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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

Texas Workers' Compensation Insurance Fund v. Texas Workers' Compensation Commission

The Texas Workers’ Compensation Insurance Fund, now Texas Mutual, challenged an appeals panel decision by the Texas Workers’ Compensation Commission which awarded lifetime income benefits to claimant Leonard D. Watts. Watts, a truck driver for Mono Chem Corporation, sustained a leg injury in 1994, leading to severe medical conditions and ultimately the loss of use of both feet. A hearing officer initially denied lifetime benefits due to insufficient evidence of a causal connection to the original injury, but the appeals panel twice reversed this decision, rendering a new decision in favor of Watts. Texas Mutual sought judicial review, arguing the appeals panel exceeded its statutory authority and improperly engaged in factual-sufficiency review. The district court set aside the appeals panel's decision. This court, however, reversed the district court's decision, affirming the appeals panel’s award of lifetime income benefits to Watts, holding that the appeals panel acted within its statutory authority.

Workers' CompensationLifetime Income BenefitsAppeals Panel ReviewJudicial ReviewFactual SufficiencyStatutory AuthorityCausationRes JudicataCollateral EstoppelTexas Labor Code
References
13
Case No. G107 435
Regular Panel Decision
Jun 02, 2023

Matter of Marku v. ABM Industries

This case concerns the claim of Denise Perry under the Workers' Compensation Law. The Workers' Compensation Law Judge (WCLJ) previously found that the employer, Adventist Home Care, established a violation of Workers' Compensation Law § 114-a by the claimant for willfully making false statements to obtain benefits. Consequently, the WCLJ disallowed indemnity benefits and imposed both mandatory and discretionary penalties. A Board Panel decision filed on February 17, 2022, affirmed the WCLJ's findings. The claimant subsequently filed an application for reconsideration on March 18, 2022, which the Board Panel reviewed. After considering the claimant’s arguments, the Board Panel determined that the application did not raise new issues or present new material evidence, nor did it demonstrate an erroneous statement of material fact or law in the prior decision. Therefore, the Board Panel, by a majority vote, affirmed its prior decision.

Workers' Compensation FraudFalse RepresentationIndemnity Benefits DisallowanceWCL § 114-a PenaltyApplication for Reconsideration DeniedBoard Panel AffirmationWillful MisrepresentationWorkers' Compensation Law Judge DecisionEmployer Established Violation
References
0
Case No. ADJ11446545
Regular
Dec 03, 2019

ROSA LOPEZ RODRIGUEZ vs. UNIVERSAL BUILDING SERVICES SUPPLY COMPANY, INSURANCE COMPANY OF THE WEST

This case concerns a dispute over the appropriate medical specialty for a Qualified Medical Evaluator (QME) panel. The applicant, Rosa Lopez Rodriguez, initially requested a chiropractic QME panel, which was issued first. The defendant objected, arguing that chiropractic was inappropriate due to the applicant's prior surgery and lack of full recovery. The Medical Unit then invalidated the chiropractic panel and issued an orthopedic surgery panel. The Workers' Compensation Appeals Board granted reconsideration, overturning the WCJ's decision. The Board held that the party who first requests a QME panel has the right to designate the specialty and that the defendant failed to provide sufficient grounds to invalidate the chiropractic panel. Therefore, the Board amended the findings to sustain the applicant's objection and affirm chiropractic as the appropriate panel specialty.

AD Rule 31.5(a)(10)AD Rule 31.5(a)(9)AD Rule 31.1(b)Labor Code section 4062Labor Code section 4062.2Qualified Medical Evaluator (QME)QME panel specialtyPetition for RemovalPetition for ReconsiderationMedical Unit determination
References
1
Case No. 2015-02-0193; 2015-02-0183
Regular Panel Decision
Nov 04, 2015

Seiferth, Stephen v. Ingles Markets, Inc.

In these consolidated interlocutory appeals, employees Robin Moore and Stephen Seiferth alleged respiratory injuries due to repeated pesticide exposure at their workplace, Ingles Markets, Inc. The employer provided an initial emergency room evaluation but failed to offer a panel of physicians. Following expedited hearings, the trial court ordered the employer to provide a physician panel but denied temporary disability benefits. The employer appealed, arguing lack of causation and disputed injury dates, but failed to provide a hearing transcript or sufficiently develop their arguments. The Appeals Board affirmed the trial court's decision, presuming it was supported by sufficient evidence, and remanded the cases for further proceedings.

Workers' CompensationPesticide ExposureRespiratory InjuriesNeurological ProblemsInterlocutory AppealExpedited HearingPanel of PhysiciansTemporary Disability BenefitsCausationSufficiency of Evidence
References
3
Case No. 2019-06-1769
Regular Panel Decision
Jun 09, 2020

Ameri, Rachel v. Denso Automotive Ohio, Inc.

Rachel Ameri requested this Court to order Denso Automotive Ohio to provide another panel of physicians, pay for emergency treatment, and provide temporary disability benefits following a workplace injury. The Court denied her request for a new panel of physicians, finding she had signed a Choice of Physicians form and accepted treatment from the selected doctor. Additionally, Denso Automotive Ohio was not held responsible for her emergency room expenses as she failed to introduce the treatment bills into evidence. Her claim for temporary disability benefits was also denied, as she did not establish entitlement through sufficient documentation of lost wages or extended periods off work. The Court concluded that Ms. Ameri had not presented sufficient evidence to likely prevail at a hearing on the merits.

Workers' CompensationExpedited HearingPhysician ChoiceMedical Treatment DenialTemporary Disability BenefitsPanel of PhysiciansMedical BillsEmployee TestimonyEmployer AffidavitsMedical Impairment
References
4
Case No. MISSING
Regular Panel Decision

Matter of Burns v. New York State Workers' Compensation Board

Claimant sought workers' compensation benefits due to injuries from an automobile accident. As an employee of the Workers’ Compensation Board, his claim was processed through a neutral outside arbitration process. An arbitrator established his claim and average weekly wage. Claimant appealed, arguing his average weekly wage should have been calculated differently due to a recent promotion, as per Workers’ Compensation Law § 14 (2). An arbitration panel declined to address this argument because it was not raised before the arbitrator. The appellate court affirmed the panel's decision, citing that the panel could decline review of issues not previously raised, consistent with 12 NYCRR 300.13 [e] [1] [iii].

ArbitrationAverage Weekly WageWorkers' CompensationAppellate ReviewIssue PreservationAdministrative LawProcedural Due ProcessStatutory InterpretationWorkers’ Compensation Board
References
2
Case No. MISSING
Regular Panel Decision

Claim of Mulligan v. Workers' Compensation Board

The claimant, a former workers' compensation law judge, appealed the denial of reduced earning benefits, which stemmed from his claim that stress from his job caused him to voluntarily withdraw from the labor market. He had previously received benefits for a 1995 angina attack. An arbitrator and subsequent arbitration panel concluded that he voluntarily withdrew from the labor market, a determination the claimant contested, asserting his retirement was due to work-related stress. The court, led by Judge Carpinello, found substantial evidence supported the panel's decision, noting the claimant never complained of stress to supervisors, sought accommodations, or applied for disability retirement. The court affirmed the arbitration panel's decision, denying the claimant's appeal.

Voluntary Withdrawal from Labor MarketReduced Earning BenefitsWorkers Compensation BenefitsArbitration Panel DecisionSubstantial EvidenceDisability RetirementJob-Related StressAppellate ReviewLabor Market WithdrawalClaim Denial
References
8
Case No. MISSING
Regular Panel Decision

Home Insurance Co. v. Garcia

Nicandro Garcia, an employee, was injured in 1995 while working and filed a workers' compensation claim. After surgeries and receiving a 15% whole body impairment rating, the Texas Workers’ Compensation Commission Appeals Panel denied his application for supplemental income benefits. Garcia subsequently filed suit against The Home Insurance Company, which was the appellant in this case, seeking a review of the TWCC Appeals Panel’s decisions. A jury trial ruled in Garcia's favor, and the trial court awarded attorney's fees. The Home Insurance Company appealed, challenging the sufficiency of evidence regarding Garcia's ability to work and his good faith in seeking employment, a jury instruction, and the attorney's fee award. The appellate court affirmed the jury's findings on the sufficiency issues and the jury instruction but reversed the attorney's fee award, stating there was no statutory basis for it when the employee disputes a commission finding.

Workers' Compensation AppealSupplemental Income BenefitsImpairment RatingAttorney's Fees ReversalLegal Sufficiency of EvidenceFactual Sufficiency of EvidenceJury Instructions ReviewAbuse of Discretion StandardTexas Labor Code ApplicationEmployment Search Good Faith
References
23
Case No. 2016-03-1322
Regular Panel Decision
Oct 16, 2017

Skinner, John Matthew v. Marion Environmental, Inc.

This expedited hearing concerned John Matthew Skinner's request for medical and temporary total disability benefits, and attorney's fees, stemming from an alleged occupational illness (Chronic Inflammatory Response Syndrome - CIRS) developed during his employment with Marion Environmental, Inc. Mr. Skinner, an Emergency Manager/Incident Commander/Hazmat Response Technician, claimed exposure to hazardous materials including mold and mycotoxins over ten years. Marion Environmental disputed the exposures and challenged the credibility of Mr. Skinner's physician, Dr. Oenbrink, due to disciplinary actions. The Court found Mr. Skinner provided sufficient notice of his occupational illness, entitling him to a panel of physicians. However, the Court concluded Mr. Skinner did not present sufficient evidence to likely prevail on the merits of causation for his alleged illness arising primarily out of his employment at this time. Consequently, his claims for reimbursement of past medical expenses, temporary disability benefits, and attorney's fees were denied without prejudice, allowing him to pursue these benefits later. The Court ordered Mr. Skinner to select a physician from a previously offered panel.

Occupational DiseaseChronic Inflammatory Response SyndromeCIRSHazardous Materials ExposureMold ExposureToxic ExposureMedical BenefitsTemporary Total DisabilityExpedited HearingCausation
References
4
Case No. WCB No. G076 2707
Regular Panel Decision
Dec 09, 2021

Matter of Duncan v. John Wiley & Sons, Inc.

This Board Panel Decision concerns an appeal by the applicant, Joseph Lafayette, regarding a Workers' Compensation Law Judge's (WCLJ) finding on the causal relationship of his back injury. The applicant sustained injuries to his back, neck, and shoulder during his employment. The WCLJ had previously established a causal relationship for the neck and shoulder injuries but disallowed the claim for the back injury. Upon review, the Board Panel determined that the medical evidence in the record supports a causal relationship between the claimant's employment and his lower back injury. As a result, the Panel modified the WCLJ's decision to establish a causal relationship for the back injury, while affirming the other aspects of the original decision.

Workers' CompensationBack InjuryNeck InjuryShoulder InjuryCausal RelationshipMedical EvidencePanel ReviewWCLJ DecisionModificationAppeal
References
2
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