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Case Law Database

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

Case No. 03-14-00726-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. ADJ8331259
Regular
Dec 21, 2012

MARIELA GOMEZ vs. PROVIDENCE FARMS, LLC, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration. The Board adopted the WCJ's report, emphasizing that the defendant's failure to properly notify the applicant about changing treating physicians within the Medical Provider Network (MPN) resulted in a denial of necessary medical treatment. This failure to inform the applicant of her rights, particularly regarding physician selection and dispute resolution processes within the MPN, constituted a neglect or refusal to provide reasonable medical treatment, as established by precedent. Consequently, the applicant was permitted to continue receiving treatment outside the MPN until she could begin care with a designated physician within the network.

Workers' Compensation Appeals BoardProvidence FarmsLLCZenith Insurance CompanyMariela GomezADJ8331259Order Denying ReconsiderationPetition for ReconsiderationMedical TreatmentMedical Provider Network
References
2
Case No. ADJ7555799 (MF) ADJ7561888
Regular
Sep 08, 2017

REYNA PANIAGUA vs. T & R BANGI'S AGRICULTURAL SERVICES, INC., SEABRIGHT INSURANCE, administered by ENSTAR GROUP, STATE COMPENSATION INSURANCE FUND

This case involves an applicant seeking reconsideration of a finding that her employer did not refuse to provide medical treatment. The applicant's designated Medical Provider Network (MPN) physicians were unable to treat her, leading to delays and her eventual notification that a provider was no longer accepting new patients. Despite the applicant's frustration and inability to secure treatment within the MPN, the Board affirmed the original finding. The Board concluded there was insufficient evidence that the defendant neglected or refused to provide the requested medical treatment.

Workers Compensation Appeals BoardMedical Provider Network (MPN)Primary Treating Physician (PTP)Self-Procured TreatmentNeglect or Refusal to Provide TreatmentStipulations With Request for AwardCompromise and ReleaseExpedited HearingDeclaration of David KestnerCentral Valley Occupational Medical Group (CVO)
References
2
Case No. ADJ7532078
Regular
Mar 06, 2013

JESUS GONZALEZ vs. HERMAN WEISKER, INC., NATIONAL UNION FIRE INSURANCE, CHARTIS

The Appeals Board affirmed the WCJ's finding that applicant sustained a head and neck injury and that treatment outside the employer's medical provider network (MPN) was improper. While the employer failed to provide proper MPN notice, the applicant did not demonstrate this failure resulted in neglect or refusal to provide reasonable medical treatment. Therefore, treatment outside the MPN was not authorized. The Board found no error in the WCJ's decision.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNLabor Code section 4616.3Findings of FactReconsiderationWCJPetition for ReconsiderationReport and RecommendationKnight v. United Parcel Service
References
1
Case No. ADJ8027084
Regular
Mar 11, 2013

Teresa Amezcua vs. Westside Produce, Zenith Insurance Company

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a prior decision. The WCAB found that the defendant established a valid Medical Provider Network (MPN) and provided proper notice to the applicant. The applicant failed to present evidence of the defendant's neglect or refusal to provide treatment, thus negating her claim for self-procured treatment outside the MPN. The matter was returned to the trial level for further proceedings concerning disputed body parts and self-procured treatment.

Workers' Compensation Appeals BoardMedical Provider NetworkMPN notice requirementsself-procured treatmentindustrial injuryadmitted injurydisputed body partsreasonable medical treatmentemployer liabilityapplicant's burden of proof
References
2
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. ADJ15777619, ADJ15777625
Regular
Oct 13, 2025

VIRGINIA GALVAN vs. REGIONAL CENTER OF ORANGE COUNTY, INC.; CYPRESS INSURANCE COMPANY

Defendant sought reconsideration of the Joint Findings and Order issued on August 12, 2025, which found applicant sustained an employment-related injury and could self-procure treatment outside the defendant's medical provider network (MPN). Defendant contended the applicant failed to establish a neglect or refusal to provide reasonable medical care and that the WCJ's order allowing treatment outside the MPN was unsupported. The Appeals Board, after considering the petition, answer, and the WCJ's report, denied reconsideration. The Board adopted and incorporated the WCJ's findings that defendant failed to provide evidence of a valid MPN, proper notices, or treatment within the MPN, thereby constituting a denial of medical care and allowing the applicant to treat outside the MPN.

Workers' Compensation Appeals BoardPetition for ReconsiderationJoint Findings and OrderMedical Provider Network (MPN)Self-Procure TreatmentNeglect or Refusal to TreatAdverse InferencePre-Trial Conference Statement (PTCS)Discovery ClosureMandatory Settlement Conference (MSC)
References
12
Case No. ADJ10369582
Regular
Nov 05, 2018

Barbara Riggs vs. Sears Holdings Corporation, ACE American Insurance Company

This case involves an applicant seeking workers' compensation benefits who claims she cannot find a physician within the defendant's Medical Provider Network (MPN) due to her deafness and past negative experiences. The Administrative Law Judge initially allowed out-of-network treatment based on "exceptional circumstances." However, the Appeals Board granted reconsideration to develop the record, finding that the primary issue is whether the defendant neglected or refused to provide reasonably necessary treatment within its MPN. The Board rescinded the prior order and returned the case for further proceedings to determine if the MPN physician can accommodate the applicant's needs and if the defendant's prior actions constituted neglect or refusal.

Workers' Compensation Appeals BoardSears Holdings CorporationACE American Insurance CompanyESISPetition for ReconsiderationFindings and OrdersMedical Provider Network (MPN)exceptional circumstancesself-procure medical treatmentLabor Code section 4600
References
3
Case No. 2019-05-0988
Regular Panel Decision
Feb 28, 2020

Mason, George v, Ryder Integrated Lodistics, Inc.

Mr. Mason, an employee of Ryder Integrated Logistics, Inc., sought temporary disability benefits after lacerating his right thumb. The Court of Workers’ Compensation Claims held an expedited hearing to determine his entitlement to benefits for May 1 to May 22, 2019. Mason argued his decision to seek unauthorized medical treatment was justified due to Ryder's initial failure to provide adequate care and that he should be compensated based on restrictions from these providers. Ryder contended Mason failed to comply with statutory requirements by refusing authorized medical services. Judge Dale Tipps denied Mason's request, concluding he was unlikely to succeed on the merits as his refusal to accept authorized treatment and reliance on unauthorized medical opinions suspended his right to compensation.

Workers' CompensationTemporary Disability BenefitsMedical Treatment RefusalUnauthorized Medical CarePanel PhysicianEmployer's Right to Direct CareThumb LacerationExpedited HearingShelbyvilleSpring Hill
References
4
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
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