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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

Garza v. Doctors on Wilcrest, P.A.

Garza, an x-ray technician and radiation safety officer, was fired by Doctors on Wilerest, P.A., Duncan G. Bowell, M.D., and Alan Reichman, M.D., after reporting uncertified x-ray procedures to the Texas Board of Medical Examiners. A jury initially awarded Garza damages for wrongful termination, but the trial court granted the Doctors' motion for judgment notwithstanding the verdict (JNOV). Garza appealed, arguing the trial court erred in granting JNOV and denying her trial amendment to add a private whistleblower cause of action. The appellate court affirmed the trial court's decision, finding Garza's case did not fit the narrow Sabine Pilot exception for refusing an illegal act, nor did it extend to the Del Mar exception. Furthermore, the court declined to recognize a common law cause of action for private whistleblowers, citing the Texas Supreme Court's precedent in Austin v. Healthtrust, Inc., which defers such matters to legislative action.

Wrongful TerminationWhistleblower ProtectionEmployment-at-will doctrineCommon Law ExceptionSabine Pilot ExceptionLegislative IntentTexas Labor LawJNOVTrial AmendmentMedical Professionals
References
6
Case No. ADJ9317724
Regular
Jul 23, 2015

JUAN TORRES vs. LINEAGE LOGISTICS COLD STORAGE, TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the applicant's Petition for Removal. The applicant sought to overturn a Minute Order compelling an orthopedic QME evaluation, arguing the existing orthopedic panel was improperly obtained and preferred a treating doctor. The Board adopted the WCJ's recommendation, finding no substantial prejudice or irreparable harm, as removal is an extraordinary remedy not warranted here. The applicant's preference for a treating doctor did not override the WCJ's order for a QME evaluation requested to clarify a prior medical opinion regarding potential knee surgery.

Petition for RemovalQualified Medical EvaluatorOrthopedic QMEChiropractic QMEKnee SurgeryIndependent Medical OpinionMPNMedical Treatment AuthorizationPrimary Treating PhysicianReconsideration
References
2
Case No. ADJ3207867
Regular
Apr 21, 2011

JACKIE PLASKETT vs. SAFEWAY INC.

The Workers' Compensation Appeals Board denied Safeway Inc.'s petition for reconsideration of an award for applicant Jackie Plaskett. Safeway argued a Utilization Review (UR) doctor's opinion should have overridden the Agreed Medical Examiner (AME) and primary treating physician's recommendations for aquatherapy. The Board found the UR doctor misapplied treatment guidelines and was internally inconsistent, while the AME's opinion, corroborated by the treating physician, constituted substantial evidence for the necessary treatment. The Board also noted an improperly filed reply brief.

Workers' Compensation Appeals BoardSafeway Inc.Petition for ReconsiderationReport of Workers' Compensation Administrative Law JudgeWCAB Rule 10848Utilization ReviewAgreed Medical ExaminerPrimary Treating PhysicianMedical Treatment Utilization ScheduleMTUS
References
0
Case No. MISSING
Regular Panel Decision

Claim of Baldassari v. Greenwich Mills Co.

This case involves an appeal from a Workers’ Compensation Board decision from December 6, 1977, which reversed a referee's finding by determining that the claimant's decedent's death was not causally related to their work. The core issue was conflicting medical testimony regarding the cause of death. The treating physician linked it to work effort via a myocardial infarction, while Doctor Cutler and Doctor Fischl, an impartial specialist, testified that death resulted from unrelated abdominal disease and found no evidence of myocardial infarction. The court affirmed the Board’s determination, finding that the testimony of Doctor Cutler and Doctor Fischl provided substantial evidence to support the Board’s conclusion.

Workers' CompensationCausal RelationshipMedical TestimonyMyocardial InfarctionAbdominal DiseaseConflicting EvidenceSubstantial EvidenceAppellate ReviewAffirmation
References
1
Case No. ADJ9048259
Regular
Dec 30, 2015

Antonio Avila vs. Barrett Business Services, Inc., Corvel Insurance Company

Here's a summary of the case in four sentences for a lawyer: The Workers' Compensation Appeals Board denied reconsideration, upholding the judge's decision that the applicant must treat within the employer's Medical Provider Network (MPN). The Board found that while there were some informational deficiencies, they did not amount to a denial of medical treatment that would justify treating outside the MPN. Crucially, the applicant admitted he liked his MPN physician and only sought to change doctors based on his attorney's recommendation. Evidence showed the employer promptly provided medical treatment and confirmed the applicant's treating physician was within their MPN.

Workers' Compensation Appeals BoardPetition for ReconsiderationMPNMedical Provider NetworkWCJHealth First Medical GroupDr. Eliasattorney's recommendationBBSI MPNCorvel Insurance Company
References
1
Case No. 2015-01-0281
Regular Panel Decision
Mar 19, 2018

Tucker, David E. v. Star Transportation

David Tucker, an employee of Star Transportation, sought to change his treating physician for a shoulder injury sustained on July 1, 2015. He expressed a loss of confidence in Dr. Mejia due to perceived ineffectual treatment, improper impairment assessment methodology, and the physician's refusal to complete a Physician Certification Form. The Court, citing precedents like Scott v. Integrity Staffing Solutions and Baker v. Electrolux, found no legal basis to compel the employer to provide a new panel of physicians. The Court ruled that Mr. Tucker's subjective dissatisfaction and the alleged inadequacies of Dr. Mejia did not warrant a change in treating physician.

Workers' CompensationShoulder InjuryTreating PhysicianMedical TreatmentImpairment RatingAMA GuidesTennessee LawRight to Control Medical TreatmentPhysician Certification FormMMI (Maximum Medical Improvement)
References
3
Case No. SAL 96100; 96096
Regular
Jul 03, 2007

JEANNE LAWRENCE vs. CYPRESS URGENT CARE and PREFERRED EMPLOYERS INSURANCE, TENET/DOCTORS HOSPITAL OF MANTECA

This case involves a worker who sustained two industrial injuries, the first in 2001 with Cypress Urgent Care and the second in 2001 with Tenet/Doctors Hospital of Manteca. The defendant, Tenet/Doctors Hospital, sought reconsideration of a joint findings and award that attributed 25% of the worker's temporary disability and vocational rehabilitation costs to their injury. The WCAB granted reconsideration, finding that while the second injury occurred after the first, evidence indicated the first injury contributed to the worker's need for benefits, thus supporting the apportionment.

WCABReconsiderationJoint Findings and AwardPetition for ReconsiderationTemporary Total Disability (TTD)Vocational RehabilitationApportionmentConsecutive InjuriesMedical TreatmentSelf-Insured
References
0
Case No. MISSING
Regular Panel Decision

Samuel Campos v. Texas Property & Casualty Insurance Guaranty Association for Reliance National Insurance Company, an Impaired Carrier

Samuel Campos, an injured oilfield worker, appealed a no-evidence summary judgment granted in favor of the Carrier regarding his workers' compensation claim. The dispute centered on his impairment rating, with his treating doctor assessing 30% and a designated doctor assessing 6%, the latter of which was upheld by the hearing officer and Appeals Panel. The district court granted summary judgment, and this court affirmed, noting that Campos failed to address all grounds raised by the Carrier in his appeal, which is required when the trial court does not specify the basis for its ruling.

Summary JudgmentImpairment RatingAMA GuidesAppeals Panel DecisionJudicial ReviewBurden of ProofRange of Motion ModelDRE Injury ModelTexas Labor CodeMedical Evidence
References
16
Case No. MISSING
Regular Panel Decision
Apr 03, 2003

Lotysz v. Montgomery

Greg Lotysz, an employee of the New York Jets, sued defendant-respondent doctors for medical malpractice after being treated for work-related injuries. The Supreme Court, New York County, initially granted the defendants' motion for summary judgment, dismissing the complaint. This decision was unanimously affirmed on appeal. The court found that the defendant doctors were salaried Jets employees providing medical services to fellow employees, and the plaintiff's treatment was solely employment-related. Consequently, the action was barred by Workers’ Compensation Law § 29 (6).

Medical malpracticeWorkers' CompensationEmployee doctorsExclusive remedySummary judgmentAppellate DivisionEmployer liabilityPersonal injuryNew York County
References
2
Case No. ADJ11315508
Regular
Sep 12, 2018

SIERRA PRADO vs. PCG HOSPITALITY, TRAVELERS INSURANCE CO.

This case concerns an applicant's request to treat outside her employer's Medical Provider Network (MPN) due to alleged difficulties in scheduling an appointment with an MPN physician. The applicant argued the Medical Access Assistant (MAA) failed to secure an appointment with available MPN doctors, leading to a denial of care. The Workers' Compensation Appeals Board affirmed the WCJ's decision, finding no denial of care because the MPN list is not a guarantee of immediate appointment and the MAA reasonably attempted to find a suitable physician. The majority determined that the applicant did not exhaust reasonable efforts to find an MPN doctor, and a dissenting opinion argued the inaccurate MPN list constituted a failure to provide care, justifying out-of-network treatment.

Workers' Compensation Appeals BoardMedical Provider Network (MPN)Medical Access Assistant (MAA)Primary Treating Physician (PTP)Denial of CareOut-of-Network TreatmentLabor Code Section 4600Labor Code Section 4616Cal. Code Regs. tit. 8§ 9767.5
References
18
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