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

Case No. 2016-06-0912
Regular Panel Decision
Oct 20, 2016

Lee, Justin v. Western Plastics

This interlocutory appeal concerns an employer's challenge to a trial court's finding that an employee's recurrent shoulder dislocations and need for surgery were causally related to a compensable work injury. The employee, Justin Lee, suffered an initial work-related shoulder dislocation and underwent surgery. He subsequently experienced multiple dislocations of the same shoulder while away from work. The trial court concluded there was sufficient evidence to establish a causal link between the subsequent dislocations and the original injury, ordering ongoing medical benefits. The Appeals Board affirmed the trial court's decision, determining that the medical records, taken as a whole, supported the causal relationship and that the employee's subsequent actions did not constitute negligent intervening conduct. The case has been remanded for further proceedings.

Workers' CompensationShoulder InjuryRecurrent DislocationCausationIntervening EventMedical BenefitsSurgery RecommendationTrial Court AffirmationRemandEmployee Negligence
References
6
Case No. MISSING
Regular Panel Decision

Cook v. Great West Casualty Co.

This worker's compensation case addresses a claim for benefits stemming from the recurrence of an occupational hernia. The employee, who had a compensable hernia in 1981, experienced a recurrence in 1982 while working, leading to further surgeries and temporary total disability benefits from the insurer. The trial court denied additional compensation for the recurrence, citing T.C.A. § 50-6-212(a)(5) which states a hernia must not exist prior to the accident. The Tennessee Supreme Court reversed, clarifying that this statute applies to pre-existing non-compensable hernias, not to the recurrence or aggravation of a previously compensable one. The Court held that an employee is entitled to further benefits if a compensable hernia recurs or is aggravated in the course of employment, and remanded the case for a new trial to determine causation and additional benefits.

worker's compensationherniarecurrenceoccupational injurystatutory interpretationTennessee Supreme Courtremandtemporary total disabilitypermanent partial disabilitycausation
References
7
Case No. 11-05-00417-CV
Regular Panel Decision
Jan 04, 2008

State Office of Risk Management v. Belinda Baker

This workers' compensation case involves the State Office of Risk Management (SORM) appealing an award to Belinda Baker for depression, which she claimed resulted from a work fall. The Texas Workers' Compensation Commission found her injury extended to include depression. SORM sought judicial review. The trial court granted Baker's motion for a directed verdict, concluding SORM failed to present evidence that Baker's injury did not cause her depression recurrence. The appellate court found that SORM did create fact issues regarding the extension of the injury to include depression. The court identified ample evidence of other potential stressors contributing to Baker's depression recurrence, such as marital issues, family illness, and a long history of recurrent major depressive disorder predating the work injury. Therefore, the appellate court reversed the trial court's judgment and remanded the case for further proceedings.

Workers CompensationDepressionMental HealthPreexisting ConditionDirected VerdictAppellate ReviewCausationMedical EvidenceTexas LawRelapse
References
7
Case No. MISSING
Regular Panel Decision
Feb 27, 1981

France v. American Indemnity Co.

James Craig France sued American Indemnity Company for medical expenses under a worker's compensation settlement after suffering a shoulder dislocation. Despite a compromise agreement to cover future expenses from a 1975 injury, American Indemnity refused payment for surgery following a later dislocation in 1977, attributing it to a new injury. A jury found the expenses stemmed from the 1975 injury. The Supreme Court reversed the lower courts' take-nothing judgment, awarding France $2,192.10 for medical expenses and remanding the issue of attorney's fees for further proceedings, finding a breach of the settlement agreement.

Worker's CompensationBreach of ContractCompromise Settlement AgreementMedical ExpensesShoulder InjuryAffirmative DefensesAttorney's FeesPresentment of ClaimJury FindingsAppellate Review
References
8
Case No. MISSING
Regular Panel Decision

Claim of Di Simone v. Underwriters Adjusting Co.

The claimant, an insurance adjustor, sustained a low back injury in 1971. After initial recovery, he experienced recurrent pain, culminating in 1977 with severe back pain requiring laminectomy and fusion surgery. The Workers’ Compensation Board determined a direct causal link between the 1971 accident and the 1977 disability, rejecting a referee’s finding of a new accident in 1977. The Board’s decision relied on Dr. Wilson’s testimony, which characterized the 1977 issues as recurrences of the 1971 injury. The appellate court affirmed the Board's decision, finding it supported by substantial evidence and noting the Board’s authority to resolve conflicts in medical testimony.

Recurrent injuryPrior injury exacerbationWorkers' compensation claimLow back injuryLaminectomy and fusionCausation disputeMedical opinion conflictSubstantial evidenceAppellate reviewBoard decision affirmed
References
2
Case No. 2016-06-1429
Regular Panel Decision
Mar 31, 2017

Jackson, Eldon B. v. Express Services, Inc

Mr. Eldon B. Jackson sought payment for past medical expenses through an expedited hearing, claiming a recurrence of costochondritis was caused by his work for Express Services, Inc. The employer argued the injury was not primarily work-related and costochondritis was a pre-existing condition. The Court found Mr. Jackson failed to provide expert medical proof establishing a causal link between his employment and the condition's recurrence, which is required for non-obvious cases. Furthermore, Mr. Jackson also failed to present the actual medical bills for which he sought payment. Consequently, the Court denied his request for reimbursement of medical expenses but allowed for the possibility of presenting additional proof in the future.

Workers' CompensationMedical ExpensesExpedited HearingCostochondritisCausationPre-existing ConditionExpert Medical ProofTennesseeMisdiagnosisAortic Dissection
References
3
Case No. 2016-01-0212
Regular Panel Decision
Oct 25, 2016

Richards, Edward v. Kiewit Power Constructors Company

Edward Richards, an electrician, suffered a hernia in February 2015 while working for Kiewit Power Constructors Company, which was accepted as compensable. He underwent surgery by Dr. Claudine Siegert. In February 2016, Richards experienced a recurrence of the hernia after lifting a toolbox while working for another employer. Dr. Siegert opined that the recurrent hernia was a direct result of the original work-related hernia. The Court granted Mr. Richards' request for medical benefits, finding he is likely to prevail in proving entitlement to additional medical benefits, based on the direct and natural consequence rule. However, his request for temporary disability benefits was denied due to insufficient medical documentation of his disability post-February 2016.

Workers' CompensationHernia RecurrenceMedical BenefitsTemporary DisabilityCausationDirect and Natural Consequence RuleExpedited HearingEmployer LiabilityInsurance CarrierMedical Opinion
References
6
Case No. 2014-05-0033
Regular Panel Decision
Feb 19, 2015

Haynes, Emily v. DCI Donor Services

Employee Emily Haynes filed a Request for Expedited Hearing seeking temporary disability and medical benefits for a dislocated left kneecap sustained at work. The employer, DCI Donor Services, and its carrier, The Hartford, contended the injury was idiopathic due to Ms. Haynes' two prior left-knee dislocations and the absence of a specific work-related hazard. The Court reviewed the evidence and applicable law, including relevant Tennessee Code Annotated sections and case precedents on causation and idiopathic injuries. The Court ultimately found that Ms. Haynes failed to establish that her injury arose primarily out of her employment, concluding it was idiopathic in nature. Consequently, her request for medical and temporary disability benefits was denied, and the matter was set for an Initial Hearing.

Expedited HearingKnee DislocationIdiopathic InjuryMedical Benefits DenialTemporary Disability DenialCausation in Workers' CompPre-existing ConditionsEmployee Burden of ProofTennessee Workers' Compensation LawDCI Donor Services
References
4
Case No. ADJ9137744
Regular
Apr 21, 2023

CHARLES MONTIERTH vs. CITY OF SAN DIEGO, PERMISSIBLY SELF-INSURED

This case concerns whether the applicant's skin cancer qualifies as an insidious progressive disease. The Appeals Board affirmed the WCJ's finding that it does, based on evidence of a significantly elevated risk of recurrence and potential for increased disability, justifying reserved jurisdiction over permanent disability. This ruling aligns with precedent allowing for such reservation in cases of progressive diseases with uncertain future outcomes. Therefore, the original Findings and Award are affirmed.

Insidious progressive diseaseJackson doctrineReservation of jurisdictionPermanent disabilitySkin cancerMalignant melanomaBasal cell carcinomaActinic keratosesLifetime surveillanceMedical monitoring
References
10
Case No. ADJ7441132
Regular
Jul 20, 2012

Patrick O'Brien vs. COUNTY OF SAN DIEGO

The Workers' Compensation Appeals Board granted reconsideration to amend the original award. The Board found that the applicant's skin cancer was not an insidious progressive disease, reversing the prior reservation of jurisdiction over permanent disability. This decision aligns with previous rulings that such reservation is only appropriate for diseases with a demonstrable likelihood of future progression or recurrence. Consequently, the finding of injury was amended to specify the exact locations and types of skin damage.

Workers' Compensation Appeals BoardPatrick O'BrienCounty of San DiegoSheriff Sergeantindustrial injuryskin damagesolar skin damagecancerinsidious progressive diseasepermanent disability
References
11
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