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

Case No. MISSING
Regular Panel Decision

Second Injury Fund v. American Motorists Insurance Co.

This case addresses whether a 1971 amendment to Texas workers' compensation law (Article 8306, Sections 12c and 12c-l) permits an insurance carrier to be reimbursed from the Second Injury Fund when an employee's total and permanent incapacity results from a combination of general, rather than specific, injuries. The trial court had granted a $16,000 judgment for the carrier, American Motorist Insurance Company, but the Second Injury Fund appealed. Citing the precedent set in Second Injury Fund v. Keaton, the appellate court clarified that the 1971 amendment did not expand the fund's liability beyond specific injuries. The court emphasized that legislative intent to alter this established rule was not evident in the amendment. Consequently, the appellate court reversed the trial court's judgment, ruling against reimbursement for general injuries.

Second Injury FundWorkers' CompensationGeneral InjuriesSpecific InjuriesReimbursementStatutory InterpretationArticle 8306Vernon’s Ann.Civ.St.Appellate ReviewLegislative Intent
References
6
Case No. ADJ1279352
Regular
Nov 18, 2010

WARREN BARNA vs. PACIFIC TUBE, ST. PAUL TRAVELERS, SUBSEQUENT INJURIES BENEFITS TRUST FUND

The Subsequent Injuries Benefits Trust Fund (SIBTF) sought reconsideration of an award finding them liable for an applicant's psychiatric injury. The applicant had previously settled orthopedic claims and a cumulative trauma claim. The Appeals Board granted reconsideration to amend the original decision, adding specific findings required by Labor Code section 4751 regarding the applicant's pre-existing psychiatric disability and the compensable industrial psychiatric injury. The Board affirmed the original finding of liability against the SIBTF, while clarifying the applicant's eligibility for SIBTF benefits and addressing the issue of potential offsets.

Subsequent Injuries Benefits Trust Fundpsychiatric disabilitypre-existing disabilityindustrial injurypermanent partial disabilityLabor Code section 4751Workers' Compensation Appeals Boardreconsiderationcumulative traumaspecific injury
References
0
Case No. 04-09-00148-CV
Regular Panel Decision
Dec 09, 2009

Central Texas Orthopedic Products, Inc. v. Andrew Espinoza and Howmedica Osteronics Corp. D/B/A Stryker Orthopedics

Central Texas Orthopedic Products, Inc. (CTOP) sued Andrew Espinoza for breach of contract and fiduciary duty, and Howmedica Osteonics Corp. d/b/a Stryker Orthopedics (Stryker) for tortious interference. The trial court granted partial summary judgment for Espinoza and Stryker, and a jury found Espinoza breached fiduciary duty but awarded no damages. On appeal, CTOP challenged the summary judgments and attorney's fees awarded to Espinoza. The appellate court found the trial court erred in applying the unclean hands doctrine to CTOP's claims as the alleged misconduct was separate from the disputed contract. The court also found a genuine issue of material fact regarding Espinoza's entitlement to compensation due to his alleged breach of fiduciary duty. Therefore, the appellate court reversed the trial court's judgment and remanded the case for further proceedings.

Breach of ContractBreach of Fiduciary DutyTortious InterferenceSummary JudgmentUnclean Hands DoctrineNon-Compete AgreementCompensation AgreementTexas Payday ActAppellate ReviewReversed and Remanded
References
15
Case No. ADJ8428904, ADJ8244238, ADJ9318575
Regular
Aug 24, 2018

MICHAEL SMITH vs. CITY OF LOS ANGELES

This case involves a police sergeant's claims for cumulative and specific injuries, including orthopedic issues and hypertension. The Workers' Compensation Appeals Board affirmed the original findings, determining that the applicant sustained one cumulative and one specific injury. Crucially, apportionment of permanent disability for the applicant's heart condition (hypertension) is prohibited by Labor Code section 3212.5, as it applies to peace officers. Therefore, all resulting disabilities, regardless of the specific injury causing them, must be rated together in a single award, precluding separate awards for each injury.

Workers' Compensation Appeals BoardCumulative injurySpecific injuryApportionmentLabor Code section 4663Heart troubleHypertensionGERDPolice sergeantPermanent disability
References
4
Case No. 10-93-224-CV
Regular Panel Decision
May 18, 1994

Subsequent Injury Fund of the State of Texas (Formerly the Second Injury Fund) v. Larry Milligan

The Subsequent Injury Fund appeals a judgment awarding Larry Milligan lifetime benefits for injuries sustained at work. Milligan suffered two ankle injuries in 1987 and a third in 1989, leading to the total loss of use of both feet. He sued the Fund for lifetime benefits after settling with the workers' compensation carrier. The jury found permanent, total loss of use of both feet. The Fund challenged its statutory liability for lifetime benefits and the court's refusal to submit a jury question on total and permanent incapacity. The appellate court affirmed, finding the first issue unpreserved and the second resolved by a statutory conclusive presumption of total and permanent incapacity for the loss of both feet.

Workers' Compensation LawSubsequent Injury FundLifetime BenefitsTotal Permanent IncapacityAnkle InjuriesStatutory InterpretationAppellate ReviewJury InstructionsConclusive PresumptionOccupational Injuries
References
6
Case No. ADJ7781698, ADJ7781609
Regular
Dec 04, 2018

JULIO ARAYA vs. ORCHID ORTHOPEDIC SOLUTIONS, FEDERAL INSURANCE COMPANY/CHUBB, TRAVELERS/FARMINGTON CASUALTY COMPANY

The Workers' Compensation Appeals Board granted reconsideration and amended a prior decision, finding the original award of permanent disability was improperly made. The Board clarified that the specific injury case (ADJ7781698) only addressed compensability of the injury, not permanent disability, requiring further proceedings to determine apportionment and the extent of disability. Medical treatment was limited to the cumulative injury case (ADJ7781609) as it was not an issue in the specific injury case.

Petitions for ReconsiderationJoint Findings of FactsAward and OrderIndustrial InjuryCumulative InjuryPermanent DisabilityApportionmentBenson exceptionSpecific InjuryMachine Operator
References
4
Case No. No. 08-07-00346-CV
Regular Panel Decision
Feb 24, 2010

W.C. LaRock, D.C., P.C. D/B/A Auto & Work Injury Clinic and Maria Del Carmen Gallardo/Rosemary Smith v. Rosemary Smith/W.C. LaRock, D.C., P.C. D/B/A Auto & Work Injury Clinic and Maria Del Carmen Gallardo

Rosemary Smith, an El Paso Police Officer, sued W.C. LaRock, D.C., P.C., d/b/a Auto & Work Injury Clinic, and its employee Maria Gallardo, alleging negligence after a physical therapy session aggravated a prior back injury. The City of El Paso, Smith's worker's compensation subrogee, joined as a plaintiff. The jury found Gallardo negligent, awarding Smith $488,000, which the trial court reduced to $339,983.58. Both parties appealed. The Court of Appeals found the expert testimony on causation insufficient to establish that Gallardo's therapy proximately caused Smith's reherniation, as the expert only stated it was "possible." The court reversed the trial court's judgment.

Medical MalpracticeNegligenceCausationExpert TestimonyPhysical TherapyHerniated DiscSpinal SurgeryProximate CauseLegal SufficiencyAppeal
References
33
Case No. ADJ9944770
Regular
Oct 19, 2018

Sam Zavalata vs. Conifer Value Based Care, LLC

This case involves applicant Sam Zavaleta's workers' compensation claim for psychiatric and orthopedic injuries against Conifer Value Based Care, LLC. The Workers' Compensation Appeals Board (WCAB) rescinded the trial judge's decision, finding that the medical opinions from both the orthopedic and psychiatric evaluators required further development. Specifically, issues exist regarding the orthopedic causation of cumulative trauma injury to the applicant's psyche, back, neck, and wrist, as well as the substantial causation of the psychiatric injury in relation to the defendant's good faith personnel action defense. The matter is returned to the trial level for further proceedings and a new decision.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderPsychiatric InjuryCumulative TraumaPersonnel Action DefenseGood FaithCausationMedical OpinionApportionment
References
12
Case No. MISSING
Regular Panel Decision

Johnson v. Second Injury Fund

Walter Johnson, who had previously lost vision in his right eye, suffered an injury at work resulting in the loss of vision in his left eye, leaving him totally and permanently disabled. He received benefits from Texas Employer’s Insurance Association and the Second Injury Fund. Johnson and his wife then sued Texas Industries, Inc. for negligence. Both TEIA and the Second Injury Fund intervened, seeking subrogation rights. The trial court denied the Second Injury Fund's claim to subrogation, but the court of appeals reversed. The Texas Supreme Court reviewed whether the Second Injury Fund is subrogated to Walter Johnson's rights in his personal injury suit. The Court concluded that subrogation is a legislative creation and the statute funding the Second Injury Fund explicitly enumerates funding methods without including subrogation. Therefore, the Supreme Court reversed the court of appeals' judgment and affirmed the trial court's decision, denying subrogation for the Second Injury Fund.

SubrogationSecond Injury FundWorkers' CompensationStatutory InterpretationExpressio Unius Est Exclusio AlteriusTotal DisabilityPersonal InjuryTexas Supreme CourtFunding MechanismsLegislative Intent
References
9
Case No. ADJ7785251
Regular
Nov 14, 2014

Jon Brothers vs. STATE OF CALIFORNIA, DEPARTMENT OF FORESTRY AND FIRE PROTECTION, COASTAL/NORTH REGION; STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES

The Workers' Compensation Appeals Board granted reconsideration to clarify that the applicant's cumulative trauma orthopedic injury claim is still under development. The Board agreed with the WCJ that the defense's medical expert, Dr. Baldwin, failed to provide substantial medical evidence due to a misunderstanding of cumulative trauma principles. Dr. Baldwin improperly required documented prior specific injuries to opine on cumulative trauma, thereby failing to adequately assess the applicant's extensive work history. Therefore, the case is affirmed except for the amendment of a finding of fact to reflect that the orthopedic injury claim is contested and requires further medical evaluation.

Cumulative traumaQualified Medical EvaluatorIndependent Medical Evaluatorsubstantial medical evidenceorthopedic injurybinaural hearing losscardiovascular systemBattalion Chiefretired annuitantorthopedic cumulative trauma
References
1
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