APD 252043
The Appeals Panel affirmed the ALJ’s determination that the claimant was entitled to supplemental income benefits (SIBs) for the first and second quarters, finding reasonable grounds for noncompliance with work search requirements due to timing of the MMI/IR decision and application notice. However, the Panel reversed the award of SIBs for the third quarter, concluding the claimant failed to demonstrate reasonable grounds for not completing required work searches during portions of the qualifying period.
APD 251957
The Appeals Panel affirmed the ALJ’s determination that the compensable injury did not extend to chronic insomnia, nausea, or fatigue, but reversed the finding that it extended to additional cognitive conditions such as brain fog, vertigo, and thought disorganization. The Panel rendered a new decision that those additional disputed conditions were not part of the compensable injury, relying on the designated doctor’s causation analysis. The Panel affirmed on other grounds that the claimant reached MMI on December 5, 2024, with a 10% impairment rating.
APD 251993
The Appeals Panel reversed and remanded the ALJ’s determination that the claimant sustained a compensable injury. Although the ALJ stated that the claimant bore the burden of proof, the Panel concluded the ALJ effectively shifted the burden to the carrier by stating the carrier was required to “prove a negative.” Because this constituted a misapplication of the law regarding the claimant’s burden to prove compensability, the issue was remanded for a new determination applying the correct burden of proof.
APD 252067
The Appeals Panel affirmed the ALJ’s determination that the compensable injury did not extend to left elbow medial or lateral epicondylitis or to left wrist/hand ulnar nerve compression or Guyon’s canal conditions, finding sufficient evidence to support those extent-of-injury findings. However, it reversed by striking the portion of the decision addressing a left wrist/hand ulnar nerve transposition, holding that a surgical procedure is medical treatment, not an injury or condition, and therefore is not properly litigated as an extent-of-injury issue under the Texas Workers’ Compensation Act.
APD 251955
The Appeals Panel affirmed the ALJ’s determination that the compensable injury did not extend to lumbar ankylosing spondylitis. However, it reversed the ALJ’s finding that the first certification of maximum medical improvement and impairment rating became final, holding that a DRIS note was insufficient to establish delivery by verifiable means.
APD 251917
The Appeals Panel reversed and remanded the ALJ’s decision finding a compensable occupational disease. While affirming that the firefighter cancer presumption under Government Code § 607.055 applied, the Panel held that the ALJ failed to make the specific findings and conclusions required by § 607.058(c) addressing whether a qualified expert, using evidence-based medicine, identified a non-service-related cause that substantially caused the disease. The case was remanded for proper findings on rebuttal of the statutory presumption and a new compensability determination.
APD 251790
The Appeals Panel reversed and rendered the ALJ’s decision, holding that the claimant, a peace officer, did sustain a compensable injury in a motor vehicle accident. Applying Orozco v. County of El Paso, the Panel concluded that the claimant’s travel in an employer-provided patrol vehicle, after signing in with dispatch and while being paid and subject to duty, originated in and furthered the employer’s law-enforcement affairs. The evidence established that the coming-and-going rule did not bar compensability under these circumstances.
APD 251710
The Appeals Panel reversed and remanded the ALJ’s decision because the ALJ misstated the mechanism of injury—describing a fall over a drain instead of the actual electrocution while working on a powerline. Because this factual error affected the extent-of-injury determination, the Appeals Panel returned the case for a new decision on whether the compensable injury extends to traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD).
APD 251691
The Appeals Panel affirmed the ALJ’s extent-of-injury findings and the correct disability period but reversed other portions of the decision. The Panel held that the ALJ exceeded the scope of the disability issue by awarding disability outside the agreed dates, and those portions were struck. The Panel also ruled that the ALJ erred in finding the first MMI/IR certification was not delivered by verifiable means, concluding instead that delivery occurred on July 16, 2024, which required remand to determine whether finality applied under Labor Code §408.123.
APD 251609
The Appeals Panel reversed the ALJ’s award of first-quarter SIBs because the ALJ made an unappealed finding that the claimant’s underemployment during the qualifying periods was not a direct result of the compensable injury, which legally bars SIBs entitlement for both quarters. Based on that binding finding, the Panel rendered a decision that the claimant is not entitled to first-quarter SIBs.