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

Case No. ADJ4258585 (OXN 0130492) ADJ220258 (OXN 0130487)
Regular
Apr 17, 2018

ENRIQUE HERRERA vs. MAPLE LEAF FOODS, U.S. FIRE INSURANCE COMPANY, ALEA NORTH AMERICAN INSURANCE COMPANY

This notice informs parties that the Workers' Compensation Appeals Board (WCAB) intends to admit its rating instructions and a disability rater's recommended permanent disability rating into evidence. The WCAB previously granted reconsideration for further study. Parties have seven days to object to the rating instructions or the recommended rating, with specific procedures for addressing objections. If no timely objection is filed, the matters will be submitted for decision thirty days after service.

WORKERS' COMPENSATION APPEALS BOARDPermanent Disability RatingDisability Evaluation UnitRating InstructionsRecommended Permanent Disability RatingJoint RatingReconsiderationObjectionRater Cross-ExaminationRebuttal Evidence
References
0
Case No. ADJ8702052 ADJ8954034
Regular
Sep 13, 2018

James McClendon vs. Home Pest Defense (Rollins Inc), National Union First Insurance Company, Sedgwick Claims Management Services, Inc.

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to review an award of 100% permanent disability for two industrial injuries. The defendant argued for separate disability awards based on apportionment between the two injuries, citing the *Benson* case, and challenged the Agreed Medical Examiner's (AME) opinion. The WCAB rescinded the original award and returned the case for further development of the medical record, specifically to clarify the AME's ability to separately rate the two injuries. The majority found the AME's reasoning for not separately rating the injuries was not consistent with applicable standards, while a dissenting commissioner believed the AME's determination was within his expertise and that the defendant failed to meet its apportionment burden.

Workers Compensation Appeals BoardReconsiderationPermanent Total DisabilityJoint AwardApportionmentBensonAgreed Medical ExaminerFunctional Capacity EvaluationVocational ExpertDate of Injury
References
7
Case No. MISSING
Regular Panel Decision
Oct 03, 1956

General Telephone Company v. City of Wellington

This case involves the General Telephone Company of the Southwest's challenge against rates established by a 1952 city ordinance in Eden, Texas. The company sought a temporary injunction, arguing the rates were confiscatory and led to a net operational loss. Both the trial court and the Court of Civil Appeals denied the injunction, citing the company's failure to separate accounting for in-city and out-of-city operations, and a perceived lack of exhaustive negotiations. The Supreme Court reversed these decisions, rejecting the separation theory as applied in this context and emphasizing that the core issue was the validity of the existing rates. The Court found the company's evidence of inadequate return and property valuation largely uncontroverted, concluding that a temporary injunction should have been granted to protect the company from irreparable loss while ensuring subscriber protection through a bond.

Utility RatesTemporary InjunctionRate RegulationConfiscationTelephone CompanyCity OrdinanceTexas LawAccounting PracticesJurisdictionAppellate Review
References
9
Case No. MISSING
Regular Panel Decision

People v. Young

An attorney representing an indigent defendant in Monroe County filed an application seeking reimbursement for legal services at a rate of $200 per hour, mirroring the rate charged by the Special Prosecutor, rather than the statutory rates under County Law § 722-b. The attorney argued that the significant disparity in hourly compensation violated the defendant's right to equal protection and that his qualifications justified the requested rate. The New York State Association of Criminal Defense Lawyers supported the application as amicus curiae, while Monroe County opposed it, arguing the request was untimely and lacked extraordinary circumstances. Presiding Judge Donald J. Mark, J., acknowledged the court's authority to grant compensation in excess of statutory limits under extraordinary circumstances but ultimately denied the application. The denial was based on the court's reasoning that an analogous argument was previously rejected, that linking assigned counsel rates to prosecutor rates would render County Law § 722-b ineffective, and that extraordinary circumstances could not be demonstrated prior to the conclusion of the criminal action. The court, however, reserved the right to reconsider an increased hourly fee upon the case's termination if such circumstances are then proven.

Assigned CounselLegal Aid CompensationCounty Law Section 722-bHourly Rate DisputeSpecial Prosecutor FeesIndigent RightsJudicial DiscretionExtraordinary CircumstancesMonroe County LawEqual Protection Challenge
References
16
Case No. MISSING
Regular Panel Decision

Attorney General of Texas v. Farmers Insurance Exchange

This appeal addresses public-information requests made to the Texas Department of Insurance (TDI) concerning rate-filing information submitted by a group of insurers. The central legal question is whether exceptions to disclosure under the Public Information Act (PIA) apply to information explicitly declared 'open to public inspection' by the Texas Insurance Code. The district court had previously ruled that PIA exceptions were applicable, which could allow the insurers to withhold proprietary trade secrets. The appellate court, upon de novo review, overturned this decision, asserting that the clear and unambiguous language of the Insurance Code mandates public inspection without the limitations of PIA exceptions. The court dismissed arguments based on legislative history, constitutional separation of powers, and the takings clause, emphasizing its duty to interpret statutes based on their plain meaning.

Public Information ActTexas Insurance CodeRate FilingsTrade SecretsStatutory ConstructionOpen Records RequestsAppellate ReviewGovernmental DisclosurePublic InspectionSeparation of Powers
References
30
Case No. ADJ2239874 (STK 0170112) ADJ472994 (STK 0198041) ADJ3391005 (STK0208641)
Regular
Dec 15, 2008

MITCHELL PACHECO vs. INNOVATIVE STEEL SYSTEMS and CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of FREMONT COMPENSATION INSURANCE COMPANY, in liquidation, LENNAR CORPORATION and OLD REPUBLIC INSURANCE COMPANY, RICHMOND AMERICAN HOMES and AMERICAN HOME ASSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, rescinded the previous award, and returned the case to the trial level. The Board found that the WCJ erred by applying the wrong disability rating schedule and by issuing a combined award for three separate successive injuries. The matter is remanded for separate determinations of permanent disability for each injury, with the 2005 and 2006 injuries to be rated under the 2005 Schedule.

CIGAFremont Compensation Insurance CompanyliquidationInnovative Steel SystemsLennar CorporationOld Republic Insurance CompanyRichmond American HomesAmerican Home Assurance Companyindustrial injuriesneck
References
8
Case No. ADJ4145263 (VEN 0120366) ADJ2903274 (OXN 0124883)
Regular
Jul 16, 2012

SHARON ANGELL vs. MARYMOUNT ACADEMY, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION (CIGA) by its servicing agent SEDGWICK CMS, for FREMONT INDEMNITY in liquidation

The Workers' Compensation Appeals Board granted reconsideration and rescinded the original decision, remanding the case for further proceedings. The primary issue is whether applicant's fibromyalgia should be rated separately from her orthopedic injuries. The Board found no clear evidence in the record supporting the WCJ's conclusion that fibromyalgia was solely a consequence of the orthopedic conditions. On remand, the WCJ must determine the causation of the fibromyalgia and whether it warrants separate rating. The Board deferred ruling on other issues raised by the parties.

Workers' Compensation Appeals BoardCIGAFremont Indemnityliquidationreconsiderationfibromyalgiaorthopedic injuryapportionmentvocational evidencetemporary disability
References
3
Case No. MISSING
Regular Panel Decision

Claim of Perrin v. Builders Resource, Inc.

The case concerns an appeal from a Workers' Compensation Board decision regarding the reimbursement rate for home health aide services provided to a claimant by their sister. Initially, the carrier denied payment but was later directed to pay. The Workers’ Compensation Law Judge set the reimbursement rate at $12 per hour for services starting in 2011, which the Board affirmed. The claimant appealed, solely challenging this rate. The court dismissed the appeal, ruling that the claimant was not an aggrieved party concerning the reimbursement rate, as the dispute was between the care provider (the sister) and the carrier. The court affirmed that the claimant received the care sought and could not raise issues on behalf of the care provider.

Workers' CompensationHome Health Aide ServicesReimbursement RateAppeal DismissalAggrieved PartyCare ProviderWorkers' Compensation BoardAppellate ProcedureNew York LawCarrier Liability
References
4
Case No. ADJ2073428 (VNO 0465400) ADJ1610465 (VNO 0540972) ADJ3247765 (VNO 00384869)
Regular
Apr 04, 2011

JAY ZAVERI vs. STATE COMPENSATION INSURANCE FUND; Legally Uninsured

The applicant sought reconsideration of a workers' compensation award, arguing for a 100% permanent disability rating and challenging the permanent disability start date used for attorney fee commutation. The Appeals Board denied the petition, finding insufficient evidence to establish total permanent disability, as the applicant was currently employed and medical opinions did not definitively support such a rating. The Board also ruled that the applicant waived arguments regarding the rating of specific injuries by failing to properly object, and that even if considered, separate ratings for back, knee, and plantar fasciitis conditions would not result in a higher award due to fibromyalgia being the primary cause and rating higher. Finally, the Board clarified that the July 2, 2000 date was only relevant to the attorney fee commutation calculation and not to the determination of permanent disability indemnity payments.

WCABPetition for ReconsiderationJoint Findings and AwardWorkers' Compensation Judge (WCJ)Industrial InjuryBack InjuryHip InjuryBilateral Knee InjuryBilateral Foot InjuryBilateral Plantar Fasciitis
References
7
Case No. MISSING
Regular Panel Decision
Oct 03, 1956

General Telephone Co. v. City of Wellington

This case concerns a temporary injunction in a telephone rate dispute under Art. 1119, Vernon’s Texas Civ. Stats. General Telephone Company of the Southwest sought to prevent the City of Wellington from enforcing rate ordinance No. 333, which fixed local telephone charges, and penalty ordinance No. 332. The petitioner argued the rates were confiscatory, yielding less than a 2% return on property value. Both the trial court and the Amarillo Court of Civil Appeals denied the temporary injunction, citing no abuse of discretion, a small net return, and the lack of rate separation between urban and rural areas. The Supreme Court reversed, holding that a return of less than 2% is unreasonable and that a single community exchange operation is a proper unit for rate-making purposes, thus making the injunction refusal an erroneous application of law to undisputed facts.

Rate DisputeTemporary InjunctionTelephone Utility RegulationConfiscatory RatesFair Return on InvestmentPublic Utility LawCity OrdinancesJudicial Review of RatesSingle Exchange OperationConstitutional Guarantees
References
17
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