War Stories: MLF Legal Wins Extent Of Injury Dispute In A Texas Workers' Compensation Case For Sam
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How MLF Legal Proved a New Injury and Secured Justice for Sam
A Hardworking Employee, A Sudden Injury
Sam worked as a route driver for a porta potty company, hauling and servicing porta potties across North Texas. In March of 2025, while unloading a heavy porta potty from a trailer, the unit tilted onto him. As he tried to steady it, Sam felt a sharp pop in his right shoulder.
Despite finishing his shift, Sam struggled with basic tasks—pushing, pulling, and lifting became nearly impossible. He knew something was seriously wrong.
The Medical Evidence: Comparing Old and New MRIs
Sam had a history of prior shoulder surgeries, but this time the evidence told a different story. His MRI revealed a full-thickness tear of the supraspinatus tendon (rotator cuff) in a different location than his prior tear.
By comparing the new MRI to his earlier scans, MLF Legal showed the judge that this was not a recurrence of pain from an old injury—it was a new tear in a different section of the tendon. Multiple doctors confirmed the injury was acute and recommended surgery. That surgery was delayed only because the insurance company denied the claim by filing an extent of injury dispute.
Frequently Asked Questions About Workers’ Compensation Disputes
A peer review doctor is a physician hired by the insurance company to review medical records and issue an opinion.
- They do not examine the patient.
- Their opinions are often used to deny claims, especially by labeling injuries as “degenerative” or “pre-existing.”
- In Sam’s case, the peer review doctor ignored MRI evidence showing a new tear in a different location, and tried to lump everything together as arthritis or degeneration.
Comparing current MRIs to prior MRIs can be critical in proving whether an injury is new or old.
- If the tear is in a different location than a prior injury, it shows the accident caused a new injury.
- This kind of precise medical evidence can make the difference in winning an extent of injury dispute.
When surgery is recommended but denied, the injured worker is left in limbo—unable to recover and unable to work.
- In Sam’s case, surgery was delayed because the carrier denied the claim.
- By proving the injury was new and work-related, MLF Legal secured benefits so Robert could move forward with treatment.
MLF Legal specializes in challenging insurance company denials. We:
- Work with treating doctors to gather strong medical causation evidence.
- Compare imaging studies to prove new injuries.
- Expose weaknesses in peer review opinions.
- Fight for the benefits you need to recover and return to work.
Injured at work in Texas and your employer doesn’t have workers’ comp?
You may have the right to sue and recover full compensation.
Contact MLF Legal today for a free consultation. You pay nothing unless we win your case.
The Insurance Carrier’s Defense: Peer Review vs. Treating Doctors
The insurance company relied on a peer review doctor, Dr. B. Peer review doctors don’t examine patients; they only review records at the insurance company’s request.
Dr. B’s opinion rested entirely on Sam’s prior injury and surgeries. He tried to lump everything together as “degenerative,” citing articles about arthritis and age-related changes. But he ignored the critical fact: the new tear was in a different place than the old one.
This attempt to muddy the waters with generalized degenerative arguments fell apart when compared to the precise medical evidence from Sam’s treating doctors. The insurance company used this report to create the extent of injury dispute.
The Trial: Extent of Injury Dispute
At the contested case hearing, Sam testified credibly about the accident, his prior surgeries, and his inability to work afterward.
MLF Legal presented the MRI comparisons and medical causation evidence from Sam’s treating doctor and orthopedic surgeons. Together, they showed:
- The tear was new and acute, not degenerative.
- The location of the tear was different from the prior injury.
- Sam had been symptom-free and working full duty until the March 2025 accident.
The judge agreed, ruling that the compensable injury extends to the supraspinatus tendon tear and that Sam had disability resulting from his injury. The insurance company was ordered to pay accrued benefits in a lump sum with interest.
Why This Case Matters
This case highlights one of the most common—and most important—issues in Texas workers’ compensation law: extent of injury disputes.
Insurance carriers often argue that injuries are unrelated to the work accident. Winning these extent of injury disputes requires:
- Precise medical comparisons (like MRI-to-MRI analysis when possible)
- Strong causation evidence from treating doctors
- Aggressive legal advocacy to challenge peer review opinions
How MLF Legal Makes the Difference
At MLF Legal, we don’t just let insurance companies dismiss legitimate injuries as “degenerative.” Our workers’ compensation lawyers dig into the medical records, compare imaging studies when possible, and work with treating doctors to build a clear, compelling case.
In Sam’s case, we proved:
- The new tear was in a different section of the tendon than the prior injury.
- Treating doctors recommended surgery, delayed only by the carrier’s denial.
- Peer review opinions designed for insurance company purposes could not stand against real medical evidence.
By connecting the dots between medical science and the law, we secured justice for Sam— overturned the extent of injury dispute — and ensured he received the benefits he deserved.
Takeaway for Injured Workers
If you’ve been hurt on the job and the insurance company claims your injury is “pre-existing” or “degenerative,” don’t give up. These disputes can be won with the right evidence and the right legal team.
MLF Legal fights for injured workers every day. We know how to build strong cases, challenge carrier experts, and secure the benefits you need to recover.
📞 Call MLF Legal today at 214-357-1782 to discuss your case.
We’re here to stand up for you—just like we did for Sam.