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Case Law Database

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

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. 2018-01-0388
Regular Panel Decision
Jan 08, 2019

Vanveldhuizen, John v. Crown Automotive Group, Inc.

John Vanveldhuizen, an employee, requested an expedited hearing against Crown Automotive Group, Inc. and FFVA Mutual Ins. Co. concerning the authorization of a third lumbar surgery recommended by his treating physician, Dr. Jay Jolley. Crown denied the surgery based on a utilization review physician's opinion, Dr. Richard Lutz, who deemed it not medically necessary. The Court, however, sided with the treating physician, Dr. Jolley, affording his opinion a presumption of medical necessity due to his long history of treating the employee and the lack of compelling evidence from Crown to rebut this presumption. Ultimately, the Court ordered Crown to authorize the recommended surgery.

Lumbar surgeryMicrodiskectomyFusion surgeryRadiculopathyDisk herniationUtilization reviewMedical necessityTreating physicianExpedited hearingWorkers' Compensation Appeals Board
References
5
Case No. 01-14-00767-CV
Regular Panel Decision

Shirley Lenoir, Individually and as Personal Representative of the Estate of Shana Lenoir and Christopher McKnight , Individually and as Next Friend of Nayla McKnight v. U.T. Physicians

This is a health care liability appeal where Shirley Lenoir and Christopher McKnight, individually and as representatives of the Estate of Shana Lenoir and Nayla McKnight, challenge the trial court's decision to grant U.T. Physicians' plea to the jurisdiction and motion to dismiss. The appellants allege that U.T. Physicians' negligence in treating Shana Lenoir’s twin pregnancy, specifically the administration of a medically unnecessary and contraindicated progesterone injection by Nurse Matthews, proximately caused her death. U.T. Physicians claimed sovereign immunity as a governmental unit. Appellants argue that U.T. Physicians is a private non-profit corporation and an independent contractor, not entitled to sovereign immunity, and that a waiver of immunity under the Texas Tort Claims Act was sufficiently pled due to the use of tangible physical property.

Sovereign ImmunityGovernmental UnitIndependent ContractorTexas Tort Claims ActHealth Care LiabilityMedical MalpracticeNegligenceProgesterone InjectionTwin PregnancyWrongful Death
References
16
Case No. MISSING
Regular Panel Decision

Billy Overstreet v. TRW Commercial Steering Division

This concurring opinion by Judge William C. Koch, Jr. addresses the legal basis for prohibiting ex parte communications between an employer's counsel and an employee's treating physician in a Workers' Compensation Act claim. While the Court's main conclusion relies on an implied-in-law contract theory, Judge Koch advocates for a fiduciary duty stemming from the physician-patient relationship. He clarifies that physicians have a duty of non-disclosure, subject to statutory exceptions for workers' compensation reports, but these exceptions do not permit ex parte communications. The opinion asserts that employees retain their medical privacy unless explicitly altered by law.

Physician-patient privilegeConfidentialityEx parte communicationWorkers' CompensationFiduciary dutyImplied contractMedical records disclosureHIPAALegal ethicsPatient rights
References
34
Case No. 2016-07-0351
Regular Panel Decision
Nov 08, 2016

Crumble, Mae v. Express Services

This expedited hearing order addresses a workers' compensation claim filed by Mae Crumble against Express Services and New Hampshire Ins. Co. for a right shoulder injury sustained on November 14, 2015. The case was remanded by the Tennessee Workers’ Compensation Appeals Board to determine if Dr. Sioson was an authorized treating physician whose causation opinion was entitled to a presumption of correctness. The Court found that Express Services failed to provide Ms. Crumble with a valid panel of physicians, noting issues with the selection process and Ms. Crumble's intellectual limitations. Consequently, Dr. Sioson's opinion was not afforded a presumption of correctness, and the Court determined it did not meet the legal standard for causation. The Court ordered Express Services to provide Ms. Crumble with a new, valid panel of physicians to evaluate and treat her injury.

Medical BenefitsExpedited HearingRemandAuthorized Treating PhysicianCausation OpinionPanel of PhysiciansRight Shoulder InjuryMedical ExaminationEmployer's DutyEmployee Selection
References
4
Case No. ADJ9343248
Regular
Dec 07, 2017

LONNY BUBAK vs. SOLANO COUNTY SHERIFFS DEPARTMENT

This case, concerning a workers' compensation claim by Lonny Bubak against Solano County Sheriff's Department, involves the application of Labor Code section 4062.9, which presumes the correctness of a treating physician's opinion. The Appeals Board denied the defendant's petition for reconsideration, affirming the administrative law judge's finding that the defendant failed to rebut this presumption. This means the defendant did not provide sufficient evidence to disprove the industrial nature of the injury as determined by the treating physician. Therefore, the Appeals Board was bound to accept the treating physician's opinion as correct.

Workers' Compensation Appeals BoardPetition for ReconsiderationAdministrative Law JudgePresumptionLabor Code Section 4062.9Treating PhysicianBurden of ProofRebuttalIndustrial RelationshipSolano County Sheriffs Department
References
2
Case No. MISSING
Regular Panel Decision

Kuppersmith v. Dowling

This appeal challenged regulations and procedures of the New York State Department of Social Services (DSS) concerning home care services authorized under the Medicaid program. Petitioners, including Jennie Kuppersmith, sued DSS and the New York City Human Resources Administration, arguing that the regulation (18 NYCRR 505.14 [b] [3] [i] [a] [3]), which prohibits treating physicians from recommending the number of hours of home care, was arbitrary and capricious. They also sought a judicially created presumption in favor of the treating physician’s estimate. The Court affirmed the Appellate Division's decision, concluding that the regulation is rational, reasonable, and consistent with the broad discretion granted to states under the Medicaid Act. The Court rejected the adoption of a "treating physician’s rule" in this context, emphasizing that home care assessments involve a complex mix of expertise beyond purely medical determinations.

Medicaid ProgramHome Care ServicesRegulations ChallengeAdministrative ReviewTreating Physician RuleState DiscretionAppellate ReviewSocial Services LawHealth BenefitsPersonal Care
References
12
Case No. 23-0697
Regular Panel Decision
Jun 28, 2024

State of Texas Office of the Attorney General of the State of Texas Texas Medical Board Texas Health and Human Services Commission And Ken Paxton, in His Official Capacity as Attorney General of the State of Texas v. Lazaro Loe, Individually and as Next Friend of Luna Loe, a Minor Mary Moe and Matthew Moe, Individually and as Next Friends of Maeve Moe, a Minor Nora Noe, Individually and as Next Friend of Nathan Noe, a Minor Sarah Soe and Steven Soe, Individually and as Next Friends of Samantha Soe, a Minor Gina Goe, Individually and as Next Friend of Grayson Goe, a Minor Pflag, Inc. Richard Ogden Roberts III, M.D. David L. Paul, M.D. Patrick W. O'malley, M.D. And American Association of Physicians for Human

The Supreme Court of Texas reversed and vacated a temporary injunction against Senate Bill 14, which prohibits certain medical treatments for minors related to gender transition. Parents of children with gender dysphoria, along with physicians and LGBTQ+ advocacy groups, had challenged the law as unconstitutional, alleging infringements on parental rights, occupational freedom for physicians, and discrimination based on sex and transgender status. The Court concluded that the plaintiffs failed to establish a probable right to relief, asserting that parental rights are not absolute and the Legislature has constitutional authority to regulate medicine, especially regarding novel treatments for new conditions. The Court also found no unconstitutional discrimination, stating the law treats males and females equally in its prohibitions and that "transgender status" is not a protected class under the Texas Constitution.

Parental RightsMedical RegulationGender DysphoriaConstitutional LawDue Course of LawEqual ProtectionTransgender RightsMinors' Medical TreatmentLegislative AuthorityTexas Supreme Court
References
62
Case No. 2018-01-0590
Regular Panel Decision
Jul 08, 2019

Buckner, Charles v. Ecolab Manufacturing, Inc.

Charles Buckner, a forklift operator for Ecolab, experienced neck pain after lifting. He underwent a C4-5 and C5-6 fusion surgery in June 2017. Despite initial surgery and conservative treatments, his neck pain and radicular symptoms persisted. Dr. Jason Eck, his authorized orthopedist, recommended further surgery for C5-C6 narrowing, which was twice denied following utilization reviews. The Court, applying the presumption of medical necessity for treatment recommended by an authorized physician, overruled the UR denials. The decision highlighted the treating physician's greater familiarity with the patient compared to non-treating UR physicians.

Medical BenefitsExpedited HearingNeck PainFusion SurgeryUtilization ReviewMedical NecessityTreating PhysicianExpert OpinionDiagnostic TestingTennessee Law
References
3
Case No. 2018-03-1494
Regular Panel Decision
May 24, 2019

Stephens, Tonya Lynn v. Quality Private Care d/b/a Volunteer Staffing, Inc.

Ms. Tonya Lynn Stephens, a Licensed Practical Nurse, sustained work-related injuries including a left shoulder injury, leading to a diagnosis of Complex Regional Pain Syndrome (CRPS). Her authorized treating physician, Dr. David Newman, prescribed compounded creams as part of her pain management treatment. This prescription was initially denied by a Utilization Review physician, but the Court of Workers’ Compensation Claims at Knoxville reviewed the case based on an expedited hearing request. The court, presided over by Judge Lisa A. Lowe, found Dr. Newman's recommendations to be medically necessary and upheld the presumption of correctness for the authorized treating physician's orders. Consequently, the court ordered the employer, Quality Private Care, and its carrier, Bridgefield Casualty Insurance Company, to provide the recommended compounded creams to Ms. Stephens.

Workers' CompensationCRPSCompounded CreamsMedical TreatmentUtilization ReviewPain ManagementShoulder InjuryLumbar Facet SyndromeExpedited HearingMedical Necessity
References
4
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