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

Case No. ADJ3206000 (LAO 0877236)
Regular
Aug 10, 2012

JENNIFER HESTER vs. TECHNICOLOR, Permissibly Self-Insured

The applicant sought reconsideration of a decision limiting the defendant's payment for hip surgery to the Official Medical Fee Schedule, which the applicant's surgeon deemed insufficient. The Appeals Board granted reconsideration due to the complex fee dispute, noting that while extraordinary circumstances existed regarding the surgeon's qualifications, the reasonableness of his requested fee was unproven. To resolve this, the Board ordered the appointment of an agreed physician to investigate the surgeon's usual fee and its reasonableness compared to others with similar expertise.

ReconsiderationFindings of FactAgreed PhysicianMedical TreatmentFee ScheduleExtraordinary CircumstancesUsual FeeHip ArthroscopyOsteoplastyChondroplasty
References
1
Case No. MISSING
Regular Panel Decision

In Re North Shore Hematology-Oncology Associates, P.C., Debtor

This memorandum opinion addresses whether the Debtor, a physician-owned healthcare practice, is a health care business under the Bankruptcy Code and if a patient care ombudsman should be appointed. The Court finds the Debtor is a healthcare business but waives the appointment of an ombudsman at this time. The decision is based on several factors, including the Debtor's lack of inpatient services, low patient complaint rate, existing compliance programs (HIPAA, CLIA), ability to maintain high-quality care, and monitoring by the New York State Department of Health. The Court notes the potential for revisiting the appointment if circumstances change.

BankruptcyPatient Care OmbudsmanHealthcare BusinessChapter 11Debtor in PossessionEastern District of New YorkSection 333(a)(1)Bankruptcy CodePatient ProtectionMedical Practice
References
16
Case No. MISSING
Regular Panel Decision

Union Appointed Trustees of the Tapers Industry Insurance & Annuity Funds v. Employer-Appointed Trustees of the Tapers Industry Insurance & Annuity Funds

A dispute arose between the Employer-Appointed Trustees and Union-Appointed Trustees of the Tapers Industry Insurance and Annuity Funds concerning delinquent employer contributions. An arbitrator issued an award, which the Employer-Appointed Trustees sought to confirm and the Union-Appointed Trustees cross-moved to vacate. Judge Walker of the District Court reviewed the arbitration award, noting the arbitrator based his findings on prior judicial decisions rather than independently interpreting the collective bargaining agreement. The Court determined that the arbitrator failed to apply the contract as bargained for by the parties, thus exceeding his authority. Consequently, the Court vacated the arbitration award and remanded the dispute for proceedings consistent with its order.

Arbitration AwardVacate Arbitration AwardConfirm Arbitration AwardCollective Bargaining AgreementTrust FundsDelinquent ContributionsRes JudicataManifest Disregard of LawScope of Judicial ReviewLabor Dispute
References
12
Case No. ADJ4378069 (AHM 0085676) ADJ2997222 (AHM 0085721)
Regular
Jun 09, 2010

LARRY LAZAR vs. HOME DEPOT, Permissibly Self-Insured

The Workers' Compensation Appeals Board denied the applicant's petition for removal and dismissed his petition for disqualification of the judge. The applicant argued that his treating physician's reports constituted substantial evidence and questioned the need for a court-appointed regular physician. The Board found that the judge correctly followed procedures for supplementing the medical record and that the existing reports lacked substantial evidence. Therefore, the Board upheld the judge's appointment of a regular physician.

Workers Compensation Appeals BoardPetition for RemovalPetition for DisqualificationRegular PhysicianLabor Code Section 5701Findings and OrderIndustrial InjuryPermanent DisabilitySubstantial EvidenceTreating Physician
References
1
Case No. ADJ7532290
Regular
Aug 28, 2012

MAXINE BROWN VIRGIL vs. LUNCH STOP, INC., EMPLOYERS COMPENSATION INSURANCE

This case involves a dispute over obtaining a Qualified Medical Evaluator (QME) panel. The applicant requested a new panel because a QME on the initial panel could not provide an appointment within 60 days. However, the applicant failed to properly strike a physician from the original panel after the defendant did. As a result, the defendant was authorized to schedule an appointment with a remaining physician, and the applicant was not entitled to a new QME panel. The Appeals Board granted removal to amend the prior order to reflect a rescheduled appointment with the original QME.

Workers' Compensation Appeals BoardPetition for RemovalQualified Medical EvaluatorpanelstrikeLabor Code section 4062Administrative Director Rule 31.5section 4062.2(c)medical evaluatorappointment
References
1
Case No. ADJ1462684 (SBR 0332199) ADJ4330124 (SBR 0332208) ADJ2350306 (SBR 0333426) ADJ6736405
Regular
Dec 13, 2011

ISABELA AGARONYAN vs. REGENTS, UNIVERSITY OF CALIFORNIA

This case involves defendant's challenge to the Workers' Compensation Judge's (WCJ) appointment of a new physician, Dr. Watkin, after prior medical reports from Dr. Kuschner were deemed not substantial evidence. The WCAB dismissed the petition for reconsideration, finding it challenged an interim procedural order, not a final decision. The petition for removal was denied because the defendant failed to demonstrate significant prejudice or irreparable harm from the appointment of Dr. Watkin. The Board affirmed the WCJ's discretion to appoint a new physician to develop a substantial medical record, especially given concerns about the adequacy of Dr. Kuschner's previous reports.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalAdministrative Law JudgeSpecial PhysicianRegular PhysicianPanel Qualified Medical ExaminerSubstantial Medical EvidenceJoint LetterBias
References
11
Case No. ADJ11315508
Regular
Sep 12, 2018

SIERRA PRADO vs. PCG HOSPITALITY, TRAVELERS INSURANCE CO.

This case concerns an applicant's request to treat outside her employer's Medical Provider Network (MPN) due to alleged difficulties in scheduling an appointment with an MPN physician. The applicant argued the Medical Access Assistant (MAA) failed to secure an appointment with available MPN doctors, leading to a denial of care. The Workers' Compensation Appeals Board affirmed the WCJ's decision, finding no denial of care because the MPN list is not a guarantee of immediate appointment and the MAA reasonably attempted to find a suitable physician. The majority determined that the applicant did not exhaust reasonable efforts to find an MPN doctor, and a dissenting opinion argued the inaccurate MPN list constituted a failure to provide care, justifying out-of-network treatment.

Workers' Compensation Appeals BoardMedical Provider Network (MPN)Medical Access Assistant (MAA)Primary Treating Physician (PTP)Denial of CareOut-of-Network TreatmentLabor Code Section 4600Labor Code Section 4616Cal. Code Regs. tit. 8§ 9767.5
References
18
Case No. 533089
Regular Panel Decision
Oct 07, 2021

Matter of Barden v. General Physicians PC

Claimant, a patient services representative, sought to amend her workers' compensation claim to include left shoulder aggravation after a work-related injury to her right shoulder. The Workers' Compensation Board disallowed this request, finding that claimant failed to provide sufficient credible medical evidence to establish a causal relationship between her employment and the left shoulder condition. The Appellate Division, Third Department, affirmed the Board's decision. The court noted that the claimant's treating physician opined the left shoulder pathology was largely preexisting and unrelated to the work injury, and other medical opinions either lacked sufficient weight or were based on inaccurate information, providing no basis to disturb the Board's finding.

Workers' CompensationShoulder InjuryCausationMedical EvidencePreexisting ConditionAppellate ReviewBoard DecisionClaim AmendmentPatient Services Representative
References
10
Case No. MISSING
Regular Panel Decision
Apr 07, 1988

De Coste v. Champlain Valley Physicians Hospital

Decedent, Darwin A. De Coste, experienced chest pain and elevated blood pressure, leading him to Champlain Valley Physicians Hospital where he was seen by Dr. William Amsterlaw. Amsterlaw diagnosed reflux esophagitis despite an abnormal electrocardiogram, discharging De Coste, who subsequently suffered a fatal cardiopulmonary arrest 12 hours later. The administrator of De Coste's estate filed a wrongful death action, alleging medical malpractice and that the misdiagnosis was the proximate cause of death. A jury awarded pecuniary damages and funeral expenses, which the defendants appealed. The appellate court affirmed the verdict, finding rational support for the jury's malpractice finding and rejecting the defendants' argument to reduce the award by Social Security benefits due to the effective date of CPLR 4545 (c).

Medical MalpracticeWrongful DeathProximate CauseCollateral Source RuleCPLR 4545Jury VerdictEmergency Room CareMisdiagnosisArteriosclerosisMyocardial Infarction
References
3
Case No. MISSING
Regular Panel Decision

Massachusetts Mutual Life Insurance v. Avon Associates, Inc.

This case addresses a motion by defendants mortgagors to vacate an ex parte order appointing a receiver during a mortgage foreclosure action. Defendants asserted that the lack of notice for the receiver's appointment violated CPLR 6401 and their Federal constitutional due process rights, citing Fuentes v Shevin. The court found that New York's Real Property Actions and Proceedings Law § 1325 (subd 1) permits ex parte receiver appointments when the mortgage contract explicitly waives notice. Furthermore, the court distinguished the present case from Fuentes, concluding that the sophisticated business operators involved had knowingly and voluntarily waived their right to notice, akin to the circumstances in Overmyer Co. v Frick Co. Based on these findings, the court affirmed the validity of the ex parte order and denied the defendants' motion to vacate the appointment of the receiver.

Mortgage ForeclosureReceiver AppointmentEx Parte OrderDue ProcessWaiver of NoticeContractual WaiverCPLRReal Property Actions and Proceedings LawConstitutional LawBusiness Disputes
References
9
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