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

Case No. 04-09-00401-CV
Regular Panel Decision
Jul 21, 2010

Texas Mutual Insurance Company v. Sarah Ochoa

Sarah Ochoa sustained a lumbar sprain injury at work and filed a workers' compensation claim. Texas Mutual Insurance Company, the carrier, initially accepted the lumbar sprain but disputed later claims of extensive lumbar disc pathology as an ordinary disease of life. The hearing officer found a sprain/strain injury superimposed on pre-existing degenerative conditions but also ruled that Texas Mutual waived its right to contest the extent of injury by not timely disputing it within 60 days, making the degenerative conditions compensable. Texas Mutual appealed to the state district court, which granted Ochoa's no-evidence motion for summary judgment. This appellate court reverses and remands the trial court's judgment, holding that the 60-day waiver rule in the Texas Labor Code does not apply to extent-of-injury disputes, citing Texas Supreme Court precedent.

Workers' CompensationSummary JudgmentWaiver RuleExtent of Injury DisputeLumbar SprainDegenerative Disc DiseasePre-existing ConditionAppellate ReviewTexas Labor CodeJudicial Precedent
References
7
Case No. MISSING
Regular Panel Decision

Claim of Gaylord v. Ichabod Crane Central School District

Claimant, a school bus driver, suffered muscle spasms and lower back pain attributed to her work, including lifting a nonambulatory child and enduring kicks from an autistic child. After seeking chiropractic and medical treatment, she was diagnosed with fibromyalgia and permanent disability. The Workers’ Compensation Board, however, only found a minor back strain that had resolved, largely relying on a medical expert who deemed the fibromyalgia a preexisting condition. The claimant appealed for a higher degree of disability, but the Appellate Division affirmed the Board's decision, finding substantial evidence to support the Board's conclusion that the fibromyalgia was not a causally related disability.

Workers' CompensationBack InjuryFibromyalgiaCausationMedical OpinionDisabilityAppellate ReviewPreexisting ConditionSubstantial EvidenceSchool Bus Driver
References
2
Case No. 2015-07-0153
Regular Panel Decision
Dec 22, 2015

Caldwell, Bryan v. Corrections Corp. of America

Bryan Caldwell, a Senior Correctional Officer for Corrections Corp. of America (CCA), filed a Request for Expedited Hearing (REH) seeking medical benefits for a left knee injury sustained at work. Mr. Caldwell reported his knee "popped" while standing from a chair. Medical evaluations diagnosed a knee strain/sprain. CCA denied the claim, stating the injury was not compensable under the Tennessee Workers' Compensation Act. The Court reviewed the file without an evidentiary hearing and determined that Mr. Caldwell's injury was idiopathic and did not arise primarily out of his employment, as there was no proof of an employment hazard causing or exacerbating the injury. The Court therefore denied his request for medical and temporary disability benefits, and the matter was set for an Initial (Scheduling) Hearing.

Expedited HearingMedical BenefitsIdiopathic InjuryKnee InjuryWorkers' Compensation LawCausationCourse of EmploymentScope of EmploymentTennessee LawBurden of Proof
References
11
Case No. 2016-03-0298
Regular Panel Decision
Sep 13, 2018

Hollis, Aleceia v. Komyo America

Ms. Hollis, a material handler for Komyo America, sustained a work injury in January 2016, leading to a lumbar sprain and later a herniated disc. She sought various benefits, including temporary and permanent disability, and medical expenses for the herniated disc. The Court found that Ms. Hollis failed to establish by a preponderance of the evidence that her herniated disc arose primarily out of and in the course and scope of her employment. This decision was largely based on the authorized treating physician's opinion, Dr. Sanabria, which was presumed correct and deemed unrebutted by other medical experts' testimony. Consequently, the Court denied benefits related to the herniated disc but ordered Komyo America to provide ongoing reasonable and necessary medical care for her work-related lumbar strain.

Workers' CompensationLumbar StrainHerniated DiscCausation DisputePre-existing ConditionMedical Expert TestimonyPreponderance of EvidenceMaximum Medical ImprovementAuthorized PhysicianUnauthorized Treatment
References
1
Case No. 02-19-00224-CV
Regular Panel Decision
Jan 14, 2021

John Ellis v. Dallas Area Rapid Transit

John Ellis appealed a trial court's judgment affirming a Texas Department of Insurance (TDI) decision in his workers' compensation case against Dallas Area Rapid Transit (DART). Ellis claimed a 2014 motor-vehicle accident aggravated preexisting injuries, including a right-shoulder rotator-cuff tear and right-wrist tendinitis. However, medical examiners, including a designated doctor, concluded that only cervical, shoulder, and wrist sprains/strains were compensable, while the disputed conditions were preexisting or inconsistent with the 2014 injury. The trial court upheld TDI's finding that the compensable injury did not extend to the rotator-cuff tear and tendinitis, and the appellate court affirmed the trial court's judgment, finding sufficient evidence to support its conclusion.

Workers' CompensationMedical CausationPreexisting InjuryAppellate ReviewLegal SufficiencyExpert Medical EvidenceTexas LawOn-the-Job InjuryRotator Cuff TearWrist Tendinitis
References
34
Case No. MISSING
Regular Panel Decision
Apr 15, 2003

Claim of Paradise v. Goulds Pump

In March 1993, the claimant suffered a cervical and thoracic spine strain/sprain while lifting a heavy carton at work. Although he initially recovered, he later developed recurring neck pain and numbness in his left hand. Neurosurgeon Webster Pilcher diagnosed nerve root compression at C5 and C6, attributing it to the 1993 work-related injury and recommending surgery. The employer's workers’ compensation carrier declined coverage. The Workers’ Compensation Board subsequently found a causal relationship between the injury and the claimant's current condition, authorizing the surgery. The employer and carrier appealed, contending that the Board's finding was based on speculative medical opinion. The court affirmed the Board's decision, finding that Pilcher's opinion had a rational basis and was supported by substantial evidence.

Workers' CompensationNerve Root CompressionCervical SpineThoracic SpineCausationMedical OpinionSubstantial EvidenceNeurosurgeonSpinal InjuryAppeal
References
2
Case No. 2015-01-0473
Regular Panel Decision
May 17, 2016

Murphy, Ned Eugene v. ADM Trucking, Inc.

Ned Eugene Murphy, a truck driver, sustained a back injury on December 9, 2014, while working for ADM Trucking, Inc. The employer failed to provide a statutory written panel of physicians, instead directing Mr. Murphy to a specific clinic. After an initial diagnosis of lumbar sprain/strain, his condition worsened, and subsequent medical evaluations, particularly by Dr. Darden, attributed his symptoms to pre-existing degenerative disc disease, leading to the denial of his claim and his termination. Mr. Murphy sought an expedited hearing to compel medical benefits and a panel of physicians. The Court, giving little weight to Dr. Darden's opinions, found ADM failed to meet its statutory obligations and ordered the provision of a panel of orthopedic surgeons for Mr. Murphy's injury.

Back injuryTruck driverDegenerative disc diseasePanel of physiciansMedical benefitsExpedited hearingWorkers' compensation fraudSymptom magnificationLumbar sprainTennessee law
References
5
Case No. 2017-06-2296 / 46712-2017
Regular Panel Decision
Aug 08, 2018

Miles, Jerry v. Amley Logistics, Inc.

Jerry Miles, an employee of Amley Logistics, Inc., filed an expedited hearing request for additional medical benefits, specifically a panel of orthopedic physicians, for alleged right shoulder, neck, and low-back injuries sustained in a June 2017 work accident. Although he initially saw Occ Med providers and then a neurologist, Dr. Steven Graham, for his head injury, Mr. Miles testified that his shoulder and low-back complaints were not adequately addressed by the authorized treating physicians. The employer contended that Mr. Miles did not complain of these issues to the physicians. The Court, finding Mr. Miles credible and noting that Occ Med records did document a 'shoulder strain/sprain' at his first visit, granted his request, ordering Amley to provide a panel of orthopedic specialists.

Expedited HearingMedical BenefitsShoulder InjuryNeck InjuryLow Back InjuryCredibility AssessmentTreating PhysicianPanel of PhysiciansNeurological EvaluationOrthopedic Specialists
References
2
Case No. 2019-03-0360
Regular Panel Decision
Oct 07, 2019

Gonzales, Elman v. Smoky Mountain Resort Services

Elman Gonzales, an employee, filed a claim alleging that his hernias arose from lifting a heavy dumpster at work in August 2017. Despite reporting pain and undergoing emergency treatment, initial medical assessments by providers at University General Surgeons did not confirm a work-related hernia or attributed his pain to other sources like a rectus muscle strain. Later, Dr. Roy Frank Roberts identified an inguinal hernia but specifically stated he could not causally link it to Mr. Gonzalez’s work activities due to a significant treatment gap and other non-work-related factors. Consequently, the Court found that Mr. Gonzales failed to provide sufficient medical expert opinion to prove his hernias were work-related, leading to the denial of his requested medical benefits at the expedited hearing.

HerniaWork InjuryCausationMedical EvidenceExpedited HearingDenial of BenefitsTennessee Workers' CompensationUmbilical HerniaInguinal HerniaMedical Expert Opinion
References
2
Case No. 2016-02-0037
Regular Panel Decision
May 17, 2016

Fannon, Jerry v. Ron's Millwright Service, Inc.

Jerry Fannon, a sixty-seven-year-old retired employee of Ron’s Millwright Service, Inc., filed a Request for Expedited Hearing seeking temporary disability and medical benefits for an alleged work injury. He claimed to have sustained muscle and joint strains on his first day of employment while lifting a heavy steel propane tank. The employer and its insurance carrier, FCCI Insurance Co., disputed the claim, arguing that Mr. Fannon failed to establish a compensable injury under Tennessee Workers’ Compensation Law. The Court found that Mr. Fannon did not provide sufficient evidence, including expert medical evidence, to prove the employment contributed more than fifty percent in causing his alleged injury. Consequently, the Court denied his requests for additional medical and temporary disability benefits at this time.

Workers' CompensationExpedited HearingTemporary DisabilityMedical BenefitsCompensabilityWork InjuryBurden of ProofExpert Medical EvidenceCausationTennessee Law
References
4
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