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

Case No. 2015-02-0044 / 71577/2014
Regular Panel Decision
Dec 21, 2015

Gibson, Jayetta v. Claiborne County Board of Education

Employee Jayetta Gibson, a janitor for Claiborne County Board of Education, suffered a fall at work, seeking temporary disability and medical benefits for her injuries. She requested an unloader brace for pre-existing osteoarthritis, allegedly aggravated by the fall, and psychiatric treatment for anxiety. Judge Brian K. Addington denied both medical benefit requests, finding insufficient evidence of primary causation by the work injury, and gave more weight to the treating physician's opinion. However, the Court granted Ms. Gibson $1,106.51 in temporary disability benefits for a compensable knee contusion. This matter is set for an Initial (Status) Hearing on January 26, 2016.

Temporary DisabilityMedical BenefitsExpedited HearingOsteoarthritisKnee InjuryAggravation of Pre-existing ConditionPsychiatric Treatment DenialMedical ImpairmentWork RestrictionsTreating Physician Preference
References
3
Case No. 2016-03-1328
Regular Panel Decision
Apr 13, 2017

Woods, Natalie v. Dollar General

Natalie Woods sought workers' compensation benefits after two incidents: an alleged stroke at work on October 14, 2016, and an armed robbery at gunpoint on November 16, 2016, which resulted in stroke-like symptoms and psychological issues. The Workers' Compensation Judge, Pamela B. Johnson, conducted an expedited hearing. The Court found Dollar General failed to provide a proper panel of physicians to Ms. Woods as required by law, granting her request for a new panel. However, her claims for past medical expenses, temporary total disability benefits, and attorney's fees were denied due to insufficient expert medical proof establishing a causal connection between her conditions and employment. A scheduling hearing is set for June 22, 2017.

Workers' CompensationExpedited HearingMedical BenefitsTemporary Total DisabilityAttorney's FeesPanel of PhysiciansCausationExpert Medical TestimonyStroke-like SymptomsPost-Traumatic Stress Disorder
References
4
Case No. MISSING
Regular Panel Decision
Jun 16, 2006

Fortis Benefits v. Cantu

Vanessa Cantu suffered severe injuries in a car accident and sued multiple parties. Her medical insurer, Fortis Benefits, intervened, seeking subrogation for medical benefits paid under the policy. After Cantu settled with the defendants, Fortis pursued recovery from Cantu. Cantu argued that the equitable "made whole" doctrine barred Fortis's claim because her total losses exceeded the settlement amount plus the benefits Fortis paid. The trial court and court of appeals sided with Cantu. The Texas Supreme Court reversed, holding that the "made whole" doctrine does not override an insurer's clear contractual subrogation rights. The Court affirmed the dismissal of Fortis's claims against Ford due to a pretrial agreement.

Insurance SubrogationMade Whole DoctrineContractual SubrogationEquitable SubrogationERISATexas LawInsurance Policy InterpretationPersonal InjuryAutomobile AccidentSettlement Proceeds
References
28
Case No. 2018-06-1641
Regular Panel Decision
Apr 26, 2019

DZIADOSZ, JASON v. WHITESTONE INVESTMENTS, INC.

Mr. Jason Dziadosz, an employee of Whitestone Investments, Inc., filed for temporary disability and medical benefits due to a left-hand injury. The Court of Workers' Compensation Claims at Nashville held an expedited hearing, finding that Mr. Dziadosz's injury likely arose from his employment. The Court granted medical benefits, designating Dr. Todd Wurth as the authorized treating physician for future care and ordering Whitestone Investments to reimburse $250 for prior treatment. However, the request for temporary disability benefits was denied as no medical professional had placed Mr. Dziadosz off work beyond the period for which he had already received benefits. The matter is set for Status Conference on June 24, 2019.

Medical Benefits GrantedTemporary Disability DeniedLeft Hand InjuryTenosynovitisTrigger FingerAuthorized Physician DesignationEmployer Refusal of TreatmentExpedited Hearing OrderWork-Related InjuryCausation
References
4
Case No. 2017-04-0215
Regular Panel Decision
Feb 26, 2018

Lee, Jimmy v. Servpro Holding Co., Inc.

Mr. Lee, an employee of Servpro Holding Co., Inc., sought temporary disability benefits for an alleged work-related injury from July 13, 2016. The Court held an Expedited Hearing on February 15, 2018, to determine his entitlement to benefits from September 15, 2016, until August 15, 2017. The Court found Mr. Lee failed to provide adequate statutory notice of the injury and also failed to provide sufficient medical proof to establish causation for his claimed disability benefits. Despite the employer's inability to prove prejudice from the lack of notice, Mr. Lee's request for benefits was ultimately denied due to the lack of medical evidence linking his symptoms to a work-related injury. The matter is set for a Scheduling Hearing on April 23, 2018.

Temporary Disability BenefitsWorkers' CompensationNotice RequirementMedical CausationExpedited HearingCredibility AssessmentEmployee InjuryEmployer LiabilityShoulder InjuryBack Pain
References
5
Case No. 2015-06-0486, 2015-06-0303, 53530-2015, 38045-2015
Regular Panel Decision
Sep 15, 2015

Covington, Timothy v. GCA Services

Timothy Covington, a custodian, filed requests for expedited hearing seeking medical and temporary disability benefits for a gradually-occurring back injury, with two dates of injury: December 11, 2014, and May 6, 2015. For the December 11, 2014 injury, the Court denied benefits, finding Mr. Covington failed to prove a causal connection between his back condition and his work. For the May 6, 2015 injury, the Court found Mr. Covington is entitled to medical benefits for a lumbar strain incurred while lifting items at work and ordered GCA Services to continue providing reasonable and necessary medical care. However, the Court denied temporary disability benefits for the May 6, 2015 injury, as Mr. Covington presented no proof of a doctor taking him off work due to it. The matter is set for an Initial (Scheduling) Hearing on October 20, 2015.

Expedited HearingMedical Benefits AwardedTemporary Disability DeniedBack Injury CausationLumbar StrainDegenerative Disc DiseaseSpinal StenosisNeurosurgeon OpinionEmployee Burden of ProofTennessee Workers' Compensation Claims
References
9
Case No. MISSING
Regular Panel Decision
Feb 22, 1984

Barnhardt v. Hudson Valley District Council of Carpenters Benefit Funds

The plaintiff, injured in May 1978 during maintenance work, was denied workers' compensation due to the absence of an employer-employee relationship. Subsequently, he sought reimbursement for medical expenses from the Hudson Valley District Council of Carpenters Benefit Funds (Benefit Funds) through a union insurance policy. Continental Assurance Company (Continental), Benefit Funds' insurer, rejected the claim, citing an employment-related injury exclusion in the policy. The plaintiff then initiated an action against Benefit Funds, which in turn filed a third-party action against Continental seeking indemnification. Continental's motion for summary judgment, asserting the exclusion, was denied by the County Court. The appellate court affirmed this denial, ruling that the exclusionary language was ambiguous and applied only in cases where a clear employer-employee relationship existed, a fact still to be determined.

Insurance Policy InterpretationEmployment StatusWorkers' Compensation ExclusionSummary Judgment MotionContractual AmbiguityGroup Health InsuranceMedical Expense ReimbursementThird-Party ActionAppellate ReviewEmployer-Employee Relationship
References
10
Case No. MISSING
Regular Panel Decision

Lovell v. Nashville Electric Service

This workers' compensation case involves Ms. Lovell, who suffered a work-related injury and received benefits under a non-work related disability program from her employer, Nashville Electric Service. She subsequently sought workers' compensation benefits for the same injury. The trial court initially awarded these benefits without allowing a full set-off for the previously paid non-work related benefits. This court previously remanded the case for determination of the set-off amount. On the current appeal, the court addresses the Chancellor's refusal to set off the balance of the non-work related benefits against partial permanent disability benefits. Citing prior precedent, the court reverses the trial court's judgment, asserting that all non-medical benefits paid under the non-work related claim should be set off from the total workers' compensation award. The case is again remanded for calculation of the credit and redetermination of compensation.

Workers' CompensationDisability BenefitsSet-offWork-Related InjuryNon-Work Related BenefitsTemporary Total DisabilityPartial Permanent DisabilityEmployer LiabilityRemandPrior Precedent
References
3
Case No. MISSING
Regular Panel Decision

Cook v. Pension Benefit Guarantee Corp.

The Trustees of the Local 852 General Warehouseman’s Union Pension Fund sued the Pension Benefit Guarantee Corporation (PBGC) seeking reimbursement for pension benefits paid to retirees of two closed warehouses. The Fund argued for recovery based on equitable estoppel, asserting detrimental reliance on an initial PBGC determination that it would guarantee these benefits. The PBGC moved for summary judgment, contending that estoppel against a federal agency requires a showing of affirmative misconduct or manifest injustice. The Court found no evidence of affirmative misconduct by the PBGC and concluded that its change in determination, made to conform with Congressional intent, did not constitute manifest injustice. Consequently, the Court granted the PBGC's motion for summary judgment, ruling that equitable estoppel was inapplicable.

Equitable EstoppelFederal Agency EstoppelSummary JudgmentERISAPension BenefitsMulti-employer PlanPension Benefit Guarantee Corporation (PBGC)Affirmative MisconductManifest InjusticeDetrimental Reliance
References
10
Case No. Civ. A. No. 3:93-CV-0171-G.
Regular Panel Decision
Aug 31, 1993

Mills v. INJURY BENEFITS PLAN OF SCHEPPS-FOREMOST

Walter Mills was injured during his employment and sought benefits under his employer's Injury Benefits Plan. He subsequently filed a civil action alleging wrongful termination in retaliation for filing a workers' compensation claim under Texas law. Defendants removed the case to federal court, asserting ERISA preemption. The court granted the defendants' motion to dismiss Mills' claims against the Injury Benefits Plan, finding them preempted by ERISA. However, the court denied the dismissal of Mills' state law claims against Schepps-Foremost, Inc., d/b/a Oak Farms Dairies. Ultimately, the court remanded the remaining state law claims against Schepps-Foremost, Inc. to the County Court at Law Number 5 of Dallas County, Texas, due to a lack of federal subject matter jurisdiction.

ERISA preemptionWorkers' CompensationRetaliatory dischargeTexas lawFederal jurisdictionMotion to dismissRemandEmployee benefitsCivil procedureDallas County
References
18
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