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He applied for and received workers' compensation benefits for the work-related injury. This fee-shifting provision in § 408.221 did not exist until 2001. This multi-faceted review involving both evidentiary and discretionary matters is required by the language of the Act. In concluding that reasonableness and necessity of attorney's fees were matters of fact committed to a jury, we also noted that there are "factors prescribed by law which guide the determination of whether attorney fees are reasonable and necessary." Id. Crump has not pointed us to a reason to exempt § 408.221 from the general rule announced in those cases: "[T]he reasonableness of statutory attorney's fees is a jury question." City of Garland, 22 S. Nor do we see language in § 408.221 that distinguishes it from the language of the statutory regimes to which we applied the general rule in those cases. If the claimant prevails only on some issues, then after the jury's verdict is announced the court will apportion the fees per the factors in subsection (d), and will award reasonable and necessary attorney's fees to the claimant's attorney only for those issues on which the claimant prevails. First, Transcontinental did not procedurally preserve error regarding the "substantial factor" language because it did not request the language in the trial court. Hendrick Mem'l Hosp., , 973 (Tex.1943) ("[A] contractual relation arises under the Workmen's Compensation Law in which the employer, the employee and the insurer are the principal parties."). Corp., , 297 (Tex.1988) ("[W]e have warned that the provisions of the Act `should not be hedged about with strict construction, but should be given a liberal construction to carry out its evident purpose.'" (quoting Yeldell v. & Nursing Ctr., , 75 (1953) ("Since the workman coming under the terms of the Act is denied his common law rights it is held that the Act should be liberally construed in his favor. The injury caused a contusion (bruise) and a hematoma (a collection of blood) at the wound site. We had to determine whether a judge or jury was to decide the amount of fees in order to answer another question: "[B]y what standard is such an award of attorney fees to be reviewed on appeal"? Because the Act read "may," the trial court had discretion to decide whether to award fees at all. We recognized that the Act limited this discretion in four ways: reasonableness, necessity, equity, and justice. Unreasonable fees cannot be awarded, even if the court believed them just, but the court may conclude that it is not equitable or just to award even reasonable and necessary fees. The principles established for construing statutory fee-shifting provisions in City of Garland and Bocquet assist the interpretation of § 408.221(c) of the Texas Labor Code. The next step depends on whether the claimant totally or partially prevails on the issues appealed by the insurance carrier. Regardless of what the Court says "substantial factor" means legally, the implication of a cause being substantial to a lay juror is that the cause must be more than minor, even if the minor cause is a concurring cause without which the death or disability would not have occurred.

After hearing the evidence, the jury answered in the affirmative the single question put before it, "Was Charles Crump's May 9, 2000 injury a producing cause of his death? Crump's expert and treating physician, Daller, testified that the wound site of the May 2000 work-related injury became infected, the infection caused Crump's already-weakened organs to fail, and his organ failure in turn caused his death. denied) (en banc) ("[Differential diagnosis] is a clinical process whereby a doctor determines which of several potential diseases or injuries is causing the patient's symptoms by ruling out possible causes—by comparing the patient's symptoms to symptoms associated with known diseases, conducting physical examinations, collecting data on the patient's history and illness, and analyzing that data—until a final diagnosis for proper treatment is reached."). The mere fact that differential diagnosis was used does not exempt the foundation of a treating physician's expert opinion from scrutiny—it is to be evaluated for reliability as carefully as any other expert's testimony. "Differential diagnosis is `the basic method of internal medicine' and enjoys widespread acceptance in the medical community. [to] determine whether there are any significant analytical gaps in the expert's opinion that undermine its reliability.") (citations omitted). At the time that he experienced the injury, that injury caused a progression of his hepatic insufficiency, and because of his inability to fight off infections and also because of his overall medical condition, it caused a series of events that led to his death. Crump would have been in there in Polly Ryon [Memorial Hospital] on January 23rd of 2001, dying of liver failure, kidney failure, aspiration of the stomach, his heart was giving out—I mean, his whole body was shutting down. Transcontinental bore the burden of proving, by a preponderance of the evidence, the negative proposition that the May 2000 injury was not a producing cause of Crump's death. Here, the charge error "relate[d] to a contested, critical issue"—indeed, the sole issue—that of causation. To ask the jury to resolve this dispute without a proper legal definition [of justification,] the essential legal issue[,] was reversible error."). In these circumstances, the absence of a proper definition of producing cause probably resulted in an improper judgment and, as such, was reversible error. Transcontinental tendered its own definition in writing, including a but—for component: "that cause, which in a natural and continuous sequence, produces death and without which, the death would not have occurred." See TEX. Transcontinental first argues that the trial court erred in denying it a jury trial on the amount of Crump's reasonable and necessary attorney's fees for which Transcontinental was statutorily liable, and second, in permitting Crump to recover attorney's fees incurred in pursuing those statutory attorney's fees. Specifically, we are guided by prior decisions examining the issue of reasonable and necessary attorney's fees in the context of fee-shifting provisions in other statutory regimes and by the history of how § 408.221 has evolved over the years. Because, in effect, the claimant pays in this situation, the claimant's attorney's fees are limited to 25% of the claimant's recovery. The trial court disagreed with Transcontinental and awarded Crump attorney's fees, as well as fees for time spent pursuing those fees. The court of appeals grouped Transcontinental's issues into three categories: (1) the trial court's acceptance of the reliability of Crump's expert's testimony on causation, as well as the legal and factual sufficiency of that testimony to support the verdict; (2) the trial court's definition of producing , 96 (Tex. Finding no error in any category, the court of appeals affirmed the trial court's judgment. Without Daller's testimony, Transcontinental argues, Hunt's testimony establishes the lack of causation. Joiner, [I]n very few cases will the evidence be such that the trial court's reliability determination can properly be based only on the experience of a qualified expert to the exclusion of factors such as those set out in Robinson, or, on the other hand, properly be based only on factors such as those set out in Robinson to the exclusion of considerations based on a qualified expert's experience., 638 (Tex.2009); see also Mack Trucks, 206 S. Although Hunt would have reached different conclusions regarding Crump's infection, he stated that he agreed with the treatment methodology Daller employed. W.2d at 557 (noting that the Robinson reliability inquiry focuses "solely on the underlying principles and methodology, not on the conclusions they generate"); cf. Moving to the other Robinson factors, we note that, in some cases, a physician's differential diagnosis may be too dependent upon the physician's subjective guesswork or produce too great a rate of error—for example, when there are several consistent, possible causes for a particular set of symptoms. W.3d at 237 ("An expert's failure to rule out alternative causes of an incident may render his opinion unreliable."); Robinson, 923 S. W.2d at 558-59 (concluding that the trial court did not abuse its discretion by excluding testimony by an expert who "conducted no testing to exclude other possible causes . We conclude that Daller's testimony adequately excluded, with reasonable medical certainty, the other plausible causes raised by the evidence. But to assist the parties and the court on remand, we further held that producing cause should be correctly defined as "a substantial factor in bringing about an injury, and without which the injury would not have occurred." Id. The definition submitted by Crump and accepted at trial—"`Producing Cause' means an efficient, exciting, or contributing cause that, in a natural sequence, produces the death in question. Transcontinental asserts that the trial court's omission of the but-for component of the producing cause definition was reversible error. "A judgment will not be reversed for charge error unless the error was harmful because it probably caused the rendition of an improper verdict. Relying on this Court's precedent and the language of § 408.221, Transcontinental argues that the trial court erred when it refused to grant a jury trial and, instead, decided the disputed amount of Crump's attorney's fees for which Transcontinental was liable under § 408.221(c). According to Crump, subsection (c)'s instruction that the court is to award apportioned fees means that the court alone determines the reasonable and necessary amount of fees—according to criteria given in subsection (d). Accordingly, we must decide whether Daller's testimony was reliable and, if so, whether it was some evidence of causation. W.3d at 579 ("[T]he criteria for assessing reliability must vary depending on the nature of the evidence."). Related to these factors, Transcontinental contends that Daller's diagnostic technique is not reliable because he did not exclude the other possible causes of Crump's death with reasonable medical probability. W.2d at 559 ("An expert who is trying to find a cause of something should carefully consider alternative , 500 (Tex.1995) ("[T]o constitute evidence of causation, an expert opinion must rest in reasonable medical probability."). Few expert opinions would be reliable if the rule were otherwise. Hunt testified that, in his opinion, Crump died from a combination of kidney failure, cirrhosis of the liver, and a fungal infection in the lungs exacerbated by preexisting diabetes and a history of immunosuppressant drug usage. Because we held that the trial court committed reversible error in a separate part of the charge, we reversed on that ground and remanded the case for new trial. There may be more than one producing cause."—is the same as the pattern jury charge definition we rejected in Ledesma, substituting only "death" for "incident." Transcontinental urges us now to adopt for workers' compensation cases the same definition we approved in Ledesma for products liability cases. 1995) ("For DTPA violations, only producing cause must be shown. Crump contends that the statute's plain language alone provides that the court, and not a jury, is to determine the amount of reasonable and necessary attorney's fees for which Transcontinental is liable. We hold that when a question of fact exists on the reasonableness and necessity of a claimant's attorney's fees under § 408.221(c), the carrier has a right to submit that question to a jury. This interpretation, Crump argues, comports with subsection (b)'s general rule that attorney's fees under § 408.221 are based on written evidence of time and expenses presented to the court, which would have no use for this information if it were not deciding the amount to award. The evidence was not conclusive, but it was not required to be. Rather, the `gap' in [the expert]'s analysis was his failure to show how his observations, assuming they were valid, supported his conclusions that [the passenger] was wearing her seat belt or that it was defective." Id. The injury must be the producing cause of the death, and producing cause has been defined as that cause which, in a natural and continuous sequence, produces the death . Crump argues that the "substantial factor" component of the Ledesma definition imposes a higher causation burden upon workers' compensation claimants than what exists at present. We have always required in workers' compensation cases a showing of "unbroken causal connection" between the compensable injury and the claimant's injury or death. It does not demand, nor even imply, a higher standard of legal causation beyond the ordinary sense of the concept. It was sufficiently reliable to be considered by the jury. The analysis set out in Gammill lends support to the reliability of Daller's expert opinion testimony in this case. Transcontinental argues that the omission of but-for language in the charge submitted by the trial court renders the definition legally incorrect. As we discussed in one workers' compensation case, "to say of a cause of an injury that it is one `but for which the injury would not have happened' is to repeat something already included in the usual and ordinary meaning of the word `cause.'" Id. Based on Daller's experience and training as a transplant specialist and surgeon, his dealings with infection-susceptible immunosuppressed patients, and his direct dealings with Crump—which included taking cultures directly from the wound site for diagnostic purposes—he concluded that Crump's wound became infected, that the infection weakened his organs, and that the natural progression of these events caused his death. W.2d at 500 ("Reasonable [medical] probability is determined by the substance and context of the opinion, and does not turn on semantics or on the use of a particular term or phrase."). Compensation is awarded to the legal beneficiary of the deceased employee if death results from the injury. Having concluded that Ledesma applies to this case, we must determine whether the definition given here was erroneous. Transcontinental cites Ledesma for the proposition that the use of the "efficient, exciting, or contributing cause" language is erroneous. In Ledesma, we reasoned that those terms had no practical meaning to modern jurors in products liability cases. But we did not go so far as to say that employing the terms "efficient, exciting, or contributing cause" in a producing cause definition was, as Transcontinental suggests, erroneous. The cause must be more than one of the countless ubiquitous and insignificant causes that in some remote sense may have contributed to a given effect as, for example, simply getting up in the morning. Because both interpretations are reasonable as to their applicability here, we conclude that the statute is ambiguous.

In other words, Daller's medical causation opinion provided a cause that excluded, with reasonable medical certainty, Hunt's suggested causes of death. When, as here, the content of a trial court's definition is challenged as legally incorrect, our standard of review is de novo. Causal connection must be established between the injury and the death. The definition of producing cause given by the trial court in this case is, in all relevant respects, the same as the pattern jury charge definition we rejected in Ledesma. Thus, while the concerns about terminology "foreign to modern English" and incomplete definitions expressed in Ledesma apply equally to this case, the mere use of these terms is not, in itself, error. That the term substantial factor is given to this commonsense aspect of legal causation simply makes plain to jurors that more than causation in this indirect, "philosophic sense" is required. W.2d at 1030 (recognizing that but-for language repeated something already included in the usual and ordinary meaning of "cause" and draws juror attention to the importance of an unbroken causal connection).

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Once Daller effectively responded to Hunt's other plausible causes of death with reliable testimony, the question was no longer one of legal sufficiency, but rather one of competing evidence to be weighed , 40-41 (Tex.2007). and [the expert]'s opinion was not shown to be due to his techniques in assessing the vehicle restraint system. Daller is board-certified in general surgery and critical care, specializes in multiple-organ transplantation, and has worked as a clinician in teaching hospitals across the country—including the University of Texas Medical Branch at Galveston, where he treated Crump.