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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

Main Evaluations, Inc. v. State

The claimant, Main Medical Evaluations, entered into contracts with the New York State Office of Temporary and Disability Assistance (OTDA) to perform consultative medical evaluations. OTDA terminated these contracts, alleging the claimant failed to disclose professional disciplinary proceedings against its chief medical officer, Arvinder Sachdev, and submitted false information during the bidding process. Following the dismissal of its claim in the Court of Claims, the claimant appealed. The appellate court affirmed the lower court's judgment, concluding that OTDA had legitimate grounds for termination due to the claimant's misrepresentations and failure to report substantial contract-related issues concerning Sachdev's integral role. Additionally, the court rejected the claimant's equal protection argument, finding no evidence of selective enforcement based on impermissible considerations.

Contract TerminationProfessional MisconductFalse RepresentationEqual ProtectionGovernment ContractsAppellate ReviewBreach of ContractMedical LicensingAdministrative ProceedingsDue Diligence
References
5
Case No. 2016-03-0413
Regular Panel Decision
Oct 05, 2017

Dodson, Deborah v. LHC Group

Deborah Dodson, an employee of LHC Group, injured her left ankle and right knee in May 2015. She underwent knee surgery and was placed at maximum medical improvement by Dr. Johnson. She later developed small fiber neuropathy, and despite a referral, faced difficulties obtaining a neurologic impairment evaluation. The Court granted Ms. Dodson's request for a neurologic impairment evaluation, either by Dr. Butler or another neurologist, referring Dr. Butler to the Penalty Program for failure to provide an impairment opinion. However, the Court denied her claim for additional temporary total disability benefits, finding she reached MMI on March 23, 2017, when Dr. Butler ceased active treatment.

Workers' CompensationNeurologic Impairment EvaluationTemporary Total Disability BenefitsMaximum Medical ImprovementSmall Fiber NeuropathyPain ManagementExpedited HearingMedical TreatmentImpairment RatingPenalty Program
References
3
Case No. No. 13
Regular Panel Decision

Fagg v. Hutch Manufacturing Co.

This workers' compensation case involved an appeal by Hutch Manufacturing Company and its insurance carrier concerning an employee, Mrs. Fagg, who sustained a compensable injury. The appeal raised issues regarding the duration of temporary total disability (TTD) benefits, the extent of permanent partial disability (PPD), a 6% penalty for unpaid installments, and medical expenses. The Court dismissed a preliminary appeal as interlocutory. It found the trial court erred in determining the termination date of TTD, concluding that Mrs. Fagg's TTD benefits should cease on October 9, 1984, the latest date for maximum medical recovery according to Dr. Coughlin's evaluations. The Court affirmed the trial court's award of 65% PPD to the body as a whole, emphasizing the consideration of non-medical factors in assessing disability. Furthermore, the Court upheld the 6% penalty on unpaid compensation installments due to the employer's demonstrated bad faith. The case was remanded for a more explicit allocation of medical expenses.

Temporary Total DisabilityPermanent Partial DisabilityMedical Impairment RatingJudicial ReviewRemandPenalty for Non-PaymentMedical EvidenceObjective SymptomsSubjective ComplaintsWorkers' Compensation Appeal
References
12
Case No. MISSING
Regular Panel Decision

Donaldson v. Texas Department of Aging & Disability Services

David Donaldson appealed a trial court's summary judgment in favor of the Texas Department of Aging and Disability Services (DADS) on claims of race and disability discrimination, retaliation, and hostile work environment under the TCHRA and Title VII. Donaldson, an African-American employee diagnosed with multiple conditions including prostate cancer and PTSD, alleged DADS failed to accommodate his disabilities and discriminated against him through various adverse actions, culminating in his termination. The appellate court affirmed the summary judgment for DADS on the race discrimination, retaliation, and hostile work environment claims, finding insufficient evidence of discriminatory intent or materially adverse actions in those areas. However, the court reversed and remanded the reasonable accommodation claim, concluding that Donaldson presented a fact issue regarding DADS's failure to provide continued assistance for his disabilities despite initial accommodations. This decision partially reverses the trial court's judgment, necessitating further proceedings on the reasonable accommodation aspect of the disability discrimination claim.

DiscriminationRetaliationHostile Work EnvironmentDisability DiscriminationRace DiscriminationReasonable AccommodationSummary JudgmentTexas Commission on Human Rights ActTitle VIIEmployment Law
References
83
Case No. Docket No. 2018-03-0072; State File No. 86263-2017
Regular Panel Decision
Nov 01, 2018

Daniels, Melvin v. Daniels Farms

Melvin Daniels, a part owner and working supervisor of Daniels Farms, suffered multiple injuries in October 2017 due to an air-conditioning pressure switch explosion and subsequent fall from a tractor. He sought temporary disability benefits, which were denied by Daniels Farms's carrier. Despite a medical evaluation by Dr. Salekin indicating total disability and impairment, Mr. Daniels continued to receive benefits and allowances from Daniels Farms, albeit without a salary. The Court found Mr. Daniels failed to demonstrate he was temporarily totally or partially disabled from working, as he continued some supervisory duties and received prior benefits. Therefore, his claim for temporary disability benefits was denied.

Workers' CompensationTemporary DisabilityExpedited HearingFarm InjuryTractor AccidentChemical ExposureRotator Cuff RepairMedical ImpairmentAverage Weekly WageBenefits Continuation
References
3
Case No. 2015-07-0040
Regular Panel Decision
Mar 11, 2016

Choate, Jerry v. Revel Logging, LLC

Jerry Choate, a truck driver, sustained neck, back, and head injuries in an August 2014 work accident. He sought permanent partial disability, additional temporary total disability (TTD), and mileage reimbursement. The employer, Revel Logging, LLC, disputed these claims and requested reimbursement for a TTD overpayment. Medical evaluations indicated no permanent impairment and set the maximum medical improvement (MMI) date at December 9, 2014. The Court denied Mr. Choate's claims for permanent partial disability, additional TTD, and mileage reimbursement, concluding his injuries did not result in permanent disability and his legal residence was within the qualifying mileage for providers. However, the Court granted Mr. Choate future medical benefits and denied Revel's request for TTD overpayment reimbursement, citing employer oversight and potential hardship to Mr. Choate.

Workers' CompensationDisability BenefitsMedical BenefitsPermanent Partial DisabilityTemporary Total DisabilityMileage ReimbursementOverpayment ReimbursementPost-traumatic HeadachesMaximum Medical Improvement (MMI)Neurosurgeon Evaluation
References
9
Case No. 08-23-00177-CV
Regular Panel Decision
Aug 30, 2024

Texas Department of Aging and Disability Services v. Claudia Gomez

The Texas Department of Aging and Disability Services (DADS) terminated Claudia Gomez, alleging she physically assaulted a coworker; Gomez contended the termination was discriminatory based on age, gender, and disability. The trial court denied DADS's plea to the jurisdiction regarding Gomez's discrimination claims. On appeal, the court found Gomez failed to present evidence of a similarly situated comparator, thus not establishing a prima facie case for age, gender, or disability discrimination. Furthermore, Gomez did not demonstrate that DADS's stated reason for termination was a pretext for discrimination. Consequently, the appellate court reversed the trial court's decision and dismissed Gomez's claims for lack of jurisdiction.

DiscriminationAge DiscriminationGender DiscriminationDisability DiscriminationEmployment LawTerminationPretextPrima Facie CaseSovereign ImmunityTexas Labor Code
References
30
Case No. MISSING
Regular Panel Decision

Smith v. Bayer Corp. Long Term Disability Plan

Plaintiff Terry Smith, a former Diabetes Sales Specialist for Bayer Corporation, filed an action under ERISA to recover long-term disability benefits, claiming wrongful denial due to psychiatric impairments including depression, panic disorder, and bi-polar disorder. The Plan administrator, Bayer, upheld the denial based on reviews by non-examining physicians. However, Smith's treating psychiatrists, Dr. LeBuffe and Dr. McCool, consistently found him disabled. The court found the Plan's reliance on non-examining doctors, who 'cherry-picked' medical records and distorted findings, to be arbitrary and capricious. Consequently, the court granted Smith's motion for benefits, denying Bayer's, and also awarded partial disability benefits, ruling that Smith's failure to seek rehabilitation approval was excused by the prior wrongful denial.

ERISALong-term disabilityDisability benefits denialPsychiatric impairmentDepressionPanic disorderBi-polar disorderAttention Deficit Disorder (ADD)Treating physician ruleArbitrary and capricious standard
References
26
Case No. 2018-01-0702
Regular Panel Decision
Dec 16, 2019

Mollica, Gena M. v. EHHI Holdings, Inc. DBA Advanced Home Care Management, Inc. DBA Encompass Home Health

Ms. Mollica requested medical and temporary disability benefits from EHHI Holdings, Inc., which had accepted her back injury but failed to provide orthopedist treatment and denied her claim that the medication Lyrica aggravated a pre-existing mental condition. The Court found Ms. Mollica entitled to the requested benefits. It ordered EHHI to authorize psychiatric evaluation with Dr. Sandvi and orthopedic treatment with Dr. Caputo, reimburse out-of-pocket medical expenses incurred for her mental condition, and pay past and ongoing temporary total disability benefits. Additionally, EHHI was required to respond regarding a potential twenty-five percent penalty for non-payment of temporary disability benefits.

Temporary Total DisabilityMedical Treatment AuthorizationPre-existing Mental Health ConditionDrug AggravationLyrica Side EffectsPsychiatric EvaluationOrthopedic ReferralCausation StandardPhysician Opinion PresumptionPenalty for Non-payment
References
2
Case No. 2015-07-0067
Regular Panel Decision
Oct 02, 2015

Hardin, Chris v. Dewayne’s Quality Metals

Chris Hardin, an employee, sought medical and temporary disability benefits for bilateral arm injuries allegedly sustained gradually during his repetitive work at Dewayne's Quality Metals. The employer and its insurer, Accident Fund, contested the work-relatedness of the injury. The court granted Mr. Hardin medical benefits for further evaluation of his alleged injuries, determining he presented sufficient evidence to likely prevail on the causation issue for medical treatment. However, the court denied his claims for temporary disability benefits and outstanding medical bills at this time, awaiting expert medical evidence confirming a causal connection between his employment and disability.

Workers' CompensationGradual InjuryBilateral Arm InjuriesCarpal Tunnel SyndromeUlnar Nerve NeuropathyDiabetic NeuropathyMedical BenefitsTemporary Disability BenefitsCausationNotice Requirements
References
8
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