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

Case No. No. M2018-01696-COA-R3-CV; No. 15-4-IV
Regular Panel Decision
Dec 07, 2020

What Happened in Felix vs. Weber Metals Reconsideration?

This case involves an appeal concerning a failed merger between two professional dental associations, American Board of Craniofacial Pain (ABCP) and American Board of Orofacial Pain (ABOP). ABCP sued ABOP, alleging a breach of an agreement to merge formed through email exchanges and seeking specific performance and damages. The Chancery Court for Davidson County granted summary judgment to ABOP, finding no meeting of the minds and thus no enforceable contract. The Court of Appeals of Tennessee affirmed this decision, concluding that the parties’ objective manifestations showed a lack of mutual assent because an essential term (disposition of intellectual property) was not agreed upon and they intended to reduce the agreement to a formal Memorandum of Understanding, which was never finalized. The court also agreed that specific performance was not an available remedy due to the incompleteness of the purported contract.

Contract DisputeMerger NegotiationsCorporate MergerDental ProfessionMutual AssentSpecific Performance DenialSummary Judgment AffirmationTennessee Court of AppealsContract FormationLack of Agreement
References
26
Case No. 2024 NY Slip Op 00599 [224 AD3d 428]
Regular Panel Decision
Feb 06, 2024

How Did the WCAB Rule in Hardgrove vs. Intercon Security?

This case involves two appeals by New Millennium Pain & Spine Medicine, P.C. against Garrison Property & Casualty Insurance Company and GEICO Casualty Company. New Millennium sought to vacate master arbitration awards that denied its claims for no-fault benefits for medical services. The Supreme Court denied these applications. The Appellate Division, First Department, affirmed the Supreme Court's decisions, stating that an arbitrator's award will not be set aside unless it is irrational. The court also addressed the argument regarding a 20% wage offset in no-fault benefits, finding it unavailing under Insurance Law § 5102 (b). Ultimately, New Millennium was not entitled to attorneys' fees as it was not the prevailing party.

No-fault benefitsarbitration awardvacaturinsurance lawwage offsetappellate reviewmedical servicesno-fault policy exhaustionattorneys' feesCPLR Article 75
References
8
Case No. MISSING
Regular Panel Decision
May 05, 2000

What Did the WCAB Decide in Cuadra vs. Community Home Care?

This case addresses a dispute regarding the payment of first-party no-fault benefits to a health provider, Pain Resource Center, as the assignee of John Hiotis, who was injured in an auto accident. The defendant, Travelers Ins. Co., challenged the validity of the assignment and the necessity of the medical services provided. The court affirmed the validity of the assignment under New York's Insurance Law and related regulations. However, based on conflicting expert testimonies, the court limited the compensable medical services to six hours and awarded the plaintiff $566.10, along with statutory interest and attorney's fees.

No-Fault InsuranceFirst-Party BenefitsAssignment ValidityMedical ServicesPeer ReviewInsurance LawHealth Provider ClaimAutomobile AccidentDamagesStatutory Interpretation
References
5
Case No. MISSING
Regular Panel Decision

How Were Death Benefits Handled in Bocanegra vs. Sun-Gro Commodities?

Nancy Kosakow sued her former employer, New Rochelle Radiology Associates, alleging FMLA violations and wrongful denial of severance pay under ERISA. The court previously found FMLA claims collaterally estopped but remanded the ERISA claim to the Plan Administrator for a determination on severance eligibility. The Administrator denied severance, finding Kosakow not "terminated" and, even if so, not entitled to severance. This court reversed the "not terminated" finding, stating Kosakow was terminated due to a reduction in force. However, the court affirmed the Administrator's denial of severance, concluding that the "where applicable" clause in the Plan gave the Administrator broad discretion and that Kosakow's circumstances did not warrant severance. The court found that the denial was not unreasonable, even when considering a severance payment made to another full-time employee under different circumstances.

ERISASeverance PayFMLATerminationSummary JudgmentDe Novo ReviewPlan Administrator DiscretionEmployee BenefitsReduction in ForcePolicy Manual
References
8
Case No. MISSING
Regular Panel Decision

Can a WCJ Be Disqualified for Appearance of Bias?

The New York court addresses a motion for reargument by Universal Acupuncture Pain Services, P.C. against Lumbermens Mutual Casualty Company concerning no-fault insurance claims. The central legal question is whether an expert witness's peer review report, created after a timely denial of a no-fault claim, can be admitted at trial, specifically under the Cirucci precedent regarding the specificity of denial grounds. The court grants the motion for reargument but upholds its initial ruling, which granted partial summary judgment on one of five claims. It clarifies that the expert's testimony must be strictly limited to the "concurrent or excessive care" ground initially stated by the insurer, excluding any new grounds like "medical necessity" not specified in the original denial. The court emphasizes that the issue of whether different treatment modalities constitute concurrent care for the same condition requires a trial for factual determination.

No-Fault InsurancePeer ReviewExpert Witness TestimonySummary Judgment MotionInsurance Law InterpretationSpecificity of DenialConcurrent Medical CareAcupuncture TreatmentChiropractic TreatmentPhysical Therapy
References
7
Case No. 04-19-00538-CV
Regular Panel Decision
Jul 28, 2021

What Were the Key Rulings in Torrez vs. SuperShuttle?

William Alec Tisdall, M.D., and his medical practice appealed a final judgment stemming from a medical negligence lawsuit initiated by Thomas and Rebecca Varebrook. The jury found Tisdall negligent, awarding substantial damages after Thomas developed a severe septic sacroiliac joint infection following steroid injections administered by Dr. Tisdall, which left him permanently disabled and unable to continue his police career. On appeal, Tisdall argued that the trial court erred by allowing improper jury argument, admitting cumulative and prejudicial independent medical examinations, and denying a motion for mistrial. The Fourth Court of Appeals in San Antonio, Texas, affirmed the trial court's judgment, concluding that the jury argument was invited error, the medical examination evidence was properly admitted given its probative value and lack of unfair prejudice, and any error regarding the motion for mistrial was unpreserved and, if preserved, cured by the court's instruction to disregard.

Medical negligenceJury verdict appealEvidentiary rulingsImproper jury argumentIndependent medical examinationsMotion for mistrialInstruction to disregardStandard of careCausationDamages award
References
31
Case No. MISSING
Regular Panel Decision

Why Was Removal Denied in Rush vs. California Correctional Institution?

Claimant, employed by SCM Corporation for 19 years, injured her back in April 1979, leading to sacroileitis and severe back pain. She was awarded workers' compensation benefits at a reduced earnings rate. In 1980, SCM offered her a modified assembly line job, designed to accommodate her physical limitations. However, claimant declined the job, citing continued severe back pain and the impracticality of performing the work given her need for frequent exercises and potential muscle spasms. SCM argued that her refusal constituted a voluntary withdrawal from the labor market, seeking to deny further benefits. The Workers’ Compensation Board found that she did not voluntarily withdraw, a decision upheld by the appellate court due to substantial evidence supporting claimant's inability to perform the offered job.

Workers' Compensation AppealVoluntary Withdrawal from Labor MarketSacroileitisModified Duty OfferPhysical ImpairmentSubstantial Evidence ReviewAppellate ReviewCausally Related InjuryAssembly Line WorkBenefit Denial
References
2
Case No. MISSING
Regular Panel Decision

What Did the WCAB Clarify in Ontiveros vs. Savers Stores?

This case involved an appeal where the court affirmed the validity of a 5-1 jury verdict, rejecting the defendants' claim of being deprived of a constitutional right to a jury of six. The court also found the defendants' argument regarding Labor Law § 241 (6) violations unpreserved for review. Critically, the court agreed with the plaintiff that the awarded damages for past and future pain and suffering were inadequate given the plaintiff's severe injuries, including a herniated disk leading to total disability and excruciating pain. Consequently, a new trial on damages for past and future pain and suffering was granted, contingent on the defendants' refusal to stipulate an increase in the verdict to $150,000 ($100,000 for past and $50,000 for future pain and suffering).

Jury VerdictDamagesPain and SufferingHerniated DiskLabor LawAppellate ReviewVerdict ModificationStipulationMedical Expert TestimonyConstitutional Right to Jury
References
12
Case No. 2016-01-0546
Regular Panel Decision
Sep 26, 2017

Why Was Reconsideration Denied in Gomez vs. Dorothy Stevens?

Jeremiah Roper, an Allegis Group employee, suffered a traumatic left-hand amputation during a work-related accident, leading to multiple surgeries and a sepsis infection. He subsequently experienced severe phantom and neuropathic pain, which he attempted to self-medicate with illegal drugs, resulting in substance abuse issues. After being referred to a pain management specialist, Dr. Joe Browder, Mr. Roper was refused further treatment due to a positive drug screen. The Court, recognizing the potential for substance abuse following a work injury, denied Mr. Roper's request for another pain management panel. Instead, it ordered Allegis Group to authorize and schedule Mr. Roper to see his authorized treating physician, Dr. Brian Tonne, on an expedited basis, to evaluate his current condition, pain management needs, and potential substance abuse problem.

Amputation InjuryPain ManagementSubstance AbuseMedical BenefitsExpedited HearingPhysician ReferralDrug ScreeningComplex Regional Pain SyndromeTreating PhysicianEmployer Liability
References
4
Case No. No. 02-10-00291-CV
Regular Panel Decision
Aug 31, 2011

Why Was Reconsideration Dismissed in Sabino vs. Johnson Pump Company?

Curtis Chesser, through his spouse and power of attorney Ava Chesser, sued LifeCare Management Services (LMS) and LifeCare Hospitals of North Texas (Hospital) for health care liability. After Chesser suffered a mild stroke, he was transferred to Hospital where a PEG tube was surgically inserted. The tube's bolster was too tight, leading to severe pain, tissue necrosis, hemorrhage, cardiac arrest, cerebral injury, and permanent cognitive deficits. A jury found for Chesser. The Court of Appeals sustained Chesser's issue that no evidence supported the negligence of three settling doctors, modifying the judgment to apply a dollar-for-dollar settlement credit of $183,000. It also sustained Appellees' challenge to the jury's joint enterprise finding, removing joint and several liability for LMS and making it severally liable for 30% of the judgment. Furthermore, the court modified the judgment to impose several liability on Hospital and LMS for their respective $250,000 noneconomic damage awards, affirming the trial court's judgment as modified.

Health Care LiabilityMedical NegligencePEG Tube ProcedureJoint EnterpriseVicarious LiabilityComparative ResponsibilitySettlement CreditNoneconomic DamagesPrejudgment InterestStatutory Caps
References
70
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