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

Case No. ADJ7868976
Regular
May 02, 2018

JAMES BARRIOS vs. BUENA VISTA FOOD PRODUCTS, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board granted reconsideration of a judge's order requiring defendants to pay the balance of a lien claimant's bill. The primary dispute concerns the reasonable value of medical services under the Official Medical Fee Schedule (OMFS). Neither the lien claimant's testimony nor the defendant's bill review expert provided substantial evidence to establish the OMFS amount due. Therefore, the case is remanded for further proceedings to develop the record, potentially through an agreed bill reviewer or an appointed independent reviewer.

Petition for ReconsiderationFindings and OrderCompromise and Releaselien claimantDr. Paynebill reviewofficial medical fee scheduleOMFSsubstantial evidenceindependent bill review
References
1
Case No. ADJ7038469
Regular
Sep 17, 2014

AZIZA SAYED vs. GIORGIO ARMANI, FEDERAL INSURANCE COMPANY

The defendant's petition to appeal an Administrative Director's Independent Bill Review (IBR) determination was dismissed. The Board found the petition premature as it was not first heard by a trial level Workers' Compensation Judge (WCJ). Additionally, the petition failed to comply with numerous procedural requirements, including proper captioning, verification, service, and stating specific grounds for appeal. Consequently, both the petition for reconsideration and the petition appealing the IBR determination were dismissed.

Workers' Compensation Appeals BoardIndependent Bill ReviewPetition for ReconsiderationAdministrative DirectorLabor Code section 4603.6MAXIMUS Federal ServicesInc.Lien claimantOfficial Medical Fee ScheduleWCAB Rules of Practice and Procedure
References
0
Case No. ADJ1504028 (AHM 0081465); ADJ603748 (AHM 0081464)
Regular
Oct 09, 2025

JENNIFER DICORATO vs. BLOOMFIELD BAKERY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION

The case involves a petition for removal filed by lien claimant Stuart Silverman, M.D., challenging an order by a Workers' Compensation Administrative Law Judge (WCJ). The WCJ's order permitted the defendant to substitute a bill review expert witness and allow remote testimony. The Appeals Board, after reviewing the petition, defendant's answer, and the WCJ's report, dismissed the petition. The Board concluded that the issue was not yet ripe for adjudication as no final order or decision regarding the expert witness substitution or remote testimony had been issued by the WCJ. The decision further noted the importance of a complete record and admonished the lien claimant's representative, Dan Escamilla, for misrepresenting facts in the verified petition for removal.

Petition for RemovalLien ClaimantSubstitution of Expert WitnessRemote TestimonyWCJ DecisionNot Ripe for AdjudicationPretrial Conference StatementSubstantial EvidenceAdmitted EvidenceSanctions
References
4
Case No. MISSING
Regular Panel Decision

People v. Gans

This court opinion addresses whether a certified social worker can be qualified as an expert witness to provide testimony regarding a defendant's mental capacity to proceed and future competency. The defense sought to qualify Hillel Bodek, a certified social worker specializing in forensic clinical social work, as an expert witness for these purposes. The court meticulously reviewed the qualifications of clinical social workers, acknowledging their critical role in the diagnosis of mental disorders, including their involvement in the development of the DSM III. Despite statutory provisions in CPL article 730 outlining who may serve as psychiatric examiners, the court emphasized that other appropriately trained and experienced experts can also offer testimony on competence. Ultimately, the court ruled in the affirmative, concluding that certified social workers with demonstrated training and supervised clinical experience in diagnosis and capacity assessment are qualified to provide expert testimony on these crucial issues.

Expert Witness QualificationCertified Social WorkerMental Capacity AssessmentCompetency to ProceedForensic Mental HealthDiagnostic AssessmentPrognostic StatementsCriminal Procedure Law Article 730DSM IIINon-Medical Expert Testimony
References
13
Case No. MISSING
Regular Panel Decision

Haddad v. City of Albany

The petitioner appealed a Supreme Court judgment that dismissed their application, which combined a CPLR article 78 proceeding and an action for declaratory judgment. The application challenged the respondent's denial of a request to rescind waste removal violation bills issued by the Department of General Services (DGS) of the City of Albany. The Supreme Court had found that the petitioner failed to exhaust administrative remedies and that claims regarding preemption of local waste ordinances by state penal law were without merit. During the pendency of the appeal, the Board of Zoning Appeals (BZA) administratively reviewed the violations, reversing some charges and upholding others. The appellate court affirmed the Supreme Court's judgment, concluding that a violation of the City of Albany's waste code was not a criminal violation under Penal Law § 55.10, and that the petitioner was indeed required to exhaust administrative remedies for their constitutional claims, as these claims implicated specific aspects of the administrative proceeding rather than the administrative scheme itself.

WasteManagementAdministrativeLawMunicipalCodePenalLawExhaustionOfRemediesDeclaratoryJudgmentAppellateReviewEnvironmentalViolationsPublicHealthPropertyMaintenance
References
10
Case No. ADJ9417187
Regular
Jun 05, 2018

CARLOS CAMMON vs. COUNTY OF ORANGE permissibly selfinsured, administered by YORK RISK SERVICES GROUP, INC.

This case involves lien claimants Western Medical Center and Cedars Sinai seeking reconsideration of a decision regarding their unpaid medical bills. The administrative law judge had ruled the bills were subject to independent bill review and deemed satisfied due to a failure to request second bill review. The Appeals Board rescinded the original decision, finding that the threshold issue of whether the defendant was a beneficiary of a PPO contract needed to be determined first. Furthermore, the timeliness of Cedars Sinai's second bill review request remains unresolved, necessitating further proceedings to develop the record on this issue.

Workers' Compensation Appeals BoardLien ClaimantsIndependent Bill Review (IBR)Second Bill ReviewLabor Code Section 4603.2Labor Code Section 4603.3PPO ContractExplanation of Review (EOR)Guardian Ad LitemStipulations with Request for Award
References
0
Case No. ADJ9615494
Regular
Oct 08, 2019

CARLOS SOTO TORRES vs. THE CLIFF RESTAURANT, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board rescinded an Amended Findings of Fact and Order because essential documentation regarding the timeliness of medical-legal billings and reviews was missing. Specifically, the record lacked proof of service for the provider's invoice, the defendant's initial Explanation of Review (EOR), and the subsequent second bill review. This prevented determination of whether the defendant timely objected to the bill and whether the provider timely requested a second review, necessitating further proceedings at the trial level.

Workers' Compensation Appeals BoardReconsiderationAmended Findings of Fact and OrderQualified Medical EvaluatorQMEDr. Payam MoazzazZenith Insurance CompanyStatute of LimitationsLabor Code section 4903.5Independent Bill Review
References
0
Case No. 2022 NY Slip Op 01011
Regular Panel Decision
Feb 16, 2022

Hamm v. Review Assoc., LLC

The plaintiff, Peter Hamm, an employee, sustained injuries after falling from a ladder while servicing a security system at premises owned by Review Associates, LLC and leased by Fresh Direct, LLC. He initiated a personal injury action alleging common-law negligence and violations of Labor Law §§ 200, 240(1), and 241(6). The Supreme Court initially granted summary judgment to the defendants, dismissing the complaint. On appeal, the Appellate Division modified this order, denying summary judgment for the Labor Law § 240(1) claim against both defendants due to triable issues of fact regarding whether the work constituted "repairs" or "routine maintenance." Additionally, the court denied summary judgment for the common-law negligence and Labor Law § 200 claims against Fresh Direct, LLC, as it failed to establish a lack of notice regarding the defective ladder. The court affirmed the dismissal of the Labor Law § 241(6) claim against both defendants and the common-law negligence and Labor Law § 200 claims against Review Associates, LLC.

Personal InjuryLadder AccidentLabor Law § 240(1)Labor Law § 200Common-law NegligenceSummary JudgmentAppellate DivisionDuty to Maintain Safe PremisesRoutine Maintenance vs. RepairDangerous Condition
References
44
Case No. ADJ2834079 (SDO 0293027) ADJ2839895 (SDO 0358837)
Regular
Jun 25, 2009

THUAN CRIM-ROLFE vs. LA COSTA RESORT AND SPA, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for LEGION INSURANCE COMPANY, BROADSPIRE, SAFETY NATIONAL CASUALTY INSURANCE COMPANY

This case involves a clerical error in a prior Workers' Compensation Appeals Board (WCAB) decision. The WCAB previously ordered Safety National Casualty Insurance Company (SNCC) to reimburse the California Insurance Guarantee Association (CIGA) a specific amount for bill review charges. CIGA requested clarification, noting the amount ordered was incorrect. The WCAB affirmed its earlier decision that CIGA is entitled to reimbursement for bill review costs but amended the order nunc pro tunc. The corrected order now states SNCC must reimburse CIGA for bill review charges, with the exact amount to be determined by the parties or the arbitrator.

California Insurance Guarantee AssociationLegion Insurance CompanySafety National Casualty Insurance Companynunc pro tuncclerical errorbill review chargesliquidationcovered claimsreimbursementpetition for reconsideration
References
6
Case No. 21-mc-102
Regular Panel Decision

Socha v. 110 Church, LLC

Plaintiffs, Marek Soeha, Jerzy Muszkatel, Tadeusz Kowalewski, Wla-dyslaw Kwasnik, and Waldemar Ropel, sought to compel expert testimony from non-retained physicians associated with the Mt. Sinai World Trade Center Medical Monitoring Program and a Workers’ Compensation physician. These "Non-Retained Experts" possess unique knowledge regarding the effects of World Trade Center dust but were unwilling to provide data or serve as expert witnesses due to time constraints and concerns about compromising neutrality. District Judge Alvin K. Hellerstein denied the plaintiffs' motion to compel depositions and amended expert disclosures, finding a lack of "substantial need" as the information was not unique and comparable witnesses were available. However, acknowledging the unparalleled scope of the Mt. Sinai WTC Health Program's research, the court ordered Mt. Sinai to produce its data, with appropriate redactions, following an established protocol.

Expert Witness DepositionMotion to CompelFederal Rules of Civil Procedure 26Non-Retained ExpertsWorld Trade Center LitigationMedical Monitoring ProgramDiscovery DisputeSubpoena Expert WitnessCausation TestimonyData Disclosure Order
References
3
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