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

Case No. No. M2018-01696-COA-R3-CV; No. 15-4-IV
Regular Panel Decision
Dec 07, 2020

American Board of Craniofacial Pain v. American Board Of Orofacial Pain

This case involves an appeal concerning a failed merger between two professional dental associations, American Board of Craniofacial Pain (ABCP) and American Board of Orofacial Pain (ABOP). ABCP sued ABOP, alleging a breach of an agreement to merge formed through email exchanges and seeking specific performance and damages. The Chancery Court for Davidson County granted summary judgment to ABOP, finding no meeting of the minds and thus no enforceable contract. The Court of Appeals of Tennessee affirmed this decision, concluding that the parties’ objective manifestations showed a lack of mutual assent because an essential term (disposition of intellectual property) was not agreed upon and they intended to reduce the agreement to a formal Memorandum of Understanding, which was never finalized. The court also agreed that specific performance was not an available remedy due to the incompleteness of the purported contract.

Contract DisputeMerger NegotiationsCorporate MergerDental ProfessionMutual AssentSpecific Performance DenialSummary Judgment AffirmationTennessee Court of AppealsContract FormationLack of Agreement
References
26
Case No. MISSING
Regular Panel Decision
Sep 04, 2013

Matter of Madigan v. ARR ELS

In 1994, the claimant sustained a low back injury during employment as a machinist, leading to workers' compensation benefits. Liability for the case was transferred to the Special Fund for Reopened Cases in 2003. Due to poor surgical outcomes, the claimant has been on pain medication, including oxycontin, since at least 2007, with doses escalating. A consultant for the Special Fund questioned the necessity of the increased medication, prompting a hearing. A Workers’ Compensation Law Judge ruled that the pain medications should continue, with the Special Fund covering the costs, until new Board guidelines or physician recommendations advised otherwise. The Workers’ Compensation Board affirmed this decision, citing that their Medical Treatment Guidelines for chronic pain were still in draft form at the time. The appellate court subsequently affirmed the Board's decision, noting that the guidelines were not yet in effect at the time of the Board's ruling and that the Board's interim guidance was rational.

Workers' CompensationPain ManagementOpioid PrescriptionsMedical Treatment GuidelinesSpecial FundReopened CasesLumbar InjuryOxycontinAppellate ReviewAdministrative Law
References
4
Case No. ADJ1088522 (RIV 0015524)
Regular
Jan 03, 2013

SAMANTHA VAN DUINHOVEN vs. SPA HOTEL & CASINO, CALIFORNIA CASUALTY, Administered by GAB ROBINS NORTH AMERICA

This case involved an applicant who claimed industrial injury to her neck, back, left shoulder, psyche, and associated chronic pain syndrome, resulting in a finding of permanent total disability. The defendant sought reconsideration, arguing the medical evidence did not support injury to the low back or a diagnosis of chronic pain syndrome. The Appeals Board reversed the findings on the low back and chronic pain syndrome, finding no substantial evidence to support them. Consequently, the applicant's permanent disability award was amended to 70%, based on ratings for her neck, left shoulder, and psyche.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPermanent Total DisabilityChronic Pain SyndromeAgreed Medical EvaluatorQualified Medical EvaluatorMedical Record ReviewIndustrial InjuryPermanent Disability Indemnity
References
0
Case No. 2024 NY Slip Op 00599 [224 AD3d 428]
Regular Panel Decision
Feb 06, 2024

Matter of New Millennium Pain & Spine Medicine, P.C. v. Garrison Prop. & Cas. Ins. Co.

This case involves two appeals by New Millennium Pain & Spine Medicine, P.C. against Garrison Property & Casualty Insurance Company and GEICO Casualty Company. New Millennium sought to vacate master arbitration awards that denied its claims for no-fault benefits for medical services. The Supreme Court denied these applications. The Appellate Division, First Department, affirmed the Supreme Court's decisions, stating that an arbitrator's award will not be set aside unless it is irrational. The court also addressed the argument regarding a 20% wage offset in no-fault benefits, finding it unavailing under Insurance Law § 5102 (b). Ultimately, New Millennium was not entitled to attorneys' fees as it was not the prevailing party.

No-fault benefitsarbitration awardvacaturinsurance lawwage offsetappellate reviewmedical servicesno-fault policy exhaustionattorneys' feesCPLR Article 75
References
8
Case No. 03-00-00171-CV
Regular Panel Decision
Jan 19, 2001

John Molyneaux v. Insurance Company of the State of Pennsylvania

This workers' compensation case involves an appeal by John Molyneaux against the Insurance Company of The State of Pennsylvania regarding the termination of his medical benefits. Molyneaux suffered an on-the-job injury in December 1993, and later experienced low back pain. The insurance company denied payment for a second series of epidural steroid injections in 1996, claiming the pain was no longer caused by the compensable injury. A district court jury found that the 1993 injury ceased being a producing cause of his low back condition as of July 11, 1994, leading to a judgment relieving the insurance company of liability for benefits after that date. The Court of Appeals modified the judgment, ruling that while the denial of benefits for current low back pain was proper, the judgment improperly terminated Molyneaux's rights to all possible future medical benefits related to the compensable injury. The judgment was affirmed as modified.

Workers' CompensationMedical BenefitsCausationJudicial ReviewTexas LawAppeals CourtLow Back PainInsurance LiabilityEmployer LiabilityStatutory Interpretation
References
3
Case No. 2018-03-1124
Regular Panel Decision
Feb 28, 2019

Darnell, Lisa v. Star Vending, Inc.

This case involves Lisa Darnell's claim for workers' compensation benefits for low back pain, left knee, and hip injuries sustained from a fall at Star Vending, Inc. While the employer accepted the claim for her knee and hip, treatment for her low back was denied due to questions of causation. The Court found that Ms. Darnell failed to demonstrate her low back pain primarily arose from her employment, citing medical opinions that attributed her back issues to non-work-related causes, especially after she took a standing job outside her restrictions. Furthermore, her claim for temporary partial disability benefits was denied because her refusal of a modified duty offer was based on personal transportation difficulties rather than her work restrictions. Consequently, the Court denied her claim for both medical and temporary partial disability benefits.

Expedited HearingDenial of BenefitsLow Back PainKnee InjuryHip PainCausation of InjuryMedical Treatment DisputeTemporary Partial DisabilityModified Duty OfferRefusal of Work
References
3
Case No. 2017-05-0892
Regular Panel Decision
Apr 02, 2018

Hunt, Michele v. Amazon.com

Michelle Hunt, an employee of Amazon.com, sustained injuries including her right ankle, wrist, and low back after a slip and fall incident in 2015. Amazon provided a panel of physicians, and Ms. Hunt chose Dr. Jeffrey Hazlewood. Despite conservative treatment, Ms. Hunt's low back pain persisted and worsened, showing a diffuse disc bulge and mild central disc extrusion at L5-S1 on an MRI. Dr. Hazlewood concluded the back pain did not warrant a specialist referral. Ms. Hunt sought an expedited hearing to request a panel of orthopedists for her low back complaints, arguing Dr. Hazlewood's care failed to improve her symptoms. The Court, however, denied her request, finding her testimony alone insufficient to overcome the presumption of medical necessity accorded to Dr. Hazlewood's opinion.

Workers' CompensationMedical BenefitsExpedited HearingLow Back PainOrthopedistsPanel of PhysiciansTreating PhysicianMRIDisc BulgeDegenerative Disc Disease
References
2
Case No. 2017-03-0447
Regular Panel Decision
Aug 27, 2018

Muncy, Rick v. Premium Distributors, Inc.

This case involves Rick O. Muncy, an employee of Premium Distributors, Inc., who experienced bilateral elbow and low back pain while unloading ice cream on July 14, 2016. He sought evaluation for his back pain from his authorized treating physician, Dr. Gerald Russell, but Premium Distributors refused, citing Dr. Russell's prior assessment that his current back symptoms were not work-related. The employer relied on a medical questionnaire from Dr. Russell, who had last seen Mr. Muncy two years prior. The Court questioned Dr. Russell's knowledge of Mr. Muncy's current complaints and found that Mr. Muncy presented sufficient evidence to warrant a return visit. The Court ordered Premium Distributors to provide Mr. Muncy with a return visit to Dr. Russell for evaluation and treatment of any work-related back injury.

Workers' CompensationExpedited HearingMedical BenefitsBack PainElbow PainTreating PhysicianCausation OpinionBurden of ProofTennesseeMedical Evaluation
References
2
Case No. 2019-08-0045
Regular Panel Decision
Sep 14, 2020

Mask, Michael v. Hub Group, Inc.

Employee Michael Mask, a truck driver, suffered a low back injury at work but was subsequently diagnosed with multiple myeloma. The employer, Hub Group, Inc., provided workers' compensation benefits for the back strain but denied further benefits for conditions related to his cancer, asserting it was not work-related. Mask sought additional medical and disability benefits, arguing his ongoing pain was connected to the work injury. The trial court, Judge Allen Phillips presiding, found Mask only established entitlement to benefits for his low back strain and not for temporary or permanent disability or cancer-related treatment, crediting Dr. Wolf's opinion that his pain stemmed from cancer. The Workers' Compensation Appeals Board affirmed the trial court's decision, concluding Mask was only entitled to reasonable and necessary future medical care for his low back strain, thereby denying benefits for cancer or additional disability.

Workers' CompensationBack InjuryMultiple MyelomaCausationMedical BenefitsDisability BenefitsTemporary DisabilityPermanent DisabilityAppeals BoardPro Se Litigant
References
5
Case No. MISSING
Regular Panel Decision
Apr 12, 2013

Matter of Poverelli v. Nabisco/Kraft Company

Claimant sustained a compensable lower back injury in 1986. Years later, in 2008, she began experiencing bilateral knee pain, which she asserted was a consequential injury arising from her established back injury. Both a Workers’ Compensation Law Judge and the Workers’ Compensation Board found insufficient medical evidence to establish a causal relationship between the back injury and the knee pain. The Board also assessed a penalty against claimant's attorney for pursuing review without reasonable grounds. The Appellate Division affirmed the Board's decision, concluding that the finding of no causal relationship was supported by substantial evidence from medical testimony, including an independent medical examination.

Workers' CompensationConsequential InjuryBilateral Knee PainLower Back InjuryCausal RelationshipMedical EvidenceIndependent Medical ExaminationDegenerative DiseaseAttorney PenaltyWorkers' Compensation Board Appeal
References
7
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