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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. MISSING
Regular Panel Decision
Jan 27, 1998

Grubb v. Chater

Plaintiff Charisse Grubb initiated a challenge under the Social Security Act against the Commissioner's final decision regarding Supplemental Security Income (SSI) benefits. The court initially denied the Commissioner's Rule 12(c) motion, reversing the Administrative Law Judge's (ALJ) decision, finding it lacked substantial evidence, particularly in rejecting the treating physician's opinion about the plaintiff's disability due to Type I diabetes. The case was remanded for benefits calculation. Subsequently, the Commissioner moved for reconsideration under Rule 59(e), revealing that the treating physician's report, central to the court's initial ruling, might have been altered. Citing potential fraud, the court granted the reconsideration motion, overriding its previous reversal. The case is now remanded to the Commissioner for further administrative proceedings, with specific instructions for the ALJ to verify the treating physician's report and potentially involve a medical advisor, all within 30 days. The court retains jurisdiction.

Social Security BenefitsDisability ClaimAdministrative Law JudgeTreating Physician RuleSubstantial Evidence ReviewPro Se RepresentationDiabetes MellitusReconsideration MotionRemandFunctional Capacity
References
22
Case No. MISSING
Regular Panel Decision
Jun 24, 1991

Marziliano v. Sullivan

Plaintiff Josephine Marziliano sought review of a determination by the Secretary of the United States Department of Health and Human Services that denied her request to waive recovery of an overpayment of Supplemental Security Income benefits. The Magistrate Judge recommended that the matter be referred to the Secretary for a new hearing, emphasizing the importance of giving required deference to the treating physician’s opinions in such overpayment waiver proceedings. The defendant objected to the application of the treating physician rule in these proceedings. District Judge Goettel adopted the Magistrate Judge's report and recommendation, affirming that the treating physician rule applies with full force when determining whether a claimant was 'at fault' in accepting an overpayment and ordered the case remanded for a new hearing.

Supplemental Security Income (SSI)Overpayment WaiverTreating Physician RuleMental ImpairmentAdministrative Law Judge (ALJ)RemandSocial Security Administration (SSA)Disability BenefitsResource LimitationsReporting Requirements
References
8
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. MISSING
Regular Panel Decision

Claim of Quail v. Central New York Psychiatric Center

Claimant appealed a Workers' Compensation Board decision that awarded a 10% schedule loss of use of the right hand. The WCB's decision was based on a September 1998 report from the carrier's consultant, which found a 10% loss. The claimant's treating physician had reportedly found a 20% loss in a July 1998 report, but this report was not properly filed. Despite multiple directives to submit a final medical report from the treating physician, claimant failed to do so before the WCLJ's decision. After the WCLJ's ruling, claimant submitted a newly prepared report from his treating physician indicating a 20% loss. The Board declined to consider this new evidence, citing its discretion to refuse evidence that could have been presented earlier. The appellate court affirmed the Board's decision, finding no abuse of discretion in their refusal to consider the late evidence.

Schedule Loss of UseRight Hand InjuryMedical EvidenceAppellate ReviewBoard DiscretionFailure to Submit EvidenceTreating Physician ReportCarrier Consultant ReportProcedural IssuesPermanency Determination
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. MISSING
Regular Panel Decision

Golden v. Secretary of Health and Human Services

William Golden, a Vietnam veteran, challenged the Secretary of Health and Human Services' denial of disability benefits. Golden asserted disability since November 1980 due to severe Post Traumatic Stress Disorder (PTSD) and back problems, contrary to the Administrative Law Judge's (ALJ) finding of disability commencing November 1985. District Judge Curtin ruled that the ALJ incorrectly applied the treating physician rule by dismissing Dr. Herman Szymanski's retroactive diagnosis as speculative. The court emphasized that a treating physician's long-standing relationship with a patient warrants extra weight for their opinion, which Dr. Szymanski's opinion, supported by other witnesses, demonstrated despite some contradictory medical evidence. Ultimately, the court found the Secretary's denial unsupported by substantial evidence, granted Golden's motion for summary judgment, and remanded the case for benefit calculation.

PTSDDisability BenefitsSocial Security ActTreating Physician RuleRetroactive DiagnosisAdministrative Law JudgeMedical EvidenceVocational RehabilitationMental DisorderBack Pain
References
13
Case No. 2022-02-0286
Regular Panel Decision
Sep 01, 2023

Roy, David v. Kenan Advantage Group

David Roy, the employee, injured his right arm and shoulder in August 2020. Although Kenan Advantage Group, the employer, initially provided medical treatment, Mr. Roy's authorized physician later declined to continue care. Despite Kenan sending multiple panels of physicians, all selected doctors refused to treat Mr. Roy after reviewing his medical records. Mr. Roy sought a court order compelling Kenan to provide a new panel of physicians, citing persistent pain and concern over his previous surgery. Kenan did not dispute Mr. Roy's entitlement to treatment but acknowledged difficulty in finding a willing physician. The Court ruled in favor of Mr. Roy, ordering Kenan to supply a panel of physicians willing to treat his injuries as per Tennessee Code Annotated sections 50-6-204(a)(3)(A)(i) and 50-6-204(a)(3)(B).

Workers' CompensationMedical TreatmentPhysician PanelRight Arm InjuryShoulder InjuryEmployer ObligationEmployee RightsTennesseeCourt OrderPanel of Physicians
References
0
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
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