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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

Mayfield v. Employers Reinsurance Corp.

Calvin A. Mayfield claimed a July 24, 1973, injury while working for Texas Tubular Products, which was appealed by their insurer, Employers Reinsurance Corporation. The case centered on the admissibility of evidence regarding Mayfield's prior injuries and the sufficiency of evidence to support the jury's finding that he was not injured on the date in question. Mayfield's treating physician linked his condition to the 1973 injury, while the defense introduced evidence of other injuries and testimony suggesting no injury occurred on July 24, 1973. The jury found Mayfield was not injured, leading to a take-nothing judgment, which the appellate court affirmed, finding no error in the admission of evidence or the jury's finding.

Workmen's CompensationAdmissibility of EvidenceOther InjuriesSole Producing CauseJury FindingSufficiency of EvidencePrior ClaimsSettlementsLump Sum RecoveryHardship
References
9
Case No. ADJ1448881 (VNO 0460995), ADJ1459734 (VNO 0385398)
Regular
Jan 19, 2011

CLEMENTE MEJIA vs. PACIFIC MAT, INC., STATE COMPENSATION INSURANCE FUND, CIGA for FREMONT

The Appeals Board admitted Dr. Capen's November 10, 2009 report into evidence and affirmed the WCJ's Amended Joint Findings and Award. SCIF's petition for reconsideration primarily argued that Dr. Capen's report was not substantial evidence for apportionment, but the Board found SCIF waived this argument by not raising it explicitly. The majority concluded Dr. Capen's November 10, 2009 report provided substantial evidence for apportionment, affirming the WCJ's findings. One Commissioner dissented, finding the report was not substantial evidence and that further development of the record was needed.

Workers' Compensation Appeals BoardAmended Joint Findings and AwardWCJindustrial injurypermanent disabilityapportionmentState Compensation Insurance Fund (SCIF)CIGAliquidationCambridge
References
6
Case No. MISSING
Regular Panel Decision

Feliciano v. Colvin

Plaintiff Carmen Feliciano sought judicial review of a final decision by the Commissioner of Social Security denying her application for Supplemental Security Income. Both the plaintiff and defendant moved for judgment on the pleadings. The court examined whether the Commissioner's decision, which concluded the plaintiff was not disabled under the Social Security Act, was supported by substantial evidence. The court considered new evidence submitted to the Appeals Council, including a report from the plaintiff's treating physician, but found it inconsistent with other substantial evidence, such as reports from three consulting physicians. Ultimately, the court concluded that the Administrative Law Judge's decision was supported by substantial evidence. Consequently, the defendant's motion for judgment on the pleadings was granted, and the plaintiff's cross-motion was denied, leading to a final judgment for the defendant.

Social SecuritySupplemental Security IncomeDisability BenefitsJudicial ReviewAdministrative Law JudgeAppeals CouncilResidual Functional CapacityLight WorkSubstantial EvidenceTreating Physician Rule
References
13
Case No. MISSING
Regular Panel Decision

Arrellano v. Texas Employment Commission

Mr. Gilberto U. Arrellano appealed the denial of unemployment benefits by the Texas Employment Commission (TEC), which had found he voluntarily left his work with Holguin Bros. without good cause. Arrellano challenged the district court's grant of summary judgment, arguing an incorrect standard of review was used and genuine issues of material fact existed. The appellate court affirmed the district court's decision, holding that the proper standard of review for TEC decisions is the "substantial evidence/trial de novo" standard, which involves a legal question of whether the agency's ruling is supported by substantial evidence. The court further clarified that summary judgment is appropriate in such cases since the fact-finding is concluded at the administrative level. The court found that despite conflicting evidence presented to the Commission, there was sufficient substantial evidence to support the TEC's finding that Arrellano voluntarily separated from his employment.

Unemployment Benefits AppealVoluntary QuittingSubstantial Evidence StandardTrial De Novo ReviewSummary Judgment ProprietyAdministrative Agency DecisionsAppellate Court AffirmationTexas LawEmployment Commission RulingJudicial Review of Agency Action
References
14
Case No. ADJ13220426
Regular
Mar 10, 2023

MARICELA RODRIGUEZ vs. SOFT GEL TECHNOLOGIES, INC., CALIFORNIA INSURANCE COMPANY, APPLIED RISK SERVICES, INC.

The Workers' Compensation Appeals Board denied reconsideration of an amended findings and award, upholding the Workers' Compensation Judge's (WCJ) decision. The Board deferred to the WCJ's credibility determinations, finding no substantial evidence to overturn them. The WCJ's report, which was adopted by the Board, concluded that the applicant's arguments regarding the substantiality of medical evidence and claims for additional body parts were not raised at trial. The Board also affirmed that a single physician's opinion can constitute substantial evidence, even if it conflicts with other medical opinions.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ credibility determinationsubstantial medical evidencephysician's opinionbilateral wristscarpal tunnel syndromeneck injuryback injuryupper extremity injury
References
2
Case No. 03-14-00735-CV
Regular Panel Decision
Apr 30, 2015

Entergy Texas, Inc.// Office of Public Utility Counsel and Public Utility Commission of Texas v. Public Utility Commission of Texas and Texas Industrial Energy Consumers// Office of Public Utility Counsel and Entergy Texas, Inc.

The Commission’s Order should be affirmed. The Commission reasonably interpreted its prior rate-case order, the Black-box Order, to authorize Entergy to book and amortize a regulatory asset for unrecovered Hurricane Rita reconstruction costs. The Black-box Order was ambiguous concerning the Rita Asset. That order was based on a “black box” settlement—one where only the amount of rates to be collected was set forth, not all of the individual components of a rate case. Because the Black-box Order did not explicitly state whether booking and amortizing the regulatory asset had been authorized, it was ambiguous. Courts defer to an agency’s interpretation of its prior, ambiguous order, and the evidence in the record supports the Commission’s decision. Substantial evidence supports the Commission’s decision that $13 million should be added to Entergy’s storm reserve based on the expenses Entergy incurred to repair equipment after a severe ice storm in 1997. A prior Commission decision that faulted Entergy for poor service quality did not amount to a finding that Entergy could not include the repair costs in the insurance reserve amount. Substantial evidence supports the Commission’s decision that Entergy failed to meet its burden to prove that predicted purchased-power capacity costs were known-and-measurable changes to the test-year data. The record supports the Commission’s decision that Entergy did not meet its burden of proving that requested changes were known and measurable. For example, Entergy based its arguments about purchasing capacity on the assumption that it would always purchase the maximum amount under new contracts. Entergy claimed that it would have more customers in the future. Not only is that speculative, but the utility failed to account for how additional customers would otherwise affect its recovery through rates. And Entergy’s arguments about transmission charges are controlled by numerous unknown variables used in a complex formula. The Commission’s test-year rule is created to avoid just such unknowns. Moreover, most of Entergy’s request for post-test-year changes to transmission costs were based on an agreement that was still waiting for approval from the Federal Energy Regulatory Commission. That is patently not a “known” change. Because substantial evidence supports the Commission’s decisions, the Order should be affirmed.

Utility RegulationRate CasePublic Utility CommissionAppellate BriefHurricane Rita CostsRegulatory AssetStorm Damage ReservePurchased Power CapacityTransmission EqualizationAdministrative Law
References
24
Case No. ADJ11406698
Regular
Feb 03, 2020

JOSE MORENO vs. GREEN VALLEY LABOR INC., STAR INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, affirming the WCJ's finding that the applicant sustained a back injury arising out of and occurring in the course of employment. The Board found that the Qualified Medical Examiner's (QME) reports provided substantial evidence for injury AOE/COE based on the "reasonable probability" standard. However, the Board found the QME's apportionment opinion lacked the necessary reasoning and detail to be considered substantial evidence. Therefore, the WCJ's findings regarding AOE/COE and the lack of substantial evidence for apportionment were upheld.

AOE/COEPetition for ReconsiderationQualified Medical ExaminerQMECumulative traumaPermanent disabilityApportionmentSubstantial evidenceWorkers' Compensation Appeals BoardWCJ
References
5
Case No. ADJ16048168
Regular
Feb 13, 2023

OMAR A. ATILANO vs. BURKETT'S POOL PLASTERING, INC., CALIFORNIA CONTRACTORS NETWORK, AMERICAN CLAIMS MANAGEMENT

The Workers' Compensation Appeals Board denied a petition for reconsideration, upholding the original decision. The Board gave great weight to the Workers' Compensation Judge's credibility determination, finding no substantial evidence to warrant overturning it. The judge's report addressed the defendant's arguments that the Qualified Medical Evaluator's (QME) opinion lacked substantial evidence, finding consistency in the injury history and that the QME's report was indeed substantial evidence. The Board also concluded that a prior work release was not material to the temporary disability awarded from a later date, affirming the original award.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ credibility determinationGarza v. Workmen's Comp. Appeals Bd.PQME Sclafanitemporary disabilityExpedited Findings of FactOrdersand Awardsubstantial evidence
References
3
Case No. ADJ7264915
Regular
Jul 15, 2013

ANA GONZALES vs. WAL-MART ASSOCIATES, INC., ACE AMERICAN INSURANCE

This case involves an applicant who sustained industrial psychiatric injury but whose orthopedic claims were denied due to insufficient medical evidence. The Appeals Board denied the applicant's petition for reconsideration, finding the applicant failed to present substantial medical evidence of industrial causation for her orthopedic complaints. A dissenting commissioner argued that the primary medical evaluator's report was deficient and lacked substantial evidence, warranting further development of the record on orthopedic injuries and other claims. The dissent emphasizes the Board's duty to ensure substantial justice, suggesting it should have ordered further investigation on the denied orthopedic issues.

WCABPetition for ReconsiderationFindings and Orderindustrial injurypsychelow backneckright shoulderright wristright elbow
References
11
Case No. MISSING
Regular Panel Decision
Apr 14, 2017

Smith v. Berryhill

Ritchie Smith sought judicial review of the Commissioner of the Social Security Administration's decision denying him disability benefits, arguing the decision used incorrect legal standards and lacked substantial evidence regarding his ability to perform substantial gainful activity. The court examined extensive medical evidence from numerous physicians and Smith's own testimony concerning his physical and mental impairments. The hearing officer previously determined that despite severe impairments, Smith retained the residual functional capacity to perform sedentary work. The court affirmed the Commissioner's decision, concluding that the hearing officer applied the correct legal standards, and the findings, including the assessment of Smith's credibility and daily activities, were supported by substantial evidence in the record.

Disability Benefits AppealSocial Security Disability InsuranceSupplemental Security IncomeResidual Functional CapacityMedical OpinionsTreating Physician RuleClaimant CredibilitySedentary Work CapacityPhysical ImpairmentsMental Health Impairments
References
11
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