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

Case No. 03-17-00352-CV
Regular Panel Decision
Aug 22, 2018

Vista Medical Center Hospital Vista Healthcare, Inc. And Surgery Specialty Hospital, Inc.// State Office of Risk Management v. State Office of Risk Management// Vista Medical Center Hospital Vista Healthcare, Inc. And Surgery Specialty Hospital, Inc.

This case involves cross-appeals stemming from a dispute over the appropriate reimbursement for medical services provided by Vista Medical Center Hospital and its affiliates to injured employees covered by the State Office of Risk Management (SORM) under Texas workers’ compensation statutes. The district court had affirmed 23 administrative orders that required SORM to make additional payments to Vista, a decision which SORM challenged on appeal citing insufficient evidence. Vista, in turn, cross-appealed the district court's denial of prejudgment interest. The appellate court found substantial evidence supported the administrative law judges' conclusion that SORM's original reimbursement model was unfair and unreasonable, and that Vista's proposed methodology was valid. Consequently, the court affirmed the district court's judgment but modified it to include the prejudgment interest that Vista was statutorily entitled to.

Workers' CompensationMedical ReimbursementAdministrative LawAppellate ReviewSubstantial EvidencePrejudgment InterestTexas LawHealthcare ProvidersInsurance DisputesFee Guidelines
References
23
Case No. 07-12-00232-CV
Regular Panel Decision
Jan 08, 2013

Wendell H. Taylor v. Lubbock Regional MHMR & JI Texas Risk Management and Texas Department of Insurance Division of Workers' Compensation

Wendell H. Taylor, an employee of Lubbock Regional MHMR, sustained a compensable injury in 2009. His subsequent claim for chronic pain and related conditions was denied by the Workers' Compensation Division's appeals panel. Taylor filed suit in district court seeking judicial review and alleging intentional torts, bad faith, and other claims against MHMR, JI Specialty Services, Texas Council Risk Management Fund, and the Division. The trial court dismissed most of Taylor's claims against all defendants based on a lack of jurisdiction and governmental immunity. On appeal, the court affirmed the dismissals for MHMR, the Risk Management Fund, and the Division, citing failure to exhaust administrative remedies and sovereign/governmental immunity for tort claims. However, the court reversed the dismissal against JI Specialty Services, Inc., concluding it had not established its claim to governmental immunity. The case was remanded for further proceedings regarding JI Specialty Services.

Interlocutory AppealPlea to the JurisdictionSovereign ImmunityGovernmental ImmunityTort ClaimsAdministrative Remedies ExhaustionSelf-insured EntityThird-Party Administrator LiabilityWorkers' Compensation BenefitsTexas Appeals Court
References
28
Case No. 07-12-00232-CV
Regular Panel Decision
Jan 08, 2013

Wendell H. Taylor v. Lubbock Regional MHMR & JI Texas Risk Management and Texas Department of Insurance Division of Workers' Compensation

Wendell H. Taylor appealed the trial court's dismissal of portions of his suit against Lubbock Regional MHMR, JI Specialty Services, Inc., Texas Council Risk Management Fund, and Texas Department of Insurance-Workers' Compensation Division. Taylor sustained a compensable injury while employed by MHMR and sought to extend his injury claim to include chronic pain and other conditions, which the appeals panel denied. He subsequently sued in district court, alleging intentional tortious acts, altering medical records, and bad faith treatment, alongside seeking judicial review and lifetime healthcare benefits. The appellate court affirmed the dismissal of Taylor's claims against MHMR, the Risk Management Fund, and the Workers' Compensation Division due to a lack of jurisdiction and governmental immunity for tort claims. However, it reversed the dismissal against JI Specialty Services, Inc., finding its claim of governmental immunity was not supported by the record and remanded for further proceedings.

Workers' CompensationGovernmental ImmunitySovereign ImmunityPlea to the JurisdictionAdministrative RemediesIntentional TortsAppeals Panel DecisionSelf-insured EntityThird-party AdministratorRisk Management Fund
References
26
Case No. 03-15-00219-CV
Regular Panel Decision

Hallmark Specialty Underwriters, Inc. and Hallmark Specialty Insurance Company v. Texas Mutual Insurance Company

This case arises from a declaratory judgment action filed by Appellee Texas Mutual Insurance Company, seeking a determination regarding its duty to defend Absolute Oil Field Services, LLC. The trial court granted summary judgment in favor of Texas Mutual and denied Appellants Hallmark Specialty Underwriters, Inc. and Hallmark Specialty Insurance Company's cross-motion for summary judgment. Appellants contend that the trial court erred in its decision, arguing that the underlying petition contained sufficient factual allegations to trigger Appellee's duty of defense under the 'eight corners' rule, as the injured party, Jose Guzman, was an employee of Absolute and was potentially injured in the course of his employment. They argue that Texas law requires liberal interpretation of pleadings, resolving doubts in favor of coverage, and that Appellee's arguments misinterpret established legal principles regarding the duty to defend.

Insurance CoverageDuty to DefendWorkers' CompensationEight Corners RuleSummary JudgmentAppellate ReviewTexas LawEmployee InjuryCourse and Scope of EmploymentDeclaratory Judgment Action
References
38
Case No. 2024 NY Slip Op 03519
Regular Panel Decision
Jun 27, 2024

Matter of Reyes Bonilla v. XL Specialty Ins.

Claimants Jose Reyes Bonilla and Marvin Reyes Bonilla, carpenters, were involved in a motor vehicle accident while commuting to a job site in Greenpoint, Brooklyn, in an employer-provided van. They filed workers' compensation claims, which were established against XL Specialty Insurance by a Workers' Compensation Law Judge (WCLJ). XL Specialty appealed, arguing its policy did not cover commuting injuries and that it was not the proper carrier. The Workers' Compensation Board affirmed the WCLJ's decisions, finding XL Specialty failed to preserve its challenge to being the carrier and that the employer's responsibility for transportation made the injuries compensable. The Appellate Division, Third Department, affirmed, agreeing that the issue was unpreserved and that the injuries arose out of and in the course of employment due to the employer's control over the conveyance.

Workers' CompensationMotor Vehicle AccidentEmployment InjuriesCommuting AccidentEmployer Provided TransportationWrap-up PolicyInsurance Coverage DisputeCarrier LiabilityIssue PreservationAppellate Review
References
16
Case No. ADJ3419685 (GRO 0029797)
Regular
Dec 10, 2000

MARLENA MOORE vs. ALBERTSONS, SPECIALTY RISK SERVICES

This case involves a Petition for Removal filed by Marlena Moore against Albertsons and Specialty Risk Services. The Workers' Compensation Appeals Board (WCAB) has reviewed the petition and the report from the workers' compensation administrative law judge. Consequently, the WCAB has denied the Petition for Removal. The decision incorporates the reasoning provided in the WCJ's report.

WORKERS' COMPENSATION APPEALS BOARDMARLENA MOOREALBERTSONSSPECIALTY RISK SERVICESPetition for RemovalWCJ reportdenial of removaladministrative law judgeADJ3419685GRO 0029797
References
0
Case No. 07-05-0268-CV
Regular Panel Decision
Apr 11, 2006

State Office of Risk Management v. Rachel Herrera and Texas Municipal League Intergovernmental Risk Pool

The State Office of Risk Management (SORM) appealed the dismissal of its attempt to judicially review a Texas Worker’s Compensation Commission appeals panel ruling. The trial court had dismissed SORM's petition for lack of jurisdiction, asserting it was not timely filed within 30 days. SORM argued that the dispute concerned compensability, which allowed for a 40-day filing period under the Labor Code. The Court of Appeals determined that the core issue of identifying the responsible employer for death benefits, thereby defining the course and scope of employment, constituted a matter of compensability. Consequently, SORM had 40 days to file. The appellate court reversed the trial court’s order of dismissal and remanded the case for further proceedings.

Worker's CompensationJudicial ReviewJurisdictionTimelinessCompensabilityCourse and Scope of EmploymentDeath BenefitsTexas Labor CodeGovernment CodeAppeals Court
References
3
Case No. ADJ3288082 (LBO 0384974)
Regular
May 09, 2013

ANDRES CRUZ vs. ALLSTATE/KOOKLANCAR PEYMAN, SPECIALTY RISK/SEDGWICK

This case, *Andres Cruz v. Allstate/Kooklancar Peyman; Specialty Risk/Sedgwick*, concerns a workers' compensation claim. The Workers' Compensation Appeals Board (WCAB) granted reconsideration of the Administrative Law Judge's (ALJ) prior decision. The WCAB rescinded the ALJ's decision and remanded the case back for further proceedings and a new decision at the trial level. This order is not a final determination on the merits of the claim.

Workers Compensation Appeals BoardReconsiderationAdministrative Law JudgeRescinded DecisionFurther ProceedingsTrial LevelFinal DecisionMeritsDental Trauma CenterSpeciality Risk
References
0
Case No. 03-98-00169-CV
Regular Panel Decision
Jun 17, 1999

Texas Workers' Compensation Commission and Subsequent Injury Fund v. Texas Municipal League Intergovernmental Risk Pool

The Texas Municipal League Intergovernmental Risk Pool (Risk Pool) challenged the constitutionality of specific provisions within the Texas Workers' Compensation Act and related Texas Workers' Compensation Commission (TWCC) rules. These provisions mandated contributions to the Subsequent Injury Fund, which the Risk Pool argued violated constitutional restrictions on political subdivisions lending credit or granting public money, and imposing state ad valorem property taxes. The trial court initially sided with the Risk Pool, declaring the requirements unconstitutional as applied to its members. On appeal, the Court of Appeals addressed the Risk Pool's standing and the core constitutional arguments. The appellate court characterized the mandatory contributions as analogous to a custodial escheat statute, where the state assumes custody of unclaimed death benefits rather than gaining absolute ownership. Consequently, the court reversed the trial court's judgment, concluding that the Risk Pool failed to meet its burden for an "as applied" constitutional challenge, notably by not asserting a limitations defense.

Workers' Compensation ActSubsequent Injury FundDeclaratory JudgmentConstitutional ChallengeAs-Applied ChallengeAssociational StandingAcceptance of Benefits DoctrineEscheat LawCustodial EscheatUnclaimed Death Benefits
References
18
Case No. 01-22-00031-CV
Regular Panel Decision
Nov 03, 2022

Turner Specialty Services, LLC v. Michaela Horn, Individually and as Next Friend of G.H. and M.M., Minors

Justin Horn died while working for Turner Specialty Services, LLC. His family, Michaela Horn and Atrelle Horn, sued Turner Specialty for gross negligence. Turner Specialty filed a special appearance, contesting personal jurisdiction in Texas. The trial court denied the special appearance, and Turner Specialty appealed. The Court of Appeals for the First District of Texas affirmed the trial court's decision, finding that Turner Specialty had sufficient minimum contacts with Texas through its recruitment, hiring, and initial safety training of Justin Horn and other employees in Texas, which was purposefully availed and related to the Horns' gross negligence claim.

personal jurisdictionspecial appearanceminimum contactspurposeful availmentgross negligencewrongful deathworkers' compensationappellate reviewforum stateinterstate federalism
References
24
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