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Case Law Database

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

Case No. MISSING
Regular Panel Decision
Dec 21, 1995

In re Jordan Rehabilitation Service, Inc.

Jordan Rehabilitation Service, Inc., providing medical and vocational rehabilitative services, appealed a decision by the Unemployment Insurance Appeal Board. The Board assessed additional unemployment insurance contributions, finding that specialists hired by Jordan were employees, not independent contractors, between 1989 and 1991. The court reviewed whether there was substantial evidence to support the Board's conclusion of an employer-employee relationship. Key factors included Jordan's control over recruitment, screening, compensation, billing, and contractual restrictions on specialists. Ultimately, the court affirmed the Board's decision, determining that Jordan exercised sufficient overall control to establish an employer-employee relationship and thus was liable for the contributions.

Unemployment InsuranceEmployer-Employee RelationshipIndependent ContractorRehabilitation ServicesLabor LawSubstantial EvidenceControl TestJudicial ReviewAdministrative Law JudgeDepartment of Labor
References
8
Case No. 13-08-00351-CV
Regular Panel Decision
Aug 31, 2009

Mitch Burkhart and Christine Burkhart v. Sedgwick Claim Management Services, Inc. and Concentra Integrated Services, and rgv/nueces Rehabilitation D/B/A Innovative Physical and Occupational Therapy

Mitch Burkhart sustained a foot and ankle injury while training for his employer, Verizon Communications. Verizon's workers' compensation claims were administered by Sedgwick Claim Management Services, Inc., who, along with Concentra Integrated Services, arranged a Functional Capacity Evaluation (FCE) for Burkhart with RGV/Nueces Rehabilitation d/b/a Innovative Physical and Occupational Therapy. The Burkharts alleged that the FCE aggravated Mitch's injury, causing permanent damage. They sued Sedgwick, Concentra, and Innovative, claiming negligence, civil conspiracy, assault, fraud, and breach of the duty of good faith and fair dealing. The trial court dismissed the case against Innovative for an inadequate expert report and granted summary judgment to Sedgwick and Concentra, citing the exclusive remedy provision of the Texas Workers' Compensation Act. The appellate court affirmed the trial court's judgment, concluding that Mitch's aggravation injury was an 'extension injury' covered by the exclusive remedy provision of the TWCA.

Workers' CompensationFunctional Capacity EvaluationExclusive RemedyAggravation InjurySummary JudgmentMedical Expert ReportHealth Care LiabilityCivil ConspiracyBreach of Duty of Good Faith and Fair DealingTexas Court of Appeals
References
23
Case No. NO. 03-05-00031-CV
Regular Panel Decision
Dec 08, 2005

Texas Department of Assistive and Rehabilitative Services, Successor in Interest to the Former Texas Rehabilitation Commission v. Richard Howard

Richard Howard, a unit manager at the Texas Department of Assistive and Rehabilitative Services, reported alleged illegal practices to the State Auditor’s Office (SAO). Howard claimed his superiors retaliated against him by rating him below standard on performance appraisals and denying promotions and merit pay increases. He sued under the Whistleblower Act, and a jury awarded him damages, costs, and attorney's fees. The Department appealed, challenging the sufficiency of evidence regarding Howard's good faith report, appropriate authority, causation, and damages. The Court of Appeals affirmed the trial court's judgment, finding sufficient evidence to support the jury's verdict that Howard made a good faith report to an appropriate authority and that his report caused the adverse actions.

Whistleblower ActRetaliationPublic EmployeeState Auditor’s OfficePerformance AppraisalMerit PayPromotion DenialDamagesCausationGood Faith Report
References
20
Case No. MISSING
Regular Panel Decision

Texas Department of Assistive and Rehabilitative Services, Successor in Interest to the Former Texas Rehabilitation Commission v. Richard Howard

Richard Howard, a unit manager with the Texas Department of Assistive and Rehabilitative Services, reported several alleged legal violations by his employer to the State Auditor’s Office. Howard subsequently experienced retaliation, including denial of promotions and merit pay increases, which he attributed to his whistleblowing activities. He successfully sued the department under the Whistleblower Act, and a jury awarded him damages. The Department appealed the verdict, challenging the sufficiency of the evidence on multiple grounds, including good faith reporting, appropriate authority, causation, and damages. The appellate court affirmed the trial court's judgment, concluding that the evidence was legally and factually sufficient to support the jury's findings.

Whistleblower ActPublic Employee RetaliationPerformance EvaluationEmployment DiscriminationState Auditor's OfficeGood Faith ReportCausal LinkEconomic DamagesAppellate ReviewJury Verdict
References
20
Case No. 03-03-00738-CV
Regular Panel Decision
Aug 12, 2004

Sante Rehabilitation, L.P. v. National Heritage Insurance Company Texas Health and Human Services Commission And Albert Hawkins, Commissioner

Sante Rehabilitation, L.P. sued National Heritage Insurance Company and the Texas Health and Human Services Commission after 2,050 Medicaid claims totaling $345,978 were not processed or paid. Sante sought declaratory and mandamus relief, arguing the claims were timely submitted but improperly rejected due to electronic transmission difficulties, qualifying for an exception to the 95-day filing deadline. The defendants invoked sovereign immunity, which the district court upheld. The Third District Court of Appeals affirmed the lower court's decision, determining that Sante's requests for declaratory and mandamus relief did not waive sovereign immunity, as the suit was primarily for monetary damages against the State. The court also noted Sante's failure to utilize available administrative remedies, reinforcing the lack of jurisdiction.

Medicaid claimsSovereign immunityDeclaratory judgmentWrit of mandamusClaims processingElectronic transmission issuesAdministrative remediesAppellate reviewHealth and Human Services CommissionFiscal intermediary
References
24
Case No. MISSING
Regular Panel Decision

Brentwood Pain & Rehabilitation Services, P.C. v. Allstate Insurance

This opinion addresses whether Magnetic Resonance Imaging (MRI) procedures are subject to the same fee limitations as X-rays under New York's no-fault auto insurance law. Plaintiffs, a group of MRI service providers ("Providers"), argued that applying x-ray fee schedules to MRIs is improper and violates insurance contracts. Defendants, numerous insurance companies ("Insurers"), along with the New York State Workers’ Compensation Board (WCB) and Department of Insurance (DOI), contended that the fee limitations for multiple diagnostic x-ray procedures (Ground Rule 3 of the WCB Fee Schedule) should also apply to MRIs. The court, deferring to the interpretations of the WCB and DOI, found their application of Ground Rule 3 to MRIs to be reasonable. Consequently, the court granted the Insurers' motion for summary judgment, denied the Providers' cross-motion for summary judgment, and denied the Providers' motion for class certification as moot.

MRIX-rayNo-Fault InsuranceFee ScheduleWorkers' Compensation BoardDepartment of InsuranceRegulatory InterpretationSummary JudgmentClass ActionDiagnostic Imaging
References
35
Case No. ADJ2862114
Regular
Oct 30, 2008

PATRICIA TRUJILLO vs. EARTHLINK, INC., CHUBB INSURANCE SERVICES

The Workers' Compensation Appeals Board affirmed a prior ruling that the defendant, Earthlink, Inc., owes vocational rehabilitation benefits to the applicant, Patricia Trujillo. The court found that the defendant failed to provide legally required notices when the applicant deferred vocational rehabilitation services. This failure meant the deferral was invalid, making the defendant liable for vocational rehabilitation maintenance allowance (VRMA) from the date of the notice breach.

Vocational rehabilitationAD Rule 9813(a)(4)VRMAdeferral of servicesnotice requirementsclaims administratorinterrupted servicesreinstatement of servicesstatute of limitationsemployer's duty
References
6
Case No. 03-10-00709-CV
Regular Panel Decision
Aug 31, 2011

Green Tree Servicing, LLC, as Authorized Servicing Agent for Conseco Finance Servicing Corporation v. Travis County

Green Tree Servicing, LLC appealed a post-answer default judgment concerning ad valorem taxes on mobile homes. The original suit was filed by Travis County and other entities against Conseco Finance Servicing Corporation, later substituted with Green Tree. Green Tree failed to appear at trial, resulting in a default judgment. Green Tree filed a motion for new trial, asserting its failure to appear was due to an accident or mistake (attorney transition) and that it had a meritorious defense, arguing that as a repossessing lienholder and not an owner, it was not liable for the taxes under Texas Tax Code Ann. § 32.07. The appellate court applied the Craddock test and found that Green Tree satisfied all three elements. The court adopted the interpretation that a repossessing lienholder is not considered an 'owner' under the tax code. Consequently, the appellate court reversed the trial court's judgment and remanded the case for a new trial.

Post-answer default judgmentAd valorem taxesMobile homesLienholder liabilityProperty ownershipMeritorious defenseCraddock testNew trialStatutory interpretationTexas Tax Code
References
22
Case No. ADJ4303823
Regular
Dec 11, 2008

GLORIA BUSTOS vs. BAYSIDE SERVICES/STAFFING, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION through their servicing facility CAMBRIDGE INTEGRATED SERVICES, INC., for LEGION INSURANCE COMPANY, in liquidation

The Appeals Board affirmed the WCJ's denial of retroactive VRMA, finding that merely listing vocational rehabilitation as an issue in applications did not establish a good faith demand for services. However, the Board rescinded the denial of attorney's fees under LC 5814.5, remanding the issue for further determination in light of the en banc decision in *Ramirez v. Drive Financial Services*. This ruling clarifies that LC 5814.5 applies to delays occurring after January 1, 2003, regardless of the injury date.

Workers' Compensation Appeals BoardVocational Rehabilitation Maintenance AllowanceQualified Injured WorkerLabor Code section 5814.5Date of InjuryDate of AwardApplication for Adjudication of ClaimGood Faith DemandRehabilitation UnitUnreasonable Delay
References
5
Case No. MISSING
Regular Panel Decision

Volt Technical Services Corp. v. Immigration & Naturalization Service

Plaintiff Volt Technical Services Corp. applied for H-2 visas for nuclear start-up technicians, which the Immigration and Naturalization Service (INS) denied, asserting the need was permanent, not temporary. After the denial was affirmed on appeal, Volt filed suit, alleging the INS's decision was arbitrary and capricious. The court upheld the INS's interpretation of the Immigration and Nationality Act § 101(a)(15)(H)(ii), which requires the employer's need for services to be temporary, not just the individual assignments. Finding that Volt demonstrated a recurring need for such technicians over several years, the court granted the INS's motion for judgment on the pleadings and denied Volt's.

Immigration LawH-2 visasNonimmigrant WorkersTemporary EmploymentImmigration and Nationality ActAdministrative Procedures ActDeclaratory Judgment ActAgency InterpretationJudicial ReviewNuclear Industry
References
5
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