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

Case No. 03-03-00176-CV
Regular Panel Decision
Dec 04, 2003

Texas Workers' Compensation Insurance Fund/Texas Workers' Compensation Commission and Leonard D. Watts v. Texas Workers' Compensation Commission and Leonard D. Watts/Texas Workers' Compensation Insurance Fund

This case involves a cross-appeal stemming from a workers' compensation claim by Leonard D. Watts, who sought lifetime income benefits for injuries sustained as a truck driver. The Texas Workers' Compensation Commission (appeals panel) initially reversed a hearing officer's decision and awarded Watts benefits, but this decision was later set aside by a Travis County district court. In this appeal, the Texas Workers' Compensation Insurance Fund (Texas Mutual) and the Commission challenged the district court's ruling. The Court of Appeals addressed arguments regarding the appeals panel's statutory authority for factual-sufficiency review and the interpretation of "issue" under the labor code, including legal doctrines of res judicata and collateral estoppel. The court ultimately reversed the judgment of the district court, thereby affirming the decision of the Commission's appeals panel which granted Watts lifetime income benefits.

Workers' CompensationLifetime Income BenefitsAppeals Panel ReviewFactual SufficiencyStatutory AuthorityCross-AppealRes JudicataCollateral EstoppelCausationMaximum Medical Improvement
References
17
Case No. 07-02-0169-CV
Regular Panel Decision
Jan 14, 2003

Texas Workers' Compensation Commission v. Texas Workers' Compensation Insurance Fund

The Texas Workers' Compensation Commission (Commission) appealed a summary judgment that relieved the Texas Worker's Compensation Insurance Fund (Insurance Fund) of liability for workers' compensation benefits to Glenn Everett, the real party of interest. The Commission contended that the Texas Workers' Compensation Act abrogates the common law defense of election of remedies and that Everett did not make an election. Everett had previously settled a personal injury suit for $37,500 and later pursued a worker's compensation claim. The Court of Appeals affirmed the trial court's decision, finding that the Act does not abrogate the election of remedies defense and that Everett made an informed choice to elect remedies by settling his claim after consulting with attorneys, thus barring his right to workers' compensation benefits.

Workers' CompensationElection of RemediesSummary JudgmentTexas Appellate CourtStatutory InterpretationCommon Law DefenseIndemnificationSettlement AgreementEmployee StatusInsurance Fund Liability
References
18
Case No. 03-03-00435-CV
Regular Panel Decision
Jul 29, 2004

Texas Workers' Compensation Commission Richard Reynolds, in His Official Capacity as Executive Director of the Texas Workers' Compensation Commission/East Side Surgical Center Clinic for Special Surgery And Surgical and Diagnostic Center, L.P. v. East Side Surgical Center Clinic for Special Surgery/Texas Workers' Compensation Commission Richard Reynolds, in His Official Capacity as Executive Director of the Texas Workers' Compensation Commission

This case involves the Texas Workers’ Compensation Commission's failure to establish fee guidelines for ambulatory surgical centers under the Texas Workers’ Compensation Act. East Side Surgical Center, Clinic for Special Surgery, and intervenor Surgical and Diagnostic Center, L.P. (collectively "East Side") sued the Commission to invalidate certain default rules that applied when specific guidelines were absent. The district court declared one rule (133.304(i)) invalid and enjoined its enforcement, citing unlawful delegation of authority. On appeal, the Court of Appeals reversed the district court's judgment regarding the rule's invalidity and dissolved the injunction, citing a Texas Supreme Court decision finding no unlawful delegation. The court affirmed that East Side was not entitled to its usual and customary fee in the absence of specific guidelines.

Workers' CompensationAdministrative LawDelegation of AuthorityRulemakingAmbulatory Surgical CentersJudicial ReviewInsurance CarrierFee GuidelinesFair and Reasonable RatesStatutory Interpretation
References
38
Case No. MISSING
Regular Panel Decision

Claim of Beth V. v. New York State Office of Children & Family Services

Claimant, a youth division aide, suffered severe injuries including physical assault, rape, and kidnapping during work, leading to established workers' compensation benefits and a classification of permanent partial disability. She subsequently reached a $650,000 settlement in a federal civil rights action against her employer and co-employees for the same injuries. The workers' compensation carrier waived its lien for past benefits but asserted a right to a credit for future payments against the settlement under Workers’ Compensation Law § 29. The Workers’ Compensation Board reversed a Workers’ Compensation Law Judge’s decision, ruling in favor of the carrier's credit, finding the settlement covered the same injuries for which workers' compensation benefits were awarded. The appellate court affirmed the Board's decision, confirming the carrier's entitlement to a credit against the third-party settlement recovery.

Workers' CompensationThird-Party SettlementCredit Against RecoveryLienFuture BenefitsPermanent Partial DisabilityPTSDRapeCivil Rights ClaimFederal Lawsuit
References
4
Case No. 03-11-00009-CV
Regular Panel Decision
May 26, 2011

Rod Bordelon, Commissioner of the Texas Department of Insurance, Division of Workers' Compensation And the Texas Department of Insurance, Division of Workers' Compensation v. Brian Fanette

The appellants, Rod Bordelon, Commissioner of the Texas Department of Insurance, Division of Workers' Compensation, and the Texas Department of Insurance, Division of Workers' Compensation, filed a motion requesting the dismissal of their appeal. The Texas Court of Appeals, Third District, at Austin, granted this motion and consequently dismissed the appeal. This decision was made in the case against Appellee Brian Fanette.

Texas Court of AppealsWorkers' Compensation DivisionAppeal DismissalAppellant MotionJudicial DistrictTravis CountyMemorandum OpinionAdministrative AgencyState GovernmentAppellate Procedure
References
0
Case No. 03-94-00124-CV
Regular Panel Decision
May 24, 1995

Texas Workers' Compensation Commission, the Subsequent Injury Fund, and Todd Brown in His Official Capacity as Executive Director of the Texas Workers' Compensation Commission v. the City of Bridge City, Texas, and the Texas Municipal League Intergovernmental Risk Pool

The Texas Workers' Compensation Commission and other appellants appealed a trial court's declaratory judgment and permanent injunction that found parts of the Texas Workers' Compensation Act unconstitutional. The trial court's decision was based on alleged violations of the Texas Constitution, particularly regarding the requirement of immediate payment of benefits during an appeal without reimbursement. The appellate court reversed the trial court's judgment, dissolved the injunction, and rendered a declaratory judgment affirming the constitutionality of the statutory scheme. The court reasoned that municipal corporations are not protected by certain constitutional provisions and that the 'suitability' of laws is a political question. It concluded that the payment scheme was rationally related to the state's interest in securing prompt payments to injured workers.

Texas Court of AppealsWorkers' Compensation ActConstitutional LawDeclaratory JudgmentPermanent InjunctionDue ProcessMunicipal CorporationsGovernmental ImmunityStatutory InterpretationLegislative Power
References
24
Case No. MISSING
Regular Panel Decision

Bopp v. Wiest

This is a case of first impression concerning the application of a workers' compensation lien to a wrongful death settlement involving beneficiaries who are not statutory dependents. The decedent's estate received $50,000 in workers' compensation benefits under Workers' Compensation Law § 16 (4-b) following a workplace death, as there were no dependents. The estate's coexecutrices secured a $60,000 wrongful death settlement on behalf of the decedent's adult children. Liberty Mutual, the workers' compensation carrier, asserted a lien against this settlement. The court, presided over by Justice Andrew V. Siracuse, ruled that the 1990 amendment to Workers' Compensation Law § 16 (4-b) made the distinction between dependents and distributees irrelevant in this context. Consequently, the court approved the settlement but confirmed that the proceeds are subject to Liberty Mutual's workers' compensation lien, ensuring that adult children receiving benefits through the estate do not have a superior position to minor dependents receiving direct benefits.

wrongful deathworkers' compensationliensettlementstatutory interpretationdependentsdistributeesNew York lawfirst impressionsubrogation
References
7
Case No. MISSING
Regular Panel Decision

Texas Workers' Compensation Insurance Fund v. Travis

This case involves an appeal by the Texas Workers’ Compensation Insurance Fund (Appellant) contesting the trial court's judgment regarding the distribution of settlement proceeds. The Appellant, an intervenor in the original suit, sought to enforce its workers' compensation lien against a settlement reached between the injured employee, Boyd Travis, his beneficiaries, and the third-party tortfeasor, Lillian Thoele. The appellate court determined that the trial court's apportionment of the $100,000 settlement, which allocated a disproportionately small amount to Travis and a large sum to his wife, improperly circumvented the Appellant's statutory subrogation rights to recover past benefits and claim a credit against future payments. Consequently, the appellate court sustained the Appellant's point of error, reversed the judgment of the trial court, and remanded the case for proceedings consistent with its opinion. Additionally, the court overruled the attorney ad litem's cross-point for appellate attorney's fees.

Workers' Compensation LienSettlement ApportionmentSubrogation RightsThird-Party RecoveryFuture Medical BenefitsStatutory InterpretationAttorney Ad Litem FeesAppellate ReviewInjured EmployeeBeneficiaries
References
8
Case No. 2017 NY Slip Op 08244
Regular Panel Decision
Nov 22, 2017

Matter of New York State Workers' Compensation Bd. v. Murray Bresky Consultants, Ltd

This appeal concerns the allocation of settlement proceeds from a defunct group self-insured trust. The New York State Workers' Compensation Board, as administrator of the Manufacturing Self Insurance Trust Fund, sought judicial apportionment of settlement funds recovered from third parties. Murray Bresky Consultants, Ltd, a former member of the trust, objected to the Board receiving all proceeds and asserted a counterclaim for its share and an accounting. The Supreme Court granted the Board all proceeds and dismissed Murray Bresky's objections. The Appellate Division modified this decision, ruling that Murray Bresky was entitled to share in the jointly-recovered settlement proceeds and that the Board must file a verified accounting, remitting the matter for further proceedings.

Workers' Compensation LawSelf-Insurance TrustSettlement ProceedsJudicial ApportionmentVerified AccountingCPLR Article 77Contractual InterpretationTrust DeficitAppellate ReviewFiduciary Duty
References
13
Case No. MISSING
Regular Panel Decision

Texas Workers' Compensation Insurance Fund v. Serrano

This per curiam decision addresses whether a workers' compensation carrier must prove that the amount of benefits paid was reasonable and necessary before it is entitled to reimbursement from a third-party settlement. Jose Serrano sustained on-the-job injuries and, along with his family, sued third parties. The Texas Workers’ Compensation Insurance Fund intervened to assert subrogation rights for paid medical and indemnity benefits. The district court denied reimbursement for medical benefits, finding the Fund failed to prove reasonableness and necessity. The court of appeals affirmed. The Supreme Court of Texas disagreed, holding that Section 417.002(a) of the Texas Workers’ Compensation Act does not limit reimbursement to only reasonable and necessary amounts, as the statute refers to the care and services provided, not the amounts paid. The Court reversed the judgment of the court of appeals and remanded the case for further proceedings.

Workers' CompensationSubrogation RightsReimbursement ClaimMedical BenefitsIndemnity BenefitsThird-Party ActionSettlement ProceedsReasonable and Necessary CostsStatutory InterpretationAppellate Review
References
10
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