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

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. 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. 15-25-00061-CV
Regular Panel Decision
Apr 02, 2025

Francisca Okonkwo, Administrative Law Judge, Texas Department of Insurance, Division of Workers' Compensation, in Her Official Capacity and Fort Bend County v. Joshua David Heiliger, Individually, and on Behalf of the Estate of Lauren Brittane Smith, and on Behalf of Death Benefits Beneficiaries Joshua David Heiliger and Emma Destiny Heiliger

Fort Bend County appeals a temporary injunction granted by a Harris County District Court, which prevents discovery of mental health records in an ongoing workers' compensation dispute. The underlying administrative case involves a claim for death benefits by Joshua Heiliger, whose spouse, Lauren Brittane Smith, was a paramedic. Heiliger asserts Smith's mental health condition and stress contributed to her death, thus placing her mental health at issue. The Division of Workers' Compensation's Administrative Law Judge (ALJ) issued a subpoena for Smith's mental health records from her psychiatrist, Dr. John Marcellus. Heiliger bypassed the administrative process by obtaining the injunction in District Court. Fort Bend County argues the District Court erred in interfering with the Division's exclusive jurisdiction and that Heiliger failed to exhaust administrative remedies or demonstrate irreparable injury, as Texas law provides a qualified privilege for mental health records with exceptions relevant to this case.

Workers' CompensationTemporary InjunctionDiscovery DisputeMental Health RecordsSubpoena EnforcementAdministrative Law JudgeExclusive JurisdictionExhaustion of Administrative RemediesQualified PrivilegePatient-Litigant Exception
References
53
Case No. 2018 NY Slip Op 08227
Regular Panel Decision
Nov 29, 2018

Matter of Kelly v. New York State Workers' Compensation Bd.

In 2006, claimant Grace Kelly established a workers' compensation claim for an occupational disease. The State Insurance Fund (SIF) repeatedly sought to transfer liability to the Special Fund for Reopened Cases, which was denied by Workers' Compensation Law Judges. The Workers' Compensation Board affirmed these denials and assessed $500 penalties against both SIF and its counsel, Walsh and Hacker, for filing an application for review without reasonable grounds. Walsh and Hacker appealed the penalty imposed against them to the Appellate Division, Third Department. The Appellate Division found insufficient evidence to support the Board's finding that Walsh and Hacker's application lacked reasonable grounds, and therefore reversed the penalty against them, modifying and affirming the Board's decision.

PenaltiesAppellate ReviewSpecial Fund for Reopened CasesWorkers' Compensation Law § 25-aWorkers' Compensation Law § 114-aAttorney SanctionsAdministrative LawBoard DecisionJudiciary Law § 431
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. 14-18-00274-CV
Regular Panel Decision
Mar 17, 2020

Dr. Louis Patino, D.C. Dr. Stephen Wilson, M.D. And Dr. Gary Craighead, D.C. v. Texas Department of Insurance-Division of Workers' Compensation Commissioner Cassandra J. Brown and Dr. Donald Patrick, in Their Official and Individual Capacities State Office of Administrative Hearings, Texas Chief Administrative Law Judge Cathleen Parsley in Her Official Capacity Tommy Broyles, in His Official Capacity The State of Texas And the Attorney General of the State of Texas

Three doctors, Patino, Wilson, and Craighead, appealed the dismissal of their claims against the Texas Department of Insurance-Division of Workers’ Compensation and other state entities. The doctors were excluded from the state's workers' compensation approved doctor list between 2004 and 2007, leading to administrative penalties and a subsequent lawsuit. The trial court dismissed their claims for lack of jurisdiction, asserting immunity. The appellate court affirmed the dismissal of claims challenging final agency orders due to unexhausted administrative remedies and collateral attack immunity. However, the court reversed the dismissal of the doctors' constitutional challenges to the Workers’ Compensation Act and ultra vires claims against the Commissioner, concluding these claims were properly pleaded and not barred by sovereign immunity.

Physician ExclusionAdministrative LawJudicial ReviewSovereign ImmunityUltra Vires ClaimsConstitutional ChallengeDue Process RightsProfessional LicensingGovernment RegulationTexas Labor Code
References
24
Case No. MISSING
Regular Panel Decision

Claim of D'Addio v. Peter Annis, Inc.

A widow filed a claim for workers' compensation death benefits after her husband, who had an established claim for asbestosis, died. A Workers' Compensation Law Judge (WCLJ) found a work-related death and ordered the employer's carrier to deposit funds into the aggregate trust fund (ATF) in July 2010. The carrier did not appeal this initial decision. After a subsequent WCLJ decision in December 2010 reiterated the ATF deposit, the carrier sought review, arguing the deposit was unwarranted. The Workers' Compensation Board denied the carrier's application as untimely. The appellate court affirmed the Board's decision, holding that the 30-day appeal period for the July 2010 decision had expired and the later WCLJ decision did not extend that timeframe. The court found no abuse of discretion by the Board.

Workers' CompensationUntimely ApplicationAggregate Trust FundDeath BenefitsAsbestosisOccupational DiseaseAppellate ReviewBoard DiscretionTimelinessAppeal Denial
References
5
Case No. 532391
Regular Panel Decision
Nov 18, 2021

Matter of Richman v. New York State Workers' Compensation Bd.

Claimant, Rebecca Richman, appealed three decisions from the Workers' Compensation Board regarding her claim for a work-related right shoulder injury. She alleged a fall at work on January 19, 2018, but did not seek medical treatment for 19 months. A Workers' Compensation Law Judge initially established the claim, but the Board reversed, finding that Richman failed to submit sufficient, credible medical evidence to demonstrate a causally-related injury and denied her claim. The Board subsequently denied her application for reconsideration and/or full Board review. The Appellate Division affirmed the Board's decisions, concluding that the Board's finding of no causally-related injury was supported by substantial evidence and that the Board did not abuse its discretion in denying reconsideration.

Workers' Compensation ClaimCausation (Medical)Shoulder InjuryMedical Evidence SufficiencyBoard ReversalAppellate Division ReviewBurden of ProofCredibility of EvidenceOsteoarthritis DiagnosisDelayed Medical Treatment
References
8
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