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

Case No. 2023-06-4955
Regular Panel Decision
Jun 18, 2024

Kean, Carma v. NAVION BKE BELLEVUE, LLC

Navion BKE Bellevue, LLC, filed a motion for partial summary judgment, contending there was no genuine issue of material fact regarding permanent impairment from Ms. Kean’s work-related injury. After a hearing, the Court granted the motion, finding no permanent impairment. However, because the parties agreed the claim was compensable, the Court ordered Navion to provide continuing reasonable and necessary medical treatment. The Court dismissed Ms. Kean's claim for permanent disability benefits with prejudice but affirmed her entitlement to future medical benefits, the need for which must be determined at the time they are requested.

Summary JudgmentPermanent ImpairmentMedical Treatment BenefitsWorkers' Compensation Appeals BoardAdmissibility of EvidenceC-32 FormsMedical Records AdmissibilityWaiver of ObjectionCompensabilityTemporary Disability Benefits
References
6
Case No. MISSING
Regular Panel Decision

United States v. 13.10 Acres of Land in County of Putnam

This case involves a condemnation action brought by the United States against Christina Mattin to acquire 13.1 acres of her land in Putnam County for a buffer zone around the Appalachian National Scenic Trail. Mattin moved for summary judgment, arguing a "substantial relocation" of the trail requiring an act of Congress, and that the acquisition was not "reasonably necessary" and made arbitrarily. The Court denied Mattin's motion for summary judgment and granted the plaintiff's cross-motion, ruling that the trail relocation was not substantial based on the Secretary's reasonable interpretation of the National Trails System Act, and that the acquisition was necessary for trail protection and not arbitrary or capricious, and that reasonable efforts for acquisition were made.

CondemnationSummary JudgmentNational Trails System ActAppalachian TrailLand AcquisitionStatutory InterpretationBuffer ZoneAdministrative DeferenceProperty RightsFederal Land
References
7
Case No. ADJ10033983 ADJ11112700
Regular
Jul 08, 2019

PABLO PEREZ vs. TAYLOR FARMS, ZURICH NORTH AMERICA INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted applicant Pablo Perez's Petition for Removal, rescinding the prior finding that a Functional Capacity Evaluation (FCE) was not a reasonable and necessary medical-legal expense. The WCAB found that an FCE, recommended by Panel Qualified Medical Evaluator Dr. Ali Soozani to assess permanent impairment, provides crucial objective data not fully captured by subjective complaints or a standard physical examination. The Board reasoned that while a physical therapist conducts the FCE, this is permissible under Labor Code section 3209.5 for medical treatment and does not violate Labor Code section 4628 when viewed as a distinct diagnostic tool supporting the QME's overall evaluation. Consequently, the WCAB issued a new Finding of Fact and Order deeming the FCE reasonable and necessary.

Functional Capacity EvaluationMedical-Legal ExpensePanel Qualified Medical EvaluatorPermanent ImpairmentActivities of Daily LivingSubstantial EvidenceAlmaraz/GuzmanLabor Code Section 4628Diagnostic ToolMedical Opinion
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. MISSING
Regular Panel Decision

Carver v. Sparta Electric System

Plaintiff, employed by Charles Lee d/b/a Lee’s Tree Service, was injured while working for Sparta Electric System, sustaining severe electrical burns to his head and hand. The chancellor found an employer-employee relationship existed between Plaintiff and Sparta Electric, awarding disability benefits and medical expenses, including future cosmetic surgery for a scarred scalp. Defendants appealed, arguing Plaintiff was an an independent contractor and the surgery was not "reasonably necessary." The appellate court affirmed the trial court’s finding of an employer-employee relationship, emphasizing Sparta Electric's right to control and terminate employment. The court also upheld that the cosmetic surgery was "reasonably necessary" under the Worker's Compensation Act, rejecting the Defendants' arguments and remanding the cause.

Employer-Employee RelationshipIndependent Contractor AnalysisRight to Control TestRight to Terminate EmploymentMedical Treatment NecessityCosmetic Surgery CoverageElectrical Burn InjuryScalp DisfigurementTemporary Total DisabilityAppellate Affirmation
References
11
Case No. 05-21-00758-CV
Regular Panel Decision
Dec 28, 2022

Yvette Branch v. Laura McCaskill, Coldwell Banker Residential Brokerage NRT Texas LLC, Full Scope Property Inspection PLLC

Yvette Branch appealed a trial court's judgment awarding attorney's fees to Laura McCaskill, Coldwell Banker Residential Brokerage Company, and NRT Texas, LLC. The case originated from a failed real estate transaction where Branch was the buyer and appellees represented the sellers. Branch subsequently sued the appellees, alleging various claims including violations of the Texas Deceptive Trade Practices-Consumer Protection Act (DTPA), fraud, trespass, and negligence. The trial court granted summary judgment in favor of the appellees on all claims and awarded them attorney's fees. On appeal, Branch challenged the attorney's fee award, arguing it was not authorized by contract, not justified under the DTPA, and not reasonable or necessary. The Court of Appeals affirmed the trial court's judgment, concluding that the attorney's fees were authorized by the 'related to this contract' clause in the real estate agreement and that the awarded amount was reasonable and necessary.

Attorney's FeesSummary JudgmentReal Estate ContractDeceptive Trade Practices ActTrespass ClaimNegligence ClaimFraud ClaimAppellate ReviewTexas Civil PracticePrevailing Party
References
12
Case No. MISSING
Regular Panel Decision

Delcon Construction Corp. v. United States Department of Housing, & Urban Development

Deleon Construction Corporation (plaintiff) filed an action against the United States Department of Housing and Urban Development (HUD) and its Secretary, Mel Martinez (defendants), based on quantum meruit/unjust enrichment and conversion of trust funds. The defendants moved to join Russand, Inc., as a necessary party, arguing that Russand was a party to the underlying construction contract and Building Loan Agreement, which are central to Deleon's claims. The court found that Russand is a necessary party under Rule 19(a)(1) of the Federal Rules of Civil Procedure because complete relief cannot be accorded among the existing parties without Russand's presence, and its absence could subject HUD to inconsistent obligations. Therefore, the court granted the defendants' motion and ordered Deleon to join Russand as a necessary party defendant within thirty days, or face dismissal of the action.

Federal Rules of Civil ProcedureRule 19(a)(1)Necessary PartyJoinderQuantum MeruitUnjust EnrichmentConversion of Trust FundsConstruction ContractMortgage InsuranceHUD
References
10
Case No. ADJ1634986
Regular
Sep 10, 2013

REGINA CAMACHO vs. RIO SCHOOL DISTRICT, YORK INSURANCE SERVICES

This Workers' Compensation Appeals Board decision denies a lien claimant's petition for reconsideration. The lien claimant, Pueblo Surgery Center, failed to meet its burden of proof to establish the reasonableness of its $18,940.00 surgical charges. The Board adopted the WCJ's reasoning that Pueblo's submitted exhibits lacked necessary substantiation and were insufficient to prove their charges were reasonable. Therefore, the denial of reconsideration stands, upholding the original determination regarding the lien claim.

Workers' Compensation Appeals BoardPetition for ReconsiderationLien ClaimantReasonableness of ChargesOutpatient Surgery CenterBillingDeclarations Under Penalty of PerjuryComparative BillingBurden of ProofIndependent Bill Review
References
4
Case No. ADJ577900 (STK 0187827)
Regular
Jul 18, 2011

DARIO MEDRANO vs. FEIST CABINETS, VIRGINIA SURETY

The Workers' Compensation Appeals Board granted reconsideration of a prior decision regarding Dr. Brown's medical lien. The Board found that the reasonableness and necessity of Dr. Brown's treatment charges for applicant's 2003 industrial neck and back injury require further review. While defendants failed to properly object to bills, Dr. Brown still bears the burden of proving reasonableness. The case is remanded for the WCJ to determine which specific charges were reasonable and necessary, subject to OMFS, penalties, and interest.

Workers' Compensation Appeals BoardReconsiderationMedical Treatment LienReasonableness and NecessityOfficial Medical Fee ScheduleBurden of ProofIndustrial InjuryCompromise and ReleaseBill ReviewAdministrative Director Rules
References
2
Case No. 2014-06-0070
Regular Panel Decision
May 11, 2015

Campbell, Laura v. Mid-South Waffles, Inc. dba Waffle House

Laura Campbell, an employee of Mid-South Waffles, Inc. d/b/a Waffle House, filed a Request for Expedited Hearing seeking additional medical benefits for a knee injury sustained after slipping on Tabasco sauce at work. Waffle House, through its TPA Brentwood Services, denied the claim, stating the injury did not arise out of or in the course of employment. After reviewing evidence and testimony, the Workers' Compensation Judge found that Ms. Campbell's injury did arise out of and in the course of employment and that Dr. Salyer's recommendation for an MRI was reasonable and necessary. The Court ordered Waffle House to provide medical treatment, including authorizing an MRI and further treatment with Dr. Salyer. Furthermore, the Court referred Brentwood Services for a civil penalty investigation due to its denial of benefits without a reasonable investigation, as their stated reasons for denial were deemed insufficient.

Workers' CompensationMedical BenefitsExpedited HearingKnee InjurySlip and FallCausal ConnectionCourse of EmploymentArising Out of EmploymentMRI RecommendationDenial of Claim
References
7
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