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

Case No. 03-17-00352-CV
Regular Panel Decision
Aug 22, 2018

Vista Medical Center Hospital Vista Healthcare, Inc. And Surgery Specialty Hospital, Inc.// State Office of Risk Management v. State Office of Risk Management// Vista Medical Center Hospital Vista Healthcare, Inc. And Surgery Specialty Hospital, Inc.

This case involves cross-appeals stemming from a dispute over the appropriate reimbursement for medical services provided by Vista Medical Center Hospital and its affiliates to injured employees covered by the State Office of Risk Management (SORM) under Texas workers’ compensation statutes. The district court had affirmed 23 administrative orders that required SORM to make additional payments to Vista, a decision which SORM challenged on appeal citing insufficient evidence. Vista, in turn, cross-appealed the district court's denial of prejudgment interest. The appellate court found substantial evidence supported the administrative law judges' conclusion that SORM's original reimbursement model was unfair and unreasonable, and that Vista's proposed methodology was valid. Consequently, the court affirmed the district court's judgment but modified it to include the prejudgment interest that Vista was statutorily entitled to.

Workers' CompensationMedical ReimbursementAdministrative LawAppellate ReviewSubstantial EvidencePrejudgment InterestTexas LawHealthcare ProvidersInsurance DisputesFee Guidelines
References
23
Case No. NO. 14-05-00819-CV
Regular Panel Decision
May 15, 2007

Norma Hunt v. State Office of Risk Management

Norma Hunt appealed a judgment in a workers' compensation case where a jury found she did not sustain a compensable psychological injury. Hunt had previously suffered physical injuries from a fall at work. She later developed depression and panic attacks, arguing these psychological conditions were compensable as a result of her original physical injury. The State Office of Risk Management disputed the compensability of the psychological component. The trial court rendered judgment in favor of Risk Management, and the appellate court affirmed, concluding that the evidence was legally and factually sufficient to support the jury's verdict that Hunt's compensable injury did not include a psychological component.

Workers' CompensationPsychological InjuryDepressionPanic AttacksCompensabilityPreexisting ConditionFactual SufficiencyLegal SufficiencyDirected VerdictCausation
References
8
Case No. 15-25-00134-CV
Regular Panel Decision
Jul 30, 2025

Texas Association of School Boards Risk Management Fund // Southwest Texas Junior College v. Southwest Texas Junior College // Cross-Appellee, Texas Association of School Boards Risk Management Fund

This case involves an intergovernmental contract dispute between the Texas Association of School Boards Risk Management Fund (Appellant) and Southwest Texas Junior College (Appellee). The College is seeking replacement cost value benefits under a self-insurance contract for property damage allegedly sustained during an April 2021 hailstorm. The College claims a waiver of the Fund’s governmental immunity under TEX. LOC. GOV’T CODE § 271.152, asserting equitable theories of waiver and unconscionability, and intentional torts of fraud and bad faith to expand coverage beyond the express terms of the agreement. The Fund argued that its governmental immunity had not been waived for these claims and damages, emphasizing that statutory waivers are to be narrowly construed. The trial court partially granted the Fund's jurisdictional plea, dismissing claims for exemplary, consequential, or treble damages, but denied the plea regarding the College's equitable and intentional tort theories, viewing them as defensive in nature. The Fund appeals this partial denial, arguing that the Act's narrow immunity waiver does not extend to these theories which attempt to create coverage where none explicitly exists in the written contract.

Governmental ImmunityContract DisputeSelf-Insurance PoolRisk ManagementEquitable DoctrinesIntentional TortsWaiverUnconscionabilityTexas LawAppellate Review
References
14
Case No. 07-05-0268-CV
Regular Panel Decision
Apr 11, 2006

State Office of Risk Management v. Rachel Herrera and Texas Municipal League Intergovernmental Risk Pool

The State Office of Risk Management (SORM) appealed the dismissal of its attempt to judicially review a Texas Worker’s Compensation Commission appeals panel ruling. The trial court had dismissed SORM's petition for lack of jurisdiction, asserting it was not timely filed within 30 days. SORM argued that the dispute concerned compensability, which allowed for a 40-day filing period under the Labor Code. The Court of Appeals determined that the core issue of identifying the responsible employer for death benefits, thereby defining the course and scope of employment, constituted a matter of compensability. Consequently, SORM had 40 days to file. The appellate court reversed the trial court’s order of dismissal and remanded the case for further proceedings.

Worker's CompensationJudicial ReviewJurisdictionTimelinessCompensabilityCourse and Scope of EmploymentDeath BenefitsTexas Labor CodeGovernment CodeAppeals Court
References
3
Case No. ADJ3698541 (VNO 0412457), ADJ3246761 (VNO 0416345), ADJ2731611 (VNO 0416346)
Regular
Feb 06, 2015

WEST GRIFFIN vs. HARBOR UCLA MEDICAL CENTER, TRISTAR RISK MANAGEMENT

The Workers' Compensation Appeals Board denied Tristar Risk Management's petition for removal, which sought to halt trial proceedings for the applicant's claim for home health care reimbursement. Tristar argued the trial was premature, preventing adequate discovery and the development of the evidentiary record concerning new statutes applicable to the claim. The Board found that removal is an extraordinary remedy not warranted here, as the applicant bears the burden of proof at trial and Tristar has remedies available if aggrieved by a post-trial decision. The Board also confirmed Tristar's petition was timely filed.

ADJ3698541ADJ3246761ADJ2731611HARBOR UCLA MEDICAL CENTERTRISTAR RISK MANAGEMENTPetition for RemovalWCJhome health care servicesNeri HernandezAugust 21
References
1
Case No. 07-12-00232-CV
Regular Panel Decision
Jan 08, 2013

Wendell H. Taylor v. Lubbock Regional MHMR & JI Texas Risk Management and Texas Department of Insurance Division of Workers' Compensation

Wendell H. Taylor, an employee of Lubbock Regional MHMR, sustained a compensable injury in 2009. His subsequent claim for chronic pain and related conditions was denied by the Workers' Compensation Division's appeals panel. Taylor filed suit in district court seeking judicial review and alleging intentional torts, bad faith, and other claims against MHMR, JI Specialty Services, Texas Council Risk Management Fund, and the Division. The trial court dismissed most of Taylor's claims against all defendants based on a lack of jurisdiction and governmental immunity. On appeal, the court affirmed the dismissals for MHMR, the Risk Management Fund, and the Division, citing failure to exhaust administrative remedies and sovereign/governmental immunity for tort claims. However, the court reversed the dismissal against JI Specialty Services, Inc., concluding it had not established its claim to governmental immunity. The case was remanded for further proceedings regarding JI Specialty Services.

Interlocutory AppealPlea to the JurisdictionSovereign ImmunityGovernmental ImmunityTort ClaimsAdministrative Remedies ExhaustionSelf-insured EntityThird-Party Administrator LiabilityWorkers' Compensation BenefitsTexas Appeals Court
References
28
Case No. 07-12-00232-CV
Regular Panel Decision
Jan 08, 2013

Wendell H. Taylor v. Lubbock Regional MHMR & JI Texas Risk Management and Texas Department of Insurance Division of Workers' Compensation

Wendell H. Taylor appealed the trial court's dismissal of portions of his suit against Lubbock Regional MHMR, JI Specialty Services, Inc., Texas Council Risk Management Fund, and Texas Department of Insurance-Workers' Compensation Division. Taylor sustained a compensable injury while employed by MHMR and sought to extend his injury claim to include chronic pain and other conditions, which the appeals panel denied. He subsequently sued in district court, alleging intentional tortious acts, altering medical records, and bad faith treatment, alongside seeking judicial review and lifetime healthcare benefits. The appellate court affirmed the dismissal of Taylor's claims against MHMR, the Risk Management Fund, and the Workers' Compensation Division due to a lack of jurisdiction and governmental immunity for tort claims. However, it reversed the dismissal against JI Specialty Services, Inc., finding its claim of governmental immunity was not supported by the record and remanded for further proceedings.

Workers' CompensationGovernmental ImmunitySovereign ImmunityPlea to the JurisdictionAdministrative RemediesIntentional TortsAppeals Panel DecisionSelf-insured EntityThird-party AdministratorRisk Management Fund
References
26
Case No. 07-07-0288-CV
Regular Panel Decision
May 28, 2009

State Office of Risk Management v. Rachel Leigh Herrera, Victoria Danielle Herrera, Matthew Ryen Herrera, Kelcey Mercedes Dena Herrera, Care'n Destiny Herrera, Beneficiaries of Jose Arturo Herrera, And Texas Municipal League Intergovernmental Risk Pool

The State Office of Risk Management (SORM) appealed the trial court's dismissal of its lawsuit seeking judicial review of an appeals panel decision, which found SORM responsible for paying death benefits to the beneficiaries of deceased police officer Jose Herrera. Officer Herrera died in the line of duty, and SORM denied liability, arguing he was employed by the City of Friona, a self-insured entity, not the State. The trial court dismissed SORM's suit because SORM failed to timely name the City of Friona as a defendant within the statutory 40-day period. The appellate court affirmed the dismissal, ruling that the City of Friona was an indispensable party and the 40-day limitations period was not tolled for misidentification of parties. The court also upheld the award of attorney's fees to certain Herrera defendants, deeming SORM's claims against them to be without foundation.

Workers' CompensationJudicial ReviewInsurance Carrier LiabilitySubject Matter JurisdictionIndispensable PartyAttorney's FeesStatutory BeneficiariesMisidentification of PartiesAppellate Court DecisionTexas Labor Law
References
20
Case No. MISSING
Regular Panel Decision

Simpson v. State Office of Risk Management

Carol G. Simpson, an employee of the Texas Workforce Commission, appealed a judgment in favor of the State Office of Risk Management (SORM) concerning her workers' compensation claim. Simpson developed tenosynovitis and carpal tunnel syndrome due to repetitive typing. After initial approvals by a hearing officer and the Appeals Panel, the district court reversed the decision, leading to Simpson's appeal. The appellate court found the evidence legally insufficient to support the jury's finding that Simpson did not sustain a repetitive trauma injury, reversing the trial court's judgment and affirming the Workers’ Compensation Appeals Panel's decision.

Workers' CompensationRepetitive Trauma InjuryTenosynovitisCarpal Tunnel SyndromeSufficiency of EvidenceAppellate ReviewOccupational DiseaseErgonomic IssuesOrthopedic SurgeryNeurology Testimony
References
4
Case No. MISSING
Regular Panel Decision

STATE OFFICE OF RISK MANAGEMENT v. Berdan

The State Office of Risk Management (SORM) appealed a summary judgment and associated orders favoring Maria L. Berdan in a workers' compensation case. SORM's appeal was based on alleged non-compliance with the Texas Labor Code, claiming the judgment was void. However, the court determined that the relevant statutory provision, Section 410.258, does not apply to judgments rendered after fully adversarial proceedings. Consequently, the judgment was not rendered void. The court ultimately dismissed SORM's appeal for lack of jurisdiction, finding its motion for new trial and notice of appeal untimely, and further ruling that several other contested post-judgment orders were not independently appealable.

Workers' CompensationAppeal DismissalJurisdictionTimeliness of AppealSummary JudgmentAttorney's FeesTexas Labor CodeStatutory InterpretationFinal JudgmentInterlocutory Order
References
33
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