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

Case No. 2022-08-0195
Regular Panel Decision
Sep 02, 2022

Evans, Antron v. Family Dollar Stores, Inc.

Mr. Antron Evans requested a panel of psychiatrists, attorney's fees, and payment of a medical bill following a store robbery where he sustained a head injury. Family Dollar, the employer, contended he was not entitled to a psychiatric panel without a referral from an authorized physician, disputed the medical bill, and denied wrongfully denying the claim for attorney's fees. The Court denied Mr. Evans's requests for a psychiatric panel and payment of the emergency room bill, citing the statutory requirement of a panel physician's referral for psychiatric services and lack of proof for the medical bill. However, the Court granted his request for attorney's fees due to Family Dollar's five-month delay in timely initiating medical benefits. Additionally, Family Dollar was referred to the Compliance Program for potential penalties concerning the late filing of the First Report of Injury and the untimely provision of a panel of physicians.

Workers' CompensationMedical Benefits DenialAttorney's Fees GrantEmployer PenaltiesExpedited HearingPsychiatric ReferralStatutory InterpretationLate Claim ProcessingFirst Report of Injury DelayPost-Traumatic Stress
References
6
Case No. Docket No. 2016-06-0418; State File No. 32833-2015
Regular Panel Decision
Oct 02, 2018

Boutros, Nesreen v. Amazon

This expedited hearing addresses Nesreen Boutros' request for treatment from a physician other than Dr. Victor Isaac, the authorized treating physician, following alleged employer delays in authorizing referrals and prescriptions. The Court acknowledged Amazon's numerous delays in approving physical therapy and an orthopedist referral. Despite Amazon's argument for terminating medical benefits due to Ms. Boutros' alleged non-compliance, the Court found her explanations for refusing an injection and not filling a prescription reasonable, attributing issues to Amazon's failure to provide necessary documentation. The Court found Ms. Boutros credible, rejected Amazon's arguments, and concluded she is likely to prevail on her entitlement to further medical benefits with Dr. Isaac.

Workers' CompensationMedical TreatmentAuthorized PhysicianExpedited HearingEmployer Non-compliancePhysical TherapyPrescription MedicationCredibility AssessmentCausationMaximum Medical Improvement
References
4
Case No. 2016-07-0772
Regular Panel Decision
May 25, 2017

Jacks, Bonnie v. Camden Healthcare/Northpoint Senior Services, LLC

Bonnie Jacks, an employee of Northpoint, sustained a left shoulder injury in 2015. She requested an expedited hearing for additional medical benefits and approval of physician referrals to orthopedic and pain management specialists, as well as payment of outstanding medical bills. The employer, Northpoint, failed to provide a panel of physicians as required by law, instead offering Dr. Berry and later accepting a referral to Dr. Chandler. The Court found Ms. Jacks entitled to a panel of physicians for an orthopedic evaluation and ordered Northpoint to approve Dr. Berry’s referral to Tennessee Orthopedic Alliance. Additionally, Northpoint was ordered to pay Dr. Berry's outstanding bills totaling $340.00. The Court denied Ms. Jacks' counsel's request for attorney's fees but referred the case to the Penalty Unit for consideration of a penalty against Northpoint for failing to timely provide a panel of physicians.

Workers' CompensationMedical BenefitsExpedited HearingPhysician PanelOrthopedic ReferralPain ManagementAttorney's Fees DeniedPenalty Unit ReferralRotator Cuff TearShoulder Injury
References
3
Case No. MISSING
Regular Panel Decision

Texas Employers' Ins. Ass'n v. Leake

Appellee H. B. Leake sued appellant Texas Employers’ Insurance Association to overturn an Industrial Accident Board award and seek compensation for a 1935 back injury. Leake filed his claim nine years later, alleging "good cause" due to initial belief of trivial injury and doctors misdiagnosing his condition as rheumatism, a claim supported by a jury verdict. However, the appellate court reversed the judgment, ruling that Leake’s testimony, even when viewed favorably, failed to establish "good cause" for the extensive delay. The court highlighted that Leake knew of his injury from the start, suffered continuous pain, and notably withheld injury details from his consulted physicians. Furthermore, a two-year period following a varicose vein operation lacked any documented "good cause" for continued delay in filing, solidifying the court's decision to render judgment for the appellant.

Delayed Claim FilingGood Cause ExceptionStatute of LimitationsWorkman's CompensationBack InjuryMedical MisdiagnosisPermanent Total IncapacityAppellate ReviewReversed and RenderedIndustrial Accident Board
References
14
Case No. 2024-60-5751
Regular Panel Decision
Jul 17, 2025

Rooks, Sabrina v. Amazon.com

Sabrina Rooks, an employee, filed for an expedited hearing against Amazon.com and American Zurich Insurance Company after injuring her right foot, ankle, and knee at work. The Court found that Amazon unreasonably delayed authorizing a direct medical referral to Dr. Christopher Jones, prompting a referral to the Compliance Program for a penalty. Despite this, Ms. Rooks's claim for temporary partial disability benefits was denied. The Court determined that Amazon proved Ms. Rooks violated a valid workplace rule by sleeping on the job, which was the true motivation for her termination, making her unlikely to prevail on the merits for these benefits.

Workers' CompensationExpedited HearingMedical Treatment DelayTemporary Partial DisabilityWorkplace Rule ViolationEmployer PenaltyDirect Medical ReferralCausation of InjuryAttorney's Fees AwardTennessee Law
References
4
Case No. MISSING
Regular Panel Decision

Thompson v. Stolar

Maria G. Thompson filed a medical and chiropractic malpractice lawsuit against Dr. Jaime Stolar, Dr. Luis Marioni, and Alivio Medical Center after suffering knee injuries and subsequent infections allegedly caused by their treatment. Thompson had prior knee issues and surgeries, and Dr. Stolar administered knee injections which likely caused an infection due to improper technique. Dr. Marioni was found negligent for failing to make an emergent referral when Thompson presented with signs of infection. The appellate court reversed the judgment against Dr. Marioni due to insufficient evidence of causation regarding his delayed referral and Thompson's auto-fusion. The court affirmed the judgment against Dr. Stolar and upheld the jury's zero damage awards for certain categories, citing other contributing factors to Thompson's injuries and the payment of past medical expenses by worker's compensation.

Medical MalpracticeChiropractic MalpracticeKnee InjuryKnee InfectionSteroid InjectionsKnee FusionMedical NegligenceCausationApparent AgencyDirected Verdict
References
45
Case No. ADJ6973825
Regular
May 21, 2012

MONICA BENARD vs. JENNY CRAIG, SEDGWICK CMS

This case concerns a penalty imposed on Jenny Craig for unreasonably delaying authorization for applicant Monica Benard's chiropractic treatment. The WCJ found a 25% penalty for the delay, which Jenny Craig appealed, arguing the delay was due to the applicant's choice of a chiropractor outside their Medical Provider Network (MPN). The Appeals Board affirmed the unreasonable delay finding but reduced the penalty to 20% of the delayed treatment's value, citing a failure in case management rather than intentional disregard. Jurisdiction was reserved for the parties to adjust the penalty amount.

Workers Compensation Appeals BoardMonica BenardJenny CraigSedgwick CMSADJ6973825ReconsiderationFindings and AwardLabor Code section 5814Medical Provider Network (MPN)chiropractic treatment
References
9
Case No. 2018-01-0040 ja bis
Regular Panel Decision
Jan 04, 2019

Newton, Cameron v. OM Hixson, LLC

Cameron Newton sustained a psychological injury diagnosed as post-traumatic stress disorder by Dr. John Robertson, who ordered psychotherapy. The employer, OM Hixson, LLC, failed to provide a panel of psychotherapists for over two months, contending Mr. Newton had not established that Dr. Robertson was unwilling to provide the therapy or that the order was limited to psychiatrists or psychologists. The Court found the employer's arguments without merit, noting a pattern of previous delays in providing benefits. The Court ordered OM Hixson, LLC to promptly provide Mr. Newton with a panel of psychotherapists and referred the case to the Bureau’s Compliance Unit for assessment of a penalty due to the employer's repeated failure to timely provide recommended medical treatment.

Psychological InjuryPost-traumatic Stress DisorderPsychotherapyEMDR TherapyMedical BenefitsWorkers' Compensation LawExpedited HearingPenalty AssessmentEmployer DelayCompliance Unit Referral
References
1
Case No. ADJ9932467
Regular
Oct 16, 2017

THERESA MCFARLAND vs. REDLANDS UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board denied an applicant's petition for reconsideration, affirming the WCJ's decision that "Return-To-Work" supplemental payments under Labor Code section 139.48 are not "compensation" as defined by Labor Code section 3207. Therefore, the applicant was not entitled to a second penalty under Labor Code section 5814 for the employer's delay in providing a Supplemental Job Displacement Benefit voucher, as that delay did not cause a delay in a compensable benefit. The Board found that the applicant's penalty claim for the voucher delay was already resolved and that imposing a second penalty for a non-compensable benefit delay would be unfair and against the principle of balancing justice.

Labor Code section 139.48Return-To-Work supplemental paymentscompensation definitionLabor Code section 3207Labor Code section 5814 penaltyLabor Code section 4658.7 voucherSupplemental Job Displacement Benefitcompromise and release agreementGage v. Workers' Comp. Appeals Bd.unreasonable delay
References
1
Case No. MISSING
Regular Panel Decision

Blau Mechanical Corp. v. City of New York

This appeal addresses whether contractual delays, for which the plaintiff-respondent sought monetary damages for plumbing work at the New York Zoological Park, were contemplated by the parties' agreement. The court concluded that these delays were indeed contemplated, reversing a prior Supreme Court finding. The contract included a clause barring damages for delay unless caused by intentional wrongdoing, gross negligence, or willful misconduct. The plaintiff alleged delays due to structural changes, unexpected subsurface conditions, and interference from a local community group. However, the court found that the contract explicitly anticipated changes and differing subsurface conditions. Additionally, delays from community group intrusion were not attributable to the City as grossly negligent or intentional, thereby precluding recovery for damages.

Contractual DelaysDamages for DelayContemplated DelaysConstruction ContractPlumbing WorkNew York CityAppellate ReviewSubsurface ConditionsChange OrdersCommunity Interference
References
4
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