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

Case No. ADJ7732498
Regular
Apr 20, 2016

ERIC RINGER vs. RESTORATION HARDWARE, LIBERTY MUTUAL FIRE INSURANCE COMPANY

This case concerns a dispute over the necessity of an anterior cruciate ligament (ACL) reconstruction surgery for an industrial knee injury. The Workers' Compensation Appeals Board (WCAB) affirmed the administrative law judge's (ALJ) award of the surgery. The primary issue was the timeliness of the employer's utilization review (UR) denial of the proposed treatment. The WCAB found the UR decision invalid because it was issued outside the statutory timeframe after the request for authorization was received. Therefore, the proposed surgery was deemed authorized.

Utilization ReviewRequest For AuthorizationTimely DenialAllograft vs. AutograftACL ReconstructionLabor Code Section 4610Workers' Compensation Appeals BoardFindings And AwardReconsiderationAdministrative Director Rule 9792.9.1
References
2
Case No. MISSING
Regular Panel Decision
Jun 02, 2008

Claim of Laezzo v. New York State Thruway Authority

The claimant suffered a work-related slip and fall in 2002, leading to injuries including his head, neck, back, and knees. His morbid obesity contributed to his back and knee issues, prompting him to seek authorization for gastric bypass surgery. The Workers’ Compensation Law Judge approved the surgery, a decision affirmed by the Workers’ Compensation Board, which found the surgery causally related to the compensable injuries. The employer and its carrier appealed, challenging the causal link. The court affirmed the Board's decision, noting substantial evidence that the claimant's weight gain was a result of the sedentary lifestyle imposed by his injuries, and that the surgery would aid in his recovery.

Workers' CompensationConsequential InjuryGastric Bypass SurgeryMorbid ObesityMedical Treatment AuthorizationCausationKnee InjuryBack InjurySedentary LifestyleBoard Decision Appeal
References
2
Case No. MISSING
Regular Panel Decision

Claim of Casiano v. CCIP/Union Settlement Home Care

In March 2001, claimant sustained a work-related back injury. Neurosurgeon Richard J. Radna recommended and performed decompression surgery despite the workers' compensation carrier denying preauthorization for the procedure. Both a Workers’ Compensation Law Judge and the Workers’ Compensation Board subsequently ruled that the surgery was not medically necessary, thereby absolving the carrier of liability for its cost. Claimant and Radna appealed this determination to the appellate court. Radna's appeal was dismissed due to lack of standing, and the Board's decision was affirmed, as it was within its purview to resolve the conflicting medical evidence presented by Radna and the carrier's neurosurgeon regarding the necessity of the surgery.

Workers' Compensation LawMedical NecessitySurgical ProcedurePreauthorization DenialNeurological InjuryConflicting Medical OpinionsAppellate ReviewStanding IssueCarrier LiabilityBack Injury
References
3
Case No. LAO 0811779, LAO 0811780
Regular
Mar 06, 2008

ELENA BLANKEVOORT vs. HUNTINGTON MEMORIAL HOSPITAL, S&B SURGERY CENTER

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a trial judge's order disallowing a lien claim from S&B Surgery Center. The WCAB found that while S&B Surgery Center did have a required "surgical clinic" license, it failed to prove compliance with fictitious business name filing requirements. However, the WCAB returned the case to the trial level for further proceedings, allowing S&B Surgery Center an opportunity to correct this procedural defect to recover on its lien.

Fictitious business nameLien claimantSurgical clinic licenseBusiness and Professions Code section 17910Medical BoardDepartment of Health ServicesBurden of proofReconsiderationWorkers' Compensation Appeals BoardOutpatient setting
References
12
Case No. MISSING
Regular Panel Decision
Apr 25, 1979

Woodward v. Black Clawson/Dilts Div.

The Workers' Compensation Board found the claimant's cardiac disability and surgery were causally related to an accidental injury on January 12, 1972, based on the testimony of Dr. A. Black. The court affirmed this decision, finding substantial evidence in the record to support the board's determination. Costs were awarded to the Workers’ Compensation Board against the employer and its insurance carrier.

cardiac disabilitycardiac surgeryaccidental injurycausal relationshipmedical testimonyWorkers' Compensation Boardappeal affirmedemployer liabilityinsurance carrier liabilitysubstantial evidence
References
0
Case No. MISSING
Regular Panel Decision

Fernandez v. North Shore Orthopedic Surgery & Sports Medicine, P.C.

Frank Fernandez, an x-ray technician, sued his former employer, North Shore Orthopedic Surgery & Sports Medicine, P.C., for retaliation under Title VII after filing a national origin discrimination complaint. A jury found in favor of Fernandez, awarding back pay, front pay, and punitive damages. North Shore subsequently moved for judgment as a matter of law, a new trial, and to modify the damage awards. The court denied North Shore's motions for judgment and a new trial, affirmed the jury's back pay award, but vacated and reduced the front pay award from $160,000 to $50,000, and the punitive damages award from $100,000 to $50,000.

RetaliationTitle VIIEmployment DiscriminationBack PayFront PayPunitive DamagesMitigation of DamagesFederal Rules of Civil ProcedureJudicial DiscretionEquitable Relief
References
27
Case No. MISSING
Regular Panel Decision

Meyers v. Epstein

This case concerns a motion in limine filed by the plaintiffs, Samara Meyers and her parents, in a 'ghost surgery' case. The plaintiffs allege that a different surgeon, Dr. Ira Richmond Abbott, performed brain surgery on Samara than the one they consented to, Dr. Fred Epstein. Following the surgery, Samara experienced severe complications including left side paralysis and cognitive impairments. The plaintiffs sought to recover damages for these complications, arguing that they were proximately caused by the unauthorized surgery. However, the court denied their motion, ruling that under New York law, a plaintiff cannot recover for injuries that would have foreseeably resulted from the surgery even if performed by the consented doctor, especially without evidence of negligent performance. The court limited potential recovery to nominal damages and mental anguish for the unauthorized act itself, not the inherent risks or consequences of the surgery.

Ghost surgeryBatteryMedical malpracticeInformed consentCausationDamagesMotion in limineBrain surgery complicationsProximate causeIntentional torts
References
18
Case No. MISSING
Regular Panel Decision

Claim of Prescott v. Town of Lake Luzerne

A claimant fell off a dump truck at work in February 2008, landing on his right buttock and injuring his hip. The injury led to surgery in May 2008 to remove heterotopic bone and subsequent two-stage hip replacement revision surgeries in November 2008 and February 2009 due to an infection. The Workers’ Compensation Board found the initial surgery and subsequent revisions causally related to the work fall and supported compensation awards. The employer appealed, arguing that an independent medical examination (IME) was improperly precluded and that the initial surgery lacked proper authorization. The Appellate Division affirmed the preclusion of the IME due to untimeliness and upheld the causal relationship findings for the injury and subsequent surgeries. However, the court reversed the Board's determination that the May 2008 surgery was properly authorized, remitting that specific issue for further proceedings, while affirming all other appealed decisions.

Causal RelationshipIndependent Medical Examination (IME)Evidence PreclusionSurgery AuthorizationHip InjuryHeterotopic OssificationMedical Opinion ConflictDue ProcessRemittiturEmployer Liability
References
8
Case No. MISSING
Regular Panel Decision

Marshall v. Atlantic Container Line, GIE

The Secretary of Labor alleged that Atlantic Container Line (ACL) violated the Age Discrimination in Employment Act (ADEA) by involuntarily retiring employees at age 62, while ACL contended these retirements were exempt under ADEA § 4(f)(2). The court had previously denied summary judgment, noting factual questions regarding whether a 1974 amendment to ACL's pension plan constituted a subterfuge to evade the ADEA and if ACL relied in good faith on administrative regulations. Upon review of stipulated facts, the court found no evidence of subterfuge in ACL's plan amendment, which aimed to create promotional opportunities and harmonize retirement ages. Furthermore, ACL successfully established a good faith defense under the Portal-to-Portal Act, having relied on official administrative regulations despite conflicting advice from a Department of Labor representative. Consequently, the defendants' motion for summary judgment was granted.

Age DiscriminationEmployment ActPension PlanSubterfugeGood Faith DefenseSummary JudgmentMandatory RetirementEmployer LiabilityStatutory InterpretationDepartment of Labor
References
8
Case No. MISSING
Regular Panel Decision

Zapico v. Bucyrus-Erie Co.

This case addresses post-trial motions concerning the liability of Atlantic Container Lines (ACL), a stevedore, to Bucyrus-Erie Co., a truck-crane manufacturer and third-party plaintiff. The central issue is whether ACL enjoys immunity from contribution or indemnity claims under 33 U.S.C. § 905, following a jury finding that both Bucyrus-Erie's negligent manufacturing and ACL's incompetent employee (Antonio Fuet) equally contributed to the injury of Adolfo Millan and death of Joseph Zapico, ACL's employees. ACL argued it was immune as a compensation-paying stevedore and lacked an indemnity agreement. The court found that Bucyrus-Erie's claim was not 'on account of' the employee injury, but rather for partial indemnification based on ACL's implied warranty of workmanlike performance or a quasi-contractual theory. The court concluded that extending third-party benefits or apportioning damages based on fault would not violate statutory immunity and would be equitable, especially given manufacturers' lack of control over stevedoring functions and increasing strict liability. Therefore, ACL's motion for judgment in its favor was denied, Bucyrus-Erie Co.'s motion to amend its pleadings was granted, and Celia Zapico's motion to strike the jury's finding of contributory negligence was denied.

Stevedore LiabilityMaritime IndemnityLongshoremen's ActThird-Party ClaimsProduct Manufacturer NegligenceEmployee IncompetenceContribution LawWarranty of Workmanlike PerformanceFederal Civil ProcedurePost-Trial Litigation
References
14
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