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

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. MISSING
Regular Panel Decision

Claim of Vanostrand v. Felchar Manufacturing Corp.

The case involves an appeal from a Workers’ Compensation Board decision concerning a claimant found to have defrauded employers and carriers by overstating mileage and making false statements about her physical condition. The Board ruled that Workers’ Compensation Law § 114-a, which bars future wage replacement benefits for such violations, does not preclude the claimant from receiving future mileage expenses or medical coverage. The Appellate Division, Third Department, affirmed this decision, citing its previous ruling in Matter of Rodriguez v Burn-Brite Metals Co., which established that the penalties under Workers’ Compensation Law § 114-a are limited to wage replacement benefits and do not extend to medical benefits. The court also found no error in the Board's tacit refusal to require the claimant to directly repay the mileage overpayments to the subject carriers.

Workers' Compensation Law § 114-aMedical BenefitsMileage ExpensesFraudulent MisrepresentationStatutory InterpretationAppellate DecisionWage Replacement BenefitsBoard Decision ReviewAffirmative RulingLegal Precedent
References
2
Case No. 03-17-00352-CV
Regular Panel Decision
Aug 22, 2018

Vista Medical Center Hospital Vista Healthcare, Inc. And Surgery Specialty Hospital, Inc.// State Office of Risk Management v. State Office of Risk Management// Vista Medical Center Hospital Vista Healthcare, Inc. And Surgery Specialty Hospital, Inc.

This case involves cross-appeals stemming from a dispute over the appropriate reimbursement for medical services provided by Vista Medical Center Hospital and its affiliates to injured employees covered by the State Office of Risk Management (SORM) under Texas workers’ compensation statutes. The district court had affirmed 23 administrative orders that required SORM to make additional payments to Vista, a decision which SORM challenged on appeal citing insufficient evidence. Vista, in turn, cross-appealed the district court's denial of prejudgment interest. The appellate court found substantial evidence supported the administrative law judges' conclusion that SORM's original reimbursement model was unfair and unreasonable, and that Vista's proposed methodology was valid. Consequently, the court affirmed the district court's judgment but modified it to include the prejudgment interest that Vista was statutorily entitled to.

Workers' CompensationMedical ReimbursementAdministrative LawAppellate ReviewSubstantial EvidencePrejudgment InterestTexas LawHealthcare ProvidersInsurance DisputesFee Guidelines
References
23
Case No. 2015-08-0454
Regular Panel Decision
Jan 30, 2017

Ricks, Carmen v. Methodist Healthcare

The employee, Carmen L. Ricks, sought mileage reimbursement for travel to authorized medical providers located sixty miles from her home. The employer, Methodist Healthcare, and its insurance carrier, PMA Group, refused to pay, arguing she should only be reimbursed for travel from her new workplace. The Workers' Compensation Judge, Allen Phillips, interpreted Tenn. Code Ann. § 50-6-204(a)(6)(A) and determined that the statute provides for reimbursement from either the employee's residence or workplace. The court found Ms. Ricks' choice to schedule appointments on her days off to avoid wage loss reasonable and ordered Methodist to pay $221.29 in mileage reimbursement and future consistent reimbursements.

Workers' CompensationMileage ReimbursementMedical ExpensesStatutory InterpretationTravel ExpensesReasonable ExpensesDisjunctive Article 'or'Employee RightsEmployer ResponsibilitiesTennessee Law
References
5
Case No. MISSING
Regular Panel Decision

Claim of Simpson v. Glen Aubrey Fire Co.

A volunteer fireman suffered an acute lumbosacral strain requiring frequent hospital and doctor visits. He sought reimbursement for 290 miles of travel expenses. The Workers' Compensation Board approved reimbursement at 20 cents per mile, leading to this appeal. The court examined whether travel expenses for medical treatment are reimbursable under the Volunteer Firemen’s Benefit Law and Workers’ Compensation Law. It concluded that access to medical treatment implies the financial means to obtain it, upholding the humanitarian goals of the legislation.

Volunteer FiremanLumbosacral StrainMileage ReimbursementTravel ExpensesMedical TreatmentWorkers' Compensation LawVolunteer Firemen's Benefit LawStatutory InterpretationRemedial LawLiberal Construction
References
2
Case No. 2015-06-0841
Regular Panel Decision
Dec 30, 2015

Valentine, Kimberly v. Dollar General

Kimberly Valentine, an employee, sought medical benefits after sustaining a work-related back injury while employed by Dollar General. She filed a Request for Expedited Hearing, arguing that Dollar General failed to provide a statutorily compliant panel of physicians and seeking reimbursement for unauthorized medical care and related expenses. The Court found that Dollar General indeed failed to provide a written panel of physicians as required by law, having only verbally directed Ms. Valentine to a single provider. Consequently, the Court granted Ms. Valentine's request for a panel of orthopedic specialists. However, her claim for reimbursement of past unauthorized medical bills and mileage was denied at this time, pending submission of medical evidence demonstrating a causal link between her injury and the treatment received from her chosen physician, Dr. John Williams. The Court also clarified it lacked jurisdiction to award lost wages from a second job.

Workers' Compensation Law ComplianceMedical BenefitsPanel of PhysiciansUnauthorized Medical CareCausationExpedited HearingBurden of ProofEmployer LiabilityOrthopedic SpecialistsSpinal Stenosis
References
4
Case No. 2016-06-0150
Regular Panel Decision
Apr 15, 2016

McVey, Karen v. Child Care, USA

Karen S. McVey, an employee of Child Care, USA, filed a request for an expedited hearing seeking temporary disability, medical benefits, and mileage reimbursement after injuring her right upper-thigh area at work. The Court found that Ms. McVey had already received medical care through workers' compensation and failed to provide medical proof that her injury prevented her from working. Furthermore, her claim for mileage reimbursement was denied as the travel distance did not exceed thirty miles, round trip, falling short of the statutory requirement. The employer also stated it terminated Ms. McVey for cause, not due to her injury. Consequently, the Court denied her claims for additional medical benefits, temporary disability benefits, and mileage reimbursement.

Temporary Disability BenefitsMedical Benefits ClaimMileage Reimbursement DenialExpedited Hearing OrderFile Review DecisionEmployment Termination for CauseCompensability DisputePhysician PanelRight Thigh InjuryOsteoarthritis Diagnosis
References
11
Case No. MISSING
Regular Panel Decision

Memorial Medical Center of East Texas v. Howard

Memorial Medical Center of East Texas (Memorial) appealed a summary judgment ruling that favored James A. Howard, Special Deputy Receiver of Texas Employers’ Insurance Association, and the Texas Property and Casualty Insurance Guaranty Association. Memorial sought a declaration that the appellees were obligated to reimburse it for defense costs in an underlying lawsuit (*Allen v. Memorial Medical Center of East Texas*) concerning employee exposure to ethylene oxide gas. The appellate court affirmed the trial court's decision, concluding that the Texas Insurance Code explicitly removed the duty to defend or reimburse defense costs for a receiver of a delinquent insurer and a guaranty association in such proceedings. Therefore, appellees had no obligation to defend or reimburse Memorial.

Workers' Compensation InsuranceInsurance ReceivershipGuaranty AssociationDuty to DefendReimbursement of Defense CostsSummary Judgment ReviewTexas Insurance LawDelinquent InsurerEmployer LiabilityEthylene Oxide Exposure
References
11
Case No. 2-06-016-CV
Regular Panel Decision
Mar 15, 2007

Shioleno Industries, Inc. AND Columbia Medical Center of Arlington Subsidiary, L.P. and Columbia North Texas Subsidiary, GP, LLC D/B/A Medical Center of Arlington v. Columbia Medical Center of Arlington Subsidiary, L.P. and Columbia North Texas Subsidiary, GP, LLC D/B/A Medical Center of Arlington AND Shioleno Industries, Inc.

Shioleno Industries, Inc. appealed a summary judgment granted in favor of Columbia Medical Center of Arlington Subsidiary, L.P. and Columbia North Texas Subsidiary, GP, LLC d/b/a Medical Center of Arlington (the Hospital). The case originated from the Hospital's alleged failure to disclose an employee's positive drug and alcohol test results to Shioleno after an on-the-job injury. Shioleno contended that this omission led to increased workers' compensation premiums and expenses in unemployment benefit disputes. The appellate court affirmed the trial court's judgment, ruling that Shioleno failed to provide a valid authorization for the disclosure of medical information. Consequently, the Hospital had no legal duty to disclose the results and could not be held liable for negligence, breach of contract, or Deceptive Trade Practices Act (DTPA) violations.

Summary JudgmentMedical RecordsDisclosure AuthorizationHealth & Safety CodeNegligenceBreach of ContractDTPADrug TestingAlcohol TestingEmployer Liability
References
13
Case No. 03-17-00357-CV
Regular Panel Decision
Nov 21, 2017

George Allibone, M.D. v. Scott Freshour, in His Official Capacity as the Interim Executive Director of the Texas Medical Board Juanita Garner, Investigator of the Texas Medical Board And the Texas Medical Board

George Allibone, M.D., appealed the denial of his petition for a protective order against an administrative subpoena issued by the Texas Medical Board. The subpoena sought patient medical and billing records for an investigation into complaints against Allibone. He contended the trial court erred by failing to issue findings of fact and conclusions of law and by abusing its discretion in finding the subpoena reasonable and relevant. The appellate court found Allibone waived his complaint regarding missing findings. It also concluded the trial court did not abuse its discretion, citing the Board's need for complete records for investigation and Allibone's failure to prove the unconstitutionality of the statute requiring compliance. The trial court's order was affirmed.

Medical Board InvestigationAdministrative SubpoenaPhysician RecordsConstitutional RightsDue ProcessJudicial Review of Agency ActionAbuse of DiscretionFourth AmendmentTexas LawProfessional Licensing
References
50
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