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

Case No. 2016-03-0449
Regular Panel Decision
Oct 03, 2016

Rodgers, Katherine v. NHC Healthcare

Katherine Rodgers, an employee, filed an Expedited Hearing Request seeking temporary disability benefits and reimbursement for unauthorized medical expenses after a work-related right shoulder injury. The employer, NHC Healthcare, and its carrier, Premier Group Insurance, had provided authorized medical panels, but Rodgers sought additional treatment without their authorization due to ongoing pain. The Court found that Rodgers' decision to seek unauthorized care was not reasonable, as she failed to properly notify her employer and did not establish the necessity and reasonableness of the associated charges. Furthermore, the Court concluded that she was not entitled to temporary disability benefits because no authorized medical provider had taken her completely off work, and she did not substantiate her claims regarding work restrictions. Consequently, the Workers' Compensation Judge denied Ms. Rodgers' claims for both unauthorized medical treatment expenses and temporary disability benefits.

Workers' CompensationTemporary Disability BenefitsMedical ExpensesUnauthorized TreatmentExpedited HearingWork InjuryShoulder InjuryCertified Nursing AssistantEmployer ObligationsEmployee Responsibilities
References
7
Case No. 08-11-00264-CV
Regular Panel Decision
Oct 08, 2014

Maria G. Thompson/Luis Marioni, D.C. v. Jaime Stolar, M.D., Alivio Medical Center, Alivio Treatment Centers, P.A. and Luis Marioni, D.C./Maria G. Thompson

This multi-party appeal originated from a medical and chiropractic malpractice lawsuit filed by Maria G. Thompson against Dr. Jaime Stolar, Dr. Luis Marioni, and Alivio Medical Center and Alivio Treatment Centers, P.A. Thompson alleged negligence resulting in severe knee injuries, including infection and fusions, following injections and treatment. A jury found Dr. Stolar and Dr. Marioni negligent, awarding damages. On appeal, the court reversed the judgment against Dr. Marioni due to insufficient evidence of causation but affirmed the judgment against Dr. Stolar. The court also upheld the denial of Thompson's claims regarding damages and apparent agency against Alivio.

Medical MalpracticeChiropractic MalpracticeKnee InjuryKnee InfectionSpontaneous FusionSurgical FusionNegligenceCausationDamages AssessmentApparent Agency
References
48
Case No. Docket Nos.: 2015-04-0010, 2015-04-0065; State File Nos.: 62832-2014, 49410-2015
Regular Panel Decision
Jun 28, 2016

Holborn, Shanan v. Walmart

Shanan Holborn, an employee, sought medical benefits for two work-related injuries: a right foot injury from July 4, 2014, and a low back injury from August 12, 2014. The Court consolidated these claims and addressed whether Ms. Holborn was entitled to further medical treatment and reimbursement for unauthorized emergency room visits. The Court determined that Ms. Holborn was entitled to additional medical treatment for her right foot injury with Dr. Drake and continued treatment for her low back injury with Dr. Leonardo Rodriguez-Cruz, finding Dr. Cruz's opinion held a presumption of correctness over an independent medical evaluation. However, her request for reimbursement for unauthorized emergency room visits was denied due to insufficient evidence to establish the necessity or reasonableness of such care. The matter is set for an Initial Hearing/Status Conference on August 5, 2016.

Workers' CompensationMedical BenefitsExpedited HearingFoot InjuryLow Back InjuryIndependent Medical EvaluationTreating PhysicianReimbursementUnauthorized TreatmentCausation
References
25
Case No. 02-22-00072-CV
Regular Panel Decision
Jul 27, 2023

BioTE Medical, LLC v. John Carrozzella, MD, JCMD Medical Services, Inc., Dan Deneui, and Terri Deneui

This case addresses whether a contractual "residual benefit" clause, requiring a post-termination fee for using a competing treatment method, constitutes a covenant not to compete under Texas law. Appellant BioTE Medical, LLC, licensed a pellet-based bioidentical hormone replacement therapy (BHRT) method. Appellee JCMD Medical Services, Inc., a former customer, terminated its agreement and began using a competitor's BHRT without paying the residual-benefit fee. BioTE Medical sued JCMD for breach of contract. The trial court granted summary judgment to JCMD, finding the clause unenforceable either as a noncompete or a violation of public policy. The appellate court reversed, holding that the residual-benefit clause is not a covenant not to compete as it does not restrict JCMD from competing with BioTE Medical, but rather from using a competitor's product. The court also declined to invalidate the clause on uncodified public policy grounds, deferring to the Legislature's policy determinations.

Contract lawCovenants Not to Compete ActResidual benefit clausePublic policyBioidentical hormone replacement therapy (BHRT)Breach of contractSummary judgmentAppellate reviewTexas lawBusiness and Commerce Code
References
33
Case No. 2015-06-0165
Regular Panel Decision
Nov 12, 2015

Glover, Sharon v. Vanderbilt Medical Center

Sharon Glover, an employee of Vanderbilt Medical Center, sought payment for chiropractic treatment from Dr. Jason Crist following a workplace fall on November 14, 2014. Initially, she was treated at Vanderbilt Occupational Health Clinic (VOHC). After Vanderbilt denied further medical care, Ms. Glover pursued unauthorized chiropractic treatment. The Workers' Compensation Judge, Robert V. Durham, acknowledged that Vanderbilt's blanket denial of liability allowed Ms. Glover to seek unauthorized care. However, the Court ultimately denied her request for payment for Dr. Crist's bills, concluding that Ms. Glover failed to establish a causal relationship between her work injury and the chiropractic treatment, and did not prove the reasonableness and necessity of the incurred medical expenses.

Workers' CompensationExpedited HearingMedical BenefitsChiropractic TreatmentCausationReasonableness of ChargesUnauthorized Medical CarePanel of PhysiciansEmployee's Burden of ProofDenial of Benefits
References
13
Case No. 13-09-00350-CV
Regular Panel Decision
Jan 21, 2010

Gulf Coast Medical Center, LLC, Tony Todd, Crna, Dan Madsen, M.D. and South Texas Medical Clinics, P.A. v. Jacqueline Temple and Marcus Banks, Individually and as Representatives of the Estate of Markasia Banks, a Minor Child

Appellants, Gulf Coast Medical Center, LLC, Tony Todd, CRNA, Dan Madsen, M.D., and South Texas Medical Clinics, P.A., appealed the trial court's denial of their motions to dismiss. The underlying suit was filed by appellees Jacqueline Temple and Marcus Banks, alleging negligence in the care and treatment of their deceased minor child, Markasia Banks. The core issue on appeal was the appellees' failure to timely serve an expert medical report as required by the Texas Civil Practice and Remedies Code. The Court of Appeals determined that the appellees' claims were 'health care liability claims' and that the expert report was indeed untimely, and that an abatement due to a failure to provide medical authorization did not extend the deadline. The court also affirmed the constitutionality of the expert report requirement. Consequently, the appellate court reversed the trial court's judgment, granted the appellants' motions to dismiss, and remanded the case for the award of attorney's fees and costs to the appellants.

Health Care Liability ClaimExpert Medical ReportMotion to DismissTimeliness of ReportAbatementMedical MalpracticeNegligenceDue ProcessTexas ConstitutionAppellate Review
References
32
Case No. 2016-08-1486
Regular Panel Decision
Nov 30, 2018

Nance, Amy v. JCSD Emergency Medical Group d/b/a Medic One Response

Ms. Nance, an emergency medical technician, injured her left upper extremity while moving a patient. After conservative treatment, she was diagnosed with cubital tunnel syndrome and later recommended for a cervical spine evaluation by Dr. Cole. Medic One denied the requested benefits, claiming misrepresentation and non-work-related activity. The Court found Ms. Nance likely to prevail for medical benefits, ordering Medic One to authorize a cervical spine evaluation and allow her to select a specialist. However, Ms. Nance was not found eligible for temporary disability benefits due to insufficient medical proof of disability.

Workers' CompensationMedical BenefitsTemporary Disability BenefitsCubital Tunnel SyndromeCervical Spine EvaluationMedical MisrepresentationCausal ConnectionExpedited HearingPermanent ImpairmentTreating Physician
References
3
Case No. 2015-04-0196
Regular Panel Decision
Jun 02, 2016

Miller, Christopher v. TRW Automotive U.S., LLC

The case involves Christopher Miller, an employee, seeking reimbursement for emergency medical treatment of a rash on his left forearm, which he attributed to chemical exposure at his workplace, TRW Automotive U.S., LLC. The employee filed a Request for Expedited Hearing (REH) after developing the rash and seeking unauthorized emergency care. The employer denied the request, questioning the causal connection between the rash and employment, as well as the necessity and reasonableness of the emergency treatment. The Workers' Compensation Judge denied Miller's request for reimbursement, finding insufficient expert medical evidence to establish causation and deeming his account of an arm-grabbing incident, which he claimed necessitated the emergency visit, not credible. While the court acknowledged Miller was entitled to a panel of physicians upon notice of injury, it concluded he failed to prove the reasonableness and necessity of the unauthorized emergency treatment.

Workers' CompensationExpedited HearingMedical BenefitsContact DermatitisChemical ExposureUnauthorized TreatmentCausationCredibility AssessmentEmployee RashEmployer Liability
References
5
Case No. 2015-03-0285
Regular Panel Decision
Feb 02, 2016

Long, Joann v. Southeast Eye Specialists

This Expedited Hearing Order addresses Joann Long's request for medical and temporary disability benefits after a workplace fall. Ms. Long, employed by SouthEast Eye Specialists, sustained a severe hamstring injury. She initially received treatment from Dr. Hovis, the authorized treating physician, who did not recommend surgery. Ms. Long sought a second opinion and, dissatisfied with Dr. Hovis's care, pursued unauthorized surgery with Dr. Damon Petty. SouthEast Eye Specialists subsequently suspended her benefits, citing her non-compliance with the authorized physician. The Court found insufficient evidence to determine if Dr. Hovis's treatment was inappropriate, and thus, Ms. Long failed to justify seeking unauthorized medical care. Consequently, the Court denied her requests for reimbursement of medical expenses incurred with Dr. Petty and for temporary total disability benefits. Dr. Hovis is to remain the authorized treating physician, or SES must provide a new panel.

Workers' Compensation LawExpedited HearingMedical BenefitsTemporary Total DisabilityUnauthorized Medical TreatmentAuthorized Treating PhysicianPanel of PhysiciansBurden of ProofConflicting Medical OpinionsHamstring Injury
References
5
Case No. 03-05-00620-CV
Regular Panel Decision
Mar 14, 2008

Texas Orthopaedic Association, Texas Medical Association and Andrew M. Kant, M.D. v. Texas State Board of Podiatric Medical Examiners Texas Podiatric Medical Association And Bruce A. Scudday, D.P.M.

The Texas Orthopaedic Association and others challenged a rule by the Texas State Board of Podiatric Medical Examiners that defined 'foot' to include portions of the ankle and soft tissues extending into the leg. Appellants argued this rule impermissibly expanded the scope of podiatry beyond its statutory definition and intruded into the practice of medicine. The district court initially found the rule valid. However, the Court of Appeals reversed this decision, holding that the Board exceeded its authority. The appellate court concluded that the rule's expansive definition authorized podiatrists to treat anatomical features located well above the traditional foot and ankle, which is inconsistent with the occupations code and constitutes an unauthorized practice of medicine.

Podiatry ScopeRegulatory AuthorityStatutory InterpretationAdministrative Rule ValidityMedical Practice ActTexas Occupations CodeDeclaratory JudgmentAnkle TreatmentFoot DefinitionMedical Licensing Board
References
29
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