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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. 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. MISSING
Regular Panel Decision
Mar 25, 2004

Foote v. Lyonsdale Energy Limited Partnership

Glenn A. Foote, Jr., an employee, sustained injuries when a wood chip stacker collapsed at the Lyonsdale Cogeneration Facility. He and his wife filed a lawsuit alleging negligence and violations of Labor Law §§ 200, 240, and 241 against the facility owners (Lyonsdale Energy Limited Partnership and Moose River Energy, Inc.), the stacker designer (American Bin & Conveyor), and the procurer (Wolf & Associates). The Supreme Court partially granted summary judgment to Lyonsdale and Wolf, dismissing the Labor Law § 240(1) claim against Lyonsdale and the negligence claim against Wolf. On cross-appeals, the Appellate Division affirmed the lower court's decision, concluding that Labor Law § 240(1) was inapplicable as the injury resulted from the structure's collapse rather than the failure of a safety device. The court also upheld the dismissal of the negligence claim against Wolf due to the absence of a duty to the plaintiff, and found a question of fact existed regarding Lyonsdale's supervisory control, thus denying summary judgment to Lyonsdale on other claims.

Labor LawWorkplace InjurySummary JudgmentNegligenceElevated Work SiteScaffold LawWood Chip StackerDesign DefectSupervisory ControlContractual Obligation
References
19
Case No. MISSING
Regular Panel Decision
May 05, 2000

Pain Resource Center v. Travelers Insurance

This case addresses a dispute regarding the payment of first-party no-fault benefits to a health provider, Pain Resource Center, as the assignee of John Hiotis, who was injured in an auto accident. The defendant, Travelers Ins. Co., challenged the validity of the assignment and the necessity of the medical services provided. The court affirmed the validity of the assignment under New York's Insurance Law and related regulations. However, based on conflicting expert testimonies, the court limited the compensable medical services to six hours and awarded the plaintiff $566.10, along with statutory interest and attorney's fees.

No-Fault InsuranceFirst-Party BenefitsAssignment ValidityMedical ServicesPeer ReviewInsurance LawHealth Provider ClaimAutomobile AccidentDamagesStatutory Interpretation
References
5
Case No. MISSING
Regular Panel Decision

Universal Acupuncture Pain Services, P.C. v. Lumbermens Mutual Casualty Co.

The New York court addresses a motion for reargument by Universal Acupuncture Pain Services, P.C. against Lumbermens Mutual Casualty Company concerning no-fault insurance claims. The central legal question is whether an expert witness's peer review report, created after a timely denial of a no-fault claim, can be admitted at trial, specifically under the Cirucci precedent regarding the specificity of denial grounds. The court grants the motion for reargument but upholds its initial ruling, which granted partial summary judgment on one of five claims. It clarifies that the expert's testimony must be strictly limited to the "concurrent or excessive care" ground initially stated by the insurer, excluding any new grounds like "medical necessity" not specified in the original denial. The court emphasizes that the issue of whether different treatment modalities constitute concurrent care for the same condition requires a trial for factual determination.

No-Fault InsurancePeer ReviewExpert Witness TestimonySummary Judgment MotionInsurance Law InterpretationSpecificity of DenialConcurrent Medical CareAcupuncture TreatmentChiropractic TreatmentPhysical Therapy
References
7
Case No. 534239
Regular Panel Decision
Sep 29, 2022

In the Matter of the Claim of Lorna Lyman

Lorna Lyman, a motorized snow operator, sustained lower back and right foot injuries in January 2018. Her workers' compensation claim was accepted and established for a work-related right foot injury, leading to surgery. Medical evaluations by treating podiatrist Carrie O'Neil and orthopedic surgeon Robert Karpman initially assessed schedule loss of use. However, the Workers' Compensation Board affirmed a Workers' Compensation Law Judge's finding that her injury was amenable to a nonschedule classification. This decision was based on findings of a chronic painful condition and marked permanent partial medical impairment, supported by substantial medical evidence of chronic pain and severe swelling despite exhausted treatment options. The Appellate Division affirmed the Board's decision.

Nonschedule classificationPermanent partial disabilityChronic painFoot injurySchedule loss of useMedical impairmentIndependent medical examinationTreating physicianAppellate reviewSubstantial evidence
References
6
Case No. Docket No. 2020-05-0361 / State File No. 25334-2020
Regular Panel Decision
Nov 18, 2020

Elmore, Stacey v. Federal Express Ground

Ms. Elmore, an employee of FedEx, sustained a left foot injury on November 27, 2018. She developed complex regional pain syndrome in her foot and leg, leading her authorized pain specialist, Dr. Matthew Rupert, to recommend a spinal cord stimulator trial in February 2020. The recommendation was denied by utilization review due to missing lab work, a denial upheld on appeal. Ms. Elmore sought a court order for the trial, but FedEx argued that prerequisite lab work was missing for UR approval. The Court ruled that FedEx failed to rebut the presumption of medical necessity for Dr. Rupert's recommendation, as it did not provide evidence related to ODG guidelines or generally accepted medical practice standards. Consequently, the Court granted Ms. Elmore's request, ordering FedEx to provide the recommended spinal cord stimulator trial.

spinal cord stimulatorcomplex regional pain syndromemedical necessityutilization reviewODG guidelinesauthorized treating physicianexpedited hearingworker's compensationTennesseemedical treatment dispute
References
2
Case No. ADJ7525978
Regular
Jun 07, 2013

CLADYS ROBERTSON vs. MORENO VALLEY UNIFIED SCHOOL DISTRICT, Permissibly Self-Insured

This case involves Gladys Robertson's workers' compensation claim against Moreno Valley Unified School District. The Workers' Compensation Appeals Board dismissed Robertson's petition for reconsideration because it was filed late. Even if timely, the petition would have been denied on the merits. The Administrative Law Judge found Robertson's testimony not credible, citing inconsistencies with contemporaneous medical records that indicated pre-existing bilateral foot pain and a denial of trauma. Therefore, the judge recommended denial of the petition.

Petition for ReconsiderationDismissalTimelinessSkeletal PetitionWCJ ReportAOE-COECredibilityAME ReportKaiser RecordsTrauma Denial
References
0
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. ADJ7744103, ADJ7580182 (MF)
Regular
May 05, 2014

IGNACIO RAMOS vs. GREENWOOD DAIRY, CALIFORNIA LIVESTOCK PROCDUCERS

The Workers' Compensation Appeals Board granted reconsideration, rescinded the judge's decision, and returned the case for further proceedings. While finding no permanent disability from the applicant's industrial foot injury, the Board determined that the applicant did sustain industrial injury in the form of a fungal foot infection and bilateral foot sprain. The Board disagreed with the trial judge's finding of no industrial injury and clarified that Dr. McCoy's opinion, not Dr. Panting's, constituted substantial evidence regarding the nature of the industrial injury. Issues of temporary disability and further medical treatment were deferred to the trial level for further decision.

AOE/COEPetition for ReconsiderationFindings and OrderAgreed Medical ExaminerPanel Qualified Medical ExaminationSubstantial EvidenceMedical ProbabilityOsteonecrosisFreiberg's infractionFungal foot infection
References
0
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