Recent M&B Cases
M&B recently made a lawsuit recovery for a house fire in the amount of $500,000.
Claimant was injured as a teacher in the UT System. The State of Texas denied her claim and offered two teachers as witnesses which claimed she was not injured at work. M&B presented only the Claimant as a witness and proved to the judge that the injured worker was involved in an accident which resulted in her inability to work. Claimant was awarded 5 months of back due off-work benefits plus future medical and indemnity payments.
New Hampshire Ins. Co. accepted only a strain/sprain injury and asked for a state-appointed Designated Doctor who then issued a 0% Rating 4 months after an injury to the Claimant. M&B fought the strain/sprain diagnosis and convinced the judge the injury was much larger. Following a CCH a new Rating was issued of 5% and the Claimant was paid 14 months of back due off-work benefits and 15 weeks of Impairment Income Benefits (IIBS).
SIBS Win – Central Texas
Client of M&B was denied his 2 nd Quarter of SIBS because he failed to properly document his SIBS application with the correct number of JOBS. M&B presented case law to the Hearing Officer which proved that the insurance carrier provided incorrect or inaccurate information which is why the injured worker failed to properly document his job search. The judge agreed with M&B and awarded 2 nd Quarter benefits to the injured worker. The judge also ordered the insurance carrier to pay the Claimant’s attorney’s fees directly to M&B so that it cost the injured worker nothing to have legal representation.
Client was injured and then incarcerated for over eight months. M&B postponed the injured worker’s hearing until after he was released and then despite his incarceration won back due disability of nine months and also won the injured workers’ right to have his hernia surgery covered by workers’ compensation insurance.
Death Claim Won
M&B attended a Contested Case Hearing on behalf of a common-law spouse and won lifetime benefits. When the injured worker died he resided with his common-law spouse and several children. The insurance carrier refused to initiate benefits based on a denial that the M&B client was in fact the common law spouse of the deceased worker. There were several parties claiming rights to death benefits including a prior girlfriend of the injured worker and distant family members. M&B assisted the decedent’s common-law wife in winning death benefits for the remainder of her life as well as defeating the claims of other parties. M&B is also assisting the children in applying for special educational scholarships for the surviving children of workers killed while working in Texas.
Central Texas Intoxication
M&B assisted an injured worker in beating Texas Mutual in an intoxication case. Our client was injured in a motor vehicle accident while working for a construction company. While at the hospital a drug test revealed positive findings for THC or marijuana. Texas Mutual disputed the injured workers rights to both medical and indemnity benefits and denied the claim based on intoxication. M&B fought for the Claimant and beat Texas Mutual and the injured worker was awarded lifetime medical benefits as well as six months of back due off-work benefits.
Claimant gets his Statutory Maximum Medical Improvement (MMI) Date extended over the objection of the DWC and the Insurance Carrier’s expert. After the injured worker applied for an extension he was given just 3 extra days beyond his normal MMI Date. M&B went to CCH and won an additional five months of benefits after retaining an expert report and showing that the Carrier’s expert failed to consider the proper foundations of Texas Labor Code Sec. 408.104 and Rule 126.11(f).
M&B defeats oilfield service company and Zurich American Insurance Company and obtains lifetime medical treatment for injured worker’s knee. The Judge ruled that the Claimant’s injury extended to include chondromalacia and osteoarthritis following an injury at work thereby allowing the injured worker to receive a total knee replacement.
San Antonio, Texas
M&B wins 6 months of back due benefits for injured worker who had moved out of state and appeared at CCH by phone. M&B presented documentary evidence and convinced the Hearing Officer that the injured worker was unable to work and entitled to TIBS despite being fired from her job. The Judge agreed and order the back pay of over 6 months of TIBS and continuing payment of benefits.
Texas Mutual insurance refused to honor their own doctor’s 15% Impairment Rating. M&B attended hearings and won that the insurance company would have to pay the entire 15% Rating assigned by their own RME doctor. Carrier then was forced to pay substantial back due benefits and the injured worker became SIBS eligible.
M&B Defeats West Texas Gas
Client was injured when a truck ran over her foot. The Employer claimed that the injury was not job related because she was exiting her personal vehicle. The Employer participated in the hearing and testified against the injured worker. M&B proved that what vehicle she was exiting was irrelevant to the question of whether she was furthering the business affairs of her employer at the time of the injury. Claimant was ruled to be entitled to 4 months of back due benefits as well as future benefits and all of her medical expenses covered.
M&B Defeats Basic Energy
Judge ruled that hernia was caused by work even though the Employer contended it was not work related. Injured worker was hurt working for Basic Energy when he was connecting 400 pound pipes with a co-worker. Ace American Insurance disputed the claim and alleged that the hernia was not work related. M&B proved that the injury occurred at work and the injured employee was granted five months of back due benefits.
Claimant prevailed in a dispute over whether his injury was caused due to his having engaged in horseplay. Carrier, Texas Mutual Insurance, disputed the Claimant’s injury when he was lifted by a co-worker, after having requested that he be left alone, and was dropped resulting a break to his ankle. The Hearing Officer found the Claimant had not engaged in horseplay and was therefore still in the course and scope of his employment when a co-worker dropped him, thusly fracturing his ankle. The Claimant was also awarded disability for the lost time from work.
San Angelo, Texas
Claimant was found to have sustained a compensable injury and have disability from that injury when he was injured lifting pipe. Carrier, American Zurich Insurance, argued among other things, Claimant an employee of Nabors, had not suffered any injury, had not reported said injury, had sustained the injury (if one existed) while he was not at work and had been treating for said injury prior to the date of the work-related incident, and that Claimant was an attorney in his home country and had concocted this story simply to obtain workers’ compensation benefits (a charge which was unfounded and based on hearsay only). Claimant prevailed in demonstrating that he did in fact sustain the compensable injury, and that he had sustained continuing disability due to the compensable injury.
Claimant was found to have sustained disability despite her separation from work. Carrier, Texas Mutual Insurance, argued Claimant had been working post injury in her job at full duty wages and therefore due to her having “quit,” (the Claimant maintained she was terminated) she was not entitled to disability benefits for the lost wages post separation from the employment. Claimant successfully argued her lost time from work was at least caused in part due to her work-related injuries. She argued she was terminated when she was unable to come to work during an ice storm and that post that date her injury had in fact regressed and she had gotten worse (borne out by the evidence). The Hearing Officer found the Claimant’s compensable injury was in fact a cause of her inability to obtain or retain employment at her pre-injury wages and she was awarded disability pay for those injuries.
M&B Defeats Insurance Company on Intoxication Claim
Claimant was found to have sustained a compensable injury, that his injury did not occur while he was in a state of intoxication, and to have sustained disability as a result of that work-related injury. Carrier, Texas Mutual Insurance, argued Claimant (for whom there was a positive drug screen evidencing the presence of marijuana metabolites) was in a state of intoxication at the time of his injury, as a result they were relieved of liability for benefits, that he did not sustain a compensable injury, and there was no disability as a result of the work-related injuries. Clamant successfully argued he was not in a state of intoxication when the injury occurred. He relied on his interactions with his supervisors which occurred on four occasions throughout the day prior to the accident, the fact he was not requested to stop working and go home for the day, the emergency room records which evidenced he had normal pupil reactivity and was cooperative, alert and awake during all examinations, as well as a narrative from the surgeon which indicated Claimant had been examined by the Emergency Room physician, the surgeon, and an anesthesiologist all of whom obtained informed consent and did not at any point believe the Claimant was in a state of intoxication when he presented directly following the injury for treatment. The Hearing Officer found the Claimant was not in a state of intoxication when the injury occurred, Texas Mutual Insurance Company was not relieved from liability, and the Claimant had sustained-and was sustaining at the time of the hearing-disability as a result of the crush injury to the Claimant’s hand which required extensive plates and pinning.
Extent of Injury Victor
Claimant was found to have sustained a Lumbar herniation with extruded disc fragment and resulting radiculitis due to his work place accident. Carrier, Starr Indemnity and Insurance Company, argued the Claimant’s injury was only a lumbar sprain/strain and that he did not sustain disability as a result of that injury. The Claimant and Carrier had already gone to a Contested Case Hearing months prior to obtaining this attorney and he had been found to have sustained disability; however, the Carrier paid the period in question and ceased payment of anything post the initial Contested Case Hearing date. Claimant was able to successfully argue through use of a narrative from his surgeon, his injury extended to and included a lumbar herniation with extruded disc fragment and resulting radiculitis. Additionally, the Hearing Officer did find he had sustained disability from the date following the previous Contested Case Hearing, the same continuing through the date of this Contested Case Hearing.
Claimant was found to have sustained disability as a result of the compensable injuries. Case was initially in Lubbock, but the venue was changed to Abilene post Benefit Review Conference when Claimant moved from Lubbock to Abilene prior to the Contested Case Hearing. Carrier, State Office of Risk Management, argued the Claimant did not sustain disability as a result of the compensable injury, the Claimant had not sustained a compensable injury, and if he had done so the Carrier was able to take credit for wages offered to Claimant pursuant to an offer of employment. Claimant was able to demonstrate, despite losing the issue over the extent of his compensable injury, that he had in fact sustained disability as a result of the compensable injuries. Perhaps more importantly, Carrier was not allowed to take credit for the offered wages as the Employer had not offered a “Bona Fide Offer of Employment” as they had not satisfied the requirements to have done so. As a result the Claimant was awarded his Temporary Income Benefits and is being paid the same during pendency of appeal over the extent of injury issue.
Claimant successfully argued without need for a Contested Case Hearing, that his application for Supplemental Income Benefits was not late as it was received by the Insurance Carrier timely. The Carrier made payment of all previously disputed benefits during pendency of the Benefit Review Conference and claimant was made whole without the necessity of further intervention by the Division of Workers’ Compensation.
Energy Company Defeated
Miller & Bicklein assisted an injured worker from Andrews, Texas who was injured when his finger was crushed in an oil field accident. The Employer and Carrier denied that he was disabled after he was laid off by the energy company. M&B fought his company doctor and the Carrier and won the injured worker 5 months of back due benefits.
School Employee Defeats State
Bandera employee won a 22% Impairment Rating that was disputed by the insurance carrier. M&B assisted the injured worker in obtaining substantial evidence that her injury was severe and long lasting and deserving of a 22% Rating. The self-insured school district hired attorneys and experts to dispute the Rating but where not able to overcome the case presented on the injured employee’s behalf.
Out-Of-State Worker Wins
An over-the-road truck driver was injured in the State of Texas. His employer denied the claim and he retained Miller & Bicklein to assist him. M&B defeated the insurance carrier and employer despite a very conservative traveling judge. The Claimant won the right to pursue badly needed shoulder surgery.
Injured worker prevails after M&B obtain multiple expert reports which prove that her injury did extend to and include an L5-S1 protrusion/herniation and lumbar radiculopathy. She is now pending spinal surgery and is seeking to extend her Statutory Maximum Medical Improvement Date because of the victory. The Judge also ruled that she was not at MMI and overturned a seven month old Rating from a state-appointed Designated doctor which will result in seven months of back due benefits being sent to our client.
Wink Resident Wins
Client who lived in Wink, Texas was denied disability benefits. The insurance carrier and Employer insisted that the injured worker was able to work and refused to pay him off work benefits. After hiring Royce Bicklein a Contested Case Hearing was held and the Judge ruled in the our client’s favor resulting in 3 months of back due benefits and continuing benefits to be paid to client.
M&B Wins Intoxication Case
Claimant was injured in a drilling rig accident when the driller made a mistake which crushed the floor hand’s fingers. The insurance company denied the claim based on a positive drug screen for cocaine. M&B proved that the Claimant was not intoxicated at the time of the accident and the judge ordered the payment of back due benefits and future medical coverage.
Simons v. Texas Mutual Ins. Co.
In Ector County District Court, Kevin Miller and Matthew Olivarez represented a young man who was accused of being intoxicated at work when he was injured. Texas Mutual produced a drug test and expert witness who alleged that the injured worker was intoxicated at the time of his accident. Texas Mutual withdrew their expert after Miller & Bicklein proved that he was an employee of the Carrier’s own healthcare network and therefore biased. The parties then proceeded to a trial at which, an Odessa jury awarded Mr. Simons all of his back due Temporary Income Benefits as well as Impairment Income Benefits and lifetime medical benefits for his injuries when they found that he was not intoxicated.
Canyon Lake Resident Wins Benefits
A man injured working at a remote substation installing cable injured his low back. The Employer and Zurich American Insurance denied the claim and alleged that the injury happened at home. Royce Bicklein attended a Contested Case Hearing and won the Claimant’s medical and income benefits.
Texas Mutual Loses
Injured worker was left in a coma after he had an accident with his Hot Oil propane truck. He was left with severe burns which caused amputation of his fingers and the resulting surgery left him in a coma for several weeks. The Employer alleged the accident didn’t happen at work and accused the injured worker of stealing propane and injuring himself off premises. Texas Mutual brought six witnesses to the Contested Case Hearing in an attempt to prove the allegation. M&B defeated the Employer and Carrier and won the injured worker’s rights to lifetime medical coverage for his injuries as well as over six months of back due benefits.
M&B Defeats West Texas Gas & AIG
Employee was injured when she moved a heavy “tote” of products while restocking shelves. West Texas Gas manager disputed the claim and encouraged AIG to fight the benefits. M&B went to a Contested Case Hearing and won the injured employee’s rights to medical benefits and 6 months of back due benefits.
CRPS / RSD Covered
AIG Insurance denied an injured worker’s Complex Regional Pain Syndrome (CRPS) / Reflex Sympathy Dystrophy (RSD) based on their own RME doctor’s opinion. M&B obtained expert reports that the injured worker met the “Harden” and “Budapest” criteria which define CRPS/RSD and the Hearing Officer Ruled that the injured worker’s injury did include the condition and therefore his Impairment Rating was a 25%, not the 2% previously certified. Claimant was therefore eligible for long term Supplemental Income Benefits.
M&B Defeats Basic Energy
A Big Spring, Texas injured worker was placed at MMI by a state-appointed Designated Doctor based on only her lower back injury. M&B went to CCH and won that her injury also included her middle back or thoracic spine and got the Designated Doctor report thrown out which allowed the injured worker to obtain 11 months of back due benefits and potential spinal surgery.
M&B Gets Out-Of-State Worker Texas Benefits
An Arizona resident was injured in Texas when he was breaking down equipment. His shoulder required surgery for repair and his claim was denied by the workers’ compensation insurance company, Broadspire. M&B attended a CCH in San Antonio, Texas where it defeated the Carrier and the Hearing Officer ruled that the injured worker was injured within the course and scope of his employment and was unable to work and should be paid by Broadspire. The Hearing Officer also ruled that he did not make an election of remedies which barred him from taking workers’ compensation and that he did inform his supervisor of his injury within 30 days.
M&B Successfully Disqualifies A Designated Doctor
Our client in Alpine, Texas was scheduled to see a Designated Doctor at the office of his former treating doctor who was the company’s choice of physicians. Our client changed doctors to receive better care and was then sent back to the office of his former treating doctor to see a new state-appointed Designated Doctor. M&B successfully threw out the Designated Doctor because of the influence his Employer might impose on the appointment.
Back-Due TIBS Won Almost 2 Years After Injury
Client was injured and suffered an eye injury, but continued to work until he was fired. Six months after he was terminated he retained M&B and we fought for and successfully obtained Temporary Income Benefits (TIBS) despite the injury being almost two years old and despite the fact he continued to work and was terminated for cause.
Extent of Injury: Shoulder
Odessa client wins supraspinatus tendon tear in shoulder with impingement syndrome. M&B convinced the Hearing Officer to ignore the opinion of the insurance company expert and the state-appointed Designated Doctor and ruled for our client on extent of injury. Our client is now pending shoulder surgery that he badly needs.
Andrews, Tx: Client Wins SIBS
Client with deep vein thrombosis and resultant pulmonary embolism wins a 20% Impairment Rating, qualifying him for Supplemental Income Benefits (SIBS). The DWC approved the 1 st Quarter of SIBS, but the insurance carrier filed a dispute. M&B won the Client’s right to payment for the 1 st Quarter of SIBS under the theory that he was unable to work because of his DVT and PE.
Injury From Motor Vehicle Accident Covered
On March 13, 2015 a Midland, Texas Hearing Officer ruled that our client’s injuries did extend to and include multiple lumbar conditions including herniated discs and radiculopathy. Our Client is now scheduled for badly needed lumbar surgery and M&B are pursuing a new Impairment Rating to get additional income benefits.
Oilfield Service Company Loses
M&B defeated the insurance company claim that our client wasn’t really hurt at work because he failed to report the injury to the Monahan’s company he worked for in a timely fashion. The Hearing Officer ruled for the M&B Client that he was in fact injured at work and was entitled to both medical and indemnity benefits for his knee injury.
Oilfield Injury Gets Covered
On March 13, 2015 a Midland Hearing Officer ruled for an M&B Client. The Client was injured while working for an oilfield service company. While on location the Client twisted his knee and suffered internal derangement. Texas Mutual denied the claim as not within the course and scope of his employment. M&B won coverage for his knee as well as back due benefits owed and continuing medical treatment.
Quick Results vs. Texas Mutual Insurance Company
M&B was hired on January 20, 2015 to challenge an Impairment Rating by an ExamWorks doctor. Without attending a hearing our client received $39.917.52 on March 10, 2015 from Texas Mutual when M&B obtained a new Impairment Rating for our client.
American Zurich Insurance Co. v. Sandra Jasso
Ms. Jasso retained Miller & Bicklein, PC after her husband died in a traffic accident in Odessa, Texas. Mr. Jasso worked in oil field servicing pumping stations. Zurich American insurance denied his wife’s claim for spousal survivor death benefits. Royce Bicklein won at the Division of Workers’ Compensation of the Texas Department of Insurance that Mr. Jasso was in the course and scope of employment when his auto accident occurred and therefore his wife was entitled to benefits. The Contested Case Hearing (CCH) in Midland, Texas ordered Zurich Insurance to immediately start benefits. Zurich Insurance appealed this decision to Federal District Court in Midland where Kevin Miller won her continued benefits in Federal District Court. Miller & Bicklein continue to represent Ms. Jasso before the Fifth Circuit US Court of Appeals. On January 31, 2015 the Fifth Circuit Court of Appeals upheld the prior decisions and Miller & Bicklein, PC won the right for her to continue to receive spousal survivor benefits for the remainder of her life.
M&B Defeats American Casualty Company
Miller & Bicklein, PC defeat American Casualty Co. and won carpal tunnel as part of client’s injuries. The Hearing Officer of the Division of Workers’ Compensation ruled that the New Mexico resident’s injuries did extend to and include carpal tunnel syndrome from repetitive trauma working in a laundry. Surgery was recently performed and now we are using the surgery to challenge the prior Impairment Rating.
Texas Mutual Insurance defeated by M&B
Miller & Bicklein beat Texas Mutual and a Midland Judge rules that client’s injury does include cervical and lumbar herniations and radiculopathy following a motor vehicle accident in the oilfield. The Judge also threw out our client’s prior low Impairment Rating resulting in back due benefits being paid to client in lump sum.
M&B Win Intoxication Case
Mark Cevallos wins an intoxication case against Texas Mutual in San Antonio, Texas. Following a denial of client’s claim by Texas Mutual which was based on a belief that our client was intoxicated. Mark Cevallos convinced the DWC to reverse that denial and order the back payment of monetary benefits and ordered them to pay for all of client’s medical treatment.
M&B Win Extent of Injury Case
Miller & Bicklein defeat Texas Mutual on extent of injury case. Our Client was injured in October, 2013 and had spinal surgery which the insurance carrier refused to pay for. Royce Bicklein won an administrative hearing wherein the DWC ordered the insurance carrier to pay for surgery and all medical care related to L4-5 retrolisthesis and L5-S1 disc derangement and degeneration following an injury suffered by a nurse lifting a patient.
M&B Wins Oilfield Injury
On December 8, 2014 Miller & Bicklein attend a fourth CCH and defeated New Hampshire Insurance company for the fourth time in a case involving an oilfield injury. In the final case for client the Judge ordered the back payment of six months of benefits that the insurance carrier refused to pay. Previous cases won prior benefits and medical rights including the payment of spinal surgery.
School District Employee Suffers Shoulder Injury
On December 1, 2014 Royce Bicklein defeated NEISD in San Antonio, Texas where a janitor was hurt in a stair-well slip and fall accident. The Judge ruled that client’s injuries of right shoulder tear and degenerative conditions were related to the fall and the surgery performed was compensable. NEISD was forced to pay back due benefits in lump sum to client.
Zurich American Insurance Defeated
Miller & Bicklein won the right for spinal surgery for a worker who was injured while lifting a box. Miller & Bicklein defeat Zurich American Insurance and overturned the Impairment Rating of a Designated Doctor based on the need for surgery. Our Client is now due a new Impairment Rating which will result in additional income.