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

Case No. 03-03-00435-CV
Regular Panel Decision
Jul 29, 2004

Texas Workers' Compensation Commission Richard Reynolds, in His Official Capacity as Executive Director of the Texas Workers' Compensation Commission/East Side Surgical Center Clinic for Special Surgery And Surgical and Diagnostic Center, L.P. v. East Side Surgical Center Clinic for Special Surgery/Texas Workers' Compensation Commission Richard Reynolds, in His Official Capacity as Executive Director of the Texas Workers' Compensation Commission

This case involves the Texas Workers’ Compensation Commission's failure to establish fee guidelines for ambulatory surgical centers under the Texas Workers’ Compensation Act. East Side Surgical Center, Clinic for Special Surgery, and intervenor Surgical and Diagnostic Center, L.P. (collectively "East Side") sued the Commission to invalidate certain default rules that applied when specific guidelines were absent. The district court declared one rule (133.304(i)) invalid and enjoined its enforcement, citing unlawful delegation of authority. On appeal, the Court of Appeals reversed the district court's judgment regarding the rule's invalidity and dissolved the injunction, citing a Texas Supreme Court decision finding no unlawful delegation. The court affirmed that East Side was not entitled to its usual and customary fee in the absence of specific guidelines.

Workers' CompensationAdministrative LawDelegation of AuthorityRulemakingAmbulatory Surgical CentersJudicial ReviewInsurance CarrierFee GuidelinesFair and Reasonable RatesStatutory Interpretation
References
38
Case No. DC-13-04564-L
Regular Panel Decision
Apr 16, 2015

in Re: Island Hospitality Management, Inc., Post Properties, Inc. and Post Addison Circle Limited Partnership

Plaintiff Jane Doe filed a lawsuit alleging sexual assault and related damages, including mental anguish. Her designated psychologist, Dr. William Flynn, conducted a mental examination. Defendants Island Hospitality Management, Inc., Post Properties, Inc., and Post Addison Circle Limited Partnership sought an independent psychological examination of the plaintiff by their expert, Dr. Lisa Clayton. The district court initially denied this motion, and subsequently denied the defendants' joint motion for reconsideration. This mandamus record documents the appellate review of this discovery dispute.

Sexual AssaultMental AnguishPsychological ExaminationDiscovery DisputeForensic PsychologyPremises LiabilityMandamus PetitionCivil ProcedureExpert WitnessTexas Law
References
59
Case No. MISSING
Regular Panel Decision

Hansen v. Post

The petitioner, a child protective worker, sought custody of Christopher Post, whose parents, Rose and William Post, had a documented history of child abuse and neglect, leading to the removal of seven other children from their care. Christopher had also been involved in two prior neglect proceedings. The parents exhibited severe deficiencies in parenting skills, an inability to address Christopher's emotional disturbances, and a history of rejecting assistance. After voluntarily placing Christopher with the petitioner, who became his psychological parent, they abruptly cut off contact. The Family Court found extraordinary circumstances, justified judicial intervention, and granted custody to the petitioner, a decision which the appellate court subsequently affirmed.

Custody DisputeParental UnfitnessChild NeglectExtraordinary CircumstancesFamily Court Act Article 6Child Protective ServicesAppealParental RightsPsychological ParentEmotional Disturbance
References
5
Case No. 04-15-00433-CV
Regular Panel Decision
Sep 17, 2015

Texas Commission on Environmental Quality & Post Oak Clean Green, Inc. v. Guadalupe County Groundwater Conservation District

This is an opening brief from the Texas Commission on Environmental Quality (TCEQ) and Post Oak Clean Green, Inc. (Post Oak), appealing the denial of their plea to the jurisdiction by the 2nd 25th Judicial District Court, Guadalupe County. The case concerns the Guadalupe County Groundwater Conservation District's (the District) suit seeking a declaration that Post Oak's proposed landfill violates District Rule 8.1, even though Post Oak's permit application is still under review by the TCEQ. Appellants argue that the District's claim is not ripe, is impermissibly redundant of judicial review remedies, and that the District lacks standing due to a non-redressable injury. They contend that the TCEQ has exclusive or primary jurisdiction over landfill permitting and that District rules cannot supersede a TCEQ permit. The brief requests reversal of the trial court's order and dismissal of the District's suit.

Environmental LawLandfill PermittingGroundwater ConservationJurisdiction DisputeAdministrative LawDeclaratory Judgment ActRipeness DoctrineStanding (Law)Exclusive JurisdictionPrimary Jurisdiction
References
195
Case No. 01-07-01113-CV
Regular Panel Decision
Oct 17, 2008

Paul Turner v. Precision Surgical, LLC

Paul Turner, a former sales representative for Precision Surgical, L.L.C., appealed a take-nothing judgment stemming from his retaliatory-discharge and Sabine Pilot claims. Turner alleged his termination was a result of his refusal to commit insurance fraud by misrepresenting a work-related injury to claim health insurance instead of workers' compensation, and subsequently for filing a workers' compensation claim. Precision Surgical countered that Turner was terminated due to unreliability and dishonesty. The appellate court affirmed the trial court's judgment, finding no error in the disjunctive submission of jury questions because the two claims were mutually exclusive, and even if there were an error, it would have been harmless since the jury considered and rejected both theories of recovery.

Retaliatory DischargeSabine Pilot ClaimWorkers' Compensation ClaimInsurance FraudJury Charge ErrorConditional Jury SubmissionDisjunctive Jury SubmissionMutually Exclusive Legal TheoriesAbuse of DiscretionHarmless Error
References
28
Case No. MISSING
Regular Panel Decision

Texas Workers' Compensation Commission v. East Side Surgical Center

This case addresses the Texas Workers’ Compensation Commission's failure to establish fee guidelines for ambulatory surgical centers under the Texas Workers’ Compensation Act. East Side Surgical Center and related entities sued the Commission, seeking to invalidate default rules that applied in the absence of specific fee guidelines, arguing an unlawful delegation of fee-setting authority to insurance carriers. The district court initially declared rule 133.304® invalid, but the appellate court reversed this decision, holding that the rule did not constitute an unlawful delegation of the Commission’s authority. The court further clarified that providers are entitled to fair and reasonable reimbursement, not a statutory right to fee guidelines established by rule, and affirmed that East Side was not entitled to its usual and customary fee.

Workers' CompensationFee GuidelinesAdministrative LawStatutory InterpretationDelegation of AuthorityInsurance CarriersAmbulatory Surgical CentersJudicial ReviewDeclaratory ReliefInjunctive Relief
References
19
Case No. 2017-01-0699
Regular Panel Decision
Apr 30, 2018

Matheson, Kathy v. QCJC, Inc.

Kathy Matheson, a registered nurse, sustained a compensable left knee injury on November 22, 2016. Her knee surgery, scheduled for June 19, 2017, was postponed by Dr. Matthew Bernard due to her elevated A1C level (11.9) related to noninsulin-dependent diabetes, as a level of eight or lower was deemed necessary for surgical clearance to prevent complications. QCJC, Inc., the employer, ceased temporary total disability (TTD) benefits from August 2 through November 13, 2017, arguing the delay was due to Ms. Matheson's personal health. The Court, applying the 'employer takes employee as found' and 'direct and natural consequence' rules, found that the pre-surgical diabetic clearance was 'reasonably necessary' to treat the work-related knee injury. Therefore, the Court ordered QCJC to pay Ms. Matheson $12,678.05 in past due TTD benefits for the disputed period.

Workers' CompensationTemporary Total DisabilityTTD BenefitsKnee InjuryPre-existing ConditionDiabetes ManagementSurgical ClearanceMedical NecessityCausationExpedited Hearing
References
5
Case No. MISSING
Regular Panel Decision

Surgicare Surgical v. National Interstate Insurance

This case addresses whether an insurer complies with New York's 11 NYCRR 68.6 regulation by reimbursing for out-of-state medical services according to the host state's (New Jersey's) no-fault fee schedule. Plaintiff Surgicare Surgical, assignee of an injured party, sought full payment for surgery performed in New Jersey, but defendant National Interstate Insurance Company paid a reduced amount based on New Jersey's fee schedule. The court affirmed the defendant's method, ruling that when medical services are rendered in another jurisdiction with its own fee schedule, the 'permissible' charge under that schedule constitutes the 'prevailing fee' under New York's regulation. The decision emphasized alignment with legislative intent to contain no-fault insurance costs and reduce judicial burden, dismissing the plaintiff's complaint and denying its cross-motion.

No-Fault BenefitsInsurance LawFee Schedule DisputeOut-of-State Medical ServicesNew York RegulationsNew Jersey Fee ScheduleStatutory InterpretationAutomobile AccidentReimbursement DisputeSummary Judgment
References
17
Case No. MISSING
Regular Panel Decision

Turner v. Precision Surgical, L.L.C.

Paul Turner was discharged from Precision Surgical, L.L.C. and subsequently filed claims for retaliatory discharge and for refusing to perform an illegal act (insurance fraud). He alleged he was terminated after refusing to file a fraudulent health insurance claim instead of a workers' compensation claim. The trial court submitted jury questions for both claims disjunctively, requiring a 'no' answer to the insurance fraud claim before the workers' compensation claim could be answered. The jury found against Turner on both claims, leading to a take-nothing judgment. Turner appealed, arguing the conditional submission was improper. The appellate court affirmed, ruling that the two claims were mutually exclusive and that any error in the jury instruction was harmless as the jury had considered and rejected both theories of recovery.

Retaliatory dischargeWorkers compensationInsurance fraudJury instructionConditional submissionDisjunctive submissionMutually exclusive claimsHarmful errorSabine Pilot claimEmployment law
References
40
Case No. MISSING
Regular Panel Decision

Stankowski v. Kim

Plaintiff's decedent, Janusz Stankowski, was killed after being struck by a truck backing into Post & Taback's loading dock at the New York City Terminal Market. Plaintiff alleged negligence against Post & Taback for maintaining a dangerous condition (debris) and failing to control traffic, claiming the debris caused Stankowski to slip and be struck again. The IAS court denied Post & Taback's motion for summary judgment, but the appellate court reversed, finding no admissible evidence of Stankowski slipping on debris and no duty for Post & Taback to maintain the area where the accident occurred or control traffic. The dissent argued that issues of fact remained regarding the debris contributing to the accident and Post & Taback's duty to clear the area close to its dock.

Summary JudgmentNegligencePremises LiabilityWrongful DeathAppellate ReviewEvidentiary RulesHearsay EvidenceTraffic ControlLoading Dock AccidentDuty of Care
References
16
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