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Case Law Database

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

Case No. 03-21-00418-CV
Regular Panel Decision
Jun 02, 2023

Eric Handy, Sr. v. Zurich American Insurance Company

Eric Handy, Sr. appealed the trial court's grant of a no-evidence motion for summary judgment to Zurich American Insurance Company. Handy had sought judicial review of an administrative law judge's determination that his workplace injury did not encompass disc protrusions and that he reached maximum medical improvement (MMI) with a zero-percent impairment rating. The trial court excluded Handy's untimely and unauthenticated evidence, and the appellate court affirmed this decision. The appellate court found Handy waived his arguments due to procedural non-compliance and failed to provide expert medical evidence, which is required to establish causation for complex medical conditions like disc protrusions in workers' compensation cases. Lay testimony and unauthenticated medical records were deemed insufficient to raise a genuine issue of material fact regarding causation, MMI, or impairment rating.

Workers' CompensationSummary JudgmentJudicial ReviewMedical CausationDisc ProtrusionMaximum Medical ImprovementImpairment RatingExpert TestimonyAppellate ProcedurePro Se Litigant
References
14
Case No. MISSING
Regular Panel Decision

Singletary v. Apfel

Plaintiff Sylvester M. Singletary appealed the Commissioner of Social Security's denial of disability insurance benefits, leading to this action under 42 U.S.C. § 405(g). The Court reviewed the final determination, including an Administrative Law Judge's decision, which the Appeals Council upheld. The central issue revolved around the ALJ's rejection of Singletary's treating physician's opinion of total disability, which the ALJ deemed unsupported by objective evidence, specifically the absence of disc herniation. The Court found that the ALJ arbitrarily substituted his lay opinion for competent medical evidence and ignored other objective findings like degenerative disc disease and disc bulging. Consequently, the Commissioner’s decision was not supported by substantial evidence, and the case was remanded solely for the calculation of benefits, with the plaintiff's motion for judgment on the pleadings granted.

Disability BenefitsSocial Security ActTreating Physician RuleSubstantial Evidence ReviewDegenerative Disc DiseaseChronic PainSpinal ImpairmentALJ ErrorRemandFederal Court Review
References
13
Case No. MISSING
Regular Panel Decision

Claim of Scalzo v. St. Joseph's Hospital

The claimant, a patient account representative, suffered a back injury (herniated L5-S1 disc and bulging discs) on May 18, 2000, after abruptly rising from her chair to avoid an object at work. Her claim for workers' compensation benefits was controverted by her employer and its carrier, arguing the injury was idiopathic. However, both a Workers' Compensation Law Judge and the Workers' Compensation Board found the accident established, relying on medical evidence, lay testimony, and the presumption under Workers’ Compensation Law § 21 (1). The employer appealed this decision. The appellate court affirmed the Board's decision, concluding that substantial evidence supported the finding that the injury arose out of and in the course of employment, and that credibility issues were for the Board to resolve.

Workplace InjuryBack InjuryHerniated DiscBulging DiscWorkers' Compensation BenefitsAccident Arising Out of EmploymentCourse of EmploymentPresumption of Arising Out of EmploymentCredibility IssueSubstantial Evidence
References
6
Case No. 05-21-00303-CV
Regular Panel Decision
Nov 28, 2022

Amanda McGee v. Ladonna Tatum

Amanda McGee appealed the trial court's judgment finding her liable for Ladonna Tatum's damages from an automobile accident. McGee contended the evidence was legally and factually insufficient to support the jury's verdict that Tatum's injuries were caused by the accident. The appellate court found no expert medical evidence to support causation for Tatum's medical expenses, which included diagnoses like bulging discs and herniated discs, thus reversing and rendering judgment that Tatum take nothing on her claim for medical expenses. However, the court affirmed the awards for past and future pain and suffering and physical impairment, finding lay testimony sufficient for these damages and that McGee failed to adequately brief why expert testimony was required for these specific awards. The case was also remanded for recalculation of prejudgment interest.

Automobile AccidentPersonal InjuryNegligenceCausationMedical ExpensesPain and SufferingPhysical ImpairmentLegal SufficiencyFactual SufficiencyAppellate Review
References
28
Case No. 2017-05-0892
Regular Panel Decision
Apr 02, 2018

Hunt, Michele v. Amazon.com

Michelle Hunt, an employee of Amazon.com, sustained injuries including her right ankle, wrist, and low back after a slip and fall incident in 2015. Amazon provided a panel of physicians, and Ms. Hunt chose Dr. Jeffrey Hazlewood. Despite conservative treatment, Ms. Hunt's low back pain persisted and worsened, showing a diffuse disc bulge and mild central disc extrusion at L5-S1 on an MRI. Dr. Hazlewood concluded the back pain did not warrant a specialist referral. Ms. Hunt sought an expedited hearing to request a panel of orthopedists for her low back complaints, arguing Dr. Hazlewood's care failed to improve her symptoms. The Court, however, denied her request, finding her testimony alone insufficient to overcome the presumption of medical necessity accorded to Dr. Hazlewood's opinion.

Workers' CompensationMedical BenefitsExpedited HearingLow Back PainOrthopedistsPanel of PhysiciansTreating PhysicianMRIDisc BulgeDegenerative Disc Disease
References
2
Case No. MISSING
Regular Panel Decision

Blankenship v. American Ordnance Systems, LLS

Gatha Blankenship, an employee of American Ordnance Systems, LLC, was temporarily laid off in February 2002. She voluntarily took an upper body strength test on the employer's premises on March 7, 2002, for new job openings, despite not being compensated or required to do so. Immediately after the test, she experienced back pain, later diagnosed as a bulging disc. The trial court denied workers' compensation benefits, ruling the injury did not arise out of her employment. The Supreme Court affirmed this decision, concluding that her injury was not compensable as it did not arise out of or occur in the course of her employment, given her voluntary participation and lack of compensation for the test.

Workers' CompensationBack InjuryStrength TestVoluntary ParticipationCourse of EmploymentArising Out of EmploymentLayoffCausationCompensabilityAppeal
References
9
Case No. 2019-08-0221
Regular Panel Decision
Jul 30, 2021

Smith, Willie v. Memphis National Parts Warehouse/Daimler Trucks

Willie Smith, an employee of Memphis National Parts Warehouse/Daimler Trucks, sustained a back injury in 2018. His authorized treating physician, Dr. Samuel Murrell, recommended back surgery for a disc protrusion. However, a second opinion from neurosurgeon Dr. John Brophy, supported by utilization review and medical directors, contended the surgery was not medically necessary as there was no objective evidence of nerve root compression. The Court, at an expedited hearing, considered the conflicting expert testimonies and found Dr. Brophy's reasoning persuasive. Consequently, Mr. Smith's request for the recommended surgery was denied, as he was deemed unlikely to prove its medical necessity at a hearing on the merits.

Back InjurySpinal SurgeryMedical NecessityWorkers' Compensation ClaimsExpert Medical OpinionDisc ProtrusionNerve Root CompressionOrthopedic SurgeonNeurosurgeonUtilization Review
References
5
Case No. MISSING
Regular Panel Decision

Knight v. Astrue

Plaintiff Llewelyn M. Knight applied for disability insurance benefits (DIB), which were denied by the Commissioner of Social Security. Plaintiff sought judicial review, alleging disability due to herniated and bulging discs and cervical spondylosis. The Administrative Law Judge (ALJ) initially denied the claim, finding Plaintiff not disabled and able to perform sedentary work. This court reviewed the ALJ's decision, addressing Plaintiff's arguments regarding impairment listings, residual functional capacity, the need for a vocational expert, credibility, and an independent medical examiner's opinion. Ultimately, the court found substantial evidence supporting the Commissioner's decision, granted the Commissioner's motion for judgment on the pleadings, and denied Plaintiff's motion, dismissing the case.

Disability BenefitsSocial Security ActSedentary WorkResidual Functional CapacityAdministrative Law JudgeMedical-Vocational GuidelinesCredibility AssessmentSpinal DisordersNerve Root CompressionMotor Loss
References
41
Case No. MISSING
Regular Panel Decision

Aaron S. Holmes, Dallas Spine Care P A v. Zurich American Insurance Company

This workers' compensation case involves an appeal of a summary judgment granted in favor of Zurich American Insurance Company and Gallagher Bassett Services, Inc. Appellants, including injured worker Aaron S. Holmes and medical providers, sought payment for Holmes's spinal surgery, which Zurich denied claiming it exceeded the scope of the compensable injury. The Division of Workers' Compensation (DWC) had determined Holmes's compensable injury included a disc protrusion, and an Independent Review Organization (IRO) found the surgery medically necessary. However, the appellate court affirmed the trial court's judgment, ruling that appellants failed to exhaust administrative remedies by not obtaining a DWC determination on whether the surgery solely repaired the compensable injury or what portion was related.

Workers' CompensationAdministrative RemediesExhaustion DoctrineSummary JudgmentMedical NecessityCompensable InjurySpinal SurgeryInsurance DenialJudicial ReviewTexas Law
References
12
Case No. MISSING
Regular Panel Decision

Bennett v. Secretary of United States Depatment of Health & Human Services

Charles Bennett ("plaintiff") is appealing a final decision by the Secretary of the United States Department of Health and Human Services, which denied his application for disability insurance and supplemental security income benefits. Bennett, a 41-year-old with a history of heart issues and a December 1986 back injury, claims disability, which was initially denied by an Administrative Law Judge and upheld by the Appeals Council. The court's review examines whether the Secretary's decision is supported by substantial evidence, specifically evaluating the "treating physician rule" concerning the opinions of Dr. Blum and Dr. Gold versus consulting physicians like Dr. Massoff. While objective tests confirm a bulging disc and treating physicians noted decreased range of motion, the court found their cursory "total disability" conclusion for Workers' Compensation purposes insufficient under the Act. Consequently, the court remands the case to the Secretary, requiring further information on Bennett's current residual functional capacity for sedentary or light work.

Social Security ActDisability Insurance BenefitsSupplemental Security IncomeResidual Functional CapacityLumbosacral Spine StrainBulging DiscTreating Physician RuleRemandAdministrative Law JudgeAppeals Council
References
11
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