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

Case No. ADJ376655 (SJO 0257571)
Regular
Dec 26, 2014

JORDAN STONE vs. ACHIEVE KID.; CAPS-SIG

In this workers' compensation case, the Appeals Board reversed a prior decision denying an employer's appeal of an Independent Medical Review (IMR) determination. The Board found the IMR determination for a knee cartilage transplant was plainly erroneous and acted in excess of the Administrative Director's powers. This was due to a direct contradiction between the IMR's finding of medical necessity and its stated rationale. Consequently, the Board granted the employer's appeal and remanded the case for a new IMR review by a different reviewer.

Workers' Compensation Appeals BoardIndependent Medical Review (IMR)Utilization Review (UR)Labor Code section 4610.6(h)Plainly erroneous findingsExpert opinionMedical necessityCartilage transplantRight kneeRemand
References
0
Case No. 07-CV-2634; 07-CV-4841
Regular Panel Decision
Apr 05, 2010

Price v. Reilly

Plaintiff Anthony Price, a pro se inmate, alleged deliberate indifference to his serious medical needs at Nassau County Correctional Center, violating his Eighth Amendment rights under 42 U.S.C. § 1983. Price claimed incorrect medication dosage for renal disease, failure to be tested for a kidney transplant, and inadequate treatment for shoulder pain against Sheriff Edward Reilly, Kim Edwards, Perry Intal, Mary Sullivan, Dr. Benjamin Okonta, and Nassau University Medical Center. The court granted defendants' motion for summary judgment regarding the medication dosage and all claims against Sheriff Reilly. However, the motion was denied concerning the kidney transplant request and shoulder pain claims, as genuine issues of material fact remained. The court also addressed the exhaustion of administrative remedies, finding defendants failed to establish plaintiff's non-exhaustion for the kidney transplant claim.

Eighth AmendmentDeliberate IndifferenceMedical NeedsPrisoner RightsSummary JudgmentKidney DiseaseRenal FailureDialysisShoulder PainInmate Grievance
References
70
Case No. SDO 0354449
Regular
Sep 20, 2007

ADAM PERRY vs. HAMMOND \& MASING CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed a prior award denying additional temporary disability payments beyond the statutory 104-week limit. The applicant sought to extend payments based on his knee surgeries, arguing they constituted "amputations" under Labor Code section 4656(c)(2)(C). The Board held that the term "amputation" in this context refers to the severance of external body parts, not the surgical removal of internal knee fragments or cartilage.

Workers' Compensation Appeals BoardIndustrial InjuryPsyche InjuryTemporary Total DisabilityLabor Code Section 4656(c)(1)Labor Code Section 4656(c)(2)(C)AmputationsOsteochondral FragmentChondroplastyACL Reconstruction
References
1
Case No. ADJ6801375
Regular
Jul 13, 2010

MICHAEL DAVID HERNANDEZ vs. VINCE'S ITALIAN TO GO, PREFERRED EMPLOYERS

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a prior award. The WCAB found that the applicant was not entitled to medical treatment outside the employer's Medical Provider Network (MPN) for a meniscus transplant or graft. The applicant failed to follow the required procedures for obtaining a second and third opinion within the MPN before seeking treatment from an out-of-network physician. Therefore, the WCAB concluded there was no showing that treatment outside the MPN was justified under the relevant rules.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNFurther Medical TreatmentSports Medicine DoctorMedical Meniscus TransplantGraft ProcedureDr. Patrick O'MearaDr. John DeSantisSubspecialist
References
2
Case No. ADJ10917168 (MF)
Regular
Oct 21, 2019

JACOB PIKE vs. CITY OF LONG BEACH

This case concerns an applicant seeking reconsideration of a Workers' Compensation Appeals Board decision denying a right knee meniscal transplantation. The judge found the requested treatment did not fall within presumptively correct Medical Treatment Utilization Standards (MTUS) or present sufficient scientific evidence to rebut the presumption. Applicant argued the physician's report constituted scientific evidence and supported medical necessity, but the Board affirmed the denial. The Board found the applicant failed to meet the burden of proof by a preponderance of scientific medical evidence for treatment outside MTUS guidelines.

Workers' Compensation Appeals BoardPetition for ReconsiderationJoint Findings of Factindustrial injuryright knee meniscal transplantationUtilization Review (UR)Medical Treatment Utilization Standards (MTUS)Labor Code sections 4604.55307.27medically necessary
References
4
Case No. MISSING
Regular Panel Decision

Pulos v. Comm'r of Soc. Sec.

Plaintiff Sharon K. Pulos sought judicial review of the Commissioner of Social Security's final decision denying her application for disability insurance benefits. Plaintiff alleged disability due to multiple impairments including a brain tumor, liver transplant, diabetes, and depression, with an onset date of February 1, 2008. An Administrative Law Judge (ALJ) found Plaintiff not disabled, concluding her impairments were not severe enough to significantly limit basic work activities during the relevant period. The District Court affirmed the Commissioner's decision, finding it supported by substantial evidence and free from legal error, and denied Plaintiff's motion for judgment on the pleadings.

Social Security ActDisability Insurance BenefitsALJ DecisionSubstantial EvidenceSeverity StandardCognitive ImpairmentPsychological ImpairmentBrain SurgeryLiver TransplantDiabetes
References
23
Case No. MISSING
Regular Panel Decision

McMahon v. New York Organ Donor Network, Inc.

This case addresses a discovery dispute in a whistleblower action. Plaintiff Patrick McMahon sued the New York Organ Donor Network, Inc., alleging wrongful termination after he reported concerns about illegal organ procurement practices, in violation of Labor Law § 740. Defendant countered that McMahon was fired for poor performance as a probationary employee. McMahon sought to compel the production of personnel records for other probationary transplant coordinators to compare performance evaluations. The court partially granted McMahon's motion, ordering disclosure of relevant records from 2009-2013, and denied the defendant's cross-motion for a protective order, emphasizing the relevance of comparison evidence in whistleblower cases.

Whistleblower ActRetaliation ClaimDiscovery DisputePersonnel Files DisclosureLabor Law Section 740Motion to CompelProtective OrderProbationary EmploymentWork PerformanceOrgan Donation
References
6
Case No. MISSING
Regular Panel Decision

Pender v. District Council 37 of American Federation

Plaintiff Patricia A. Pender brought an employment discrimination suit against her former employer, District Council 37 (DC 37), alleging termination due to disability in violation of the Americans with Disabilities Act (ADA) and New York law. Pender, who had undergone a liver transplant, was terminated after a medical leave and a temporary modified assignment, with DC 37 claiming she could not perform the essential functions of her Council Representative job. An arbitrator, after an extensive grievance proceeding, had previously found in favor of DC 37, concluding Pender was unable to perform her duties even with accommodations. The court, affording significant weight to the arbitrator's decision and considering Pender's own admissions of disability, found insufficient evidence for a jury to conclude she could perform her job. Therefore, the court granted DC 37's motion for summary judgment, dismissing the complaint.

Employment DiscriminationDisability DiscriminationAmericans with Disabilities ActSummary JudgmentArbitrationCollective Bargaining AgreementReasonable AccommodationEssential Job FunctionsSocial Security DisabilityArbitrator's Decision Weight
References
19
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