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Case Law Database

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

Case No. 03-03-00277-CV
Regular Panel Decision
May 13, 2004

Glen Smith v. Maximum Racing, Inc.

This appellate case concerns a dispute between Glen Smith and Maximum Racing, Inc. following the termination of an agreement to provide race cars for Smith's son. Smith refused to return a racing car, claiming Maximum Racing owed him for "compensable work" and sought a lien. Maximum Racing counterclaimed for conversion. A jury found Smith had not performed compensable work, leading the trial court to rule for Maximum Racing. On appeal, Smith challenged the waiver of the conversion claim, the finding of conversion without compensable work, and asserted a good-faith defense. The Third District Court of Appeals, at Austin, affirmed the trial court's judgment, concluding that the conversion claim was not waived, the jury's finding was supported by evidence, and good faith is not a valid defense to conversion under Texas law.

ConversionProperty LawContract DisputeAppellate ProcedureJury VerdictWorker's LienGood Faith DefenseWaiver of ClaimsTexas Court of AppealsAutomotive Industry
References
19
Case No. 03-14-00735-CV
Regular Panel Decision
Apr 30, 2015

Entergy Texas, Inc.// Office of Public Utility Counsel and Public Utility Commission of Texas v. Public Utility Commission of Texas and Texas Industrial Energy Consumers// Office of Public Utility Counsel and Entergy Texas, Inc.

The Commission’s Order should be affirmed. The Commission reasonably interpreted its prior rate-case order, the Black-box Order, to authorize Entergy to book and amortize a regulatory asset for unrecovered Hurricane Rita reconstruction costs. The Black-box Order was ambiguous concerning the Rita Asset. That order was based on a “black box” settlement—one where only the amount of rates to be collected was set forth, not all of the individual components of a rate case. Because the Black-box Order did not explicitly state whether booking and amortizing the regulatory asset had been authorized, it was ambiguous. Courts defer to an agency’s interpretation of its prior, ambiguous order, and the evidence in the record supports the Commission’s decision. Substantial evidence supports the Commission’s decision that $13 million should be added to Entergy’s storm reserve based on the expenses Entergy incurred to repair equipment after a severe ice storm in 1997. A prior Commission decision that faulted Entergy for poor service quality did not amount to a finding that Entergy could not include the repair costs in the insurance reserve amount. Substantial evidence supports the Commission’s decision that Entergy failed to meet its burden to prove that predicted purchased-power capacity costs were known-and-measurable changes to the test-year data. The record supports the Commission’s decision that Entergy did not meet its burden of proving that requested changes were known and measurable. For example, Entergy based its arguments about purchasing capacity on the assumption that it would always purchase the maximum amount under new contracts. Entergy claimed that it would have more customers in the future. Not only is that speculative, but the utility failed to account for how additional customers would otherwise affect its recovery through rates. And Entergy’s arguments about transmission charges are controlled by numerous unknown variables used in a complex formula. The Commission’s test-year rule is created to avoid just such unknowns. Moreover, most of Entergy’s request for post-test-year changes to transmission costs were based on an agreement that was still waiting for approval from the Federal Energy Regulatory Commission. That is patently not a “known” change. Because substantial evidence supports the Commission’s decisions, the Order should be affirmed.

Utility RegulationRate CasePublic Utility CommissionAppellate BriefHurricane Rita CostsRegulatory AssetStorm Damage ReservePurchased Power CapacityTransmission EqualizationAdministrative Law
References
24
Case No. 2007 NY Slip Op 30531(U)
Regular Panel Decision
Apr 05, 2007

Schirmer v. Athena-Liberty Lofts, LP

This case is an appeal from an Order of the Supreme Court, New York County, regarding a personal injury action. The plaintiff, a worker at a construction site, sustained injuries, leading to the site owner, Lofts, settling the claim after being found liable under Labor Law § 240 (1). Lofts then pursued indemnity claims against lighting contractor HP and the plaintiff's employer, Burgess. The Appellate Court modified the lower court's decision, vacating the finding that Lofts' settlement amount was reasonable due to Lofts' failure to properly demonstrate reasonableness and its mischaracterization of waiver arguments by HP and Burgess. The Court also affirmed the denial of HP's motion for summary judgment, citing unresolved factual issues concerning inadequate lighting as a cause of the accident.

Personal InjuryConstruction Site AccidentSummary JudgmentIndemnity ClaimLabor Law § 240(1)Appellate DivisionThird-Party ActionSettlement ReasonablenessCross ClaimsInadequate Lighting
References
4
Case No. MISSING
Regular Panel Decision

Texas Workers' Compensation Insurance Fund v. Serrano

This per curiam decision addresses whether a workers' compensation carrier must prove that the amount of benefits paid was reasonable and necessary before it is entitled to reimbursement from a third-party settlement. Jose Serrano sustained on-the-job injuries and, along with his family, sued third parties. The Texas Workers’ Compensation Insurance Fund intervened to assert subrogation rights for paid medical and indemnity benefits. The district court denied reimbursement for medical benefits, finding the Fund failed to prove reasonableness and necessity. The court of appeals affirmed. The Supreme Court of Texas disagreed, holding that Section 417.002(a) of the Texas Workers’ Compensation Act does not limit reimbursement to only reasonable and necessary amounts, as the statute refers to the care and services provided, not the amounts paid. The Court reversed the judgment of the court of appeals and remanded the case for further proceedings.

Workers' CompensationSubrogation RightsReimbursement ClaimMedical BenefitsIndemnity BenefitsThird-Party ActionSettlement ProceedsReasonable and Necessary CostsStatutory InterpretationAppellate Review
References
10
Case No. 2023-08-1738
Regular Panel Decision
Dec 12, 2023

Stewart, Coshando, Surviving Spouse of Michael Stewart v. Memphis, Light, Gas and Water

This compensation order addresses the amount and lump-sum payment of attorney fees for Coshando Stewart, surviving spouse of deceased employee Michael Stewart. Michael Stewart died from electric shock, and Ms. Stewart was awarded maximum benefits and burial expenses. Her attorney, Tim Williams, requested $49,324.00 in fees, representing approximately 9.78% of the total award. The Court found this amount reasonable, citing Tennessee Code Annotated sections 50-6-226 and 50-6-229, and considering factors from Tennessee Supreme Court Rule 8, RPC 1.5. The Court also ordered the attorney's fees to be paid in a lump sum, noting the Tennessee Supreme Court's precedent in death cases.

Attorney FeesLump Sum PaymentWorkers' Compensation Death BenefitsContingency FeeReasonableness of FeesStatutory InterpretationDependency BenefitsElectric Shock FatalitySettlement OfferCourt Discretion
References
1
Case No. MISSING
Regular Panel Decision

Murali v. Upton

Plaintiff, an orthopedic surgeon, sued defendant Edward Upton for an unpaid surgical fee of $8,545 after Upton's no-fault benefits were exhausted. Defendants argued that the plaintiff's charge exceeded the maximum allowable no-fault rates under Insurance Law § 5108 and 11 NYCRR 68.4, asserting a legal maximum of $3,294.08. Plaintiff contended that payment was assured prior to surgery and provided an assignment from Upton for the fee from a personal injury lawsuit. The court clarified that while Insurance Law § 5108 limits fees, it does not bar recovery for excessive billing; a provider can still sue for the legally permissible amount. Finding that defendants' calculation of the maximum permissible fee lacked expert support and that some amount might still be owed, the court denied defendants' motion for summary judgment to dismiss the complaint. The plaintiff's request for costs was also denied.

Summary JudgmentNo-Fault InsuranceInsurance LawMedical FeesWorkers' Compensation BoardOrthopedic SurgeryLaminectomyCPLRExcess BillingMedical Provider
References
1
Case No. MISSING
Regular Panel Decision

Smith v. Maximum Racing, Inc.

This case involves a dispute between Glen Smith and Maximum Racing, Inc. following the termination of an agreement where Maximum Racing provided race cars for Smith's son, and Smith performed maintenance. Smith refused to return one car, claiming he was owed money for 'compensable work' and seeking to establish a lien. Maximum Racing counterclaimed for conversion. A jury found that Smith had not performed compensable work, leading the trial court to rule in favor of Maximum Racing for conversion. Smith appealed, arguing that the conversion counterclaim was waived, that his expenses constituted compensable work, and that his good-faith exercise of statutory rights was a defense to conversion. The appellate court affirmed the trial court's judgment, finding the conversion claim was not waived, sufficient evidence supported the jury's finding against compensable work, and good faith is not a defense to conversion under Texas law.

ConversionProperty LawLienCompensable WorkJury FindingsWaiverTexas Rules of Civil ProcedureGood Faith DefenseAppellate ReviewPersonal Property
References
19
Case No. ADJ11299000
Regular
Oct 09, 2019

ORLANDO WATKINS vs. SME STEEL CONTRACTORS INC., THE HARTFORD

This Workers' Compensation Appeals Board case involves an award of additional attorney's fees and costs. Following a denial of a Petition for Writ of Review by the Second District Court of Appeal, the matter was remanded for an award of fees. The applicant's counsel and defendant's counsel stipulated to a reasonable fee amount of $4,120.88. The Board found this stipulated amount to be reasonable and issued an award accordingly.

Workers' Compensation Appeals Boardattorney's feescostsPetition for Writ of ReviewLabor Code § 5801Labor Code § 5811stipulated agreementremandappellate attorney's feesHartford Casualty Insurance Company
References
1
Case No. ADJ4070560
Regular
Mar 11, 2010

Lawrence Ware vs. Abrazo Del Sol, Inc., Zenith Insurance Company

The WCAB affirmed the judge's award of $2,625.00 to lien claimant Dr. Gabriel for a medical-legal report, reducing his billed amount by $875.00. The Board found that the doctor's report did not qualify as a Qualified Medical Evaluation and that the lien claimant failed to meet his burden of proving the reasonableness of the full billed amount, particularly regarding the time spent on report preparation. While defendants did not strictly follow objection procedures, their challenge to the report's reasonableness was considered, and the WCJ's discretionary reduction was upheld. Consequently, the lien claimant's petition for reconsideration was denied.

Medical-legal expensesLien claimantReconsiderationWCJOfficial Medical Fee ScheduleLabor Code Section 4622(a)Compromise and ReleaseConsequential injuryDental reportingQualified Medical Evaluator
References
7
Case No. MISSING
Regular Panel Decision

Pollock v. Trustmark Insurance

Plaintiff Dr. Allan Pollock sued Trustmark Insurance Company for breach of a disability insurance policy and violation of New York General Business Law § 349 after Trustmark ceased payments. The case was removed to federal court by Trustmark based on diversity of citizenship, claiming the amount in controversy exceeded $75,000. Pollock cross-moved for remand, arguing the amount in controversy was below the jurisdictional threshold. The court analyzed whether accrued payments, attorney's fees, potential statutory penalties, and future payments could be aggregated to meet the $75,000 requirement. The court found that only accrued payments ($55,000) plus reasonable attorney's fees and a $1,000 statutory penalty could be considered, and these did not reasonably exceed $75,000. Consequently, the federal court lacked subject matter jurisdiction, and the case was remanded to state court.

Jurisdictional DisputeDiversity JurisdictionAmount in ControversySubject Matter JurisdictionRemandBreach of ContractDisability InsuranceNew York General Business LawAttorney's FeesStatutory Penalties
References
25
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