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

Case No. MISSING
Regular Panel Decision

Perfect Dental, PLLC v. Allstate Insurance

In this consolidated action, plaintiffs Perfect Dental Care, P.C., Zodiac Dental, PLLC, and Smooth Dental PLLC (Dental PCs) sought unpaid insurance claims from Allstate Insurance Company and State Farm Mutual Automobile Insurance Company (Insurers). The Insurers countersued alleging insurance fraud and unjust enrichment, and initiated a third-party action against various individuals and entities. The Insurers moved for partial summary judgment, seeking a declaratory judgment that Dental PCs could not recover for services provided by dentists and physical therapists, and for summary judgment on their fraud and unjust enrichment counterclaims. The court denied summary judgment concerning dentists' services, finding a triable issue of fact regarding their employment status. However, it granted summary judgment for the Insurers regarding physical therapy services, as Dental PCs conceded these services were provided by non-employees. Consequently, the court also denied summary judgment on the fraud and unjust enrichment claims, as their resolution depended on the unresolved employment status of the dentists.

Insurance ClaimsHealthcare ServicesContract LawSummary JudgmentProfessional CorporationsIndependent ContractorsEmployment LawFraud AllegationsUnjust EnrichmentDeclaratory Judgment
References
17
Case No. 14-14-00318-CV
Regular Panel Decision
May 14, 2015

Lance Thai Tran, DDS, PA D/B/A Broadway Family Dental Care v. Maria Chavez

Maria Chavez, a dental assistant, sued her employer, Lance Thai Tran, DDS, PA d/b/a Broadway Family Dental Care, for negligence after she slipped on a wet floor in the dental office. The employer moved to dismiss the suit, arguing it was a health care liability claim (HCLC) under the Texas Medical Liability Act (TMLA) and required an expert report, which Chavez failed to provide. The trial court denied the motion. On appeal, the Fourteenth Court of Appeals, guided by Ross v. St. Luke’s Episcopal Hospital, affirmed the trial court's decision, finding no substantive nexus between the alleged safety standards violation (floor maintenance in employee work areas) and the provision of health care, thus concluding Chavez's claim was not an HCLC.

Premises LiabilityNegligenceHealth Care Liability Claim (HCLC)Texas Medical Liability Act (TMLA)Expert Report RequirementMotion to DismissAppellate ReviewDental OfficeEmployee InjuryStatutory Construction
References
4
Case No. 01-03-00924-CV
Regular Panel Decision
Oct 06, 2005

Mary Williams, D.D.S. and Russell Williams, D.D.S. v. L.M.S.C., Inc., D/B/A the Dental Solution

Mary Williams, D.D.S. and Russell Williams, D.D.S. appealed a judgment in favor of L.M.S.C., Inc., d/b/a The Dental Solution (TDS), stemming from a breach of contract dispute. TDS, a dental placement service, sued the Williams for an unpaid permanent placement fee after Diana Flanagan, whom TDS had previously placed temporarily as a dental hygienist, was hired by the Williams as a full-time dentist. The appellants challenged the jury's findings, arguing the contract did not cover dentists, lacked new consideration for modifications, and missed essential terms. The First District of Texas Court of Appeals affirmed the trial court's judgment, concluding that the placement agreement, as modified by subsequent fee schedules, applied to the placement of dentists and that sufficient evidence supported the jury's finding that the Williamses breached the contract by failing to pay the permanent placement fee. The court also upheld the award of attorney’s fees.

Breach of ContractPlacement AgreementDental IndustryPermanent Placement FeeContract ModificationConsiderationMeeting of the MindsLegal Sufficiency of EvidenceAttorney's FeesPrejudgment Interest
References
35
Case No. MISSING
Regular Panel Decision

First District Dental Society v. Sencer

The petitioners, dental societies in New York City, initiated an Article 78 proceeding to challenge a directive from the New York City Department of Health. The directive, dated August 14, 1981, mandated that all radiation installation licensees, including dental offices, make complete copies of Article 175 of the New York City Health Code available for staff examination. Petitioners argued this requirement was arbitrary and capricious due to its impracticality, financial burden, and the existence of an alternative provision allowing a descriptive notice. Respondents defended the directive as a rational measure to protect public health and ensure worker instruction regarding radiation safety, aligning with state and federal regulations. The court, applying the standard for administrative review, found a rational basis for the Department's interpretation and upheld the directive, denying the petitioners' request for nullification, though a 60-day stay on enforcement was granted.

Radiation SafetyHealth CodeAdministrative LawJudicial ReviewDental PracticesRegulatory CompliancePublic HealthArticle 78 ProceedingsAgency InterpretationDirective Challenge
References
8
Case No. MISSING
Regular Panel Decision

Texas Department of Insurance – Division of Workers' Compensation v. Ronald Mensch

Ronald Mensch was injured in a work-related accident in 1980, with State Farm Insurance initially covering dental expenses. After State Farm denied pre-approval for further dental work, Mensch initiated a lawsuit, leading to a Division of Workers' Compensation ruling in 2011 that he was entitled to lifetime medical benefits. When Mensch sought preauthorization for more dental work, the Division asserted it lacked jurisdiction to preauthorize un-incurred expenses. Mensch then amended his lawsuit to include the Division, seeking a declaration of the Division's jurisdiction and exhaustion of administrative remedies. The Division appealed the trial court's denial of its plea to the jurisdiction, arguing that under the 'old' workers' compensation law, medical expenses must be incurred and administrative remedies exhausted before judicial intervention. The appellate court reversed the trial court's decision, dismissing Mensch's claims against the Division due to lack of subject-matter jurisdiction.

Workers' CompensationAdministrative RemediesPlea to the JurisdictionMedical BenefitsDental WorkExhaustion DoctrineStatutory InterpretationTexas LawAppellate ReviewJurisdiction
References
15
Case No. 126300 R.D.
Regular Panel Decision

Bazner v. American States Insurance Co.

Walter Bazner, an insulator diagnosed with asbestosis, previously received workers' compensation benefits from L.D. Powell & Company and its insurer, American States Insurance Company, for permanent total disability and medical expenses incurred up to the judgment date. When Bazner incurred additional medical expenses post-judgment, American refused payment, arguing the prior judgment was res judicata and required pre-approval for new expenses. Bazner initiated a new suit, and the trial court sided with him. On appeal, the Supreme Court held that Bazner's claim for future medical expenses was not barred, reiterating that such expenses are recoverable under T.C.A. § 50-6-204 and established procedural rules for seeking them via petition in the original action. The court also found Bazner's decision to seek further medical attention from his treating physician reasonable under the circumstances. The case was remanded for further proceedings regarding future medical payments and related issues.

AsbestosisOccupational DiseaseFuture Medical ExpensesPost-Judgment CareRes Judicata DefenseEmployer Medical AuthorizationInsurance LiabilityStatutory BenefitsAppellate ReviewRemand Order
References
6
Case No. No. 06-03609, No. 06-03654
Regular Panel Decision

Padilla v. Wells Fargo Home Mortgage, Inc. (In Re Padilla)

This case addresses how the Bankruptcy Code and Federal Rules of Bankruptcy Procedure affect a mortgage lender's right to collect 'Reimbursable Expenses' in Chapter 13 bankruptcy cases. The Court examined the collection of such expenses both pre- and post-confirmation of a Chapter 13 plan. It held that Bankruptcy Rule 2016(a) governs the collection of these expenses by mortgage lenders in Chapter 13 cases, both pre and post-confirmation. The Court determined that while Section 506(b) limits pre-confirmation expenses for oversecured creditors, it does not apply post-confirmation. Furthermore, the Court found that failure to comply with Rule 2016(a) or the imposition of unauthorized expenses would entitle a debtor to relief, but that such conduct does not violate the automatic stay. The cross-motions for partial summary judgment were denied due to insufficient evidence regarding actual collection of disputed charges.

Bankruptcy LawChapter 13Mortgage ServicingReimbursable ExpensesAttorney FeesBankruptcy ProcedureRule 2016(a)Section 506(b)Plan ConfirmationAutomatic Stay
References
86
Case No. 2020 NY Slip Op 01355
Regular Panel Decision
Feb 26, 2020

Naula v. Utokilen, LLC

The plaintiff, Victor Naula, commenced an action for personal injuries against Utokilen, LLC, and others. The Workers' Compensation Board (WCB) found Naula's employer, Specialized Dental Construction, Inc., uninsured and Adapt Construction, LLC, to be the general contractor, awarding Naula workers' compensation benefits. Utokilen and Nancy Marin-Rojas D.D.S., P.C., initiated a third-party action against Specialized Dental for common-law indemnification and contribution. Specialized Dental moved for summary judgment, asserting exclusivity under Workers' Compensation Law § 11, but Utokilen and Marin-Rojas cross-moved, arguing Specialized Dental could not invoke § 11 due to its uninsured status. The Supreme Court granted the cross-motion and denied Specialized Dental's motion. The Appellate Division dismissed Adapt Construction, LLC's appeal as it was not an aggrieved party and affirmed the Supreme Court's order against Specialized Dental Construction, Inc.

Personal InjuriesWorkers' Compensation LawSummary JudgmentThird-Party ClaimsIndemnificationContributionGrave InjuryUninsured EmployerAppellate PracticeCollateral Estoppel
References
7
Case No. 2018-01-0006
Regular Panel Decision
Feb 07, 2019

Armstrong, Syvonia v. Chattanooga Billiard Club, Inc.

Syvonia Armstrong, a bartender, filed a claim for medical benefits, alleging dental injuries from an electrical shock at work. The employer, Chattanooga Billiard Club, Inc., and its carrier, Eastern Alliance Insurance Co., disputed causation. The court considered conflicting medical opinions from Dr. Drew Shabo, who initially found no way to link the shock to dental issues but later provided letters stating causation was more likely than not, and oral surgeon Dr. Richard L. Johnson, who found no dental disability from the shock. The Court deemed Dr. Shabo's opinions unreliable due to inconsistencies and insufficient prior information, giving greater weight to Dr. Johnson's findings. Consequently, the Court denied Ms. Armstrong's claim for medical benefits related to her dental conditions but ordered the employer to provide care for a left ear canal burn diagnosed by Dr. David Fortune.

Dental InjuriesElectrical ShockCausation DisputeMedical Benefits DenialExpedited HearingExpert Opinion ReliabilityOral Surgeon FindingsBartender AccidentTennessee Workers' Comp LawEar Canal Burn
References
1
Case No. No. 97-10-0166; No. M2002-00555-COA-R3-CV
Regular Panel Decision
Dec 31, 2002

Lisa Wade v. William Wade

This appeal concerns a modification of child support and the division of un-reimbursed medical and dental expenses following a divorce. The primary legal issue addressed by the Court of Appeals was the calculation of child support for military members, specifically how to account for non-taxable military allowances in accordance with Tennessee Child Support Guidelines. The court affirmed the increase in child support for 2001, with a modification to properly impute income for non-taxable military benefits. However, the child support award for 2002 was reversed and remanded for recalculation using the newly established imputation method. The court also affirmed the trial court's decision regarding the appellant's responsibility for half of un-reimbursed medical and dental expenses while still in the military, exercising its statutory power to modify terms despite an omission in the original marital dissolution agreement.

Child SupportMilitary IncomeNontaxable AllowancesIncome ImputationDivorce DecreeMarital Dissolution AgreementTennessee Child Support GuidelinesAppellate ReviewFamily LawStatutory Interpretation
References
15
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