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

Case No. 03-14-00726-CV
Regular Panel Decision
Oct 30, 2014

Texas San Marcos Treatment Center, L.P. D/B/A San Marcos Treatment Center v. Veronica Payton

Texas San Marcos Treatment Center appeals the trial court's denial of its motion to dismiss Veronica Payton's health care liability claim. Payton alleged negligence after being assaulted by a patient at the treatment center. The appellant argues that the expert report provided by Dr. William H. Reid is deficient, lacking factual support and specificity concerning the standard of care, its breach, and causation, as required by Chapter 74 of the Texas Civil Practices and Remedies Code. The appellant asserts the trial court abused its discretion by finding the report adequate and requests dismissal of the claims.

Medical MalpracticeExpert ReportMotion to DismissAbuse of DiscretionStandard of CareBreach of DutyCausationHealth Care Liability ClaimPsychiatric FacilityEmployee Assault
References
25
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. ADJ2401554 (FRE 023126)
Regular
Jan 07, 2013

JOSHUA GROSSMAN vs. ARAMARK UNIFORM SERVICE, ACE AMERICAN INSURANCE COMPANY

The Appeals Board granted reconsideration, reversing the judge's decision and finding the defendant liable for self-procured medical treatment. The defendant failed to prove they properly transferred the applicant into their Medical Provider Network (MPN) and neglected or refused to provide reasonable treatment by failing to ensure MPN physician availability. Consequently, the applicant's self-procured treatment from the lien claimant is deemed reasonable and compensable. The defendant is liable for the reasonable cost of this treatment, plus interest and penalties.

MPNself-procured medical treatmentneglect or refusal to provide medical treatmentprimary treating physicianlien claimantreasonable medical treatmentAramark Uniform ServiceAce American Insurance CompanySan Joaquin Accident & Medical GroupKnight v. Liberty Mut. Ins. Co.
References
16
Case No. SRO 0139219
Regular
Aug 11, 2008

JENNIFER BALKOWITSCH vs. HOME DEPOT

This case involves an applicant denied self-procured medical treatment by her employer, Home Depot, after failing to secure an MPN physician within reasonable proximity who would accept her. The Appeals Board reversed the initial finding, holding Home Depot liable for self-procured treatment. This decision was based on Home Depot's failure to prove it reasonably provided an MPN physician in accordance with accessibility standards, constituting a neglect or refusal to provide reasonable medical treatment.

Medical Provider NetworkMPN access standardsself-procured medical treatmentreasonable medical treatmentneglect or refusalapplicant's residenceemployment dutiesadministrative regulationemployer's obligationphysician availability
References
9
Case No. E2014-00302-COA-R3-CV
Regular Panel Decision
Jan 30, 2015

American Heritage Apartments, Inc. v. The Hamilton County Water and Wastewater Treatment Authority, Hamilton County, Tennessee

The plaintiff, American Heritage Apartments, Inc., challenged a monthly flat charge imposed by the Hamilton County Water and Wastewater Treatment Authority (County WWTA) for sewer lateral repairs. The trial court granted summary judgment to the County WWTA, finding no private right of action under the Utility District Law of 1937 (UDL). On appeal, the Court of Appeals reversed the summary judgment, concluding the UDL was inapplicable as the County WWTA was formed under the Tennessee Water and Wastewater Treatment Authority Act (WWTA Act). The appellate court held that the WWTA Act implicitly provides a private right of action for ultra vires and contract claims. The court also affirmed the trial court's alternative ruling that class action certification for affected customers was appropriate.

Water UtilityWastewater TreatmentFlat Rate ChargeClass Action CertificationSummary Judgment ReversalPrivate Right of ActionUltra Vires ClaimGovernmental ImmunityUtility District LawWater and Wastewater Treatment Authority Act
References
48
Case No. ADJ1448881 (VNO 0460995)
Regular
Sep 06, 2017

CLEMENTE MEJIA vs. PACIFIC MAT, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) affirmed a prior decision disallowing the balance of a lien for medical treatment provided by Dr. Arroyo. The administrative law judge found Dr. Arroyo failed to prove the reasonableness of services beyond progress and permanent and stationary reports, and that he was adequately compensated for reasonable services. The WCAB held that Labor Code section 4600(b), requiring medical treatment to be consistent with the Medical Treatment Utilization Schedule (MTUS) to be considered reasonably required, applied retrospectively to all open cases, including this one. Therefore, the original decision disallowing the remaining portion of the lien was affirmed.

Workers' Compensation Appeals BoardLien claimantPetition for ReconsiderationFindings of FactOrderMedical treatment lienIndustrial injuryCumulative periodPermanent disabilityReasonableness of services
References
1
Case No. 08-11-00264-CV
Regular Panel Decision
Oct 08, 2014

Maria G. Thompson/Luis Marioni, D.C. v. Jaime Stolar, M.D., Alivio Medical Center, Alivio Treatment Centers, P.A. and Luis Marioni, D.C./Maria G. Thompson

This multi-party appeal originated from a medical and chiropractic malpractice lawsuit filed by Maria G. Thompson against Dr. Jaime Stolar, Dr. Luis Marioni, and Alivio Medical Center and Alivio Treatment Centers, P.A. Thompson alleged negligence resulting in severe knee injuries, including infection and fusions, following injections and treatment. A jury found Dr. Stolar and Dr. Marioni negligent, awarding damages. On appeal, the court reversed the judgment against Dr. Marioni due to insufficient evidence of causation but affirmed the judgment against Dr. Stolar. The court also upheld the denial of Thompson's claims regarding damages and apparent agency against Alivio.

Medical MalpracticeChiropractic MalpracticeKnee InjuryKnee InfectionSpontaneous FusionSurgical FusionNegligenceCausationDamages AssessmentApparent Agency
References
48
Case No. MISSING
Regular Panel Decision
Jan 22, 2004

Mete v. New York State Office of Mental Retardation

This class action alleged age discrimination in employment against the New York State Office of Mental Retardation and Development Disabilities (OMRDD). Plaintiffs, former Chiefs of Developmental Center Treatment Services, claimed disparate treatment and disparate impact arising from a 1989 reduction in force (RIF) that eliminated their positions. All 46 Chiefs, who were over 40, were either demoted or retired, and statistical evidence showed a disproportionate impact on employees over 40. The Supreme Court granted defendants’ motion for summary judgment, dismissing all causes of action. The appellate court affirmed, finding that while plaintiffs established a prima facie case, OMRDD provided a legitimate, nondiscriminatory reason for the RIF (economic conditions and long-standing concerns about the position's utility), which plaintiffs failed to adequately prove was a pretext for discrimination.

Age DiscriminationClass ActionSummary JudgmentDisparate TreatmentDisparate ImpactReduction in ForceEmployment LawPretextPrima Facie CaseStatistical Evidence
References
11
Case No. ADJ1718435 (MON 0341690) ADJ2131482 (MON 0340861)
Regular
May 10, 2017

JEROME MITCHELL vs. COMMUTER EXPRESS, GALLAGHER BASSETT

This case involves a lien claimant, RS Medical, seeking reconsideration after its $6,800.28 lien for medical treatment was disallowed by the WCJ. The WCJ found RS Medical failed to prove the treatment was reasonable and necessary for the admitted industrial injuries. The Appeals Board granted reconsideration, finding the WCJ erred by focusing solely on neck treatment when evidence indicated prescriptions were for multiple body parts, including admitted injuries. The matter is returned to the trial level for the WCJ to re-evaluate the medical evidence and determine the reasonableness and necessity of the treatment.

Lien ClaimReconsiderationWCJUtilization ReviewTENS deviceMedical TreatmentBurden of ProofSubstantial EvidenceReasonableness and NecessityIndustrial Injury
References
5
Case No. ADJ2401554
Regular
Apr 02, 2013

JOSHUA GROSSMAN vs. ARAMARK UNIFORM SERVICE, ACE AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding its prior decision to grant the lien claimant's claim for medical treatment costs. The Board found that the defendant failed to properly notify the applicant of their Medical Provider Network (MPN) and that the applicant's attempts to secure an MPN physician were unsuccessful. Defendant's failure to provide sufficient assistance in transferring care was deemed a neglect to provide reasonable medical treatment, making them liable for self-procured treatment. The Board also found the lien claimant's treatment reasonable and consistent with the Agreed Medical Examiner's recommendations.

MPNMedical Provider NetworkLien ClaimantReconsiderationSelf-Procured Medical TreatmentAgreed Medical ExaminerPrimary Treating PhysicianLabor Code Section 4600Substantial Medical EvidenceIndustrial Injury
References
7
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