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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. LAO 0811779, LAO 0811780
Regular
Mar 06, 2008

ELENA BLANKEVOORT vs. HUNTINGTON MEMORIAL HOSPITAL, S&B SURGERY CENTER

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a trial judge's order disallowing a lien claim from S&B Surgery Center. The WCAB found that while S&B Surgery Center did have a required "surgical clinic" license, it failed to prove compliance with fictitious business name filing requirements. However, the WCAB returned the case to the trial level for further proceedings, allowing S&B Surgery Center an opportunity to correct this procedural defect to recover on its lien.

Fictitious business nameLien claimantSurgical clinic licenseBusiness and Professions Code section 17910Medical BoardDepartment of Health ServicesBurden of proofReconsiderationWorkers' Compensation Appeals BoardOutpatient setting
References
12
Case No. 08-06-00071-CV
Regular Panel Decision
Aug 30, 2007

Vincent Maes and Cynthia Maes and the Insurance Company of the State of Pennsylvania v. El Paso Orthopaedic Surgery Group

Vincent and Cynthia Maes and The Insurance Company of the State of Pennsylvania appealed the dismissal of a health care liability suit against El Paso Orthopaedic Surgery Group (EPOSG). The Maeses alleged negligence and vicarious liability against EPOSG after Vincent Maes suffered severe complications following back surgery by Dr. Paul Cho, an EPOSG neurosurgeon. The trial court dismissed all claims against EPOSG, finding the expert reports insufficient to address EPOSG's breach of the standard of care, even for vicarious liability claims. On appeal, the Court reviewed whether an expert report was necessary for vicarious liability claims and if the severance of claims against EPOSG was proper. The appellate court ultimately affirmed the trial court's judgment, upholding the dismissal of all claims against EPOSG and the severance.

Health Care LiabilityMedical MalpracticeExpert Report SufficiencyVicarious LiabilityRespondeat SuperiorDismissal with PrejudiceSeverance of ClaimsSpinal Surgery ComplicationsNeuroscienceOrthopedic Surgery Group Liability
References
17
Case No. MISSING
Regular Panel Decision

Maes ex rel. Maes v. El Paso Orthopaedic Surgery Group, P.A.

Vincent and Cynthia Maes, as next friend of their minor daughter Isabel, and The Insurance Company of the State of Pennsylvania (ICTSP), appealed a summary judgment granted in favor of El Paso Orthopaedic Surgery Group, P.A. (EPOSG). Isabel's claim was for loss of parental consortium due to her father Vincent Maes's alleged disabling injury following surgery performed by an EPOSG employee, Dr. Paul Cho, in 2001. Vincent Maes's initial lawsuit against EPOSG was dismissed with prejudice in 2004, and the two-year statute of limitations for his underlying claim expired in 2003. EPOSG moved for summary judgment, arguing Isabel's claims were time-barred and barred by the prior dismissal of her father's underlying claim. The appellate court affirmed the summary judgment, concluding that Isabel's derivative loss of parental consortium claims were extinguished by both the running of the statute of limitations on her father's claim and its prior dismissal with prejudice.

medical malpracticeloss of parental consortiumstatute of limitationssummary judgmentderivative claimshealthcare liabilityminor's claimsprior litigationdismissal with prejudiceTexas Civil Practice and Remedies Code
References
26
Case No. 08-11-00331-CV
Regular Panel Decision
Oct 31, 2012

Vincent Maes and Cynthia Maes, as Next Friend of Isabel G. Maes, a Minor Child and the Insurance Company of the State of Pennsylvania v. El Paso Orthopaedic Surgery Group, P. A.

Vincent Maes sustained a spinal injury in 2000 from a motor vehicle accident, leading to a lumbar laminectomy in 2001 by Dr. Paul Cho, an employee of El Paso Orthopaedic Surgery Group, P.A. (EPOSG). Following the surgery, Mr. Maes allegedly experienced severe neurological issues. In 2010, Vincent and Cynthia Maes, acting as next friend for their minor daughter Isabel, along with The Insurance Company of the State of Pennsylvania (ICTSP), filed a lawsuit against EPOSG, asserting claims for Isabel's loss of parental consortium and alleging vicarious liability for Dr. Cho's negligence. EPOSG sought summary judgment, contending that Isabel's claims were time-barred by the two-year statute of limitations applicable to Mr. Maes's original claim and also by the prior dismissal of Mr. Maes's claim with prejudice in 2004. The trial court granted summary judgment in favor of EPOSG. The appellate court affirmed the trial court's decision, ruling that claims for loss of parental consortium are derivative in nature and are consequently extinguished when the statute of limitations on the injured parent's underlying claim expires or when that underlying claim is dismissed with prejudice.

Medical MalpracticeParental ConsortiumSummary JudgmentStatute of LimitationsDerivative ClaimsDismissal with PrejudiceTexas Civil Practice and Remedies CodeHealth Care LiabilityMinor's ClaimsAppellate Review
References
28
Case No. MISSING
Regular Panel Decision

Hawkins v. Center for Spinal Surgery

Demica Hawkins, a Black former Accounts Payable Coordinator, sued her employer, The Center for Spinal Surgery (CSS), alleging race discrimination, retaliation, and FMLA interference. The lawsuit stemmed from denied pay raises, disciplinary actions, and ultimately her termination while on pregnancy leave, which Hawkins claims was discriminatory and retaliatory. CSS filed a renewed motion for summary judgment, and Hawkins filed a partial motion for summary judgment. The court granted in part and denied in part CSS's motion, dismissing Hawkins' pregnancy discrimination and certain retaliation claims. However, Hawkins' retaliatory discharge and FMLA interference claims related to her 2013 termination will proceed to trial due to genuine disputes of material fact regarding CSS's motivations.

Race DiscriminationRetaliationFMLA InterferenceSummary JudgmentEmployment LawTitle VIIPregnancy Discrimination ActMcDonnell Douglas FrameworkHonest Belief RulePretext
References
64
Case No. 03A01-9804-CH-00120
Regular Panel Decision
Mar 24, 1999

Cleveland Surgery Center v. Bradley Co. Hospital

Two private health care providers, Cleveland Surgery Center and Ocoee Physical Therapy, Inc., sought a declaratory judgment against Bradley County Memorial Hospital and its partners, alleging ultra vires acts and violations of the Tennessee Constitution. The providers challenged the hospital's business ventures with private entities, specifically the Ocoee Health Alliance. The trial court found the hospital had exceeded its authority by lending the county's credit and engaging in unconstitutional business dealings. On appeal, the Court of Appeals affirmed the trial court's judgment regarding the specific business ventures, concluding that the hospital acted as an agent of Bradley County and its partnerships with the private Alliance violated Article II, § 29 of the Tennessee Constitution. The appellate court modified the permanent injunction, narrowing its scope to prohibit transactions with private businesses that obligate County Funds without a public referendum.

Hospital AuthorityUltra Vires ActsConstitutional LawPublic-Private PartnershipsDeclaratory JudgmentInjunctionCounty LiabilityTaxation PowerReferendumHealthcare Law
References
24
Case No. 03-17-00352-CV
Regular Panel Decision
Aug 22, 2018

Vista Medical Center Hospital Vista Healthcare, Inc. And Surgery Specialty Hospital, Inc.// State Office of Risk Management v. State Office of Risk Management// Vista Medical Center Hospital Vista Healthcare, Inc. And Surgery Specialty Hospital, Inc.

This case involves cross-appeals stemming from a dispute over the appropriate reimbursement for medical services provided by Vista Medical Center Hospital and its affiliates to injured employees covered by the State Office of Risk Management (SORM) under Texas workers’ compensation statutes. The district court had affirmed 23 administrative orders that required SORM to make additional payments to Vista, a decision which SORM challenged on appeal citing insufficient evidence. Vista, in turn, cross-appealed the district court's denial of prejudgment interest. The appellate court found substantial evidence supported the administrative law judges' conclusion that SORM's original reimbursement model was unfair and unreasonable, and that Vista's proposed methodology was valid. Consequently, the court affirmed the district court's judgment but modified it to include the prejudgment interest that Vista was statutorily entitled to.

Workers' CompensationMedical ReimbursementAdministrative LawAppellate ReviewSubstantial EvidencePrejudgment InterestTexas LawHealthcare ProvidersInsurance DisputesFee Guidelines
References
23
Case No. MISSING
Regular Panel Decision
Apr 19, 2000

Star Enterprise v. Marze

Windel B. Marze, a truck driver, was severely injured after falling on a beam at a Texaco truck stop owned by Star Enterprise in 1994 while attempting to use an intercom to weigh his truck. The fall necessitated knee surgery, which subsequently led to a severe postoperative infection. Despite multiple attempts to control the infection, it spread throughout his body, resulting in an above-the-knee amputation and ultimately causing his death from septic shock in 1997. His surviving family, Mary Ann Marze, Lori Ann Marze, and Scott Windel Marze, along with Pacific Employer’s Insurance, initiated a premises liability suit against Star Enterprise, later amending it to include a wrongful death claim. The jury found Star Enterprise negligent and awarded the Marzes over $1.6 million in damages, a judgment affirmed by the appellate court despite Star Enterprise's arguments regarding jury charge errors and insufficient evidence.

Premises LiabilityWrongful DeathSurvival ActionNegligenceProximate CauseJury Charge ErrorEvidentiary ErrorMedical CausationPostoperative InfectionSeptic Shock
References
35
Case No. ADJ441410
Regular
Oct 03, 2008

HAYDEE NUNEZ vs. FAIRMONT MIRAMAR HOTEL, COMMERCE & INDUSTRY INSURANCE COMPANY

The Appeals Board denied the lien claimant's petition for reconsideration, affirming the WCJ's denial of the remaining lien balance. The Board is returning the case to the trial level to investigate potential sanctions against the lien claimant for its actions in filing the petition for reconsideration, citing alleged procedural defects and bad faith. The WCJ's original finding was that the outpatient fusion surgery was not permitted under Medicare Guidelines and the defendant paid more than the reasonable value of the services.

Workers Compensation Appeals BoardFairmont Miramar HotelCommerce & Industry Insurance CompanyAIG Domestic ClaimsOutpatient Spine & Surgery CenterLien claimantIndustrial injuryLow back injuryOutpatient fusion surgeryMedicare Guidelines
References
1
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