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Case Law Database

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

Case No. 11-04-00191-CV
Regular Panel Decision
Dec 01, 2005

Fernando Morales v. Martin Resources, Inc., Martin Operating Partnership, L.P., and Select Professional Staffing

Fernando Morales, a temporary employee, sued Martin Resources, Inc., Martin Operating Partnership, L.P., and Select Professional Staffing for negligence after sustaining a hand injury at Martin Resources' Odessa facility. The trial court initially granted summary judgment to the defendants, citing the exclusive remedy provision of the Texas Workers' Compensation Act (TWCA). On appeal, the Eleventh Court of Appeals reviewed whether the defendants had sufficiently proven their workers' compensation insurance coverage, a necessary condition for the exclusive remedy provision to apply. The court found that neither Select Professional Staffing nor Martin Resources, Inc. provided adequate evidence of explicit workers' compensation coverage for themselves. Consequently, the appellate court reversed the trial court's summary judgment and remanded the case for further proceedings, emphasizing the burden of proof for establishing affirmative defenses like the exclusive remedy provision.

Workers' Compensation ActExclusive RemedySummary Judgment ReversalTemporary EmployeesStaff LeasingNegligence ClaimsAppellate Court DecisionInsurance Coverage DisputeEmployer LiabilityTexas Labor Law
References
8
Case No. ADJ19432813; ADJ19432814
Regular
Mar 24, 2025

Yeni Saenz vs. Kellermeyer Bergensons Services, LLC; Zurich American Dallas

Applicant Yeni Saenz sought reconsideration of a Workers' Compensation Administrative Law Judge's (WCJ) finding that her strike from a Qualified Medical Evaluator (QME) panel was untimely, granting the defendant the right to select the QME. The Workers' Compensation Appeals Board granted the petition for reconsideration, concluding that although the applicant's strike was indeed untimely, the defendant had subsequently waived its right to exclusively select a QME by failing to act within a reasonable time. Consequently, the Board rescinded the WCJ's decision and ordered the parties to proceed with Dr. Patrick S. Hill as the designated Qualified Medical Evaluator. Commissioner José H. Razo issued a dissenting opinion, arguing that the applicant had obfuscated the untimeliness of her strike and scheduled an appointment during the period when the defendant held the exclusive right to selection.

QME PanelUntimely StrikeLabor Code Section 4062.2WaiverTimely SelectionReconsiderationJoint Findings and OrderWCJAppeals BoardPetition for Reconsideration
References
2
Case No. ADJ2972385 (ANA 0400658)
Regular
Jan 16, 2009

Theodore Florentz vs. Paint Your Castle, State Compensation Insurance Fund

The Appeals Board dismissed the petition for reconsideration, granted removal, and reversed the order granting permission to select a qualified medical examiner. The Board held that the WCJ erred in ordering the parties to select their own QME, as the process for selecting a QME under Labor Code section 4062.2 must be followed.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalQualified Medical Examiner (QME)Labor Code Section 4062.2Medical UnitAgreed Medical EvaluatorComprehensive Medical EvaluationIndustrial InjuryPainter
References
5
Case No. ADJ8074524
Regular
Jan 17, 2013

Geoconda Acevedo vs. Reliable Caregivers, PEGASUS RISK MANAGEMENT

The Appeals Board dismissed the defendant's petition for reconsideration because the selection of a Qualified Medical Evaluator (QME) is not a final order. However, the Board granted removal to address issues with defective QME panels. The Board rescinded the prior award and ordered the WCJ to appoint a regular physician if the parties cannot agree on an Agreed Medical Examiner. This action aims to resolve the ongoing delays and procedural defects in selecting a QME for the applicant's evaluation.

QME panelremovalagreed medical examinerpanel qualified medical evaluatorWCJ authoritylabor code section 5701substantive right or liabilityprimary treating physicianindustrial injuryreconsideration
References
6
Case No. ADJ345248 (RDG 0128229)
Regular
Oct 26, 2011

JEREMY CHISSIE vs. REIBES AUTO PARTS, LLC, PACIFIC COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board granted removal and rescinded the WCJ's order to appoint an Independent Medical Examiner (IME). The Board found the WCJ improperly bypassed the established procedure for selecting a Qualified Medical Evaluator (QME) when the original QME became unavailable. Instead, the matter must return to the trial level to follow the Administrative Director's rules for appointing a replacement QME. This ensures the defendant's right to participate in the physician selection process.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalIndependent Medical Examiner (IME)Qualified Medical Evaluator (QME)Labor Code section 4062.2Administrative Director's Rule 31.5Rule 32.6Medical UnitPanel QME
References
3
Case No. MISSING
Regular Panel Decision

Select Insurance Co. v. Boucher

Select Insurance Co. appealed a jury verdict awarding Thomas Earl Boucher workmen's compensation for six and three-fourths years of total incapacity. The defendant contended that the plaintiff suffered only partial disability and requested related issues and instructions, which the trial court refused. The appellate court affirmed this refusal, noting that partial incapacity issues in this context were inferential rebuttal issues, and the requested definition was inadequate. Furthermore, the court found Dr. Belz's psychiatric testimony, based on both personal examination and hearsay, admissible as he was a treating physician. The appellate court concluded that the jury's finding of total incapacity was supported by sufficient evidence, particularly the medical testimony regarding the plaintiff's mental condition following his injury.

Workmen's Compensation AppealTotal IncapacityPartial Incapacity DefenseRule 277 T.R.C.P.Inferential Rebuttal IssuesExpert Witness TestimonyHearsay EvidencePsychiatric EvaluationMental DisabilityEarning Capacity Reduction
References
12
Case No. ADJ7712746
Regular
Dec 08, 2015

Glen Rizuto vs. United Parcel Service, Gallagher Bassett

The Appeals Board granted UPS's Petition for Removal, rescinding the WCJ's order to negotiate a QME selection. The Board found the WCJ erred by not addressing UPS's contentions regarding the validity of the second QME panel issued over 24 months after the first. UPS successfully argued they would be prejudiced if forced to negotiate when the second panel was allegedly the only valid one. The Board ordered parties to select a QME from the July 2, 2014 panel, allowing each to strike one name.

Petition for RemovalQualified Medical Evaluator (QME)Panel SelectionCumulative Trauma InjuryLabor Code Section 4062.1Labor Code Section 4062.2Romero v. Costco WholesaleIrreparable HarmPrejudiceMedical Unit
References
3
Case No. ADJ7087412; ADJ7087413
Regular
Feb 19, 2014

MARCOS MORALES vs. THE KROGER CO. dba RALPH'S; SEDGWICK CMS

This case concerns a dispute over the selection of a Qualified Medical Evaluator (QME) to determine industrial injuries related to diabetes and cardiovascular issues. The defendant, Kroger Co., objected to the WCJ's order for a replacement QME panel in internal medicine, arguing they had selected endocrinology and would be prejudiced. The Appeals Board granted the defendant's Petition for Removal, finding the WCJ erred by ordering a QME panel after trial when the parties had waived their right to that procedure. The Board rescinded the WCJ's order and remanded the case with instructions for the WCJ to appoint a "regular physician" to develop the medical record.

Petition for RemovalQualified Medical Evaluator (QME)Agreed Medical Evaluator (AME)Regular PhysicianLabor Code Section 4062.2Medical Record DevelopmentVocational Produce WorkerDiabeticCardiovascularWaiver
References
2
Case No. MISSING
Regular Panel Decision
Jun 20, 2018

Sentry Select Ins. Co. v. Ruiz

This case involves a declaratory judgment action filed by Sentry Select Insurance Company against Rudolph Automotive, LLC, Rudolph Chevrolet, LLC, Christian Ulises Ruiz, Marcelo Flores, and Lynn Crawford. Sentry sought declarations that it had no duty to defend or indemnify these defendants under an insurance policy for an underlying auto accident lawsuit. The underlying lawsuit stemmed from an incident where a Rudolph Mazda employee, Ruiz, hit a co-worker, Villegas, with his vehicle on the dealership premises after an informal social gathering where alcohol was consumed. The court analyzed the Host Liquor Liability coverage and the Employer's Liability exclusion within Sentry's policy. The court declared that Sentry has no duty to defend or indemnify Ruiz, Flores, and Crawford, but does have a duty to defend the Rudolph Entities. The question of Sentry's duty to indemnify the Rudolph Entities was deferred pending the resolution of the underlying lawsuit, and the current case was administratively closed.

Insurance Coverage DisputeDeclaratory JudgmentAuto AccidentEmployer LiabilityHost Liquor LiabilityInsurance Policy InterpretationDuty to DefendDuty to IndemnifyCommercial Garage LiabilityExcess Liability Coverage
References
33
Case No. ADJ8149685
Regular
Oct 03, 2016

Mike Amaireh vs. ALDEX TRANSPORT, INC., PROTECTIVE INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration of a WCJ's decision that excluded Dr. Greils' reports as inadmissible due to improper QME selection. The Board found that Dr. Greils was properly selected as a psychiatric QME, emphasizing substance over form in procedural matters. Therefore, the WCJ's findings were rescinded, and Dr. Greils' reports were deemed admissible.

QME selectionadmissibility of reportspetition for reconsiderationsubstance over formpsychiatric claimorthopedic injuryagreed medical evaluatorqualified medical evaluatorWCJ findingspetition to rescind
References
9
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