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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

Insurance Co. of State of the Pennsylvania v. Moore

This appeal addresses whether a worker's compensation carrier is entitled to a proportionate reduction in supplemental income benefits (SIBs) equal to the percentage of reduction for impairment income benefits (IIBs) for a prior compensable injury under the Texas Workers’ Compensation Act. Appellant, Insurance Company of Pennsylvania, sought an 11/17ths reduction in Appellee John H. Moore's SIBs, matching the reduction applied to his IIBs for a previous back injury. A hearing officer granted the IIB reduction but denied the SIB reduction. The trial court upheld this decision. The appellate court reversed, holding that Texas Labor Code § 408.084 is unambiguous and mandates that both IIBs and SIBs be reduced by the same proportion when contribution is warranted for a prior injury. Consequently, Appellant is entitled to an 11/17ths reduction of Appellee’s supplemental income benefits.

Workers' CompensationSupplemental Income Benefits (SIBs)Impairment Income Benefits (IIBs)Prior Compensable InjuryProportionate ReductionStatutory InterpretationTexas Labor CodeSummary JudgmentAppellate ReviewCommission Appeals Panel
References
24
Case No. Dkt. # 6, Dkt. # 7
Regular Panel Decision
Feb 05, 2013

Crayton v. Astrue

Plaintiff appeals the denial of supplemental security income benefits by the Commissioner of Social Security. Plaintiff filed an application for Supplemental Security Income benefits in 2009, alleging inability to work due to various medical conditions. An Administrative Law Judge (ALJ) denied the application, and the Appeals Council denied review, making the ALJ's decision final. The District Court reviews the Commissioner's decision, finding that while the ALJ's assessment of exertional limitations was supported by substantial evidence, the ALJ failed to apply the Psychiatric Review Technique (PRT) in analyzing non-exertional limitations. Consequently, the court remands the matter for further proceedings consistent with its opinion, specifically for proper application of the PRT.

Supplemental Security IncomeSocial Security ActDisability BenefitsAdministrative Law JudgePsychiatric Review TechniqueRFCExertional LimitationsNon-exertional LimitationsDepressionAnxiety
References
15
Case No. MISSING
Regular Panel Decision
Jul 21, 1971

Claim of Wippert v. Peele Bros.

This appeal concerns a decision by the Workmen’s Compensation Board, which ruled that a claimant widow was entitled to supplemental benefits without deducting social security benefits received from her own earnings. The employer and insurance carrier appealed this decision. The central issue was whether social security benefits, regardless of their source, should be offset against supplemental benefits under subdivision 9 of section 25-a of the Workmen’s Compensation Law. The court found that the statute's language explicitly requires such an offset, irrespective of the social security benefits' originating source. Therefore, the court reversed the Board's determination, remitting the matter for recalculation of the supplemental benefit.

Workers' Compensation BenefitsSocial Security OffsetSupplemental AllowancesStatutory InterpretationAppellate DivisionBenefit ReductionLegislative HistoryClaimant WidowPublic PolicyBenefit Calculation
References
1
Case No. MISSING
Regular Panel Decision

Gill v. Bausch & Lomb Supplemental Retirement Income Plan I

Daniel E. Gill, Thomas C. McDermott, and Jay T. Holmes, retired Bausch & Lomb (B & L) executives and participants in the B & L Supplemental Retirement Income Plan I (SERP I), challenged the termination of their monthly benefits and conversion to lump sums following a change of control at B & L. The court found that B & L Human Resources personnel acted as unauthorized fiduciaries in 2007 by interpreting the plan and terminating benefits. The subsequent 2008 decision by the Compensation Committee was also found flawed due to structural conflicts of interest, procedural violations, and abdication of fiduciary responsibility. The court granted Plaintiffs' motion for summary judgment, concluding that the termination of benefits and lump-sum payments violated ERISA and vacated both decisions.

ERISA LitigationEmployee Retirement Income Security ActFiduciary DutySummary JudgmentConflict of InterestPlan AdministrationBenefit DenialChange of ControlLump Sum PaymentsProcedural Violations
References
57
Case No. 07-02-0376-CV
Regular Panel Decision
Aug 09, 2004

Floyd Weatherton v. Liberty Mutual Insurance Company

Appellant Floyd Weatherton appealed a summary judgment entered against him in his suit against Liberty Mutual Insurance Company. Weatherton, injured in a work accident in 1994, received supplemental income benefits which were later terminated by a Texas Workers' Compensation Commission (TWCC) hearing officer in 1999; Weatherton did not appeal this decision. He subsequently sued Liberty Mutual, alleging breach of contract, bad faith, and violations of various Texas codes due to the termination of benefits and denial of medical treatments. The trial court granted summary judgment for Liberty Mutual. The appellate court affirmed the dismissal of claims related to supplemental income benefits, citing Weatherton's failure to exhaust administrative remedies. However, it reversed the summary judgment regarding claims for denial of medical benefits, remanding that portion of the case for further proceedings, as those claims were not fully addressed and evidence was lacking.

Workers' CompensationSummary JudgmentAdministrative RemediesSupplemental Income BenefitsMedical BenefitsBad FaithInsurance LawJurisdictionTexas LawAppellate Review
References
7
Case No. MISSING
Regular Panel Decision

Memorial Hermann Health System v. Coastal Drilling Co., LLC Employee Benefit Trust

Plaintiff Memorial Hermann Health System (MHHS) sued Coastal Drilling for breach of contract and recovery of benefits under the Employee Retirement Income Security Act (ERISA). MHHS claimed Coastal Drilling breached a contract to pay for healthcare services at PPOplus Contracted Rates. The Court determined that MHHS's breach of contract claim was not preempted by ERISA but could not be enforced because MHHS was a non-party to the Network Access Agreement and Coastal Drilling, also a non-party, had no direct obligation under it. Regarding the ERISA claim, the Court found that Coastal Drilling, as the plan administrator, had discretionary authority to determine benefits based on the Plan's Applicable Plan Limits (APL). The Court found substantial evidence supporting Coastal Drilling's benefits determination and no evidence of bias affecting the decision, despite a structural conflict of interest. Consequently, the Court granted Coastal Drilling's motion for summary judgment and dismissed MHHS's claims with prejudice.

ERISASummary JudgmentBreach of ContractPlan AdministratorBenefits DenialHealthcare ProviderThird-Party BeneficiaryERISA PreemptionTexas LawFiduciary Duty
References
48
Case No. 07-02-0311-CV
Regular Panel Decision
May 27, 2004

Linda Teague v. Insurance Company of the State of Pennsylvania

Linda S. Teague appealed a summary judgment that denied her workers’ compensation supplemental income benefits. Teague had sustained a compensable injury in 1994 and was assigned an eighteen percent impairment rating. Her eligibility for supplemental income benefits was denied by the Texas Workers’ Compensation Commission (TWCC) benefit hearing officer and an appeals panel because she failed to look for employment every week of the qualifying period as required by TWCC regulations Section 130.102(e). Teague argued that her failure was due to attending her ill daughter and that other factors should be considered, but the Court of Appeals affirmed the trial court's judgment, finding no exception to the 'every week' requirement in the rule's clear language or the Commission's intent.

Workers' CompensationSupplemental Income BenefitsEmployment SearchGood Faith EffortAdministrative RegulationsTexas Labor CodeJudicial ReviewSummary JudgmentAppellate ReviewStatutory Interpretation
References
5
Case No. 12-09-00293-CV
Regular Panel Decision
Oct 20, 2010

American Home Assurance Company v. Susan Poehler

American Home Assurance Company appealed a trial court's judgment in favor of Susan Poehler regarding workers' compensation benefits. Poehler, a machine operator, sustained a lower back injury and Dr. Phillip Williams assigned a 20% impairment rating based on a Division Advisory. American Home challenged this rating, arguing it was invalid, and also disputed Poehler's entitlement to supplemental income benefits. The appeals court determined that the 20% impairment rating was invalid as it relied on an invalid Division Advisory, rendering judgment for a 5% impairment rating. Consequently, Poehler was largely found not entitled to supplemental income benefits for most quarters, with the exception of Quarter 1 due to procedural default, and the attorney's fees award was reversed and remanded for a jury determination.

Workers' CompensationImpairment RatingSupplemental Income BenefitsJudicial ReviewAppellate ProcedureAttorney's FeesMedical ImpairmentTexas Labor CodeSpinal Fusion SurgeryDivision Advisory
References
13
Case No. 03-18-00364-CV
Regular Panel Decision
Apr 30, 2020

Low Income Consumers, Mary Wilson and Hipolita Lutz v. Public Utility Commission of Texas

This case involves a direct appeal challenging amendments to Rules 25.478 and 25.480 adopted by the Public Utility Commission (PUC) of Texas. The appellants, "Low Income Consumers," Mary Wilson, and Hipolita Lutz, along with the intervenor City of Houston, argued that the PUC failed to comply with the rulemaking provisions of the Administrative Procedure Act (APA) and misconstrued relevant statutes. They specifically contested the repeal of the split-deposit provision in former Rule 25.478(e)(3) and amendments to Rule 25.480 concerning late fees and deferred payment plans, asserting these were essential customer protections rather than benefits tied to the expired System Benefit Fund (SBF). The Court of Appeals affirmed the Commission’s order, concluding that the Commission acted within its statutory authority and adhered to the APA's notice and reasoned justification requirements. The court found that the contested provisions were not mandated protections under other sections of the Public Utility Regulatory Act (PURA).

Public Utility CommissionAdministrative Procedure Act (APA)System Benefit Fund (SBF)RulemakingCustomer ProtectionsLow-income customersSplit-deposit provisionDeferred payment plansLate-fee waiverStatutory interpretation
References
22
Case No. 2016-06-0340
Regular Panel Decision
Dec 21, 2016

Duke, James v. Weiss Painting

James Duke, an employee of Weiss Painting, filed a request for an expedited hearing seeking reinstatement of temporary disability benefits after his employer discontinued payments. Duke claimed a left foot and ankle injury from a fall at work and denied working for another company. However, the court found Mr. Duke's testimony not credible, determining he had worked as a painter for Richard Hjerbe and concealed his income to continue receiving benefits. The court concluded that Duke was ineligible for temporary disability benefits due to his ability to work and willful concealment of income. Therefore, his claim for reinstatement of temporary partial disability benefits was denied.

Workers' CompensationTemporary Disability BenefitsExpedited HearingCredibility AssessmentConcealed IncomeFraudReturn to WorkComplex Regional Pain SyndromeTennessee LawAppellate Board
References
7
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