the appellate court reversed the trial court's judgment and remanded the case for further proceedings.

Breach of ContractBreach of Fiduciary DutyTortious InterferenceSummary JudgmentUnclean Hands DoctrineNon-Compete AgreementCompensation AgreementTexas Payday ActAppellate ReviewReversed and Remanded
References
15
Case No. ADJ10917207
Regular
Aug 13, 2019

CARMEN ROJO vs. K & M MEAT COMPANY, STARR INDEMNITY & LIABILITY COMPANY

This case involves a dispute over the necessity of an additional Qualified Medical Evaluator (QME) panel in orthopedic surgery. The Applicant sought reconsideration of an administrative law judge's (ALJ) order for a new orthopedic QME panel, arguing it was an abuse of discretion and prejudicial. The Appeals Board granted reconsideration, finding the original QME's referral for an orthopedic evaluation was for treatment, not a recommendation for a new medical-legal evaluation. Consequently, the Board amended the ALJ's findings, holding there was no good cause for an additional orthopedic QME panel and denying the defendant's request.

QME panelorthopedic surgeryreconsiderationremovalFindings & Orderchiropractic QMEmedical-legal evaluationgood causesupplemental pleadingmedical dispute
References
9
Case No. ADJ9975590; ADJ9976116
Regular
Feb 25, 2016

Ana Nieto vs. Avitus, Inc., American Zurich Insurance Company

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for reconsideration, finding the appealed order was interlocutory and not subject to reconsideration. The WCAB treated the petition as one for removal and denied it, as the defendant failed to demonstrate substantial prejudice or irreparable harm. The defendant's contention that their trial exhibits and an orthopedic QME panel were erroneously stricken was rejected, as was their claim that the orthopedic QME panel was improperly denied. The defendant failed to provide sufficient evidence to support their request for an orthopedic QME panel over a chiropractic one.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalJoint Findings of Fact & OrdersQualified Medical Evaluator (QME)Orthopedic Surgery QMEChiropractic QMETrial ExhibitsAdministrative Law Judge (WCJ)Labor Code § 4062.2
References
6
Case No. ADJ11913752
Regular
Nov 19, 2019

LAURA DOW vs. UCSF, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES

This case concerns a dispute over the proper procedure for requesting a Qualified Medical Evaluator (QME) panel after a workers' compensation claim was denied. The Workers' Compensation Appeals Board (WCAB) granted removal, reversing a WCJ's decision. The WCAB found that the defendant's request for an orthopedic surgery QME panel was valid, initiated after the denial notice and statutory waiting period. They also determined that orthopedic surgery was an appropriate specialty, overriding the WCJ's order for a pain medicine panel. The parties are now directed to proceed with the orthopedic surgery QME panel.

QME panelPetition for RemovalOpinion and OrderFindings and OrdersMedical UnitPain MedicineOrthopedic SurgeryDenial NoticeQualified Medical EvaluatorLabor Code Section 4060
References
4
Case No. ADJ8491619 ADJ9586677
Regular
May 17, 2019

Edward GAA vs. Intercare Holdings Insurance, The Hartford

The Workers' Compensation Appeals Board granted applicant's petition for removal, overturning a prior order that denied a rheumatological evaluation. While dismissing the petition for reconsideration, the Board found good cause for an additional QME panel in rheumatology, acknowledging the orthopedic QME's limited expertise in this specialty. The applicant must still attend a re-evaluation with the orthopedic QME, who must review a job analysis.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalQualified Medical Evaluator (QME)Rheumatological evaluationOrthopedic QMECumulative traumaIndustrial injuryMedical-legal issuesBias
References
1
Case No. ADJ8182717, ADJ8253375, ADJ8253377
Regular
May 18, 2018

VICTOR MCGILL vs. COUNTY OF FRESNO

This case involves a workers' compensation applicant seeking reconsideration of a judge's decision invalidating a chiropractic QME panel. The Appeals Board dismissed the petition for reconsideration as the judge's order was not a final determination. However, the Board granted removal, finding that an orthopedic QME panel was necessary for the applicant's foot and Achilles tendon injuries, as chiropractic was not the appropriate specialty. The decision rescinds the judge's order and returns the matter for further proceedings to obtain an additional orthopedic QME evaluation.

WCABRemovalReconsiderationQMEMedical DirectorChiropracticOrthopedic SurgeryPanelFindings of Fact and OrderMedical Unit
References
0
Case No. ADJ11861160
Regular
Oct 25, 2019

ADRIANA MARTINEZ vs. AVITUS, AMERICAN ZURICH INSURANCE COMPANY, GALLAGHER BASSETT SERVICES

This case involves a dispute over the selection of Qualified Medical Evaluator (QME) panels for an applicant with claimed injuries to multiple body parts. The Workers' Compensation Appeals Board (WCAB) granted the applicant's petition for removal, rescinded the prior decision, and found that the applicant's chiropractic QME panel request was proper while the defendant's orthopedic surgery panel request was improper. The WCAB determined that chiropractic medicine is the appropriate specialty and struck the orthopedic surgery panel, ordering the parties to proceed with the chiropractic QME. The WCAB clarified that while chiropractors cannot perform surgery or prescribe medication, they are qualified to evaluate injuries within their scope of practice.

QME panel disputeremoval petitionchiropractic specialtyorthopedic surgery specialtyLabor Code 4062.2Medical Directoradministrative law judgeWorkers' Compensation Appeals Boardproper panel selectioninvalid panel request
References
9
Case No. LBO 0383944
Regular
Apr 07, 2008

GABRIEL RODRIGUEZ vs. GARDENA NISSAN, SENTRY CLAIMS SERVICE

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for reconsideration, finding the prior order was procedural and not final. However, the WCAB granted removal, rescinded the prior order, and authorized the defendant to obtain a second orthopedic QME. This decision was based on the necessity of obtaining crucial medical evidence regarding the applicant's orthopedic condition, which the current internal medicine QME could not address, thus preventing a just adjudication.

Workers' Compensation Appeals BoardPetition for ReconsiderationGranting RemovalDecision After RemovalSpecialty Physician Panel QMEOrthopedicsMedical UnitLabor Code section 4062.2Industrial InjuryLeft Shoulder
References
0
Case No. ADJ9099536
Regular
Sep 09, 2014

MARIA SOTO vs. CCC HOSPITALITY PISMO, LLC dba SEACREST OCEANFRONT HOTEL, STAR INSURANCE COMPANY

In this case, the defendant hospital sought removal after the WCJ ordered a chiropractic QME panel, arguing chiropractors were unqualified for the applicant's knee injury. The defendant had initially requested an orthopedic surgeon QME, but their request was rejected by the Medical Unit as incomplete. The Appeals Board found the defendant's initial request substantially complied with regulations and was improperly rejected. Therefore, the Board granted removal, rescinded the WCJ's order, and directed the Medical Unit to issue a panel of orthopedic surgery QMEs.

Petition for RemovalPQMEMedical UnitChiropractic QMEOrthopedic Surgery QMERequest for QME PanelAdministrative Director Rule 30(b)Labor Code section 4062.2Messele v. Pitco FoodsInc.
References
1
Case No. 13-13-00552-CV
Regular Panel Decision
Feb 12, 2015

Nolana Open MRI Center, Inc. v. Guillermo R. Pechero M.D.Ruben D. Pechero M.D. Maplestar Orthopedics, P. A.

Nolana Open MRI Center, Inc. appealed a judgment rendered against it following a bench trial. The appellees, Guillermo R. Pechero, M.D., Ruben D. Pechero, M.D., and Maplestar Orthopedics, P.A., filed a motion to show authority, contending Nolana's counsel lacked the authority to bring the appeal. The underlying dispute involved the sale of Nolana's assets, patient referrals, lease agreements, and counterclaims for fraudulent inducement, conversion, and breach of contract. A key issue was a 50-50 ownership split in Nolana between Jose Castro and Agustin Garcia, where Castro had settled with defendants and granted them limited power of attorney to oppose litigation, while Garcia sought to authorize the appeal. The Court of Appeals, reviewing the trial court's findings, concluded that Nolana's counsel lacked standing due to the unresolved ownership conflict regarding the authority to initiate the appeal.

Appellate ProcedureJurisdictionMotion to Show AuthorityCorporate AuthorityShareholder DisputeLimited Power of AttorneyBreach of ContractTheft Liability ActFraudulent InducementTortious Interference
References
30
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