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Appellate Docket Number:

Appellate Case Style: WORKERS COMPENSATON SOLUTON

Vs. TEXAS HEALTH, L.L.C., dba INJURY 1 DALLAS

Companion Case No.:

DOCKETING STATEMENT (Civil)

(to be filed in the court of appeals upon perfection of appeal under TRAP 32)

Amended/corrected statement:

Appellate Court:5th Court of Appeals

I. Appellant

Address 2:

Address 1: P.O. Box 201329

 II. Appellant Attorney(s)

Pro Se:

Suffix:

Last Name:

Middle Name:

First Name:

Organization Name: Workers Compensation Soluton

Law Firm Name:Flahive, Ogden & Latson

Suffix:

Last Name: MacCarty

Middle Name:

First Name: Jessica

Lead Attorney

City: Austin

State: Texas Zip+4: 78720

Telephone: (512) 425-2164 ext.

Fax: (512) 241-3305

Email: jmm@fol.com

SBN: 24077822

Person Organization (choose one)

I. Appellant

Address 2:

Address 1: P.O. Box 201329

 II. Appellant Attorney(s)

Pro Se:

Suffix:

Last Name:

Middle Name:

First Name:

Law Firm Name:Flahive, Ogden & Latson

Suffix:

Last Name: Stokes

Middle Name: D

First Name: Robert

Person Organization (choose one) Lead Attorney

ACCEPTED

05-15-01504-CV

FIFTH COURT OF APPEALS

DALLAS, TEXAS

12/9/2015 1:29:17 PM

LISA MATZ

CLERK

05-15-01504-CV

 FILED IN 5th COURT OF APPEALS DALLAS, TEXAS 12/9/2015 1:29:17 PM LISA MATZ Clerk
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City: Austin

State: Texas Zip+4: 78720

Telephone: (512) 435-2150 ext.

Fax: (512) 241-3305

Email: rds@fol.com

SBN: 19274199

State: Texas Zip+4: 75057

Telephone: (972) 221-4541 ext.

Fax: (972) 221-4241

Email: leslie@thecasaubonfirm.com

SBN: 24040165

Lead Attorney

First Name: Leslie 

Middle Name: R.

Last Name: Casaubon

Suffix:

Law Firm Name: The Casaubon Firm, L.L.P.

Address 1: 117 Hillside Drive

Address 2:

City: Lewisville

 Person Organization (choose one)

Pro Se:

Suffix:

Last Name:

Middle Name:

First Name:

 III. Appellee IV. Appellee Attorney(s)

Organization Name: Texas Health, L.L.C., d/b/a Injury 1 Dallas
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Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Does the appeal involve the constitutionality or the validity of a statute, rule, or ordinance?

Appeal from final judgment:

Judgment or order disposes of all parties and issues: 

Yes No

Yes No

Does this case involve an amount under $100,000? Yes No

Yes No

If yes, please specify statutory or other basis for such status:

Appeal should receive precedence, preference, or priority under statute or rule: Yes No

Agreed? (See TRAP 28.2): Yes No

If yes, please specify statutory or other basis for such status:

Permissive? (See TRAP 28.3): Yes No

Parental Termination or Child Protection? (See TRAP 28.4):

If yes, please specify statutory or other basis on which appeal is accelerated:

Accelerated appeal (See TRAP 28): Yes No

If yes, please specify statutory or other basis on which interlocutory order is appealable (See TRAP 28):

Interlocutory appeal of appealable order:

If mailed to the trial court clerk, also give the date mailed:

Date notice of appeal filed in trial court: N/A

Date order or judgment signed: November 24, 2015

Nature of Case (Subject matter or type of case): Worker’s Compensation

Type of judgment: Interlocutory Order

If yes, please specify statutory or other basis for such status:

Yes No

V. Perfection Of Appeal And Jurisdiction

VI. Actions Extending Time To Perfect Appeal

Motion to Modify Judgment:

Motion for New Trial: If yes, date filed:

If yes, date filed:

Request for Findings of Fact If yes, date filed:

and Conclusions of Law:

Motion to Reinstate: If yes, date filed:

If yes, date filed: Motion under TRCP 306a:

Other:

If other, please specify:

VII. Indigency Of Party: (Attach file-stamped copy of affidavit, and extension motion if filed.)

Affidavit filed in trial court:

Contest filed in trial court:

Ruling on contest:

If yes, date filed:

Yes No

Yes No

If yes, date filed:

Date ruling on contest due:

Sustained Overruled Date of ruling:
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VIII. Bankruptcy

Has any party to the court's judgment filed for protection in bankruptcy which might affect this appeal? Yes No

If yes, please attach a copy of the petition.

Date bankruptcy filed: Bankruptcy Case Number:

IX. Trial Court And Record

Court: 134th District Court

Suffix:

Last Name: Tillery

Middle Name:

First Name: Dale

Trial Judge (who tried or disposed of case):

Trial Court Docket Number (Cause No.): DC15-07557G

County: Dallas County

Clerk's Record:

Address 1: 134th District Court

Address 2 : 600 Commerce Street, 6th Floor West

City: Dallas

Email: fly@dallascourts.org

Fax:

Telephone: (214) 653-6995 ext.

State: Texas Zip + 4: 75202

(Note: No request required under TRAP 34.5(a),(b))

Were payment arrangements made with clerk?

Yes No Indigent

If no, date it will be requested: December 10, 2015

If yes, date requested:

Trial Court Clerk: District County

Was clerk's record requested? Yes No

Reporter's or Recorder's Record:

If yes, date requested: November 24, 2015

If no, date it will be requested:

Was there a reporter's record electronically recorded?

Was reporter's record requested?

 Yes No Indigent

Yes No

Yes No

Yes No

Is there a reporter's record?

Were payment arrangements made with the court reporter/court recorder?
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Email: vdobbins@dallascounty.org

Fax:

Telephone: (214) 653-7239 ext.

State: Texas Zip + 4: 75202

City: Dallas

Address 2:

Address 1: 600 Commerce Street

Suffix:

Last Name: Dobbins

Middle Name:

First Name: Vielica

Official Substitute

Court Reporter Court Recorder

X. Supersedeas Bond

Supersedeas bond filed: 

Will file:

If yes, date filed:

Yes No

Yes No

Will you request extraordinary relief (e.g. temporary or ancillary relief) from this Court?

If yes, briefly state the basis for your request:

Yes No

XI. Extraordinary Relief

Should this appeal be referred to mediation?

If no, please specify:

Has the case been through an ADR procedure?

If yes, who was the mediator?

What type of ADR procedure?

At what stage did the case go through ADR?

If other, please specify:

Type of case? Worker's Compensaton

Give a brief description of the issue to be raised on appeal, the relief sought, and the applicable standard for review, if known (without 

prejudice to the right to raise additional issues or request additional relief):

Petitioner requests permissive Interlocutory appeal of trial court's denial of its plea to the jurisdiction. Relief sought is dismissal of the underlying 

lawsuit. 

How was the case disposed of? Other

Summary of relief granted, including amount of money judgment, and if any, damages awarded. N/A

Actual damages:

Punitive (or similar) damages:

If money judgment, what was the amount?

Yes No

Pre-Trial Post-Trial Other

XII. Alternative Dispute Resolution/Mediation (Complete section if filing in the 1st, 2nd, 4th, 5th, 6th, 8th, 9th, 10th, 11th, 12th, 13th, 

or 14th Court of Appeal)

Yes No
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Attorney's fees (trial):

Attorney's fees (appellate):

Other:

If other, please specify:

Will you challenge this Court's jurisdiction?

Does judgment have a Mother Hubbard clause?

Does judgment have language that one or more parties "take nothing"?

Other basis for finality?

Rate the complexity of the case (use 1 for least and 5 for most complex): 3 4

Please make my answer to the preceding questions known to other parties in this case.

Can the parties agree on an appellate mediator?

Name of person filing out mediation section of docketing statement:

Languages other than English in which the mediator should be proficient:

Name Address Telephone Fax Email

If yes, please give name, address, telephone, fax and email address:

 Yes No

1 2 3 4 5

Yes No

Yes No

Yes No

Yes No

XIII. Related Matters

Vs.

Style:

Docket Number: Trial Court:

List any pending or past related appeals before this or any other Texas appellate court by court, docket number, and style.
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XIV. Pro Bono Program: (Complete section if filing in the 1st, 3rd, 5th, or 14th Courts of Appeals)

The Courts of Appeals listed above, in conjunction with the State Bar of Texas Appellate Section Pro Bono Committee and local Bar 

Associations, are conducting a program to place a limited number of civil appeals with appellate counsel who will represent the appellant in 

the appeal before this Court. 

 

The Pro Bono Committee is solely responsible for screening and selecting the civil cases for inclusion in the Program based upon a number of 

discretionary criteria, including the financial means of the appellant or appellee. If a case is selected by the Committee, and can be matched 

with appellate counsel, that counsel will take over representation of the appellant or appellee without charging legal fees. More information 

regarding this program can be found in the Pro Bono Program Pamphlet available in paper form at the Clerk's Office or on the Internet at 

www.tex-app.org. If your case is selected and matched with a volunteer lawyer, you will receive a letter from the Pro Bono Committee within 

thirty (30) to forty-five (45) days after submitting this Docketing Statement. 

Note: there is no guarantee that if you submit your case for possible inclusion in the Pro Bono Program, the Pro Bono Committee will select 

your case and that pro bono counsel can be found to represent you. Accordingly, you should not forego seeking other counsel to represent you 

in this proceeding. By signing your name below, you are authorizing the Pro Bono committee to transmit publicly available facts and 

information about your case, including parties and background, through selected Internet sites and Listserv to its pool of volunteer appellate 

attorneys. 

Do you want this case to be considered for inclusion in the Pro Bono Program? 

 

Do you authorize the Pro Bono Committee to contact your trial counsel of record in this matter to answer questions the committee may have 

regarding the appeal? 

 

Please note that any such conversations would be maintained as confidential by the Pro Bono Committee and the information used solely for 

the purposes of considering the case for inclusion in the Pro Bono Program. 

 

If you have not previously filed an affidavit of Indigency and attached a file-stamped copy of that affidavit, does your income exceed 200% of 

the U.S. Department of Health and Human Services Federal Poverty Guidelines? 

 

These guidelines can be found in the Pro Bono Program Pamphlet as well as on the internet at http://aspe.hhs.gov/poverty/06poverty.shtml. 

 

Are you willing to disclose your financial circumstances to the Pro Bono Committee? 

If yes, please attach an Affidavit of Indigency completed and executed by the appellant or appellee. Sample forms may be found in the Clerk's 

Office or on the internet at http://www.tex-app.org. Your participation in the Pro Bono Program may be conditioned upon your execution of 

an affidavit under oath as to your financial circumstances. 

 

Give a brief description of the issues to be raised on appeal, the relief sought, and the applicable standard of review, if known (without 

prejudice to the right to raise additional issues or request additional relief; use a separate attachment, if necessary). 

 

XV. Signature

Signature of counsel (or pro se party) Date: December 9, 2015

Yes No

Yes No

Yes No

Yes No

Electronic Signature: /s/ Jessica MacCarty

(Optional)

Printed Name: Jessica MacCarty State Bar No.: 24077822
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XVI. Certificate of Service

The undersigned counsel certifies that this docketing statement has been served on the following lead counsel for all parties to the trial 

court's order or judgment as follows on . 

Person Served

Certificate of Service Requirements (TRAP 9.5(e)): A certificate of service must be signed by the person who made the service and must 

state:

 (1) the date and manner of service; 

 (2) the name and address of each person served, and 

 (3) if the person served is a party's attorney, the name of the party represented by that attorney 

December 9, 2015

State Bar No.: 24077822

Signature of counsel (or pro se party) Electronic Signature: /s/ Jessica MacCarty

(Optional)

If Attorney, Representing Party's Name: Texas Health D/B/A Injury 1 Dallas

Email: Leslie@TheCasaubonFirm.com

State Texas Zip+4: 75057

City: Lewisville

Address 2:

Address 1: 117 Hillside Drive

Law Firm Name:The Casaubon Firm, L.L.P.

Suffix:

Last Name: Casaubon

Middle Name:

First Name: Leslie

Manner Served: eServed

Date Served: December 9, 2015

Please enter the following for each person served:

Fax:

Telephone: ext.