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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ1617135 (VNO 0419995)
Regular
Sep 26, 2016

JOHN WILLIAMS, Johnny Williams vs. REGIONAL TRANSPORT, INC., STATE COMPENSATION INSURANCE FUND, SCIF

This case concerns a workers' compensation claim for Johnny Williams, who sustained an industrial injury in 2000. The defendant, State Compensation Insurance Fund (SCIF), sought reconsideration of a decision that limited their liability for chiropractic visits. SCIF argued that a 24-visit cap should apply, but the Workers' Compensation Appeals Board denied their petition. The Board found that the 24-visit cap applies only to injuries occurring on or after January 1, 2004, and Williams' injury predates this. Furthermore, the Board found that the chiropractic treatment provided was reasonable and necessary, supported by evidence and medical guidelines.

Workers' Compensation Appeals BoardPetition for ReconsiderationAgreed Medical ExaminerChiropractic visitsMedical treatment utilization scheduleDate of injuryPermanent disabilityLien claimsReasonable and necessary treatmentACOEM Practice Guidelines
References
1
Case No. SFO 0489218
Regular
Oct 11, 2007

JOSE FACUNDO-GUERRERO vs. NURSERYMEN'S EXCHANGE, ARGONAUT INSURANCE COMPANY

This case concerns Jose Facundo-Guerrero's workers' compensation claim for injuries sustained on February 24, 2005. The primary issue is whether the statutory limit of 24 chiropractic treatments applies, as the applicant had already received more than this number before his claim was accepted. The Appeals Board granted reconsideration and affirmed the Administrative Law Judge's decision that the 24-visit limit under Labor Code section 4604.5(d)(1) applies to this injury date, denying further chiropractic treatment visits beyond the cap but allowing for visits necessary for managing his care.

Labor Code Section 4604.5(d)(1)Petition for ReconsiderationDecision After ReconsiderationMedical Provider Network (MPN)Chiropractic treatment limitationPermanent and Stationary reportCalifornia Constitutional MandateEqual Protection ClauseWorkers' Compensation Appeals Board (WCAB)Findings and Award
References
0
Case No. 2015 NY Slip Op 09604
Regular Panel Decision
Dec 29, 2015

Maggio v. 24 West 57 PFF, LLC

Plaintiff Joseph Maggio, a drywall installer, was injured after falling from a scaffold staircase at a premises owned by 24 West 57 APF, LLC and leased by Ana Tzarev New York, LLC (ATNY). The scaffold, constructed by Atlantic Hoist & Scaffolding, LLC, had a modified staircase with plywood covering some steps, lacking anti-slip protection and having an irregular rise. Plaintiff attributed his fall to these conditions and the presence of construction debris. The Supreme Court initially denied summary judgment motions from defendants 24 West and ATNY, citing outstanding discovery, and later denied renewed motions. On appeal, the Appellate Division found 24 West and ATNY justified in bringing the second motion but denied their request for summary judgment on negligence and Labor Law § 200 claims due to factual questions regarding notice of the dangerous condition. The court also denied plaintiff's untimely cross-motion for partial summary judgment on his Labor Law § 240 (1) claim. The Appellate Division modified the lower court's order, granting ATNY conditional contractual indemnification against R&R, and otherwise affirmed the decision.

Summary JudgmentLabor Law § 200Labor Law § 240 (1)Common-Law NegligenceContractual IndemnificationCommon-Law IndemnificationScaffold AccidentConstruction Site InjuryPremises LiabilityAppellate Procedure
References
12
Case No. 2017 NY Slip Op 08460 [156 AD3d 404]
Regular Panel Decision
Dec 05, 2017

Clavin v. CAP Equipment Leasing Corp.

The Appellate Division, First Department, reversed a Supreme Court order, dismissing third-party claims for common law indemnification, contribution, and contractual indemnification. The court found that the plaintiff did not sustain a 'grave injury' as defined in Workers' Compensation Law § 11, making common law indemnification and contribution claims unsustainable against the employer. The claim for contractual indemnification was deemed unenforceable under General Obligations Law § 5-322.1, as it would indemnify CAP Rents for its own potential negligence. Additionally, the claim for failure to procure insurance was dismissed because the reservation contract did not expressly and specifically require Schiavone to name CAP Rents as an additional insured. CAP Equipment Leasing Corporation was also found to lack standing to enforce the contract.

indemnificationcontributiongrave injuryWorkers' CompensationGeneral Obligations Lawcontractual indemnificationinsurance procurementadditional insuredsummary judgmentnegligence
References
7
Case No. SAL 0113062
Regular
Jan 02, 2008

, Maria LOURDES TAPIA, vs. REGENT ASSISTED LIVING, ALASKA NATIONAL INSURANCE

The Workers' Compensation Appeals Board denied reconsideration of a decision upholding a 24-visit limit for chiropractic treatment per industrial injury. The applicant argued that the statutory cap conflicted with the liberal construction mandate of Labor Code section 3202, but the Board found no ambiguity in the clear language of Labor Code section 4604.5(d)(1). The Board further clarified that the provision allowing employers to authorize additional visits in writing (LC 4604.5(d)(2)) did not remove the cap, nor did it render chiropractors meaningless within the workers' compensation system.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code Section 4604.5(d)(1)chiropractic visitsoccupational therapyphysical therapyLiberal constructionLabor Code Section 3202employer authorizationFindings & Order
References
9
Case No. ADJ8266885
Regular
Jan 20, 2016

DAYSI PATRICIA MOLINA ROMERO vs. CALIFORNIA PIZZA KITCHEN, TRAVELERS DIAMOND BAR

This case involves a lien claim by Mario Arroyo, D.C., for chiropractic and physical therapy services provided to an injured worker. The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded the original findings. The WCAB held that "visits" must be distinguished by the type of treatment rendered, allowing for separate reimbursement caps for chiropractic and physical therapy visits. Further development of the record is required to determine the nature of services provided and whether Arroyo is entitled to reimbursement for physical therapy beyond the 24 chiropractic visits already paid.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderLien ClaimantChiropractic VisitsPhysical TherapyLabor Code Section 4604.5(c)(1)Bill ReviewerCumulative TraumaIndustrial Injury
References
2
Case No. 2024 NYSlipOp 01444 [225 AD3d 1189]
Regular Panel Decision
Mar 15, 2024

Jesmain v. Time Cap Dev. Corp.

Plaintiff Connor B. Jesmain was injured at a construction site on property owned by 980 James Street, LLC, while moving a stack of drywall panels that fell on his ankle. He commenced a Labor Law and common-law negligence action against Time Cap Development Corp. and 980 James Street, LLC (980 James defendants), and Interior Builders Framing and Drywall LLC. The 980 James defendants also sought contractual indemnification against third-party defendant Syracuse Energy Systems, Inc. The Appellate Division modified the Supreme Court's order, reinstating Labor Law §§ 240 (1) and 241 (6) causes of action due to issues of fact regarding safe storage and a dangerous material pile. The court also granted summary judgment dismissing Labor Law § 200 and common-law negligence claims against 980 James, denied contractual indemnification for 980 James defendants against Syracuse Energy, and granted summary judgment dismissing 980 James defendants' cross-claim for contractual indemnification against Interior Builders. The decision affirmed the denial of Interior Builders' motion to dismiss the amended complaint and other cross-claims.

Construction Site InjuryDrywall AccidentLabor Law § 240(1)Labor Law § 241(6)Labor Law § 200Common-Law NegligenceSummary JudgmentContractual IndemnificationThird-Party ActionAppellate Review
References
14
Case No. ADJ1208276 (VEN 0109627)
Regular
Sep 02, 2016

DANIEL GARCIA vs. PEPSI COLA CO.; SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board rescinded a prior decision and remanded the case for further proceedings concerning chiropractic treatment for an admitted neck and upper back injury. The original decision allowed 16 visits for 2007, deeming them reasonable and necessary, and found the applicant not subject to the 24-visit cap. However, the Board found the Qualified Medical Evaluator's report, used to support the decision, was stale, having been issued ten years prior to the treatment. The Board directed parties to obtain an updated report from the QME, and noted that the defendant failed to conduct utilization review, a proper avenue for disputing treatment reasonableness.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderAdministrative Law JudgeLien ClaimantChiropractic ServicesLabor Code Section 4603.2(b)(2)PenaltiesSanctionsReasonable and Necessary Treatment
References
7
Case No. LBO 0369190
Regular
Apr 21, 2008

MARTIN PEREZ vs. ROYAL CABINETS, EMPLOYERS DIRECT INSURANCE CO.

This case concerns a lien claim by a chiropractor for $13,474.90 for 45 visits. The Workers' Compensation Appeals Board (WCAB) reconsidered the decision, determining that Labor Code Section 4604.5(d)(1) limits chiropractic visits to 24 per industrial injury for injuries after January 1, 2004. The WCAB found the lien claimant failed to prove the existence of a second cumulative trauma injury, therefore limiting the lien to 24 visits.

Workers' Compensation Appeals BoardPetition for ReconsiderationCompromise and ReleaseLien ClaimantChiropractic TreatmentLabor Code Section 4604.5(d)(1)Medical Treatment Utilization ScheduleAmerican College of Occupational and Environmental MedicineOccupational Medicine Practice GuidelinesCumulative Trauma Injury
References
2
Case No. MISSING
Regular Panel Decision

Braswell v. Braswell

The case concerns an appeal by a father from a Family Court order that modified his visitation schedule with his son. The mother had initiated the modification proceeding, citing the child's entry into kindergarten and the disruptive nature of the existing schedule, as well as the child's diagnosis of acute stress disorder linked to visits with his father. The Family Court denied the father's adjournment request and, in his absence, reduced his visitation to three visits annually. The Appellate Division affirmed the Family Court's decision, finding no abuse of discretion in either the denial of the adjournment or the modification of the visitation, as a sufficient change in circumstances and the child's best interests were demonstrated.

Child visitationVisitation modificationFamily Court ActAppellate reviewAdjournment denialChild custodyBest interests of childAcute stress disorderParenting timeChild welfare
References
21
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