Page 1 of 8 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 Zip+4: 78720 State: Texas Telephone: (512) 425-2164 ext. Fax: (512) 241-3305 Email: j mm@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 Lead Attorney Person Organization (choose one) ACCEPTED 05-15-01504-CV FIFTH COURT OF APPEALS

DALLAS, TEXAS 12/9/2015 1:29:17 PM

LISA MATZ CLERKPage 2 of 8 City: Austin Zip+4: 78720 State: Texas Telephone: (512) 435-2150 ext. Fax: (512) 241-3305 Email: rds@fol.com SBN: 19274199

State: Texas Zip+4: 75057 ext. Telephone: (972) 221-4541 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 DallasPage 3 of 8 Yes No No Yes No Yes No Yes No

Yes No Yes 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 No Yes Does this case involve an amount under $100,000?
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 No Yes Agreed? (See TRAP 28.2): If yes, please specify statutory or other basis for such status: No Yes Permissive? (See TRAP 28.3): 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: N ovember 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: No Yes V. Perfection Of Appeal And Jurisdiction

VI. Actions Extending Time To Perfect Appeal Motion to Modify Judgment: If yes, date filed: Motion for New Trial: If yes, date filed: If yes, date filed: Request for Findings of Fact 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 No Yes If yes, date filed: Date ruling on contest due: Sustained Overruled Date of ruling:Page 4 of 8 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: ext. Telephone: (214) 653-6995 Zip + 4: 75202 State: Texas (Note: No request required under TRAP 34.5(a),(b)) Were payment arrangements made with clerk? No Yes 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: N ovember 24, 2015 If no, date it will be requested: Was there a reporter's record electronically recorded? Was reporter's record requested?

No Yes Indigent No Yes No Yes No Yes Is there a reporter's record?

Were payment arrangements made with the court reporter/court recorder?Page 5 of 8 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 Substitute Official Court Recorder Court Reporter

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 kno wn (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 NoPage 6 of 8 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? 4 3 Rate the complexity of the case (use 1 for least and 5 for most complex): 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: Email Fax Telephone Address Name If yes, please give name, address, telephone, fax and email address: Yes No 1 2 3 4 5 Yes No Yes No No Yes 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.Page 7 of 8 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 B ar 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 upo n a number of discretionary criteria, including the financial means of the appellant or appellee. If a case is selected by the Committee, an d can be matched with appellate counsel, that counsel will take over representation of the appellant or appellee without charging legal fees. M ore 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 In ternet 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 Com mittee 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 fact s and information about your case, including parties and background, through selected Internet sites and Listserv to its pool of volu nteer 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 committe e 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 foundin 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 kno wn (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.: 24077822Page 8 of 8 XVI. Certificate of Service The undersigned counsel certifies that this docketing statement has been served on the following lead counsel for all parties t o 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 a nd 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 In j ur y 1 Dallas Email: Leslie@TheCasaubonFirm.com Zip+4: 75057 State Texas 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.