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Case Law Database

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

Case No. MISSING
Regular Panel Decision

Smith v. Bayer Corp. Long Term Disability Plan

Plaintiff Terry Smith, a former Diabetes Sales Specialist for Bayer Corporation, filed an action under ERISA to recover long-term disability benefits, claiming wrongful denial due to psychiatric impairments including depression, panic disorder, and bi-polar disorder. The Plan administrator, Bayer, upheld the denial based on reviews by non-examining physicians. However, Smith's treating psychiatrists, Dr. LeBuffe and Dr. McCool, consistently found him disabled. The court found the Plan's reliance on non-examining doctors, who 'cherry-picked' medical records and distorted findings, to be arbitrary and capricious. Consequently, the court granted Smith's motion for benefits, denying Bayer's, and also awarded partial disability benefits, ruling that Smith's failure to seek rehabilitation approval was excused by the prior wrongful denial.

ERISALong-term disabilityDisability benefits denialPsychiatric impairmentDepressionPanic disorderBi-polar disorderAttention Deficit Disorder (ADD)Treating physician ruleArbitrary and capricious standard
References
26
Case No. MISSING
Regular Panel Decision
Sep 17, 1980

Bass v. Westchester Concrete, Inc.

This case involves an appeal from a Workers’ Compensation Board decision, which was initially filed on March 14, 1980, and later amended on September 17, 1980. The employer's insurance carrier sought reimbursement from the Special Disability Fund under Workers’ Compensation Law § 15(8), claiming a known prior physical impairment of bilateral deafness in the claimant. The record established that the claimant's total disability stemmed from a severe psychoneurotic disorder, with a pre-existing psychiatric condition materially and substantially exacerbating the present disability due to a compensable accident. However, the appeal found no substantial evidence that the employer had prior knowledge of this psychiatric condition; only the bilateral deafness was known, which was deemed incidental to the current disability. Consequently, the Board's decision, which presumably denied reimbursement, was affirmed, with costs awarded to the Special Disability Fund.

Workers' CompensationSpecial Disability FundReimbursement ClaimPrior Physical ImpairmentBilateral DeafnessPsychoneurotic DisorderPre-existing ConditionEmployer KnowledgeTotal DisabilityCompensable Accident
References
0
Case No. MISSING
Regular Panel Decision

Donaldson v. Texas Department of Aging & Disability Services

David Donaldson appealed a trial court's summary judgment in favor of the Texas Department of Aging and Disability Services (DADS) on claims of race and disability discrimination, retaliation, and hostile work environment under the TCHRA and Title VII. Donaldson, an African-American employee diagnosed with multiple conditions including prostate cancer and PTSD, alleged DADS failed to accommodate his disabilities and discriminated against him through various adverse actions, culminating in his termination. The appellate court affirmed the summary judgment for DADS on the race discrimination, retaliation, and hostile work environment claims, finding insufficient evidence of discriminatory intent or materially adverse actions in those areas. However, the court reversed and remanded the reasonable accommodation claim, concluding that Donaldson presented a fact issue regarding DADS's failure to provide continued assistance for his disabilities despite initial accommodations. This decision partially reverses the trial court's judgment, necessitating further proceedings on the reasonable accommodation aspect of the disability discrimination claim.

DiscriminationRetaliationHostile Work EnvironmentDisability DiscriminationRace DiscriminationReasonable AccommodationSummary JudgmentTexas Commission on Human Rights ActTitle VIIEmployment Law
References
83
Case No. MISSING
Regular Panel Decision

Mott v. Central New York Psychiatric Center

The claimant, a guard at a state-run psychiatric center, suffered a work-related injury and received workers’ compensation benefits. During his disability, he used personal leave time for which he received full wages. The employer sought reimbursement for these advance payments, but the Workers’ Compensation Board denied reimbursement for the personal leave portion. The Appellate Division reversed this decision, differentiating personal leave from sick leave by noting that personal leave could not be accrued or converted, thus not conferring a permanent benefit to the employer or a detriment to the claimant. The court concluded that denying reimbursement would result in the claimant receiving both full wages and compensation for the same period, a disfavored outcome, and therefore, reimbursement should be granted.

ReimbursementAdvance PaymentsPersonal LeaveSick LeaveWorkers' Compensation BenefitsDisabilityEmployer ReimbursementDisproportionate ResultAppellate DivisionNew York
References
9
Case No. MISSING
Regular Panel Decision

Claim of Keser v. New York State Elmira Psychiatric Center

This case addresses whether late payment penalty provisions of Workers’ Compensation Law § 25 (3) (f) apply to reimbursements made by an employer’s compensation carrier for wages paid during an employee's disability, and if so, whether they apply when reimbursement is in a form other than monetary payment to the employee. The Court affirmed the Appellate Division's decision, answering both questions in the affirmative. A 20% penalty was upheld against the State Insurance Fund for late reimbursement to the New York State Elmira Psychiatric Center, the employer of claimant Peter Keser. The ruling emphasizes that for penalty purposes, no distinction should be made between awards payable directly to claimants and those payable to an employer as reimbursement, and the mechanics of payment (e.g., accounting credit) do not alter the need for timely compliance with award terms, promoting prompt payment of workers' compensation benefits.

Workers' CompensationLate Payment PenaltyEmployer ReimbursementDisability BenefitsStatutory InterpretationSection 25(3)(f)Compensation DefinitionCarrier LiabilityPrompt PaymentAccrued Leave
References
6
Case No. MISSING
Regular Panel Decision

Claim of Guz v. Jewelers Machinist, Inc.

A factory worker claimant sustained a work-related injury in March 2002, leading to a claim for workers’ compensation benefits. The case was established for bilateral carpal tunnel syndrome, later amended to include a neck injury and aggravated back condition. In 2007, a major depressive disorder was added, and a Workers’ Compensation Law Judge initially found a causally related psychiatric disability. However, the Workers’ Compensation Board reversed this finding. The claimant appealed this reversal. The appellate court affirmed the Board’s decision, noting that the claimant bears the burden of establishing a causal relationship with competent medical evidence and that the Board is the sole judge of witness credibility. The court found that the Board’s determination, which was based on rejecting the claimant's treating psychiatrist's testimony due to lack of complete information and relying on subjective accounts, was supported by substantial evidence.

Psychiatric DisabilityMajor Depressive DisorderCausationMedical EvidenceExpert TestimonyWitness CredibilityWorkers’ Compensation BenefitsCarpal Tunnel SyndromeNeck InjuryBack Condition
References
11
Case No. 08-23-00177-CV
Regular Panel Decision
Aug 30, 2024

Texas Department of Aging and Disability Services v. Claudia Gomez

The Texas Department of Aging and Disability Services (DADS) terminated Claudia Gomez, alleging she physically assaulted a coworker; Gomez contended the termination was discriminatory based on age, gender, and disability. The trial court denied DADS's plea to the jurisdiction regarding Gomez's discrimination claims. On appeal, the court found Gomez failed to present evidence of a similarly situated comparator, thus not establishing a prima facie case for age, gender, or disability discrimination. Furthermore, Gomez did not demonstrate that DADS's stated reason for termination was a pretext for discrimination. Consequently, the appellate court reversed the trial court's decision and dismissed Gomez's claims for lack of jurisdiction.

DiscriminationAge DiscriminationGender DiscriminationDisability DiscriminationEmployment LawTerminationPretextPrima Facie CaseSovereign ImmunityTexas Labor Code
References
30
Case No. 2018-01-0702
Regular Panel Decision
Dec 16, 2019

Mollica, Gena M. v. EHHI Holdings, Inc. DBA Advanced Home Care Management, Inc. DBA Encompass Home Health

Ms. Mollica requested medical and temporary disability benefits from EHHI Holdings, Inc., which had accepted her back injury but failed to provide orthopedist treatment and denied her claim that the medication Lyrica aggravated a pre-existing mental condition. The Court found Ms. Mollica entitled to the requested benefits. It ordered EHHI to authorize psychiatric evaluation with Dr. Sandvi and orthopedic treatment with Dr. Caputo, reimburse out-of-pocket medical expenses incurred for her mental condition, and pay past and ongoing temporary total disability benefits. Additionally, EHHI was required to respond regarding a potential twenty-five percent penalty for non-payment of temporary disability benefits.

Temporary Total DisabilityMedical Treatment AuthorizationPre-existing Mental Health ConditionDrug AggravationLyrica Side EffectsPsychiatric EvaluationOrthopedic ReferralCausation StandardPhysician Opinion PresumptionPenalty for Non-payment
References
2
Case No. ADJ2034254 (RIV 0075737)
Regular
Jan 30, 2015

WAYNE MAVERICK vs. MARRIOTT INTERNATIONAL

The Applicant sought reconsideration of an award that apportioned his psychiatric permanent disability. The Appeals Board granted reconsideration, finding the Agreed Medical Examiner's apportionment of psychiatric disability was not supported by substantial medical evidence. The Board ruled the Applicant was entitled to an unapportioned award for his psychiatric permanent disability. Consequently, the permanent disability award and attorney's fees were increased.

Workers' Compensation Appeals BoardWayne MaverickMarriott InternationalAmended Findings and Awardapportionmentpermanent disabilitylumbar spinepsycheAgreed Medical ExaminerDr. Feldman
References
1
Case No. MISSING
Regular Panel Decision
May 20, 1988

Claim of Boiano v. Delma Engineering Corp.

The employer appealed an amended decision by the Workers’ Compensation Board, which found the claimant suffered a permanent total psychiatric disability linked to a 1979 industrial accident and resulting back injury. The employer contested the finding, arguing that the claimant’s psychiatrist’s opinion was irrational given the Board’s finding that the claimant was not physically disabled after March 10, 1980. However, the psychiatrist maintained that his opinion regarding the psychiatric disability was independent of the physical disability findings. The appellate court affirmed the Board's decision, concluding that the psychiatrist's report and testimony provided substantial evidence to support the finding of a causally related total psychiatric disability.

Psychiatric DisabilityWorkers' CompensationIndustrial AccidentBack InjuryCausationMedical OpinionExpert TestimonyPermanent Total DisabilityAppellate ReviewBoard Decision
References
0
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