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

Case No. 13-08-00351-CV
Regular Panel Decision
Aug 31, 2009

Mitch Burkhart and Christine Burkhart v. Sedgwick Claim Management Services, Inc. and Concentra Integrated Services, and rgv/nueces Rehabilitation D/B/A Innovative Physical and Occupational Therapy

Mitch Burkhart sustained a foot and ankle injury while training for his employer, Verizon Communications. Verizon's workers' compensation claims were administered by Sedgwick Claim Management Services, Inc., who, along with Concentra Integrated Services, arranged a Functional Capacity Evaluation (FCE) for Burkhart with RGV/Nueces Rehabilitation d/b/a Innovative Physical and Occupational Therapy. The Burkharts alleged that the FCE aggravated Mitch's injury, causing permanent damage. They sued Sedgwick, Concentra, and Innovative, claiming negligence, civil conspiracy, assault, fraud, and breach of the duty of good faith and fair dealing. The trial court dismissed the case against Innovative for an inadequate expert report and granted summary judgment to Sedgwick and Concentra, citing the exclusive remedy provision of the Texas Workers' Compensation Act. The appellate court affirmed the trial court's judgment, concluding that Mitch's aggravation injury was an 'extension injury' covered by the exclusive remedy provision of the TWCA.

Workers' CompensationFunctional Capacity EvaluationExclusive RemedyAggravation InjurySummary JudgmentMedical Expert ReportHealth Care LiabilityCivil ConspiracyBreach of Duty of Good Faith and Fair DealingTexas Court of Appeals
References
23
Case No. ADJ547219 (OAK 0284707) ADJ2031085 (OAK 0291936)
Regular
Apr 15, 2010

SHARON TAKAHASHI vs. COUNTY OF ALAMEDA (C/O SEDGWICK) and AIG (C/O TRISTAR)

The Workers' Compensation Appeals Board denied Tristar's petition for reconsideration while granting those of the applicant and Sedgwick. The Board affirmed the original Joint Findings and Award, but with specific amendments. These amendments clarify responsibility for Dr. Carr's medical-legal evaluation, assigning sole liability to Tristar. The decision also clarifies the administration of future medical treatment, delineating responsibilities between Tristar and Sedgwick for upper extremity versus lower extremity injuries.

ADJ547219ADJ2031085OAK 0284707OAK 0291936ReconsiderationJoint Findings and AwardIndustrial InjuryUpper ExtremitiesLeft KneeRight Ankle
References
0
Case No. 2022-08-0500
Regular Panel Decision
Apr 09, 2024

Gray, Tiffany v. Sedgwick Claims Management, Inc.

The employee, Tiffany Gray, filed an interlocutory appeal challenging a trial court order that compelled her to attend a medical examination with a physician chosen by the employer, Sedgwick Claims Management, Inc. Gray argued the request was unreasonable due to previous unsatisfactory interactions with the physician's office. The employer asserted the request was reasonable under applicable statutes. The trial court sided with the employer, and the Appeals Board affirmed this decision, finding Gray's appeal frivolous but declining to impose sanctions. The case was subsequently remanded.

Medical ExaminationEmployer's Right to IMEFrivolous AppealPro Se LitigationWorkers' Compensation ClaimsInterlocutory AppealAlleged Medical InterferenceRespiratory AilmentsMental Health ClaimsDiscovery Disputes
References
10
Case No. MISSING
Regular Panel Decision

Corbello v. Sedgwick Claims Management Services, Inc.

Plaintiff Debra Corbello sued Sedgwick Claims Management Services, Inc. after her claim for short-term disability benefits under ERISA was denied. Corbello, a dispatcher, sought benefits for panic disorder with agoraphobia and adjustment disorder, citing workplace stress. Sedgwick, the plan administrator, denied her claim, asserting insufficient medical evidence of disability preventing her from performing her job duties. The court reviewed Sedgwick's decision under an abuse of discretion standard, finding that the denial was supported by substantial evidence from independent physician advisors. These advisors concluded that Corbello's medical records did not objectively support her inability to perform her occupational assignments. Consequently, the court granted Sedgwick's motion for summary judgment and dismissed Corbello's claim with prejudice.

ERISADisability BenefitsSummary JudgmentAbuse of DiscretionPlan AdministratorMedical Records ReviewPsychiatric DisabilityObjective EvidenceTreating Physician OpinionConsulting Physician Opinion
References
33
Case No. ADJ4634338 (MON 0262377)
Regular
Jun 24, 2009

NINA GOODRICH vs. UNILAB/QUEST DIAGNOSTICS, SEDGWICK CLAIMS MANAGEMENT SERVICES, AMERICAN CASUALTY CO. OF READING, PA, CNA CLAIMSPLUS, VALLEY HEALTH SYSTEMS, TRISTAR RISK MANAGEMENT, ZURICH INSURANCE CO.

This case concerns a dispute over contribution claims following a cumulative injury to the applicant. The Workers' Compensation Appeals Board granted reconsideration, rescinded an arbitration finding, and remanded the matter for further proceedings. The Board found that Sedgwick, which paid over $180,000 in benefits, was not required to file a petition for contribution under section 5500.5 because it was not a signatory to the Compromise and Release (C&R). Furthermore, the Board held that even if Sedgwick had been required to file, the co-defendant CNA would be estopped from asserting the statute of limitations due to stipulations in the C&R reserving contribution rights. The Board concluded Sedgwick's claim for reimbursement was not time-barred.

Workers' Compensation Appeals BoardNina GoodrichUnilabQuest DiagnosticsSedgwick Claims Management ServicesAmerican Casualty Co.CNA ClaimsplusValley Health SystemsTristar Risk ManagementZurich Insurance Co.
References
2
Case No. ADJ2309063, 2603988
Regular
Jun 24, 2010

RAINIE JAEGER vs. APOTHE-CARE, INC., dba OWENS PHARMACY, FIREMAN'S FUND INSURANCE COMPANY, AMERICAN AUTO INSURANCE COMPANY, RISK ENTERPRISE MANAGEMENT, WALGREEN'S, AMERICAN MOTORISTS INSURANCE COMPANY, SEDGWICK CMS, Fairmont Premier Insurance Company, American Motorist Insurance Company adjusted by Sedgwick

This case involves a dispute over a worker's compensation claim for a low back injury determined to be a compensable consequence of a prior bilateral carpal tunnel injury. The Board granted reconsideration to correct the date of the compensable consequence injury to October 5, 2004. Furthermore, Fireman's Fund was ordered to reimburse Sedgwick CMS for benefits paid after that date, with the right to seek contribution from Fairmont Premier/REM. The Board rescinded prior findings and substituted new ones, clarifying liability for medical treatment and benefits.

compensable consequence injurybilateral carpal tunnellow back injuryspinal surgeryAgred Medical Evaluator (AME)Fireman's FundSedgwick CMSjoint and several liabilityreimbursementcontribution
References
0
Case No. ADJ6476038
Regular
Sep 18, 2013

RISHI DHIRI vs. WALGREENS, SEDGWICK

This case involves a petition for reconsideration filed by the applicant, Rishi Dhiri, against Walgreens and Sedgwick. The Workers' Compensation Appeals Board (WCAB) dismissed Dhiri's petition because it was filed from an interlocutory order granting reconsideration, not a final order. California law, supported by case precedent, establishes that petitions for reconsideration are only permissible after a final decision or award. The WCAB noted that the Workers' Compensation Judge may consider sanctions for failure to appear.

Petition for ReconsiderationFinal OrderInterlocutory OrderLabor Code section 5900DismissedWorkers' Compensation Appeals BoardWCJSanctionsGumilla v. Industrial Acc. Com.Safeway Stores v. Workers' Comp. Appeals Bd. (Pointer)
References
6
Case No. ADJ2842535
Regular
May 27, 2011

JANE HUTZELL vs. UNIVERSITY OF CALIFORNIA at BERKELEY, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves a Petition for Reconsideration by applicant Jane Hutzell against the University of California at Berkeley. The Workers' Compensation Appeals Board denied reconsideration, adopting the judge's report. The judge found that vocational experts' opinions did not adequately address the impact of medical apportionment or the specifics of part-time work availability on the overall industrial disability rating. Therefore, the judge's rating, based on established schedules, was upheld.

Workers' Compensation Appeals BoardPetition for ReconsiderationVocational ExpertsLumbar Spine ConditionCumulative TraumaNon-Industrial FactorsObesityApportionmentBilateral Carpal Tunnel SyndromeBilateral Cubital Tunnel Syndrome
References
0
Case No. ADJ7047735
Regular
Jun 17, 2013

ANGELO TOTA vs. VERIZON SERVICES, SEDGWICK

This case involves a Petition for Reconsideration regarding an Order allowing costs for applicant's former attorneys. The petition was filed by defendants Verizon Services and Sedgwick CMS, objecting to interpreter fees, but it failed to address the actual costs ordered. Crucially, the petition was not served on all adverse parties, a procedural defect that alone warrants dismissal. The Board dismissed the petition, also noting deficiencies in its substance and attorney representation.

Workers' Compensation Appeals BoardPetition for ReconsiderationOrder Allowing CostsLabor Code Section 5811Interpreter FeesDepositionService of ProcessAdverse PartiesDismissalVerification
References
0
Case No. ADJ8138407
Regular
Nov 19, 2014

SCOTT LOWE vs. ADT, SEDGWICK CMS

The applicant is Scott Lowe, and the defendants are ADT and Sedgwick CMS. The defendants sought Social Security earnings records from 2005 to the present, claiming it was proper discovery. The Workers' Compensation Appeals Board (WCAB) denied the defendant's petition for removal of the judge's order denying this discovery. The WCAB found that the requested earnings information, starting seven years prior to the injury, was not relevant and removal is an extraordinary remedy requiring a showing of substantial prejudice or irreparable harm.

Petition for RemovalSocial Security earnings recordsdiscoverydue processtemporary total disabilitysubstantial prejudiceirreparable harmreconsiderationadministrative law judgeWorkers' Compensation Appeals Board
References
2
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