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

Case No. No. M2018-01696-COA-R3-CV; No. 15-4-IV
Regular Panel Decision
Dec 07, 2020

American Board of Craniofacial Pain v. American Board Of Orofacial Pain

This case involves an appeal concerning a failed merger between two professional dental associations, American Board of Craniofacial Pain (ABCP) and American Board of Orofacial Pain (ABOP). ABCP sued ABOP, alleging a breach of an agreement to merge formed through email exchanges and seeking specific performance and damages. The Chancery Court for Davidson County granted summary judgment to ABOP, finding no meeting of the minds and thus no enforceable contract. The Court of Appeals of Tennessee affirmed this decision, concluding that the parties’ objective manifestations showed a lack of mutual assent because an essential term (disposition of intellectual property) was not agreed upon and they intended to reduce the agreement to a formal Memorandum of Understanding, which was never finalized. The court also agreed that specific performance was not an available remedy due to the incompleteness of the purported contract.

Contract DisputeMerger NegotiationsCorporate MergerDental ProfessionMutual AssentSpecific Performance DenialSummary Judgment AffirmationTennessee Court of AppealsContract FormationLack of Agreement
References
26
Case No. NO. 03-06-00631-CV
Regular Panel Decision
Mar 26, 2009

Samuel Campos v. Texas Property & Casualty Insurance Guaranty Association for Reliance National Indemnity Company, an Impaired Carrier

Samuel Campos, an employee, was injured on the job, leading to disputes over his impairment rating and reimbursement for travel expenses. The Texas Workers’ Compensation Commission affirmed a designated doctor's 6% impairment rating and denied travel expenses, which Campos challenged in court. The case involved the Texas Property & Casualty Insurance Guaranty Association (TPCIGA) because Campos's employer's insurer became impaired. Initially filed in Winkler County, the case was transferred to Travis County, where TPCIGA was granted summary judgment. The Third District Court of Appeals reversed the summary judgment, ruling that the Workers' Compensation Act's specific mandatory venue provision, which places venue in the county of the employee's residence at the time of injury (Winkler County), overrides the Guaranty Act's general venue provision, which would place it in Travis County. The court remanded the case with instructions to transfer it to Winkler County.

Workers' CompensationVenue DisputeMandatory VenueStatutory ConstructionTexas Labor CodeTexas Insurance CodeImpairment RatingTravel Expenses ReimbursementJudicial ReviewAppellate Procedure
References
12
Case No. 2024 NY Slip Op 00599 [224 AD3d 428]
Regular Panel Decision
Feb 06, 2024

Matter of New Millennium Pain & Spine Medicine, P.C. v. Garrison Prop. & Cas. Ins. Co.

This case involves two appeals by New Millennium Pain & Spine Medicine, P.C. against Garrison Property & Casualty Insurance Company and GEICO Casualty Company. New Millennium sought to vacate master arbitration awards that denied its claims for no-fault benefits for medical services. The Supreme Court denied these applications. The Appellate Division, First Department, affirmed the Supreme Court's decisions, stating that an arbitrator's award will not be set aside unless it is irrational. The court also addressed the argument regarding a 20% wage offset in no-fault benefits, finding it unavailing under Insurance Law § 5102 (b). Ultimately, New Millennium was not entitled to attorneys' fees as it was not the prevailing party.

No-fault benefitsarbitration awardvacaturinsurance lawwage offsetappellate reviewmedical servicesno-fault policy exhaustionattorneys' feesCPLR Article 75
References
8
Case No. ADJ7713711
Regular
Mar 11, 2016

JULIANA MASTERS vs. STATE OF CALIFORNIA, DEPARTMENT OF MOTOR VEHICLES

The Appeals Board denied reconsideration of the WCJ's decision, upholding the finding that applicant's sleep impairment, though present, was subsumed by the physical upper extremity impairments and thus not separately ratable. The Board found the Agreed Medical Examiner's opinion on sleep disorder impairment was not substantial evidence as it was predicated on pain already accounted for in the physical injury ratings per the AMA Guides. Therefore, the applicant's permanent disability rating remained at 69%. A dissenting opinion argued the Agreed Medical Examiner's opinion should be followed, as it addressed distinct impairments beyond pain and was supported by relevant case law.

Workers' Compensation Appeals BoardAmended Findings of Fact and AwardsIndustrial InjuryUpper ExtremitiesPsycheBook BinderSleep ImpairmentAMA GuidesPermanent DisabilityAgreed Medical Examiner
References
9
Case No. 2020-08-0198
Regular Panel Decision
Jun 03, 2020

Gray, Katie v. Conagra Foods Packaged Foods Co., Inc.

The case involves an employee, Katie Gray, who suffered a work-related hand injury and was diagnosed with complex regional pain syndrome. After her authorized treating physician, Dr. Dan Fletcher, assigned a 13% permanent medical impairment rating based on a therapist's report using the range-of-motion model, her employer, Conagra Foods, retained Dr. David West for a medical records review. Dr. West disagreed with the methodology, concluding a 4% impairment rating for complex regional pain syndrome. Due to this discrepancy, the employer requested an evaluation through the Medical Impairment Rating Registry (MIRR), which the employee moved to quash, arguing that a medical records review was an insufficient basis for a dispute. The trial court denied the motion, and the Appeals Board affirmed, holding that the statute and regulations allow either party to obtain a second opinion, even based on a medical records review, to establish a dispute for an MIRR evaluation.

Workers' CompensationMedical Impairment Rating Registry (MIRR)Permanent Medical ImpairmentComplex Regional Pain SyndromeMedical Records ReviewSecond Medical OpinionDispute ResolutionAppeals Board DecisionTennessee LawTrial Court Affirmation
References
1
Case No. MISSING
Regular Panel Decision
May 05, 2000

Pain Resource Center v. Travelers Insurance

This case addresses a dispute regarding the payment of first-party no-fault benefits to a health provider, Pain Resource Center, as the assignee of John Hiotis, who was injured in an auto accident. The defendant, Travelers Ins. Co., challenged the validity of the assignment and the necessity of the medical services provided. The court affirmed the validity of the assignment under New York's Insurance Law and related regulations. However, based on conflicting expert testimonies, the court limited the compensable medical services to six hours and awarded the plaintiff $566.10, along with statutory interest and attorney's fees.

No-Fault InsuranceFirst-Party BenefitsAssignment ValidityMedical ServicesPeer ReviewInsurance LawHealth Provider ClaimAutomobile AccidentDamagesStatutory Interpretation
References
5
Case No. MISSING
Regular Panel Decision

Universal Acupuncture Pain Services, P.C. v. Lumbermens Mutual Casualty Co.

The New York court addresses a motion for reargument by Universal Acupuncture Pain Services, P.C. against Lumbermens Mutual Casualty Company concerning no-fault insurance claims. The central legal question is whether an expert witness's peer review report, created after a timely denial of a no-fault claim, can be admitted at trial, specifically under the Cirucci precedent regarding the specificity of denial grounds. The court grants the motion for reargument but upholds its initial ruling, which granted partial summary judgment on one of five claims. It clarifies that the expert's testimony must be strictly limited to the "concurrent or excessive care" ground initially stated by the insurer, excluding any new grounds like "medical necessity" not specified in the original denial. The court emphasizes that the issue of whether different treatment modalities constitute concurrent care for the same condition requires a trial for factual determination.

No-Fault InsurancePeer ReviewExpert Witness TestimonySummary Judgment MotionInsurance Law InterpretationSpecificity of DenialConcurrent Medical CareAcupuncture TreatmentChiropractic TreatmentPhysical Therapy
References
7
Case No. 03-06-00404-CV
Regular Panel Decision
Mar 06, 2007

Johnnie M. Charles v. Texas Property and Casualty Insurance Guaranty Association, on Behalf of Phico Insurance Company, an Impaired Carrier

This case involves a restricted appeal filed by Johnnie M. Charles from a trial court's order dismissing her cause without prejudice. Charles initially appealed a Texas Workers' Compensation Commission decision regarding her impairment rating. After a venue transfer to Travis County, her case was dismissed for failure to pay filing fees. A nunc pro tunc order was later issued to correct a clerical error in the cause number of the original dismissal order. Charles appealed, citing errors in the dismissal, the lack of a court reporter, and the original hearing. The appellate court affirmed the dismissal, ruling that Charles's challenges to the original dismissal were untimely and that no error occurred in the nunc pro tunc order, which merely corrected a clerical error without altering the original judgment's substance.

restricted appealdismissal without prejudicenunc pro tunc orderclerical errorwant of prosecutionappellate jurisdictiontimeliness of appealTexas Rules of Civil ProcedureTexas Rules of Appellate Procedureworkers' compensation
References
13
Case No. ADJ2453188 (LBO 0391424)
Regular
Jul 20, 2009

WILLIAM GILBERT vs. CITY OF LOS ANGELES

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior award, finding the medical evidence insufficient. The applicant sought a higher permanent disability rating than the $12\%$ awarded, arguing the judge erred in calculating impairment and omitting pain and grip strength adjustments recommended by the Agreed Medical Evaluator. The Board returned the case to the trial level for further development of the medical record, requiring the evaluator to fully explain their findings on impairment, pain, and grip strength, and to consider *Almaraz* principles regarding equitable permanent disability awards.

Workers' Compensation Appeals BoardCumulative InjuryPermanent DisabilityLeft Median Sensory NeuropathyLeft Ulnar Motor NeuropathyAgreed Medical EvaluatorOrthopedistAMA GuidesImpairment RatingGrip Strength
References
9
Case No. ADJ10725180 ADJ11229196
Regular
Aug 08, 2018

JOAQUIN ROSALES vs. SWANSON FAHRNEY FORD, ZURICH NORTH AMERICA, GALLAGHER BASSETT SERVICES, INC.

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the administrative law judge's award of 8% permanent disability for the applicant's left elbow injury. The award was based on a panel QME's opinion that, while no scheduled impairment existed under the AMA Guides, other factors like constant pain, loss of strength, grasping difficulty, and tendon tears justified a rating under Table 13-22 and *Guzman*. The Board found Dr. Tabaddor's rationale sufficiently supported the impairment rating, distinguishing it from the "add-on" pain provisions addressed in *Blackledge*.

ADJ10725180ADJ11229196lateral epicondylitisAMA Guidespermanent disability ratingpanel qualified medical evaluatorKhosrow TabaddorMilpitas Unified School District v. Workers' Comp. Appeals Bd. (Guzman)scheduled impairmentwhole person impairment
References
4
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