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

Case No. 13-08-00351-CV
Regular Panel Decision
Aug 31, 2009

Mitch Burkhart and Christine Burkhart v. Sedgwick Claim Management Services, Inc. and Concentra Integrated Services, and rgv/nueces Rehabilitation D/B/A Innovative Physical and Occupational Therapy

Mitch Burkhart sustained a foot and ankle injury while training for his employer, Verizon Communications. Verizon's workers' compensation claims were administered by Sedgwick Claim Management Services, Inc., who, along with Concentra Integrated Services, arranged a Functional Capacity Evaluation (FCE) for Burkhart with RGV/Nueces Rehabilitation d/b/a Innovative Physical and Occupational Therapy. The Burkharts alleged that the FCE aggravated Mitch's injury, causing permanent damage. They sued Sedgwick, Concentra, and Innovative, claiming negligence, civil conspiracy, assault, fraud, and breach of the duty of good faith and fair dealing. The trial court dismissed the case against Innovative for an inadequate expert report and granted summary judgment to Sedgwick and Concentra, citing the exclusive remedy provision of the Texas Workers' Compensation Act. The appellate court affirmed the trial court's judgment, concluding that Mitch's aggravation injury was an 'extension injury' covered by the exclusive remedy provision of the TWCA.

Workers' CompensationFunctional Capacity EvaluationExclusive RemedyAggravation InjurySummary JudgmentMedical Expert ReportHealth Care LiabilityCivil ConspiracyBreach of Duty of Good Faith and Fair DealingTexas Court of Appeals
References
23
Case No. 20203-05-0474
Regular Panel Decision
May 11, 2023

Basham, Alexis v. SPB Hospitality, LLC d/b/a Logan's Roadhouse

Alexis Basham, a manager at Logan’s Roadhouse, suffered physical injuries and post-traumatic stress disorder (PTSD) after a severe assault at work in June 2021. Although she reached maximum medical improvement for her physical injuries, her psychiatric treatment continued for work-related PTSD. The employer terminated temporary total disability benefits, arguing she reached MMI for physical injuries, but the Court found her mental injury arose primarily from the assault, not solely the physical injuries. The Court determined that Tennessee Code Annotated section 50-6-207(1)(E) did not apply in this context. Consequently, the Court granted Ms. Basham's request for ongoing temporary total disability benefits and denied her interlocutory requests for attorney’s fees and a penalty.

PTSDTemporary Disability BenefitsMental InjuryPhysical InjuryCausationExpedited HearingPsychiatric TreatmentMaximum Medical ImprovementWorkplace AssaultEmployer Liability
References
5
Case No. 2020 NY Slip Op 00652
Regular Panel Decision
Jan 30, 2020

Matter of Froehlich v. New York State Dept. of Corr. & Community Supervision

Petitioner Jason Froehlich, a correction sergeant, was injured while attempting to subdue a combative parolee. Following a year of workers' compensation leave, his employment was terminated by respondent, New York State Department of Corrections and Community Supervision, pursuant to Civil Service Law § 71. Froehlich argued he was entitled to a two-year leave of absence, asserting his injuries resulted from an assault during employment. Respondent denied this, defining "assault" as an intentional physical act of violence directed toward an employee, and found no evidence the parolee intentionally directed violence at Froehlich. The Supreme Court dismissed Froehlich's CPLR article 78 petition. The Appellate Division, Third Department, affirmed the judgment, concluding that respondent's definition of assault was rational and its application to the facts, finding no intentional physical act directed at Froehlich, was also rational. A dissenting opinion argued that the inmate's actions, under respondent's own definition, constituted an assault.

Civil Service Law § 71workers' compensation leavedisability leaveassault in employmentintentional physical act of violenceCPLR article 78 proceedingadministrative determinationrational basis reviewarbitrary and capriciouscorrection sergeant
References
7
Case No. 13-04-310-CV
Regular Panel Decision
Aug 31, 2005

Opel Wiltshire v. Humpal Physical Therapy, P. C.

Opel Wiltshire was terminated from Humpal Physical Therapy, P.C. for violating a nail polish policy and making a phone call to the owner. She subsequently filed claims for race discrimination, hostile work environment, retaliation, and intentional infliction of emotional distress under the Texas Commission on Human Rights Act (TCHRA). The trial court granted summary judgment in favor of Humpal on all claims and awarded attorney's fees to Humpal. On appeal, the Court of Appeals affirmed the summary judgment on Wiltshire's claims due to lack of evidence for prima facie cases. However, the appellate court reversed the award of attorney's fees to Humpal, finding the trial court abused its discretion given its implicit finding that Wiltshire's claims were not groundless.

Reverse DiscriminationSummary JudgmentAttorney FeesRetaliationHostile Work EnvironmentRace DiscriminationEmotional DistressEmployment LawTCHRATexas Court of Appeals
References
41
Case No. 2015-2337 Q C
Regular Panel Decision
May 18, 2018

Sama Physical Therapy, P.C. v. Hereford Ins. Co.

This case concerns an action by Sama Physical Therapy, P.C., as assignee, to recover first-party no-fault benefits from Hereford Insurance Co. The defendant argued that the plaintiff's assignor had been injured during the course of employment. The Civil Court conditionally granted defendant's cross-motion for summary judgment, ordering the plaintiff to file an application with the Workers' Compensation Board within 90 days. Plaintiff failed to comply with this order, and upon renewal, the Civil Court adhered to its prior determination. The Appellate Term, Second Department, affirmed the Civil Court's order, finding that the plaintiff did not demonstrate compliance with the order to make a proper application under the Workers' Compensation Law.

No-Fault BenefitsSummary JudgmentWorkers' Compensation BoardAppellate ReviewConditional GrantFailure to ComplyRenewal MotionInsurance LawAssigneeMedical Provider
References
1
Case No. MISSING
Regular Panel Decision
Jun 28, 1993

Gagliardi v. Trapp

The plaintiff, a correction officer, appealed an order granting summary judgment to the defendants in her action for assault and negligence. She alleged physical and mental harm after being punched by a fellow correction officer, Darrell Harris, and claimed her employers, New York City Department of Correction and the City of New York, attempted to conceal the incident and discriminated against her. The Supreme Court correctly determined that her negligence claim was barred by Workers’ Compensation Law as she had already received benefits, and her allegations did not meet the high standard for an intentional tort to circumvent the exclusivity provision. Furthermore, her discrimination claims under Executive Law § 296 were found to be conclusory and unsupported.

AssaultNegligenceWorkers' CompensationSummary JudgmentDiscriminationExclusive RemedyAppellate DecisionCorrection OfficerRikers IslandEmployers' Liability
References
11
Case No. 2015-608 Q C
Regular Panel Decision
Dec 19, 2017

Adelaida Physical Therapy, P.C. v. 21st Century Ins. Co.

In this case, Adelaida Physical Therapy, P.C., acting as an assignee, appealed an order from the Civil Court of the City of New York, Queens County. The original order had granted 21st Century Insurance Company's motion for summary judgment, dismissing parts of a complaint seeking first-party no-fault benefits for services billed under specific CPT codes (97010, 97110, and 97124). The Appellate Term, Second Department, reversed the lower court's decision. The appellate court found that 21st Century Insurance Company failed to demonstrate that it had used the correct conversion factor to calculate the reimbursement rate, thus not establishing its defense that the charged fees exceeded the workers' compensation fee schedule. As a result, the branches of the defendant's motion for summary judgment related to those CPT codes were denied.

No-Fault BenefitsCPT CodesSummary JudgmentWorkers' Compensation Fee ScheduleReimbursement RateAppellate ReviewInsurance DisputeCivil ProcedureConversion FactorMedical Billing
References
2
Case No. 2016-198 Q C
Regular Panel Decision
Jun 01, 2018

Comprehensive Care Physical Therapy, P.C. v. Allstate Ins. Co.

This case concerns a provider, Comprehensive Care Physical Therapy, P.C., seeking no-fault benefits from Allstate Insurance Company. The Civil Court initially denied the plaintiff's summary judgment motion and granted the defendant's cross-motion, dismissing the complaint based on the assignor's failure to appear for independent medical examinations (IMEs) and claims exceeding the fee schedule. On appeal, the Appellate Term modified this order, finding that Allstate failed to provide sufficient proof of timely denial form mailing, thereby precluding its defenses regarding IMEs and the fee schedule. Consequently, Allstate's cross-motion for summary judgment was denied, reversing that part of the lower court's decision. However, the Appellate Term affirmed the denial of the plaintiff's summary judgment motion, as the plaintiff also failed to establish their claims.

no-fault insurancesummary judgmentindependent medical examinationstimely denialinsurance defenseappellate reviewmedical billingassignee rightsprocedural requirementsfee schedule
References
5
Case No. 46885/05, 47943/05, 47945/05
Regular Panel Decision

Robert Physical Therapy, P.C. v. State Farm Mutual Automobile Insurance

This case involves three consolidated claims for first-party no-fault benefits related to physical therapy services. The plaintiff's assignors received physical therapy, and the defendant, an insurer, denied some claims due to disputes over billing codes. The central legal issues concerned whether a physical therapist could utilize billing codes from the medicine fee schedule when such services were not explicitly in the physical medicine schedule, and if range of motion and muscle testing could be billed separately from evaluation and management on the same day. The court determined that physical therapists are not confined to the physical medicine section and can use codes from any section of the medical fee schedule. Furthermore, the defendant failed to provide sufficient evidence to justify its denials regarding separate billing for range of motion and muscle testing. Consequently, the court ruled in favor of the plaintiff, awarding judgment for all disputed amounts.

Physical Therapy BillingNo-Fault BenefitsMedical Fee ScheduleCPT CodesWorkers' Compensation RegulationsEvaluation and Management ServicesRange of Motion TestingMuscle TestingProvider SpecialtyBilling Disputes
References
4
Case No. 01-22-00505-CR
Regular Panel Decision
Jan 25, 2024

Xavier Johnson v. the State of Texas

Xavier Johnson appealed his convictions for retaliation and assault on a public servant, stemming from an incident where he assaulted his literacy teacher, Nicole Truelove, at the Ferguson Prison Unit. Truelove alleged Johnson physically assaulted her and made threats after she began writing a disciplinary report against him for violating classroom rules. The jury acquitted Johnson of aggravated sexual assault but convicted him of retaliation and assault on a public servant. On appeal, Johnson challenged the legal sufficiency of the evidence for both convictions and the trial court's evidentiary rulings regarding Truelove's financial condition and an audiotape. The First District of Texas Court of Appeals affirmed the trial court's judgment, finding sufficient evidence to support the convictions and no abuse of discretion in the evidentiary rulings.

Criminal LawRetaliationAssault on Public ServantSufficiency of EvidenceAppellate ReviewEvidentiary RulingsConfrontation ClauseRule 403 AnalysisWitness CredibilityPrison Inmate
References
64
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