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

Case No. 03-03-00435-CV
Regular Panel Decision
Jul 29, 2004

Texas Workers' Compensation Commission Richard Reynolds, in His Official Capacity as Executive Director of the Texas Workers' Compensation Commission/East Side Surgical Center Clinic for Special Surgery And Surgical and Diagnostic Center, L.P. v. East Side Surgical Center Clinic for Special Surgery/Texas Workers' Compensation Commission Richard Reynolds, in His Official Capacity as Executive Director of the Texas Workers' Compensation Commission

This case involves the Texas Workers’ Compensation Commission's failure to establish fee guidelines for ambulatory surgical centers under the Texas Workers’ Compensation Act. East Side Surgical Center, Clinic for Special Surgery, and intervenor Surgical and Diagnostic Center, L.P. (collectively "East Side") sued the Commission to invalidate certain default rules that applied when specific guidelines were absent. The district court declared one rule (133.304(i)) invalid and enjoined its enforcement, citing unlawful delegation of authority. On appeal, the Court of Appeals reversed the district court's judgment regarding the rule's invalidity and dissolved the injunction, citing a Texas Supreme Court decision finding no unlawful delegation. The court affirmed that East Side was not entitled to its usual and customary fee in the absence of specific guidelines.

Workers' CompensationAdministrative LawDelegation of AuthorityRulemakingAmbulatory Surgical CentersJudicial ReviewInsurance CarrierFee GuidelinesFair and Reasonable RatesStatutory Interpretation
References
38
Case No. 01-07-01113-CV
Regular Panel Decision
Oct 17, 2008

Paul Turner v. Precision Surgical, LLC

Paul Turner, a former sales representative for Precision Surgical, L.L.C., appealed a take-nothing judgment stemming from his retaliatory-discharge and Sabine Pilot claims. Turner alleged his termination was a result of his refusal to commit insurance fraud by misrepresenting a work-related injury to claim health insurance instead of workers' compensation, and subsequently for filing a workers' compensation claim. Precision Surgical countered that Turner was terminated due to unreliability and dishonesty. The appellate court affirmed the trial court's judgment, finding no error in the disjunctive submission of jury questions because the two claims were mutually exclusive, and even if there were an error, it would have been harmless since the jury considered and rejected both theories of recovery.

Retaliatory DischargeSabine Pilot ClaimWorkers' Compensation ClaimInsurance FraudJury Charge ErrorConditional Jury SubmissionDisjunctive Jury SubmissionMutually Exclusive Legal TheoriesAbuse of DiscretionHarmless Error
References
28
Case No. MISSING
Regular Panel Decision

Texas Workers' Compensation Commission v. East Side Surgical Center

This case addresses the Texas Workers’ Compensation Commission's failure to establish fee guidelines for ambulatory surgical centers under the Texas Workers’ Compensation Act. East Side Surgical Center and related entities sued the Commission, seeking to invalidate default rules that applied in the absence of specific fee guidelines, arguing an unlawful delegation of fee-setting authority to insurance carriers. The district court initially declared rule 133.304® invalid, but the appellate court reversed this decision, holding that the rule did not constitute an unlawful delegation of the Commission’s authority. The court further clarified that providers are entitled to fair and reasonable reimbursement, not a statutory right to fee guidelines established by rule, and affirmed that East Side was not entitled to its usual and customary fee.

Workers' CompensationFee GuidelinesAdministrative LawStatutory InterpretationDelegation of AuthorityInsurance CarriersAmbulatory Surgical CentersJudicial ReviewDeclaratory ReliefInjunctive Relief
References
19
Case No. MISSING
Regular Panel Decision

Surgicare Surgical v. National Interstate Insurance

This case addresses whether an insurer complies with New York's 11 NYCRR 68.6 regulation by reimbursing for out-of-state medical services according to the host state's (New Jersey's) no-fault fee schedule. Plaintiff Surgicare Surgical, assignee of an injured party, sought full payment for surgery performed in New Jersey, but defendant National Interstate Insurance Company paid a reduced amount based on New Jersey's fee schedule. The court affirmed the defendant's method, ruling that when medical services are rendered in another jurisdiction with its own fee schedule, the 'permissible' charge under that schedule constitutes the 'prevailing fee' under New York's regulation. The decision emphasized alignment with legislative intent to contain no-fault insurance costs and reduce judicial burden, dismissing the plaintiff's complaint and denying its cross-motion.

No-Fault BenefitsInsurance LawFee Schedule DisputeOut-of-State Medical ServicesNew York RegulationsNew Jersey Fee ScheduleStatutory InterpretationAutomobile AccidentReimbursement DisputeSummary Judgment
References
17
Case No. MISSING
Regular Panel Decision

Turner v. Precision Surgical, L.L.C.

Paul Turner was discharged from Precision Surgical, L.L.C. and subsequently filed claims for retaliatory discharge and for refusing to perform an illegal act (insurance fraud). He alleged he was terminated after refusing to file a fraudulent health insurance claim instead of a workers' compensation claim. The trial court submitted jury questions for both claims disjunctively, requiring a 'no' answer to the insurance fraud claim before the workers' compensation claim could be answered. The jury found against Turner on both claims, leading to a take-nothing judgment. Turner appealed, arguing the conditional submission was improper. The appellate court affirmed, ruling that the two claims were mutually exclusive and that any error in the jury instruction was harmless as the jury had considered and rejected both theories of recovery.

Retaliatory dischargeWorkers compensationInsurance fraudJury instructionConditional submissionDisjunctive submissionMutually exclusive claimsHarmful errorSabine Pilot claimEmployment law
References
40
Case No. 2024 NY Slip Op 24190 [84 Misc 3d 497]
Regular Panel Decision
Jul 05, 2024

Cartwright v. Kennedy

This case addresses a novel question regarding the appropriate venue for challenging an independent designating/nominating petition in an Election Law case, specifically for candidates seeking statewide office. Petitioners, led by Caroline Cartwright, sought to invalidate the nominating petition of Robert F. Kennedy, Jr. and Nicole Shanahan for President and Vice President, alleging fraud and false residency claims. Respondents-candidates moved to change venue from Dutchess County to Albany County, arguing Albany was the proper venue under CPLR 506 (b) and 22 NYCRR 202.64 (a) as the location where the New York State Board of Elections (NYSBOE) makes its determinations. The court determined that CPLR 506 (b) applied, and that "the material events" giving rise to the claims were the filing of the nominating petition and objections with NYSBOE in Albany, and NYSBOE's subsequent actions. Consequently, the court granted the respondents-candidates' motion, ordering the transfer of the case from Dutchess County to Albany County due to improper venue in Dutchess and proper venue in Albany.

Election Law DisputeVenue MotionNominating Petition ValidityCandidate Fraud AllegationsStatewide Political CampaignRobert F. Kennedy Jr. CandidacyNew York State Board of Elections JurisdictionCPLR Article 5Judicial ProcedureDutchess County Supreme Court
References
24
Case No. 2015-02-0462
Regular Panel Decision
Oct 26, 2017

Bright, Jeffrey v. HUF North America

Jeffrey Bright, a material handler, sustained a back injury on December 3, 2014, while working for HUF North America. HUF accepted the claim and provided medical treatment. Dr. Richard Duncan, the initial treating physician, determined Mr. Bright suffered a work-related injury, reached maximum medical improvement, was not a surgical candidate, and assigned a 3% permanent impairment rating. Mr. Bright sought a second opinion from Dr. David Wiles, who concurred with the non-surgical finding. The Court found Mr. Bright suffered a compensable injury and is entitled to continued medical treatment with Dr. Duncan and permanent partial disability benefits amounting to $4,788.05.

Back InjuryMaterial HandlerPermanent Partial DisabilityMedical TreatmentAuthorized Treating PhysicianImpairment RatingMaximum Medical ImprovementSecond Medical OpinionAverage Weekly WageEmployer Accepted Claim
References
2
Case No. MISSING
Regular Panel Decision

Matter of Young

The case involves an application by the Secretary of State to cancel and revoke the certification of candidates via telegram. The court affirmed the order without costs and granted the Secretary of State's application. No opinion was provided for the decision, with several judges concurring.

Secretary of Statecertification revocationcandidate certificationtelegramorder affirmedapplication grantedadministrative law
References
0
Case No. 1066539
Regular Panel Decision
Sep 29, 2015

in Re Khistina Caldwell DeJean

This case involves an 'Answer to Original Proceeding Writ of Mandamus' filed by Khistina Caldwell Dejean, a candidate for Mayor of Houston in 2015, in the Fourteenth Court of Appeals. Dejean challenges the scheduling of court dates (October 20 and October 27, 2015) after early election voting, arguing they violate her constitutional rights, specifically referencing Article XIV Section 1. She also mentions a previously granted Affidavit of Indigency. The core of her petition revolves around ensuring her inclusion on the 2015 Mayor election ballot before the election takes place, indicating concerns about election laws and due process.

Election LawWrit of MandamusConstitutional RightsDue ProcessEqual ProtectionAffidavit of IndigencyHouston Mayor ElectionTexas Appeals CourtCourt DatesVoter Rights
References
3
Case No. MISSING
Regular Panel Decision

Texas Supporters of Workers World Party Presidential Candidates v. Strake

This is a federal voting rights case where the Texas Supporters of Workers World Party Presidential Candidates and twenty-five named individuals challenged sections of the Texas Election Code and practices of the Texas Board of Pardon and Paroles and the Governor of Texas. Plaintiffs, including ex-felons, incarcerated felons, welfare recipients, and 'residents,' alleged various constitutional violations, primarily denying their right to vote and access to the political process under the 1st, 8th, 14th, 15th, and 24th Amendments. The court dismissed claims related to aliens, felons, ex-felons, 'idiots and lunatics,' and paupers for lack of standing or insubstantial federal questions. Claims regarding discriminatory denial of parole and pardon were also dismissed, largely due to lack of standing or futility, as were claims by 'residents' and 'consumers' for lack of standing. The request for a three-judge panel was denied, and ultimately, all claims of all plaintiffs were dismissed.

Voting RightsElection LawDisenfranchisementFelon RightsEx-Felon RightsWelfare RecipientsAlien RightsConstitutional LawDue ProcessEqual Protection
References
33
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