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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

Centre Insurance Co. v. Pollitt

Carl Pollitt, an employee, suffered a work-related injury and received workers' compensation benefits from Centre Insurance Company. After reaching statutory maximum medical improvement (MMI) on March 11, 1997, Pollitt underwent multiple spinal surgeries and sought an increased impairment rating, claiming a substantial change in his condition. The trial court granted his motion, increasing his impairment rating to twenty-six percent. However, the appellate court reversed the trial court's judgment, ruling that a substantial change in condition must occur before the statutory MMI date for an impairment rating to be reevaluated. Therefore, the trial court lacked authority to find a substantial change of condition or increase Pollitt's impairment rating, as his alleged change occurred after the statutory MMI date.

Workers' Compensation DisputeImpairment RatingMaximum Medical ImprovementStatutory MMISubstantial Change of ConditionAdministrative Remedies ExhaustionJudicial Review ScopeSpinal SurgeryTexas Workers' Compensation ActIncome Benefits
References
4
Case No. NO. 03-06-00631-CV
Regular Panel Decision
Mar 26, 2009

Samuel Campos v. Texas Property & Casualty Insurance Guaranty Association for Reliance National Indemnity Company, an Impaired Carrier

Samuel Campos, an employee, was injured on the job, leading to disputes over his impairment rating and reimbursement for travel expenses. The Texas Workers’ Compensation Commission affirmed a designated doctor's 6% impairment rating and denied travel expenses, which Campos challenged in court. The case involved the Texas Property & Casualty Insurance Guaranty Association (TPCIGA) because Campos's employer's insurer became impaired. Initially filed in Winkler County, the case was transferred to Travis County, where TPCIGA was granted summary judgment. The Third District Court of Appeals reversed the summary judgment, ruling that the Workers' Compensation Act's specific mandatory venue provision, which places venue in the county of the employee's residence at the time of injury (Winkler County), overrides the Guaranty Act's general venue provision, which would place it in Travis County. The court remanded the case with instructions to transfer it to Winkler County.

Workers' CompensationVenue DisputeMandatory VenueStatutory ConstructionTexas Labor CodeTexas Insurance CodeImpairment RatingTravel Expenses ReimbursementJudicial ReviewAppellate Procedure
References
12
Case No. 03-08-00483-CV
Regular Panel Decision
Mar 19, 2010

Texas Property and Casualty Insurance Guaranty Association for Reliance National Insurance Company, an Impaired Company v. Doris J. Toberny

Doris J. Toberny, an exhibit decorator, injured her back on the job in May 2000, leading to spinal-fusion surgery that also corrected pre-existing scoliosis. Initially, her employer's insurer, Texas Property and Casualty Insurance Guaranty Association for Reliance National Insurance Company ('the Company'), paid for the surgery. However, in December 2001, the Company disputed the claim, asserting the injury was only a lower back strain and not the cause of her scoliosis. After a designated doctor assigned Toberny a 25-percent impairment rating in 2002, the Company paid supplemental income benefits for eight quarters. Three years later, in September 2005, the Company sought to dispute her impairment rating and discontinue benefits, claiming her pre-existing conditions were not compensable. The Division of Workers’ Compensation and the district court found that the Company had waived its right to contest the impairment rating under former rule 130.102(g) due to late dispute filing, and affirmed Toberny's 25-percent impairment rating and entitlement to benefits. The Texas Court of Appeals affirmed the trial court's judgment, upholding the validity of rule 130.102(g) and the finding of waiver, thus confirming Toberny's impairment rating and attorney's fees.

Workers' CompensationImpairment Rating DisputeSupplemental Income BenefitsWaiver DoctrineCompensability of InjuryExtent of InjuryJudicial Review of Agency DecisionTexas Appeals CourtAdministrative Rule ValidityMaximum Medical Improvement
References
12
Case No. 2021-06-1175
Regular Panel Decision
Aug 22, 2023

Matthews, Savitri v. Family Dollar Stores of Tennessee, LLC

The employee, Savitri Matthews, suffered a mental injury after being held at gunpoint during a store robbery at Family Dollar Stores. Her claim was accepted, and she received treatment from Dr. Greg Kyser, who assigned a ten percent impairment rating. Two other psychiatrists, Dr. Stephen Montgomery and Dr. Melvin Goldin (from the MIRR), also provided impairment ratings. The trial court concluded the employee sustained an impairment consistent with the 10% ratings from Dr. Kyser and Dr. Goldin and determined she was entitled to increased benefits due to a lower post-injury wage rate. The employer appealed. The Appeals Board affirmed the trial court's order, finding the employer failed to rebut the presumption of correctness of the medical impairment ratings and that the employee's post-injury wages were indeed lower.

Workers' CompensationMental InjuryArmed RobberyPTSDImpairment RatingWage LossIncreased BenefitsAppeals BoardPsychiatric EvaluationMedical Impairment Rating Registry
References
13
Case No. ADJ7483972, ADJ7483952
Regular
Nov 08, 2012

ROY HAAS vs. CITY OF SANTA ROSA, REDWOOD EMPIRE MUNICIPAL INSURANCE FUND

This case involves a workers' compensation applicant, Roy Haas, who sustained injuries to his left elbow and bilateral shoulders. The Workers' Compensation Appeals Board (WCAB) granted reconsideration to increase Haas's permanent disability ratings. The WCAB adopted the WCJ's recommendation to rate impairments based on the highest applicable factor, citing that Dr. Suchard's report did not adequately explain combining strength and range of motion impairments for the elbow, and that strength deficits should not be rated where objective anatomic findings like loss of motion are present and prioritized by the AMA Guides. Consequently, Haas's permanent disability for the left elbow was increased to 25%, and for his shoulders to 31%.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardsPermanent Disability RatingAgreed Medical ExaminerAMA GuidesRange of MotionLoss of StrengthOccupational CodeLabor Code Sections
References
2
Case No. 2015-01-0149
Regular Panel Decision
Nov 04, 2016

Ringer, Lamar v. Welding Ceramics, Inc.

Lamar Ringer, a press operator, injured his neck, left shoulder, and arm at Welding Ceramics, Inc. on November 19, 2014. He sought treatment, including from orthopedic surgeon Dr. Jay E. Jolley, II, who diagnosed a large C5/C6 disc herniation and recommended surgery, which Ringer declined. Dr. Jolley rated Ringer's impairment at 6% to the whole body and released him to regular duty, but Ringer experienced increased pain upon returning to work. Another physician, Dr. Jerry L. Smith, rated Ringer's impairment at 10% and placed permanent restrictions. The court found Dr. Jolley's impairment rating methodology incorrect due to documented radicular symptoms and accepted Dr. Smith's 10% rating, awarding permanent partial disability benefits. The court denied additional temporary disability benefits, finding Ringer reached maximum medical improvement, and also denied his request for a new treating physician panel.

Permanent Partial DisabilityImpairment RatingAMA Guides Sixth EditionRadiculopathyDisc HerniationAuthorized Treating PhysicianRebuttal of PresumptionTemporary Disability BenefitsChange of Physician PanelFunctional Capacity Evaluation
References
9
Case No. ADJ8550681
Regular
May 14, 2015

NANCY TOM vs. PARAMOUNT PICTURES

Applicant Nancy Tom sought reconsideration of a workers' compensation award, arguing her 9% permanent disability rating was too low. She contended for further medical evaluation regarding worsening symptoms and a claimed 40% grip loss in her right hand, plus additional impairment ratings for her thumb and knee. The Board denied reconsideration, adopting the WCJ's reasoning that Dr. Angerman's conclusory deposition testimony regarding increased impairment lacked substantial medical evidence and conflicted with AMA Guides to the Evaluation of Permanent Impairment. The Board found that Applicant failed to meet her burden of proof for a higher disability rating.

Workers' Compensation Appeals BoardParamount PicturesPermissibly Self-InsuredPetition for ReconsiderationFindings of Fact and AwardExecutive AssistantIndustrial InjuryPermanent DisabilityAgreed Medical EvaluatorOrthopedist
References
4
Case No. 11-06-00214-CV
Regular Panel Decision
Oct 25, 2007

Centre Insurance Company, Successor to Business Insurance Company v. Carl Pollitt

This workers' compensation dispute involves Carl Pollitt, who received benefits from Centre Insurance Company after an on-the-job injury. Despite reaching statutory maximum medical improvement (MMI) in 1997, Pollitt underwent multiple spinal surgeries and sought an increased impairment rating, claiming a substantial change in his condition. The trial court granted his motion, raising his impairment rating to twenty-six percent. On appeal, Centre Insurance Company argued that impairment ratings cannot be reevaluated after the statutory MMI date. The Eleventh Court of Appeals reversed the trial court's judgment, holding that a substantial change in condition must occur before the statutory MMI date, thus rendering judgment that Pollitt take nothing.

Workers' CompensationImpairment RatingMaximum Medical ImprovementStatutory MMISpinal SurgeryJudicial ReviewAdministrative RemediesTexas LawAppellate CourtSummary Judgment
References
4
Case No. ADJ11197293
Regular
Dec 18, 2020

KEVIN TORRES vs. ARCTIC MECHANICAL, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

This case concerns an applicant's entitlement to an increased impairment rating for sleep dysfunction. The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration. The Board affirmed the Administrative Law Judge's finding that Labor Code Section 4660.1(c)(1) does not preclude an increased impairment rating for sleep dysfunction if it is directly caused by the industrial injury, rather than a consequence of it. Medical evidence from Dr. Jonathan Wang established a direct causal link between the applicant's sleep dysfunction and the industrial injury. The Board found Dr. Wang's report and deposition testimony constituted substantial medical evidence supporting this conclusion and rejected the defendant's arguments.

Labor Code 4660.1(c)(1)sleep dysfunctiondirect causationincreased impairment ratingcompensable consequencepsychiatric disordersubstantial medical evidenceQME reportdeposition testimonyAMA Guides
References
2
Case No. ADJ10544189
Regular
Nov 09, 2018

MARTIN GARCIA vs. HARVEST CHURCH, GUIDEONE MUTUAL

This case involves an applicant seeking an increased permanent impairment rating for a psychiatric injury stemming from a physical injury to his left foot. The applicant's injury occurred when a gate fell on his foot, and he claims this constitutes a "violent act" under Labor Code section 4660.1(c)(2)(A), which allows for exceptions to a general rule against increased impairment ratings for psychiatric issues arising from physical injuries. The Appeals Board denied reconsideration, affirming the WCJ's finding that the gate falling was an accidental injury, not a violent act, based on definitions involving strong physical force or extreme threats. The Board found the applicant's experience lacked the intensity seen in prior cases of violent acts, such as being struck by a car or being crushed in a vehicle.

AOE/COEViolent ActLabor Code Section 4660.1Psychiatric InjuryPermanent Impairment RatingPetition for ReconsiderationFindings of FactWorkers' Compensation Judge (WCJ)Industrial InjuryPreponderance of the Evidence
References
6
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