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

Case No. 03-17-00707-CV
Regular Panel Decision
Nov 21, 2018

CoreALM, LLC v. Keen Fusion, Inc.

CoreALM, LLC appealed a trial court's judgment that awarded Keen Fusion, Inc. damages for tortious interference with contract and business disparagement. CoreALM contended that the economic loss rule barred the award and that the evidence was legally insufficient to support the jury's findings. The appellate court affirmed the trial court's judgment. It determined that the economic loss rule did not preclude Keen Fusion's recovery on its tort claims because the duty not to interfere with contractual relationships arises from common law, independent of any contractual agreement between the interfering party and the party whose contract was interfered with. The court also found factually sufficient evidence to support the jury's finding that CoreALM tortiously interfered with Keen Fusion’s contract with eCommQuest, which proximately caused Keen Fusion to lose an engagement with Johnson Controls. Given the valid finding on tortious interference, the court did not address the challenge to the business disparagement claim.

Tortious Interference with ContractEconomic Loss RuleBusiness DisparagementContract BreachAppellate ReviewFactual Sufficiency of EvidenceProximate CauseCommon Law DutyIndependent Contractor DisputeSubcontractor Agreement
References
17
Case No. 2018-06-1822
Regular Panel Decision
Jun 15, 2021

Reichenberger, Donald v. Cumberland Real Estate Services, Inc.

Mr. Reichenberger, a landscaper, sustained a low-back injury in 2016. His employer, Cumberland Real Estate Services, Inc., accepted the claim for an L3-4 disc herniation. Following a failed L5-S1 fusion, Mr. Reichenberger sought authorization for a multi-level L2-ilium fusion surgery and additional temporary disability benefits. The Court denied the extensive multi-level fusion due to conflicting medical opinions regarding its necessity and likelihood of success. However, it found the aggravation of his pre-existing L5-S1 condition and the subsequent failed fusion to be compensable. As a result, the Court awarded past and ongoing temporary partial disability benefits and mandated continued medical treatment for the L5-S1 failed fusion, instructing the employer to provide a new panel of neurosurgeons if the current treating physician declines further care.

Expedited HearingMulti-level Fusion SurgeryLow Back InjuryL5-S1 PseudoarthrosisTemporary Partial Disability BenefitsMedical Necessity DisputeCausation of InjuryPre-existing Condition AggravationNeurosurgeon OpinionIndependent Medical Evaluation
References
8
Case No. 2019-05-0606
Regular Panel Decision
Nov 21, 2019

Newman, Jr., Leon v. Earth Solutions, Inc.

Leon Newman, Jr., an employee, suffered a work-related neck injury in a truck accident while working for Earth Solutions, Inc. Following initial cervical fusions that relieved right-sided symptoms, he developed severe left-sided pain. His treating physician, Dr. Shibayama, diagnosed adjacent segment degeneration from the prior surgery and recommended additional fusions at C3-5. Earth Solutions initially denied this, relying on an independent medical evaluation by Dr. Stahlman, but the Bureau's medical director reversed the denial. The Court found Dr. Shibayama's opinion more credible, ordering Earth Solutions to authorize the recommended fusions and to continue paying temporary total disability benefits to Mr. Newman, who remains unable to work.

Workers' CompensationExpedited HearingMedical BenefitsTemporary Disability BenefitsSpinal Fusion SurgeryAdjacent Segment DegenerationCervical RadiculopathyIndependent Medical Examination (IME)Utilization ReviewTreating Physician Opinion
References
5
Case No. 08-06-00170-CV
Regular Panel Decision
Jun 30, 2008

Fireman's Fund Insurance Co. v. Weldon W. Weeks

This case concerns an appeal by Fireman’s Fund Insurance Company against a district court's judgment favoring workers' compensation claimant, Weldon Weeks. The core dispute revolved around the legal sufficiency of evidence for Weeks' impairment rating and maximum medical improvement (MMI) date, following an on-the-job spinal injury and subsequent fusion surgery. The district court had adopted a 25 percent impairment rating and April 17, 2002 MMI date, based on Dr. Chapman's report, which considered the spinal fusion surgery in violation of AMA Guides for impairment ratings. The Court of Appeals, affirming that surgery is not a permissible factor under the AMA Guides' Injury Model, found Dr. Chapman's reliance on the spinal fusion legally insufficient. Consequently, the appellate court reversed the district court’s judgment and rendered judgment for Fireman’s Fund, effectively upholding the Division's original decision of a 10 percent impairment rating and January 28, 2002 MMI date.

Impairment RatingMaximum Medical Improvement (MMI)Spinal Fusion SurgeryAMA GuidesLegal SufficiencyAppellate ReviewTrial Court JudgmentDesignated DoctorTexas Labor CodeDiagnosis-Related Estimate (DRE)
References
13
Case No. SAL 0107786
Regular
Oct 16, 2007

MOLLY KIRKPATRICK vs. DOMINICAN SANTA CRUZ HOSPITAL, PSI ADMINISTERED BY OCTAGON RISK SERVICES

This case concerns an injured worker who had cervical spine surgery involving diskectomy, vertebrectomy, decompression, and fusion. The defendant sought reconsideration of an award granting temporary disability benefits beyond the statutory 104-week limit, arguing the surgery was not an amputation. The Appeals Board rescinded the prior award and returned the matter for further proceedings, as the definition of "amputation" in precedent excludes internal body parts like those removed during spinal fusion.

Workers' Compensation Appeals BoardDominican Santa Cruz HospitalOctagon Risk ServicesMolly KirkpatrickIndustrial InjuryCervical Spine SurgeryTemporary Disability IndemnityLabor Code Section 4656(c)AmputationDiskectomy
References
1
Case No. ADJ1438639 (GRO 0024593) ADJ3262777 (GRO 0025366)
Regular
Sep 20, 2011

Dennis Timmons vs. CALIFORNIA MENS COLONY, STATE COMP. INS. FUND, SUBSEQUENT INJURIES BENEFITS TRUST FUND

This case concerns applicant Dennis Timmons' petition for reconsideration of a denial of Subsequent Injuries Benefits Trust Fund (SIBTF) benefits. The Appeals Board reversed a prior award, finding applicant failed to prove a pre-existing permanent partial disability from a 1991 cervical fusion surgery prior to his 2000 industrial injury. Applicant argued the fusion itself constituted a previous impairment and that SB 899's apportionment changes should apply, but the Board affirmed its decision. The Board reiterated that contemporaneous medical evidence is required for SIBTF eligibility, and that SB 899 did not alter SIBTF's established requirements.

Subsequent Injuries Benefits Trust FundSIBTFpermanent disabilitypre-existing disabilitycervical fusionApril 132000 industrial injurySB 899apportionment to causationLabor Code section 4751
References
2
Case No. ADJ6619207 ADJ6736606
Regular
May 24, 2010

ALBERTO ALVAREZ vs. AKT DEVELOPMENT CORPORATIONS, INSURANCE OF THE WEST

The Workers' Compensation Appeals Board granted reconsideration of a decision awarding lumbar fusion surgery, finding the WCJ erred by solely relying on the *Cervantes* decision regarding timely utilization review. The Board determined that the defendant's utilization review timeliness was unclear, and the parties had agreed to an Agreed Medical Examiner (AME) to resolve the surgery dispute before *Cervantes* was issued. Furthermore, the Board held that the treating physician's recommendation for surgery must constitute substantial evidence, which was not definitively established here. Therefore, the matter was returned for further development of the record, requiring the treating physician to address the AME's concerns regarding the necessity of fusion surgery.

Workers' Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationJoint Findings Award and OrderIndustrial InjuryLumbar FusionUtilization ReviewCervantes v. El Aguila Food ProductsSubstantial Medical EvidenceExpedited Hearing
References
3
Case No. 2016-04-0074
Regular Panel Decision
Sep 26, 2016

White, Ransy v. Boles Trucking

Randy White, an employee, filed a Request for Expedited Hearing against Boles Trucking, the employer, seeking medical and temporary disability benefits for a lumbar spine fusion surgery. The alleged work-related injury occurred on February 11, 2015, exacerbating a pre-existing spondylolisthesis. The court evaluated whether the injury primarily arose out of employment and if the aggravation was compensable. Judge Robert Durham found sufficient evidence that Mr. White was likely to prevail, concluding that the February 2015 incident was a specific work-related event that significantly contributed to his current condition and need for surgery. Consequently, the court ordered Boles Trucking to provide the recommended L4-5 spinal fusion and associated medical treatment.

Workers' CompensationSpinal FusionSpondylolisthesisExacerbationPre-existing ConditionCausationMedical BenefitsTemporary DisabilityTruck Driver InjuryLumbar Spine Injury
References
4
Case No. 2024-50-2857
Regular Panel Decision
Aug 04, 2025

BROWN, MICHAEL v. CITY OF PULASKI ELECTRIC SYSTEMS

Mr. Brown, an employee of City of Pulaski Electric Systems, suffered a work injury to his head, neck, and shoulder. His authorized physician, Dr. Erion Qamirani, recommended a cervical disc fusion surgery and temporary disability benefits, which the employer denied based on utilization review and medical director opinions asserting lack of medical necessity. The Court conducted a de novo review, weighed conflicting medical opinions, and found Dr. Qamirani's opinion more credible due to his specialization, consistent patient contact, and review of actual MRI films. Consequently, the Court granted Mr. Brown's request, ordering Pulaski to authorize the C3-C4 fusion surgery and pay temporary total disability benefits from October 28, 2024, forward.

Cervical Fusion SurgeryMedical Necessity DisputeUtilization ReviewTemporary Total Disability BenefitsOrthopedic Spine SpecialistMRI InterpretationConflicting Medical EvidenceDe Novo ReviewWork Injury CompensationEmployer-Authorized Treatment
References
4
Case No. 2022-06-0596
Regular Panel Decision
Dec 05, 2022

Freeman, Lynn v. 2022-06-0596

Lynn Freeman, an employee of Kirby Pines Estates, sought an expedited hearing to compel her employer to provide a recommended lumbar fusion surgery by her authorized treating physician, Dr. Glenn Crosby, for a back injury sustained in July 2021. The proposed surgery, a transforaminal lumbar interbody fusion (TLIF), was initially denied through utilization review and upheld on appeal, with medical experts citing Official Disability Guidelines (ODG) and a lack of significant spinal instability. While Dr. Crosby supported the surgery and dismissed the guidelines, the Court found the employer successfully rebutted the presumption of medical necessity using the opinions of Drs. Samuel Murrell and Maria Sumas. Their assessments, which aligned with ODG and noted the resolution of Ms. Freeman's radicular complaints, were deemed more persuasive. Consequently, the Court denied Ms. Freeman’s request for the TLIF procedure, setting a status conference for future proceedings.

Lumbar FusionTLIFHerniated DiscRadiculopathyUtilization ReviewMedical NecessityOfficial Disability GuidelinesWorkers' Compensation ClaimsExpedited HearingSpine Surgery
References
4
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