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

Case No. ADJ1236919
Regular
Mar 26, 2009

MIKE H. FORREST vs. APPLE CONTRACTING, STATE COMPENSATION INSURANCE FUND

This case involves a lien claimant seeking reimbursement for psychiatric treatment provided to an applicant whose employment duration precluded a valid industrial psychiatric injury claim. The applicant's orthopedic injury was accepted, and treatment for his psyche was initially authorized by the defendant. However, the Appeals Board denied the lien claimant's petition for reconsideration. The denial was based on the applicant not meeting the six-month employment requirement for psychiatric claims under Labor Code section 3208.3(d). Furthermore, the psychiatric treatment was not deemed a necessary pre-condition to treating the industrial orthopedic injury, and the lien claimant failed to establish the elements of estoppel against the defendant.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationFindings and OrderWCJDisallowed LienPsychiatric TreatmentIndustrial InjuryLabor Code Section 3208.3(d)Six Month Employment Requirement
References
4
Case No. 03-14-00726-CV
Regular Panel Decision
Oct 30, 2014

Texas San Marcos Treatment Center, L.P. D/B/A San Marcos Treatment Center v. Veronica Payton

Texas San Marcos Treatment Center appeals the trial court's denial of its motion to dismiss Veronica Payton's health care liability claim. Payton alleged negligence after being assaulted by a patient at the treatment center. The appellant argues that the expert report provided by Dr. William H. Reid is deficient, lacking factual support and specificity concerning the standard of care, its breach, and causation, as required by Chapter 74 of the Texas Civil Practices and Remedies Code. The appellant asserts the trial court abused its discretion by finding the report adequate and requests dismissal of the claims.

Medical MalpracticeExpert ReportMotion to DismissAbuse of DiscretionStandard of CareBreach of DutyCausationHealth Care Liability ClaimPsychiatric FacilityEmployee Assault
References
25
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. ADJ3552048 (LAO 0795520)
Regular
Feb 28, 2011

JAVIER GALINDO vs. MEAT EXPORTE CORPORATION, STATE COMPENSATION INSURANCE FUND

This case involves a lien claimant's appeal challenging the disallowance of psychiatric treatment costs. The Workers' Compensation Appeals Board (WCAB) affirmed the original decision, finding the applicant did not meet the six-month actual work requirement under Labor Code section 3208.3(d) for psychiatric injury claims. The applicant's extensive absences due to an admitted orthopedic injury meant he did not perform six months of actual service. The WCAB clarified that this six-month threshold applies even to psychiatric injuries stemming from admitted physical injuries. The lien claimant's arguments regarding detrimental reliance and the necessity of treatment for the orthopedic injury were also rejected.

Labor Code Section 3208.3(d)psychiatric injurysix months actual worklien claimantindustrial orthopedic injurydetrimentally reliedimplied authorizationWorkers' Compensation Appeals BoardFindings and OrderPetition for Reconsideration
References
6
Case No. ADJ3637976 (BAK 0135676)
Regular
Jul 17, 2012

ANGEL VILLATORO vs. KERN LABOR CONTRACTING, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for PAULA INSURANCE, in liquidation

The Workers' Compensation Appeals Board affirmed the disallowance of the Center for Orthopedic Surgery's (COS) lien for unpaid medical treatment. COS provided treatment in 2001, received a partial payment from the insurer, Paula Insurance, and later filed a lien claim in 2011. The Board found the lien claim was barred by the statute of limitations under Labor Code Section 4903.5, which dictates specific filing deadlines after injury, service, or case resolution. Arguments for equitable tolling or estoppel were rejected, as COS unreasonably delayed filing its lien for nearly nine years after the insurer's partial payment.

CIGAPaula InsuranceCenter for Orthopedic SurgeryLien claimStatute of limitationsLabor Code § 4903.5Compromise & ReleaseReconsiderationMedical treatment lienEquitable estoppel
References
19
Case No. ADJ2015796
Regular
Nov 24, 2010

Stella Cunningham vs. Addus Health Care, Department of Social Services, IHSS, State Compensation Insurance Fund

In this workers' compensation case, the applicant sustained an industrial injury in 2007. The administrative law judge (WCJ) previously denied a lien claim for $\$3,935.00$ from Industrial Psychiatric Network, finding no substantial medical evidence supported the necessity of their treatment for the admitted orthopedic injury. The lien claimant sought reconsideration, arguing their treatment was necessary for the industrial injury. However, the Appeals Board dismissed the petition for reconsideration as untimely, as it was filed more than 25 days after the WCJ's decision was served by mail. Therefore, the lien claimant's petition is dismissed due to jurisdictional untimeliness.

Industrial Psychiatric NetworkPetition for ReconsiderationFindings and OrderCompromise and Releaseburden of proofsubstantial medical evidencereasonable and necessary treatmentadmitted orthopedic injuryuntimelyjurisdictional
References
2
Case No. ADJ1629506
Regular
Sep 18, 2014

MARIA MURILLO vs. HACIENDA HOTEL, US FIRE INSURANCE COMPANY, CRUM & FORSTER, ELENA KONSTAT, PHD

This case involves a lien claim by Dr. Elena Konstat for $35,443.85 for psychological treatment provided to applicant Maria Murillo. The WCAB denied reconsideration of the WCJ's order disallowing the lien. The WCJ found that the psychological treatment was not causally related to the applicant's industrial orthopedic injury, especially since a prior award found no psyche injury and the issue of medical-legal charges was not raised at trial.

Workers' Compensation Appeals BoardPetition for ReconsiderationMedical-legal chargesLien ClaimantFindings and OrderPermanent disabilityOrthopedic injuriesPsyche injurySuicidal tendenciesAdmissible evidence
References
3
Case No. ADJ716826 (VNO 0465033)
Regular
Feb 03, 2012

Frances Welch vs. East Ventura Medical Group, The Hartford

This case concerns a lien claim filed by Center for Orthopedic Surgery (COSI) for medical treatment provided to Frances Welch. The Workers' Compensation Appeals Board affirmed a prior decision barring COSI's lien. The Board found COSI's lien was filed outside the six-month limit from the final award issuance, despite their argument that timely billing and lack of settlement document service should toll the statute. COSI's inaction for seven years after partial payment, without filing a lien, precluded any claim of tolling. The Board clarified that partial payment does not obligate the defendant to serve the provider with all settlement documents if no lien is on file.

Labor Code section 4903.5lien claimantCenter for Orthopedic SurgeryPetition for ReconsiderationtollingLabor Code section 4904(a)Stipulations with Request for Awardpermanent disabilitystatute of limitationsLabor Code section 4903.1(c)
References
0
Case No. ADJ3246489 (LAO 0849769) ADJ3868191 (LAO 0851408)
Regular
Jun 14, 2011

JULIO ALCOCER vs. THE CALIFORNIA CLUB, STATE COMPENSATION INSURANCE FUND, CHUBB SERVICES CORPORATION, NORTH RIVER INSURANCE COMPANY, ONE OF CRUM AND FORSTER COMPANIES

Lien claimant L.A. Orthopedic sought reconsideration of a Notice of Intent to dismiss its lien, arguing it didn't receive proper notice of the lien conference. However, the Workers' Compensation Appeals Board dismissed the petition as moot. This is because the administrative law judge, within the allowed timeframe, rescinded the order of dismissal. Therefore, the initial notice of intent was no longer a final order from which to seek reconsideration.

Lien ClaimantReconsideration PetitionNotice of Intent to DismissLien ConferenceWorkers' Compensation Administrative Law JudgeAppeals Board Rule 10562Report and RecommendationCompromise and ReleaseSpecific InjuryCumulative Trauma
References
1
Case No. LAO 0837305, LAO 0837306
Regular
Apr 29, 2008

IRMA ALEJANDRA VILLAMAN vs. CALIFORNIA CLEANING SERVICE, CLARENDON NATIONAL INSURANCE COMPANY c/o AMERICAN ALL RISK LOSS ADMINISTRATORS

The Workers' Compensation Appeals Board denied the defendant's petition to reconsider the allowance of Dr. Kan's lien for medical treatment related to the applicant's industrial injuries. However, the Board granted the lien claimant's petition to clarify the award. Upon reconsideration, the Board amended the original award to disallow reimbursement for "work conditioning" services, reducing Dr. Kan's lien from $7,998.35 to $7,858.35.

Workers' Compensation Appeals BoardPetition for ReconsiderationLien ClaimantFindings and AwardIndustrial InjuryCompensableCompromise and ReleaseMedical TreatmentChiropractic VisitsWork Conditioning
References
1
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