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

Case No. 2019-06-1960
Regular Panel Decision
Nov 20, 2020

Grimes, Kimberly v. YRC, Inc.

Ms. Kimberly Grimes sought additional medical benefits, specifically shoulder-replacement surgery, for a right-shoulder injury sustained while working at YRC, Inc. in August 2018. YRC opposed, arguing the need for surgery stemmed from pre-existing 'end-stage' arthritis rather than the work injury. Two physicians, Dr. Blake Garside and Dr. Ronald Glenn, both concluded that Ms. Grimes's need for a shoulder replacement was due to her pre-existing arthritis and not the work accident. Consequently, the Court denied Ms. Grimes's claim for additional medical benefits, finding she failed to meet the burden of proof that the surgery was a reasonable and necessary treatment for her workplace injury.

expedited hearingworkers' compensationmedical benefitsshoulder injuryarthritiscausationpre-existing conditionmedical necessityexpert testimonyrotator cuff tear
References
1
Case No. 2017-06-0219
Regular Panel Decision
Apr 27, 2017

Vercek, Eugene v. Yellow Road Corp.

Eugene Vercek, an employee, sought medical benefits for a right-shoulder injury sustained on April 16, 2016, while working for Yellow Road Corp. The employer denied authorization for recommended shoulder replacement surgery, arguing the injury was due to a pre-existing condition and not primarily work-related. The court held an expedited hearing to determine entitlement to additional medical benefits. The judge reviewed the deposition testimony of Dr. R. Edward Glenn, the treating physician, who opined that the work injury exacerbated a previously asymptomatic pre-existing arthritic condition and that the recommended surgery was medically necessary. The court concluded that Mr. Vercek demonstrated a likelihood to prevail on the merits, finding a compensable aggravation of a pre-existing condition arising primarily out of employment, and thus granted the request for medical benefits, including shoulder surgery.

Medical BenefitsShoulder InjuryAggravation of Pre-existing ConditionExpedited HearingCausationMedical NecessityOrthopedic SurgeryRight ShoulderExacerbationDeposition Testimony
References
3
Case No. 03-03-00435-CV
Regular Panel Decision
Jul 29, 2004

Texas Workers' Compensation Commission Richard Reynolds, in His Official Capacity as Executive Director of the Texas Workers' Compensation Commission/East Side Surgical Center Clinic for Special Surgery And Surgical and Diagnostic Center, L.P. v. East Side Surgical Center Clinic for Special Surgery/Texas Workers' Compensation Commission Richard Reynolds, in His Official Capacity as Executive Director of the Texas Workers' Compensation Commission

This case involves the Texas Workers’ Compensation Commission's failure to establish fee guidelines for ambulatory surgical centers under the Texas Workers’ Compensation Act. East Side Surgical Center, Clinic for Special Surgery, and intervenor Surgical and Diagnostic Center, L.P. (collectively "East Side") sued the Commission to invalidate certain default rules that applied when specific guidelines were absent. The district court declared one rule (133.304(i)) invalid and enjoined its enforcement, citing unlawful delegation of authority. On appeal, the Court of Appeals reversed the district court's judgment regarding the rule's invalidity and dissolved the injunction, citing a Texas Supreme Court decision finding no unlawful delegation. The court affirmed that East Side was not entitled to its usual and customary fee in the absence of specific guidelines.

Workers' CompensationAdministrative LawDelegation of AuthorityRulemakingAmbulatory Surgical CentersJudicial ReviewInsurance CarrierFee GuidelinesFair and Reasonable RatesStatutory Interpretation
References
38
Case No. 2016-03-0400
Regular Panel Decision
Jul 18, 2016

Dunn, Jason v. United States Infrastructure

Jason Dunn, a utility worker for United States Infrastructure (USI), injured his right shoulder in October 2014. After multiple surgeries and physical therapy for his right shoulder, he began experiencing left shoulder problems in February 2015, which his authorized physician, Dr. Eric A. Morgan, diagnosed as an over-compensation injury related to the original right shoulder injury. Dr. Morgan recommended left shoulder surgery, which utilization review approved but Liberty Mutual denied. An independent medical evaluation by Dr. Edward Kahn concluded the left shoulder injury was age-related and not caused by the work incident. The Court weighed the conflicting medical opinions, giving greater weight to Dr. Morgan's opinion due to his greater contact with Mr. Dunn, and found that Mr. Dunn is likely to prevail on the merits, granting his request for left shoulder surgery.

Shoulder InjuryOvercompensation InjuryMedical BenefitsCausationConflicting Medical OpinionsExpedited HearingPreponderance of EvidenceDirect and Natural Consequences RuleMedical Treatment AuthorizationUtilization Review
References
7
Case No. MISSING
Regular Panel Decision

Fitzgerald v. BTR Sealing Systems North America-Tennessee Operations

This workers' compensation case involves Donald Fitzgerald, an employee, seeking to compel BTR Sealing Systems North America to cover shoulder joint replacement surgery for a 1997 work injury. Despite a prior settlement leaving future medical benefits open, BTR refused the surgery, arguing lack of causation. The trial court sided with Fitzgerald, ordering the treatment. On appeal, BTR contended the trial court improperly shifted the burden of proof and that evidence did not support causation. The appellate court affirmed, finding no burden shifting and sufficient evidence to link the surgery need to the original 1997 injury, compelling BTR to provide the recommended medical treatment.

Workers' CompensationShoulder InjuryMedical TreatmentCausationDegenerative ArthritisJoint ReplacementBurden of ProofAppellate ReviewMedical Expert TestimonyPreponderance of Evidence
References
9
Case No. 2017-06-1090
Regular Panel Decision
Dec 04, 2017

Henderson, Debbie v. South Central Communications

Ms. Henderson filed a Request for Expedited Hearing seeking knee and shoulder surgery and temporary total disability benefits following a work fall on July 19, 2016. Dr. Ronald Derr, the authorized treating physician, opined that her injuries to her right shoulder, left knee, left hand, and right foot stemmed from the fall, aggravating pre-existing conditions in her knee and causing soft tissue impingement in her shoulder that was previously asymptomatic. The Court found that Ms. Henderson is likely to prevail on causation, determining that her need for surgery arises primarily out of her employment. Consequently, the Court granted her requests for additional medical benefits, including the proposed shoulder and knee surgeries, and awarded her $3,516.54 in past temporary total disability benefits. A status conference is scheduled for February 5, 2018.

Medical BenefitsKnee InjuryShoulder InjuryTemporary Total DisabilityExpedited HearingCausationPre-existing Condition AggravationWork AccidentSurgeryEmployer Liability
References
4
Case No. 08-06-00071-CV
Regular Panel Decision
Aug 30, 2007

Vincent Maes and Cynthia Maes and the Insurance Company of the State of Pennsylvania v. El Paso Orthopaedic Surgery Group

Vincent and Cynthia Maes and The Insurance Company of the State of Pennsylvania appealed the dismissal of a health care liability suit against El Paso Orthopaedic Surgery Group (EPOSG). The Maeses alleged negligence and vicarious liability against EPOSG after Vincent Maes suffered severe complications following back surgery by Dr. Paul Cho, an EPOSG neurosurgeon. The trial court dismissed all claims against EPOSG, finding the expert reports insufficient to address EPOSG's breach of the standard of care, even for vicarious liability claims. On appeal, the Court reviewed whether an expert report was necessary for vicarious liability claims and if the severance of claims against EPOSG was proper. The appellate court ultimately affirmed the trial court's judgment, upholding the dismissal of all claims against EPOSG and the severance.

Health Care LiabilityMedical MalpracticeExpert Report SufficiencyVicarious LiabilityRespondeat SuperiorDismissal with PrejudiceSeverance of ClaimsSpinal Surgery ComplicationsNeuroscienceOrthopedic Surgery Group Liability
References
17
Case No. MISSING
Regular Panel Decision

Maes ex rel. Maes v. El Paso Orthopaedic Surgery Group, P.A.

Vincent and Cynthia Maes, as next friend of their minor daughter Isabel, and The Insurance Company of the State of Pennsylvania (ICTSP), appealed a summary judgment granted in favor of El Paso Orthopaedic Surgery Group, P.A. (EPOSG). Isabel's claim was for loss of parental consortium due to her father Vincent Maes's alleged disabling injury following surgery performed by an EPOSG employee, Dr. Paul Cho, in 2001. Vincent Maes's initial lawsuit against EPOSG was dismissed with prejudice in 2004, and the two-year statute of limitations for his underlying claim expired in 2003. EPOSG moved for summary judgment, arguing Isabel's claims were time-barred and barred by the prior dismissal of her father's underlying claim. The appellate court affirmed the summary judgment, concluding that Isabel's derivative loss of parental consortium claims were extinguished by both the running of the statute of limitations on her father's claim and its prior dismissal with prejudice.

medical malpracticeloss of parental consortiumstatute of limitationssummary judgmentderivative claimshealthcare liabilityminor's claimsprior litigationdismissal with prejudiceTexas Civil Practice and Remedies Code
References
26
Case No. 2018-06-0636
Regular Panel Decision
Aug 13, 2018

Frizzell, Anthony v. Tin Roof Acquisition Co., LLC

The Tennessee Court of Workers' Compensation Claims issued an Expedited Hearing Order concerning Anthony Frizzell's work-related injury. Mr. Frizzell, a security manager, sustained head, shoulder, and neck injuries in October 2017 during a workplace altercation. After undergoing initial shoulder surgery, he re-injured his shoulder in a shower fall, which led to a recommendation for a second surgery. The Court determined that the re-injury was a direct and natural consequence of the original work injury, subsequently ordering Tin Roof Acquisition Co. to authorize the follow-up surgery. However, Mr. Frizzell's request for temporary partial disability benefits was denied due to insufficient evidence of ongoing work restrictions from his treating neurologist, Dr. Steven Strickland.

Workers' CompensationExpedited HearingMedical BenefitsTemporary Partial DisabilityCausationAggravation of InjuryIntervening CauseShoulder InjurySurgery AuthorizationBurden of Proof
References
3
Case No. 2024-40-5803
Regular Panel Decision
Sep 09, 2025

Reed, Kimberly v. Critical Nurse Staffing, LLC

In this interlocutory appeal, the Tennessee Workers' Compensation Appeals Board reviewed a trial court's order concerning an employee's work-related injuries. The employee, Kimberly Reed, reported a left arm/shoulder injury and later sought treatment for head/face/TMJ complaints. The trial court had ordered the employer, Critical Nurse Staffing, LLC, to provide a second opinion for shoulder surgery and a panel of otolaryngologists for the TMJ condition. The Appeals Board affirmed the order for a second opinion on shoulder surgery, finding the authorized physician's reports constituted a recommendation for surgery. However, the Board reversed the order for the otolaryngologist panel, concluding there was insufficient evidence at this stage to prove the TMJ condition was causally related to the work injury. The case was remanded for further proceedings.

Workers' Compensation AppealSecond Opinion Medical ReviewShoulder InjuryRotator Cuff TearTemporomandibular Joint DisorderCausation of InjuryMedical Treatment AuthorizationInterlocutory AppealEvidentiary StandardProcedural Compliance
References
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