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

Case No. 14-19-00539-CV
Regular Panel Decision
Dec 22, 2020

Hand & Wrist Center of Houston, P.A. v. Lowery Masonry, LLC

Appellant Hand & Wrist Center of Houston, P.A. (HWC) appealed a summary judgment that denied it recovery from Appellee Lowery Masonry, LLC, on a guaranty agreement. Lowery's president had signed a "Letter of Guarantee" to ensure prompt medical treatment for an injured employee, Sandro Tovar, and to pay HWC's usual and customary fees. Lowery later argued an exception applied because it had workers' compensation insurance with Texas Mutual Insurance Company, leading the trial court to grant summary judgment. The appellate court determined that Lowery's interpretation of the exception was unreasonable as it would render the phrase "additional payment" meaningless within the contract. Consequently, the appellate court reversed the trial court's judgment and remanded the cause for further proceedings, concluding that Lowery had not conclusively established its entitlement to summary judgment.

Contract LawGuaranty AgreementSummary JudgmentWorker's Compensation InsuranceMedical BillingAppellate ReviewContract InterpretationTexas LawHarris CountyFourteenth Court of Appeals
References
25
Case No. MISSING
Regular Panel Decision

Hand & Wrist Center of Houston, P.A. v. SGS Control Services, Inc.

Charles Reagan was injured at work and treated by Hand & Wrist Center. SGS North America, his employer, signed a "Letter of Guarantee" promising to pay for treatment if workers' compensation insurance didn't cover it. SGS failed to pay, leading Hand & Wrist to sue for breach of contract. SGS filed a plea to the jurisdiction, arguing Hand & Wrist failed to exhaust administrative remedies under the Workers' Compensation Act. The trial court granted the plea, and Hand & Wrist appealed, contending SGS did not invoke its workers' compensation coverage and that exclusive remedies provisions do not apply to healthcare providers. The appellate court affirmed the trial court's decision, holding that SGS invoked its workers' compensation coverage when it obtained it, and Hand & Wrist was required to exhaust administrative remedies with the Texas Department of Insurance-Workers’ Compensation Division before filing suit, as the Division has exclusive jurisdiction over medical fee disputes.

Workers' CompensationAdministrative RemediesSubject Matter JurisdictionPlea to the JurisdictionBreach of ContractHealthcare Provider ReimbursementExclusive RemediesTexas Labor CodeMedical Fee DisputeAppellate Review
References
17
Case No. 01-12-00216-CV
Regular Panel Decision
Feb 04, 2014

Hand & Wrist Center of Houston, P.A. and SCA Houston Hospital for Specialized Surgery L.P. v. Maintenance Supply Headquarters, LP

Appellants Hand & Wrist Center, P.A. and SCA Houston Hospital for Specialized Surgery, L.P. appealed the trial court's summary judgment in favor of Maintenance Supply Headquarters, L.P., concerning a breach of contract claim. The dispute arose from a "Letter of Guarantee" signed by Maintenance Supply for medical services provided to an injured employee, Daniel Contreras, whose workers' compensation claim was denied. Maintenance Supply argued estoppel and the applicability of the Labor Code's exclusive remedies provision. The Court of Appeals found the estoppel defense inapplicable and, crucially, ruled that Labor Code section 408.001(a)'s exclusive remedies provision applies only to employees and their beneficiaries, not to health care providers. Consequently, the appellate court reversed the summary judgment and remanded the case for further proceedings.

Breach of contractSummary judgmentWorkers' compensationExclusive remedyHealth care providersStatutory interpretationTexas Labor CodeEstoppelLetter of GuaranteeAppellate review
References
10
Case No. MISSING
Regular Panel Decision
Jan 06, 2012

Hand & Wrist Center of Houston, P.A. and SCA Houston Hospital for Specialize Surgery, L.P. v. Republic Services, Inc.

This case concerns an appeal by Hand & Wrist Center of Houston and SCA Houston Hospital for Specialized Surgery (appellants) regarding the calculation of prejudgment interest. They sued Republic Services, Inc. (appellee) for breach of contract after Republic failed to fully pay for medical services provided to an employee, making partial payments just before trial. The trial court awarded prejudgment interest only on the damages found by the jury, excluding the pretrial partial payments. The appellate court found this to be an abuse of discretion, asserting that appellants were entitled to interest on all damages, including the belatedly paid amounts. Applying the 'declining principal' formula, the court modified the judgment to include interest on the partial payments, emphasizing the policy of compensating for lost use of money and deterring delayed payments.

Prejudgment InterestBreach of ContractPartial PaymentEquitable PrinciplesDeclining Principal FormulaAbuse of DiscretionContractual DamagesAppellate ReviewMedical ServicesTexas Law
References
18
Case No. MISSING
Regular Panel Decision
Dec 13, 2006

Claim of Aposporos v. NYNEX

Claimant applied for workers' compensation benefits in May 1996 for neck and wrist injuries. A compensable injury for her left wrist was established in February 1997, with other injury sites held in abeyance. In March 2006, claimant requested further action to establish an injury to her right wrist. The employer asserted that the Special Disability Fund was liable pursuant to Workers’ Compensation Law § 25-a due to the time elapsed. Both a Workers’ Compensation Law Judge and the Workers’ Compensation Board determined the Fund was not liable, finding the case was not truly closed because the right wrist injury issue was raised in 1996 and remained unresolved. The appellate court affirmed the Board's decision, stating that substantial evidence supported the finding that the case was not truly closed.

Workers' CompensationSpecial Disability FundCase ReopeningLiabilityUnresolved ClaimWorkers’ Compensation Law § 25-aInjury EstablishmentAppealBoard DecisionSubstantial Evidence
References
3
Case No. 2014-06-0085
Regular Panel Decision
Jul 28, 2015

Ballard, Stephanie v. Christian Broadcast Network, Inc.

Stephanie Ballard, an employee of Christian Broadcast Network, Inc. (CBN), filed an amended Request for Expedited Hearing seeking medical and temporary disability benefits after sustaining a wrist injury on August 6, 2014. The Court addressed whether CBN was obligated to provide additional medical care for her wrist and temporary disability benefits, and if her current wrist complaints were related to the work injury. The Court found conflicting medical opinions from Dr. N.K. Singh regarding Ballard's return-to-work date and the causation of her wrist pain. Due to the lack of clear expert medical proof and Ms. Ballard's failure to present countervailing evidence, the Court denied her request for temporary disability and medical benefits at this time. The matter was set for an Initial Hearing on September 14, 2015.

Workers' CompensationExpedited HearingMedical BenefitsTemporary DisabilityCausal RelationshipMedical Expert OpinionConflicting Medical ReportsWrist InjuryCervicalgiaCervical Strain
References
3
Case No. ADJ10234015 (MF) ADJ10537501
Regular
Feb 21, 2017

DON PONCE vs. BARRETT BUSINESS SERVICES, INC., permissibly self-insured; STATE COMPENSATION INSURANCE FUND

The Appeals Board denied the defendant's Petition for Reconsideration. The Board affirmed the WCJ's finding that the applicant sustained a cumulative trauma injury to his left wrist during his employment with the defendant. This finding was based on medical evidence indicating the wrist injury resulted from increased stress due to work duties after previous shoulder surgery. The Board clarified that even if the wrist injury was a consequence of a prior industrial injury, it was still compensable as an aggravation of a pre-existing condition directly attributable to the subsequent employment.

Workers' Compensation Appeals BoardJoint Findings and AwardPetition for ReconsiderationCumulative Trauma InjurySpecific InjuryCompensable ConsequencePrior Industrial InjuryShoulder InjuryWrist InjuryTruck Driver
References
9
Case No. ADJ1806235 (OAK 0229406) ADJ3677836 (OAK 0279846) ADJ3058455 (OAK 0347422)
Regular
Jun 03, 2013

THEODORE FERNANDEZ vs. TENET HEALTHCARE dba SAN RAMON REGIONAL MEDICAL CENTER, SEDGWICK CMS, VALLEYCARE HEALTH SYSTEM, LUMBERMEN'S UNDERWRITING ALLIANCE, TRAVELERS PROPERTY AND CASUALTY INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, returning the case to the trial level for further proceedings. The Board found insufficient medical evidence to definitively link the applicant's wrist condition to his 1993 injury. It noted the applicant's wrist symptoms emerged and worsened years after his employment with the original employer, suggesting a potential cumulative trauma injury with a subsequent employer. The Board ordered further development of the medical record to clarify the nature and causation of the applicant's bilateral wrist issues.

WCABReconsiderationCumulative TraumaBilateral Upper ExtremitiesCarpal Tunnel SyndromeUlnar NeuritisCubital Tunnel SyndromeAgreed Medical EvaluatorApportionmentSubstantial Medical Evidence
References
0
Case No. 2016-07-0875
Regular Panel Decision
Jun 01, 2017

Carney, Rosa v. Southwest Human Resource Agency

This Expedited Hearing Order addresses Rosa Carney's request for medical benefits for alleged left wrist and shoulder injuries sustained while working for Southwest Human Resource Agency. The Court denied benefits for the left shoulder, finding Ms. Carney failed to provide sufficient notice of a work-related injury. However, the Court granted medical benefits for the left wrist, concluding that Ms. Carney provided adequate and timely notice for her gradually occurring carpal tunnel syndrome. The employer was consequently ordered to provide a panel of orthopedic physicians for the evaluation and treatment of Ms. Carney's left wrist injury, while her request for temporary disability benefits was also denied.

Workers' CompensationMedical BenefitsExpedited HearingCarpal Tunnel SyndromeShoulder ImpingementNotice RequirementGradual InjuryCausationPanel of PhysiciansTennessee Law
References
3
Case No. 2023 NY Slip Op 00140 [212 AD3d 974]
Regular Panel Decision
Jan 12, 2023

Matter of Molnar v. JRL S. Hampton, LLC

Claimant John Molnar appealed a Workers' Compensation Board decision which disallowed his claim for occupational bilateral wrists and hands injury. The Board affirmed a Workers' Compensation Law Judge's decision, finding the claim was precluded by collateral estoppel. Molnar had a prior established claim for occupational bilateral carpal tunnel syndrome and a second claim for repetitive-use wrist injury that was disallowed by the Board in August 2020 for lack of causal relationship to employment. The Board determined that the issue of causal link between employment and repetitive-use wrist injury in the instant claim was identical to the issue previously litigated and decided against Molnar, thus applying the doctrine of collateral estoppel to preclude relitigation.

Collateral EstoppelRes JudicataOccupational DiseaseCarpal Tunnel SyndromeRepetitive-Use InjuryWorkers' Compensation BenefitsAppellate ReviewCausal RelationshipBoard DecisionClaim Disallowed
References
7
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