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

Case No. 46885/05, 47943/05, 47945/05
Regular Panel Decision

What Happened in Felix vs. Weber Metals Reconsideration?

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. MISSING
Regular Panel Decision

How Did the WCAB Rule in Hardgrove vs. Intercon Security?

William Capon sustained compensable injuries to his left leg in 1970 and 1983. In the latter incident, he fractured his femur, requiring surgery. Following his hospital discharge, Capon began physical therapy with Louis Cress. On April 8, 1983, after a reportedly strenuous therapy session, Capon suffered a fatal heart attack approximately one hour after returning home. His wife, the claimant, applied for workers' compensation benefits. The Workers’ Compensation Board sustained the claim, based on Dr. Irwin Friedman's testimony that the heart attack was causally related to the stress of the physical therapy. The employer appealed, contending that Friedman's testimony lacked substantial evidence. The court found adequate evidentiary support in the physical therapist's report and the claimant's testimony regarding Capon's condition, affirming the Board's decision.

Workers' Compensation BenefitsCausal ConnectionFatal Heart AttackStress-Induced InjuryPhysical Therapy ComplicationsMedical Expert TestimonyAppellate Court ReviewSubstantial Evidence RuleEmployer AppealDecedent's Claim
References
2
Case No. MISSING
Regular Panel Decision

What Did the WCAB Decide in Cuadra vs. Community Home Care?

Beatrice Duhon, a physical therapy technician, appealed a summary judgment granted to her employer, Bone & Joint Physical Therapy Clinics, in a suit alleging retaliatory termination in violation of the Texas anti-retaliation statute. Duhon reported an on-the-job injury and subsequently filed a workers' compensation claim after her termination. The Clinic argued she was terminated to hire a licensed physical therapist. The appellate court held that informing the employer of an injury sufficiently invokes statutory protection and found Duhon presented sufficient direct and circumstantial evidence to create a fact issue regarding the causal link between her reported injury and termination. Therefore, the summary judgment was reversed, and the case was remanded to the trial court for further proceedings.

Workers' CompensationRetaliatory DischargeAnti-Retaliation StatuteSummary JudgmentCausal LinkTexas Labor CodeOn-the-job InjuryEmployment TerminationAppellate ReviewRemand
References
14
Case No. MISSING
Regular Panel Decision

How Were Death Benefits Handled in Bocanegra vs. Sun-Gro Commodities?

Roger and Karia Vowell appealed the termination of their parental rights to their sons, R.V. and C.V., initiated by the Texas Department of Protective and Regulatory Services (TDPRS). The original termination was based on findings of sexual abuse by both parents and physical abuse by Karia. Roger challenged the trial court's rulings on his Fifth Amendment rights, the admission of old conviction evidence, and the remote televised testimony of R.V. Karia contested the admission of her written statement, the admissibility of R.V.'s testimony, and the therapist's testimony. The appellate court affirmed the trial court's judgment, finding no reversible error in any of the appellants' points.

Parental Rights TerminationChild AbuseSexual AbuseFifth AmendmentEvidentiary RulesRemote TestimonyAppellate ProcedureTexas Family LawChild Protective ServicesCivil Procedure
References
24
Case No. 03-13-00077-CV
Regular Panel Decision
Feb 25, 2015

Can a WCJ Be Disqualified for Appearance of Bias?

The amicus brief, submitted by The Association of Marital and Family Therapy Regulatory Boards (AMFTRB), urges the Third Court of Appeals to grant en banc reconsideration and reverse a panel's decision that found 22 TEX. ADMIN CODE §801.42(13) invalid. The brief argues that Licensed Marriage and Family Therapists (LMFTs) are fully qualified, trained, and tested to perform diagnostic assessments within their therapeutic role. It asserts that diagnosis alone, in the context of marriage and family therapy, does not constitute the practice of medicine under the Texas Medical Practice Act, and preventing LMFTs from performing these assessments would effectively prohibit their professional practice and create a shortage of mental health professionals in Texas. The AMFTRB also highlights that the legislature did not intend for LMFTs to be supervised by physicians and that the structure of the Occupations Code supports marriage and family therapy as a stand-alone profession. Additionally, the brief questions the qualification of the Texas Medical Association's expert witness due to prior ethical lapses.

Marriage and Family TherapyDiagnostic AssessmentMedical Practice ActOccupations CodeRegulatory BoardsLicensureScope of PracticeMental Health ServicesTexasAccreditation
References
9
Case No. MISSING
Regular Panel Decision

What Were the Key Rulings in Torrez vs. SuperShuttle?

Phillip David Garlington brought a Workers Compensation suit after sustaining injuries on an Oklahoma oil rig, leading to an award of total and permanent benefits. The insurer appealed, arguing that physical therapist Garland Picou was not qualified to testify on the cause of thrombophlebitus. The court affirmed the trial court's judgment, finding that Picou's testimony on Garlington's ability to perform tasks was within his expertise and merely cumulative to earlier medical testimony. The appeal was deemed frivolous, and the court granted additional damages for delay to the appellee in the amount of $5,674.10.

Expert Witness TestimonyPhysical Therapist Scope of PracticeThrombophlebitisFrivolous AppealDamages for DelayAppellate ReviewMedical Opinion AdmissibilityCumulative EvidenceOil Rig InjuryPermanent Disability
References
3
Case No. 2024 NY Slip Op 03326
Regular Panel Decision
Jun 18, 2024

Why Was Removal Denied in Rush vs. California Correctional Institution?

The Appellate Division, First Department, affirmed the Family Court, Bronx County's finding that the mother, Erica L., neglected her child, D.F., by inflicting excessive corporal punishment. The child's consistent in-court testimony, corroborated by statements to emergency and ACS workers, detailed multiple incidents of physical abuse with various objects, causing pain and fear. The court found the child's testimony credible and the mother's incredible. The decision emphasized that sworn testimony alone is competent evidence of abuse, even without physical injury, and that the punishments were not justified as reasonable discipline. Procedural arguments by the mother regarding pleadings and hearsay were unpreserved or found unavailing.

child neglectcorporal punishmentphysical abuseFamily Court Actcredibility determinationappellate reviewevidentiary standardschild testimonyAdministration for Children's Servicesparental rights
References
10
Case No. MISSING
Regular Panel Decision

What Did the WCAB Clarify in Ontiveros vs. Savers Stores?

Jerry Bolton, a heavy equipment operator, suffered a work-related injury in 1988, leading to complaints of neck and back pain. The Chancellor initially awarded him 60% permanent partial disability benefits and future medical expenses. The defendant, CNA Insurance Company, appealed, arguing against the inclusion of a physical therapist's opinion in determining permanent disability and questioning the causation due to a subsequent automobile accident. The Supreme Court affirmed that the work-related injury was the cause of Bolton's permanent disability, despite the intervening accident. However, the Court ruled that a physical therapist is not qualified to assess permanent impairment or physical restrictions. Consequently, the court found the evidence preponderated against the 60% disability award and remanded the case for further proceedings to determine the extent of permanent partial disability.

Worker's Compensation AppealPermanent Partial DisabilityMedical Expert CompetencyPhysical Therapist TestimonyVocational Disability AssessmentCausation of InjuryAutomobile Accident ImpactAMA Guidelines ApplicationScope of Practice LawMedical Impairment Rating
References
12
Case No. MISSING
Regular Panel Decision

Why Was Reconsideration Denied in Gomez vs. Dorothy Stevens?

Continental Casualty Company and Travelers Property Casualty Company of America sued Theraco, Inc. for additional workers’ compensation premiums, disputing the classification of physical therapists as independent contractors. Theraco’s insurance contracts with CNA and Travelers included provisions for premiums based on employees or persons posing a risk of workers’ compensation liability. The Department of Commerce and Insurance and the trial court initially sided with Theraco, ruling the physical therapists were independent contractors and not liable for additional premiums. However, upon appeal, this Court affirmed the independent contractor status but reversed the decision regarding the "risk of loss" provision. The Court concluded that the insurers were exposed to the risk of defending potential lawsuits, even if only to litigate the therapists' employment status. Consequently, Theraco was found liable for retrospective premiums totaling $44,089 to CNA and $97,522 to Travelers.

Workers' Compensation PremiumsIndependent Contractor StatusEmployer-Employee RelationshipRisk of Loss ProvisionInsurance Contract InterpretationRetroactive Premium AssessmentPhysical TherapistsAppellate ReviewAdministrative Agency DecisionStatutory Employee
References
17
Case No. 08-07-00346-CV
Regular Panel Decision
May 12, 2010

Why Was Reconsideration Dismissed in Sabino vs. Johnson Pump Company?

Rosemary Smith, an El Paso Police Officer, initially sued W.C. LaRock, D.C., P.C. (the clinic) and its employee Maria Gallardo for negligence, alleging that Gallardo's physical therapy caused a recurrent herniated disc after Smith's initial back surgery. The City of El Paso, as Smith's worker's compensation subrogee, joined the lawsuit. The jury found Gallardo negligent and awarded Smith damages, but the trial court reduced the medical-care award. On appeal, the Court of Appeals of Texas, El Paso, reversed the trial court's judgment, ruling that the evidence was legally insufficient to establish a causal connection between Gallardo's physical therapy and Smith's reherniation based on the expert medical testimony presented, which only indicated a 'possibility' rather than a 'reasonable medical probability' of causation. The court found that Smith's pre-existing condition and other possible causes meant expert testimony was required, and the testimony provided was inadequate to prove proximate cause.

Medical MalpracticeNegligenceCausationExpert TestimonyLegal SufficiencySpinal InjuryHerniated DiscPhysical TherapyPostoperative CareWorker's Compensation Subrogation
References
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