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

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. 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. 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. 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. MISSING
Regular Panel Decision

Duhon v. Bone & Joint Physical Therapy Clinics

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. 3-91-439-CV
Regular Panel Decision
Dec 11, 1991

Texas Workers Compensation Commission v. Texas Physical Therapy Association, Inc., and Jerry Hurt, Wayne Sawyer and Jeanette Winfree, Individually and as Members of TPTA

The Texas Workers Compensation Commission attempted to appeal a temporary injunction issued by the Travis County district court on August 29, 1991. The Commission's notice of appeal was filed beyond the twenty-day period, but they asserted a lack of timely knowledge. The Court of Appeals directed the Commission to file a supplemental transcript with an order from the trial court regarding the notice date, which they failed to do. Consequently, the Court of Appeals determined it lacked jurisdiction due to the untimely filing of the notice of appeal, and the appeal was dismissed.

JurisdictionTimelinessNotice of AppealTemporary InjunctionAppellate ProcedureSupplemental TranscriptTexas Civil PracticeCourt of AppealsDismissalTexas Law
References
10
Case No. 03A01-9804-CH-00120
Regular Panel Decision
Mar 24, 1999

Cleveland Surgery Center v. Bradley Co. Hospital

Two private health care providers, Cleveland Surgery Center and Ocoee Physical Therapy, Inc., sought a declaratory judgment against Bradley County Memorial Hospital and its partners, alleging ultra vires acts and violations of the Tennessee Constitution. The providers challenged the hospital's business ventures with private entities, specifically the Ocoee Health Alliance. The trial court found the hospital had exceeded its authority by lending the county's credit and engaging in unconstitutional business dealings. On appeal, the Court of Appeals affirmed the trial court's judgment regarding the specific business ventures, concluding that the hospital acted as an agent of Bradley County and its partnerships with the private Alliance violated Article II, § 29 of the Tennessee Constitution. The appellate court modified the permanent injunction, narrowing its scope to prohibit transactions with private businesses that obligate County Funds without a public referendum.

Hospital AuthorityUltra Vires ActsConstitutional LawPublic-Private PartnershipsDeclaratory JudgmentInjunctionCounty LiabilityTaxation PowerReferendumHealthcare Law
References
24
Case No. ADJ563768 (SBR 0331684), ADJ2410618 (SBR 0338943)
Regular
Mar 22, 2010

JORGE GONZALEZ vs. TOYO TIRE USA, TOKO MARINE PASADENA

Lien claimant Access Health Medical Group seeks full reimbursement for services, arguing the WCJ erred by disallowing most of its lien based on anti-referral laws (Labor Code §§ 139.3, 139.31). Access contends these laws do not apply to in-house referrals for chiropractic, acupuncture, or "work conditioning" services, as these are not "physical therapy." The Appeals Board granted reconsideration, finding the WCJ applied an overly broad definition of physical therapy. The case is returned for further proceedings to determine if the billed services were distinct from physical therapy, or if "work conditioning" constitutes physical therapy under the statute.

Labor Code §§ 139.3Labor Code § 139.31anti-referral lawsin-office referralsphysical therapychiropracticacupuncturework conditioninglien claimantFindings and Order
References
6
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