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

Case No. 2024-50-2711
Regular Panel Decision
Feb 20, 2026

Lusk v. Portopiccolo Group LLC, dba The Portopiccolo Group

This interlocutory appeal concerns an employer's denial of medical treatment for an employee's work-related injuries. Employee Cheryl Lusk, injured by a resident at Portopiccolo Group, LLC, was recommended for cervical spine surgery by her authorized treating physician, Dr. John Burleson. The employer denied the surgery based on a utilization review report, which was upheld by the Bureau's Medical Director. The trial court, however, ordered the employer to provide the surgery, relying on the presumption of medical necessity for treatment recommended by an authorized physician. The Appeals Board affirmed the trial court's decision, concluding that the employer failed to rebut this presumption, and remanded the case for further proceedings.

Workers' CompensationMedical Treatment DenialUtilization ReviewSurgical AuthorizationPresumption of Medical NecessityEmployer AppealCervical Spine InjuryACDF SurgeryAuthorized Treating PhysicianBurden of Proof
References
8
Case No. 13-15-00024-CV
Regular Panel Decision
Jul 06, 2015

Maria Zamarripa, as Temporary Guardian of the Estates of R. F. R. and R. J. R., Minors, and Olga Flores, as Temporary Administrator of the Estate of Yolanda Iris Flores v. Bay Area Health Care Group, Ltd. D/B/A Corpus Christi Medical Center, Hidalgo County EMS, and Hidalgo County Emergency Medical Service Foundation

This case involves an appeal by Maria Zamarripa and Olga Flores (Appellants) against Bay Area Health Care Group, Hidalgo County EMS, and Hidalgo County Emergency Medical Service Foundation (Appellees). The Appellants are challenging the trial court's orders that granted the Appellees' motions to dismiss. The core of the appeal centers on the qualifications of Nurse Spears as an expert witness and the sufficiency of expert reports regarding the standard of care, its breach, and causation in a medical malpractice claim involving Yolanda Iris Flores's injuries and death from placenta accreta and pre-term labor. Appellants argue that Nurse Spears is qualified, the expert reports adequately connect CCMC's alleged breach of care to the injuries, and alternatively, they are entitled to amend the reports. They pray for the reversal of the trial court's dismissal orders and a remand for further proceedings.

Medical MalpracticePlacenta AccretaPre-term LaborMedical NegligenceStandard of CareCausationExpert Witness QualificationsHospital LiabilityEmergency Medical Services (EMS)Wrongful Death
References
16
Case No. 23-0697
Regular Panel Decision
Jun 28, 2024

State of Texas Office of the Attorney General of the State of Texas Texas Medical Board Texas Health and Human Services Commission And Ken Paxton, in His Official Capacity as Attorney General of the State of Texas v. Lazaro Loe, Individually and as Next Friend of Luna Loe, a Minor Mary Moe and Matthew Moe, Individually and as Next Friends of Maeve Moe, a Minor Nora Noe, Individually and as Next Friend of Nathan Noe, a Minor Sarah Soe and Steven Soe, Individually and as Next Friends of Samantha Soe, a Minor Gina Goe, Individually and as Next Friend of Grayson Goe, a Minor Pflag, Inc. Richard Ogden Roberts III, M.D. David L. Paul, M.D. Patrick W. O'malley, M.D. And American Association of Physicians for Human

The Supreme Court of Texas reversed and vacated a temporary injunction against Senate Bill 14, which prohibits certain medical treatments for minors related to gender transition. Parents of children with gender dysphoria, along with physicians and LGBTQ+ advocacy groups, had challenged the law as unconstitutional, alleging infringements on parental rights, occupational freedom for physicians, and discrimination based on sex and transgender status. The Court concluded that the plaintiffs failed to establish a probable right to relief, asserting that parental rights are not absolute and the Legislature has constitutional authority to regulate medicine, especially regarding novel treatments for new conditions. The Court also found no unconstitutional discrimination, stating the law treats males and females equally in its prohibitions and that "transgender status" is not a protected class under the Texas Constitution.

Parental RightsMedical RegulationGender DysphoriaConstitutional LawDue Course of LawEqual ProtectionTransgender RightsMinors' Medical TreatmentLegislative AuthorityTexas Supreme Court
References
62
Case No. 13-15-00118-CV
Regular Panel Decision
Nov 19, 2015

Bay Area Healthcare Group, Ltd., D/B/A Corpus Christi Medical Center v. Brenda Martinez

Brenda Martinez, a housekeeper for Bay Area Healthcare Group, Ltd. (dba Corpus Christi Medical Center), sued her employer after sustaining a shoulder injury during "trash and linen duty," which involved heavy lifting. She alleged negligence, claiming BAHG failed to provide a safe work environment and proper assistance. BAHG moved to dismiss, arguing her claim was a "health care liability claim" (HCLC) under the Texas Medical Liability Act (TMLA) requiring an expert report. The trial court denied the motion. The Court of Appeals affirmed, concluding Martinez's claim was not an HCLC as it lacked a substantive relationship with the provision of medical care and instead concerned general workplace safety, not duties specific to a healthcare provider.

Texas Medical Liability ActHealth Care Liability ClaimWorkplace Safety StandardsEmployer NegligenceExpert Report RuleAppellate ProcedureStatutory InterpretationRoss factorsMedical Professional DutiesNon-subscriber Employer
References
5
Case No. 25 NY3d 907
Regular Panel Decision
2015-XX-XX

Government Employees Insurance v. Avanguard Medical Group, PLLC

This case addresses whether no-fault insurance carriers are obligated to pay facility fees to New York State-accredited office-based surgery (OBS) centers for the use of their premises and support services. The court concluded that neither existing statutes nor regulations mandate such payments. Plaintiffs, a group of GEICO insurers, successfully sought a declaratory judgment that they are not legally required to reimburse Avanguard Medical Group, PLLC, for OBS facility fees, totaling over $1.3 million. The decision affirmed the Appellate Division's ruling, emphasizing that OBS facility fees are not explicitly covered by statute or fee schedules, nor do they fall under reimbursable "professional health services" as per 11 NYCRR 68.5. The court highlighted the distinct regulatory frameworks for OBS centers compared to hospitals and ambulatory surgery centers, declining to mandate policy changes best left to the legislature.

No-Fault InsuranceOffice-Based Surgery (OBS)Facility FeesInsurance LawBasic Economic LossFee SchedulesWorkers' Compensation BoardDepartment of Financial ServicesStatutory InterpretationRegulatory Framework
References
16
Case No. 14-08-00399-CV
Regular Panel Decision
Sep 10, 2009

Orville Losier and Wife Joelle Losier v. Shivarajpur K. Ravi, M.D., and Ambika Medical Group, P.A.

Appellants Orville and Joelle Losier appealed a unanimous jury verdict in favor of appellees Shivarajpur K. Ravi, M.D., and Ambika Medical Group, P.A., in a medical malpractice case. The Losiers claimed the trial court erred by refusing a res ipsa loquitur jury instruction and by denying a motion for new trial based on juror misconduct. The appellate court affirmed the trial court's judgment, concluding that res ipsa loquitur did not apply as the IDET procedure and catheter retention were not matters of common lay knowledge requiring expert testimony. Additionally, the court found insufficient evidence to prove probable injury from the alleged juror misconduct, despite acknowledging impropriety in the contact. Consequently, the appellate court affirmed the trial court's judgment.

Medical malpracticeRes ipsa loquiturJuror misconductIDET procedureCatheter retentionNegligenceTexas civil procedureAppellate reviewExpert witnessTrial court discretion
References
21
Case No. 2018-01-0388
Regular Panel Decision
Jan 08, 2019

Vanveldhuizen, John v. Crown Automotive Group, Inc.

John Vanveldhuizen, an employee, requested an expedited hearing against Crown Automotive Group, Inc. and FFVA Mutual Ins. Co. concerning the authorization of a third lumbar surgery recommended by his treating physician, Dr. Jay Jolley. Crown denied the surgery based on a utilization review physician's opinion, Dr. Richard Lutz, who deemed it not medically necessary. The Court, however, sided with the treating physician, Dr. Jolley, affording his opinion a presumption of medical necessity due to his long history of treating the employee and the lack of compelling evidence from Crown to rebut this presumption. Ultimately, the Court ordered Crown to authorize the recommended surgery.

Lumbar surgeryMicrodiskectomyFusion surgeryRadiculopathyDisk herniationUtilization reviewMedical necessityTreating physicianExpedited hearingWorkers' Compensation Appeals Board
References
5
Case No. 03-19-00484-CV
Regular Panel Decision
Jun 04, 2021

Dr. Lawrence Broder, M.D. and Round Rock Medical Aesthetics & Urgent Care PLLC D/B/A Beleza Medspa v. Nexstar Broadcast Group, Inc. KXAN-TV And Jody Barr

This case involves an appeal by Dr. Lawrence Broder, M.D. and Round Rock Medical Aesthetics & Urgent Care PLLC d/b/a Beleza Medspa against Nexstar Broadcast Group, Inc., KXAN-TV, and Jody Barr. The appellants sued for defamation, business disparagement, and tortious interference after KXAN-TV aired a news report by Jody Barr regarding complaints filed against Dr. Broder with the Texas Medical Board (TMB) and the death of a patient following plastic surgery. The appellees filed a motion to dismiss under the Texas Citizens Participation Act (TCPA), which the trial court granted. The Court of Appeals affirmed the trial court's dismissal, finding that the TCPA applied, the appellants failed to establish a prima facie case for their claims, and the attorney's fee award to the appellees was reasonable. The court specifically noted that the news report was substantially true and concerned matters of public interest, thus protected under free speech.

DefamationBusiness DisparagementTortious InterferenceTexas Citizens Participation ActTCPAFree SpeechMedical MalpracticeTexas Medical BoardTMBMedia Privilege
References
30
Case No. 2014-1081 K C
Regular Panel Decision
Oct 05, 2016

High Quality Med. Supplies, Inc. v. Mercury Ins. Group

This case involves an appeal concerning assigned first-party no-fault benefits sought by High Quality Medical Supplies, Inc., as assignee of Charles Botwee. The defendant, Mercury Ins. Group, appealed an order from the Civil Court that denied its motion for summary judgment to dismiss the complaint. Mercury Ins. Group contended that billing for durable medical equipment not listed in a fee schedule is not compensable. However, the Appellate Term affirmed the lower court's decision, citing 11 NYCRR 68.5, which specifically permits reimbursement for healthcare services not explicitly covered by fee schedules, thereby rejecting the defendant's argument.

No-Fault BenefitsFirst-Party BenefitsDurable Medical EquipmentFee ScheduleSummary JudgmentAppellate TermAssigned BenefitsInsurance LawReimbursementCivil Court
References
3
Case No. ADJ869205 (SAC 0294976) ADJ302322 (SAC 0354178)
Regular
Oct 11, 2010

Patricia Rush vs. The Permanente Medical Group; Athens Administrators Concord

This case involves Patricia Rush claiming cumulative trauma injuries to her knees and back, among other body parts, against The Permanente Medical Group. The Workers' Compensation Appeals Board granted reconsideration because the Administrative Law Judge's findings of industrial causation for knee injuries lacked substantial medical evidence, with conflicting and uncertain Qualified Medical Evaluator opinions. The Board rescinded the prior findings and ordered further development of the medical record, suggesting an Agreed Medical Examiner or a court-appointed physician to resolve the causation issue for the knee injuries. The matter is returned to the trial level for a new final determination after the record is further developed on all issues, including injury causation.

Workers' Compensation Appeals BoardPermanente Medical GroupAthens Administratorscumulative trauma injurykneesbackshouldershandswristsindustrial causation
References
0
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