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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

Claim of Prescott v. Town of Lake Luzerne

A claimant fell off a dump truck at work in February 2008, landing on his right buttock and injuring his hip. The injury led to surgery in May 2008 to remove heterotopic bone and subsequent two-stage hip replacement revision surgeries in November 2008 and February 2009 due to an infection. The Workers’ Compensation Board found the initial surgery and subsequent revisions causally related to the work fall and supported compensation awards. The employer appealed, arguing that an independent medical examination (IME) was improperly precluded and that the initial surgery lacked proper authorization. The Appellate Division affirmed the preclusion of the IME due to untimeliness and upheld the causal relationship findings for the injury and subsequent surgeries. However, the court reversed the Board's determination that the May 2008 surgery was properly authorized, remitting that specific issue for further proceedings, while affirming all other appealed decisions.

Causal RelationshipIndependent Medical Examination (IME)Evidence PreclusionSurgery AuthorizationHip InjuryHeterotopic OssificationMedical Opinion ConflictDue ProcessRemittiturEmployer Liability
References
8
Case No. MISSING
Regular Panel Decision
May 20, 1996

Roman v. 1185 Avenue of the Americas Associates

This case involves an appeal from an order granting the plaintiff, Victor Roman, leave to amend his bill of particulars to include additional injuries. Roman filed an action in 1989 for injuries sustained in a 1987 job site accident, initially alleging traumatic degenerative arthritis and torn muscles in his left hip. After undergoing hip replacement surgeries in 1992 and 1994, a stipulation was made in 1994 with defendant A.J. Contracting Co., allowing for further discovery if the hip surgeries were later alleged to be causally related. In 1996, Roman moved to amend his bill of particulars to include these surgeries, supported by proof of workers' compensation coverage due to the causal connection. The court granted this motion, and the appellate court affirmed, citing the policy of freely allowing amendments in the absence of prejudice, which the defendants failed to demonstrate.

Personal injurySlip and fallConstruction accidentHip replacementBill of particularsLeave to amendStipulationCausal connectionWorkers' compensationPrejudice
References
1
Case No. 525196
Regular Panel Decision
Apr 26, 2018

Matter of Derouchie v. Massena W. Wc Smelter

Claimant Gerry J. Derouchie sustained injuries on February 18, 2015, including to his right knee and left hip, after stepping into a pothole on his employer's premises. He filed for workers' compensation benefits, and his case was established for multiple injuries. Having prior injuries and surgeries, claimant sought authorization for total right knee and left hip replacement surgeries, which the employer and carrier denied. A Workers' Compensation Law Judge (WCLJ) granted the authorization, and the Workers' Compensation Board affirmed, finding a causal relationship between the February 2015 accident and the need for surgeries. The Appellate Division, Third Department, affirmed the Board's decision, citing substantial evidence and deference to the Board's assessment of medical witness credibility.

Workers' Compensation BenefitsCausal RelationshipKnee Replacement SurgeryHip Replacement SurgeryPreexisting ConditionsAggravation of InjuryMedical AuthorizationSubstantial EvidenceCredibility AssessmentAppellate Review
References
10
Case No. 2015-05-0158
Regular Panel Decision
Oct 21, 2015

Miller, John v. Lowe's Home Centers, Inc.

John Miller, an employee, suffered a work-related fall aggravating a pre-existing left hip osteoarthritis, requiring hip replacement surgery. Lowe's Home Centers, Inc., the employer, initially denied compensability for the hip injury. The trial court concluded that the employee was entitled to medical benefits, finding the work injury primarily caused the aggravation. On appeal, the Workers' Compensation Appeals Board affirmed the trial court's decision, concluding that the employee is likely to prevail on the merits based on Dr. Wade's testimony that the work accident hastened the need for surgery and caused a chronic exacerbation of the condition. The Board also noted the trial court's harmless error in relying on pre-reform case law.

Workers' CompensationAggravation of Pre-existing ConditionHip OsteoarthritisMedical BenefitsExpedited HearingCausationStatutory InterpretationAppellate ReviewTennessee LawMedical Evidence
References
7
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. MISSING
Regular Panel Decision

Claim of Stilwell v. Marriott

The case involves an appeal from a Workers' Compensation Board decision regarding a claimant's work-related hip injury. The claimant sought authorization for hip replacement revision surgery due to recurring dislocations. The employer and its workers' compensation carrier opposed the request, arguing a lack of causal relationship and failing to provide conflicting medical evidence as required by Workers’ Compensation Law § 13-a (5). The Workers’ Compensation Law Judge and subsequently the Board authorized the surgery, finding the employer failed to comply with the statute. The employer's appeal, which also raised a due process argument, was ultimately affirmed.

Hip InjuryRevision Surgery AuthorizationCausal Relationship DisputeWorkers' Compensation Law § 13-a (5)Medical Evidence RequirementEmployer Non-complianceDue Process AppealWorkers' Compensation Board DecisionAppellate Division AffirmationTreating Physician Recommendation
References
3
Case No. MISSING
Regular Panel Decision

Blackburn v. Allied Chemical Corp.

In this worker's compensation case, an employee suffered a compensable injury in 1978, fracturing her left femur. Medical evaluations by orthopedic surgeons Dr. Charles A. Gouffon and Dr. Martin Baker indicated permanent partial disability and the likelihood of future hip replacement surgery, noting the surgical pin protruded into the hip socket and caused further issues beyond the left leg. The employee testified to significant pain and total disability. The trial court awarded permanent total disability, finding the injury extended beyond a scheduled member (left leg) to the body as a whole. The Supreme Court affirmed this decision, concluding there was material evidence to support the finding that the injury and subsequent surgery results were not confined to the left lower extremity, thus justifying an award for disability to the body as a whole.

Worker's CompensationPermanent Total DisabilityFemur FractureHip InjuryOrthopedic SurgeryScheduled Member InjuryBody as a WholeMedical ExaminerSurgical PinAppellate Review
References
6
Case No. 2021-07-1326
Regular Panel Decision
Apr 01, 2024

Wade, Courtney v. United Paecel Service, Inc.

The Court held an Expedited Hearing on March 21, 2024, to determine whether Mr. Wade’s need for a left-hip replacement primarily arose out of his work injury and if he is entitled to additional temporary disability benefits. Mr. Wade, a UPS employee, sustained a low-back and neck injury in April 2020. He later developed severe left-hip osteoarthritis, which he attributed to the work injury. While his initial treating physician, Dr. Murrell, suggested the work injury exacerbated a previously silent hip pathology, the hip replacement specialist, Dr. Wodowski, believed the exacerbation was temporary and not the primary cause necessitating a hip replacement. The Court weighed these medical opinions and found Mr. Wade unlikely to prove that the work accident primarily caused his left hip arthritic condition or his current disablement. Consequently, the Court denied his request for a left-hip replacement and additional temporary partial disability benefits, though it ordered UPS to pay for reasonable and necessary treatment for the exacerbation of his hip arthritis.

work injuryhip replacementtemporary disabilityosteoarthritiscausationexacerbationmedical opinionorthopedic surgerylow-back painneck pain
References
4
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
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