CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

Case Law Database

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

Case No. MISSING
Regular Panel Decision

Elmont Open MRI & Diagnostic Radiology, P.C. v. New York Central Mutual Fire Insurance

Plaintiff Elmont Open MRI & Diagnostic Radiology, PC. sued defendant New York Central Mutual Fire Insurance Company (NYCMFIC) for overdue first-party no-fault benefits following a brain MRI performed on Abdelghani Kinane. NYCMFIC moved for summary judgment, asserting the action was premature because Elmont allegedly failed to respond to verification requests, thereby tolling NYCMFIC's time to pay or deny the claim. Elmont countered with an affidavit from its billing supervisor, Brijkumar Yamraj, and a certificate of mailing, proving the requested MRI films and information were sent to NYCMFIC on November 12, 2008. The court found Elmont's proof of mailing sufficient to establish a response, thus denying NYCMFIC's motion and subsequently granting summary judgment to Elmont upon searching the record.

No-fault insuranceVerification requestsSummary judgmentProof of mailingMedical benefitsInsurance claims processTolling of time limitMotor vehicle accidentRadiology fee scheduleBusiness records
References
24
Case No. ADJ7845980
Regular
Oct 18, 2011

STEPHEN ZIMMERMAN vs. CITY AND COUNTY OF SAN FRANCISCO

The Appeals Board granted reconsideration of the applicant's pro per petition, staying the Stipulations and Award and returning the matter for further proceedings. The Board dismissed the former attorney's petition as moot and will allow applicant to argue the stipulation was entered into under duress and without full knowledge of his rights. The Board also noted ambiguities in the stipulation regarding the cervical MRI and the need to address temporary disability indemnity.

Workers' Compensation Appeals BoardPetition for ReconsiderationStipulations and AwardMedical Provider Network (MPN)DuressTemporary Disability IndemnityExpedited HearingDeclaration of Readiness (DOR)Continuity of CareGood Cause
References
4
Case No. MISSING
Regular Panel Decision

Henness v. Price Chopper/Golub Corp.

In March 1996, the claimant sustained injuries from a fall and received workers' compensation benefits. His case was later reopened to address a worsening neck injury, which the self-insured employer disputed, citing lack of timely notice. The Workers’ Compensation Law Judge and Board determined that the employer had waived its timeliness defense by making an advance payment of compensation for a 1998 cervical MRI and office visits, thus recognizing liability for the neck injury. The Board also awarded benefits for a subsequent fall in March 2001, concluding it exacerbated the original neck injury. The Appellate Division affirmed the Board's decision, finding substantial evidence for the advance payment and a rational basis for the benefit award.

Workers' CompensationAdvance PaymentTimeliness DefenseStatute of LimitationsNeck InjuryExacerbationSelf-Insured EmployerMedical BenefitsBoard DecisionAppellate Review
References
4
Case No. ADJ3701295 (AHM 0146448)
Regular
Oct 07, 2013

PAULA GUEVARA vs. NORTHGATE GONZALEZ MARKET, ZENITH ESIS

The Workers' Compensation Appeals Board granted reconsideration for lien claimant Max MRI. While affirming the denial of Max MRI's lien claim for lack of evidence, the Board vacated the sanctions imposed. The Board found that Max MRI was denied due process regarding the sanctions, as the issue was not properly noticed or heard. The case is returned to the trial level for further proceedings and a decision on costs and sanctions.

Workers' Compensation Appeals BoardPetition for ReconsiderationLien claimantMax MRIFrivolous lienSanctionsDue processMedical Provider NetworkCompromise and ReleaseFindings and Order
References
3
Case No. ADJ7924562
Regular
Sep 19, 2014

RAUL HERNANDEZ vs. LOS ANGELES UNIFIED SCHOOL DISTRICT

The applicant sought reconsideration of a WCJ decision that found an industrial injury to the low back but not the cervical spine or left ankle, with no permanent disability or further medical treatment. The applicant argued the QME's reports were insubstantial and that prior permanent disability was not considered. The Appeals Board granted reconsideration to amend the original award to include injury to the cervical spine, affirming the remainder of the decision. Therefore, the applicant sustained injury to his low back and cervical spine.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryLow Back InjuryCervical Spine InjuryPermanent DisabilityFurther Medical TreatmentPanel Qualified Medical EvaluatorLabor Code Section 4664(b)
References
0
Case No. ADJ1083014 (POM 0275607) ADJ4477705 (POM 0275608)
Regular
May 29, 2009

LILIAN SOTO vs. PM GLOVES, INC., STATE COMPENSATION INSURANCE FUND

This case involved a lien claimant seeking payment for an MRI. The Workers' Compensation Judge initially disallowed the lien for failing to meet Labor Code section 5703 requirements. The Appeals Board granted reconsideration, finding the WCJ erred by strictly applying section 5703. They determined that other evidence, including the treating physician's report referenced in a settlement, established the validity of the MRI expense. Therefore, the Board allowed the lien claim for the MRI.

Lien claimantReconsiderationLabor Code Section 5703Labor Code Section 4626Finding and OrderWorkers' Compensation Judge (WCJ)Compromise and Release (C&R)MRILumbar SpineSelf-procured medical treatment
References
0
Case No. MISSING
Regular Panel Decision

Claim of Pulos v. Asplundh Tree

Claimant, a tree trimmer, had an existing claim for bilateral carpal tunnel syndrome and later sought to include a cervical spine condition as an occupational disease. A workers' compensation law judge initially disallowed this amendment, but the Workers' Compensation Board reversed, finding the cervical condition was dormant and non-disabling, and that the claimant's work activities aggravated it. The employer appealed this decision. The court affirmed the Board's ruling, concluding there was substantial evidence to support the finding that the claimant's preexisting cervical condition was activated by the distinctive features of his employment.

Occupational DiseaseCervical Spine InjuryCarpal Tunnel SyndromePreexisting ConditionAggravation of InjuryWorkers' Compensation LawJudicial ReviewAppellate DecisionTree TrimmingWork Activities
References
3
Case No. ADJ1337074 (GRO 0034564) ADJ1286218 (GRO 0034565)
Regular
Jun 24, 2009

Dave Gerletti vs. SANTA MARIA AIRPORT DISTRICT, GREGORY BRAGG STOCKTON

The Workers' Compensation Appeals Board denied Dave Gerletti's petition for reconsideration of an award for a cumulative trauma injury to his cervical spine and lungs. The original award found 35% permanent disability, apportioning 50% of the cervical spine disability to non-industrial factors based on a Qualified Medical Evaluator's opinion of degenerative changes. The majority affirmed the WCJ's reliance on this opinion, finding it adequately explained. A dissenting opinion argued the QME's apportionment was speculative and improperly based on age and genetics, recommending an unapportioned award for the cervical spine injury.

Workers' Compensation Appeals Boardcumulative traumacervical spinelungspermanent disabilityapportionmentQualified Medical EvaluatorAgreed Medical Examinerarthritic degenerationnon-industrial factors
References
1
Case No. ADJ7288330
Regular
Oct 03, 2016

GLORIA BENITEZ vs. NEWPORT SUBACUTE HEALTH CARE CENTER, ALASKA NATIONAL INSURANCE COMPANY

The applicant, Gloria Benitez, sought to reopen her workers' compensation claim to include injury to additional body parts beyond her cervical spine and psyche. The original award found injury only to the cervical spine and psyche, with a 19% permanent disability rating for the cervical spine. While the WCJ's initial decision denied injury to additional body parts, the Board granted reconsideration. The Board amended the original findings to defer the issue of injury to the alleged additional body parts, while affirming other aspects of the WCJ's order, including the appointment of a regular physician to evaluate new and further disability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderNew and Further DisabilityAgreed Medical ExaminerRegular PhysicianLabor Code Section 5410Petition to ReopenIndustrial InjuryCervical Spine
References
4
Case No. 526688
Regular Panel Decision
Dec 27, 2018

Matter of Bufearon v. City of Rochester Bur. of Empl. Relations

Claimant Kamren Bufearon sustained work-related injuries in a motor vehicle collision on March 4, 2016, for which his workers' compensation claim was established for injuries to his left shoulder, left hip, and lower back. Subsequently, he sought to amend his claim to include a causally-related cervical spine injury, which was initially approved by a Workers' Compensation Law Judge. However, the Workers' Compensation Board reversed this decision, finding that the claimant failed to sufficiently demonstrate a causal relationship between his cervical spine condition and the March 4, 2016 incident. The Appellate Division affirmed the Board's decision, noting that the medical testimony from two physicians contained conflicting findings and equivocal narratives regarding causation. The court concluded that the Board was entitled to reject the physicians' opinions as speculative, particularly since neither physician had reviewed the claimant's prior medical records for a pre-existing cervical spine fusion surgery.

Cervical spine injuryCausal relationshipMedical evidenceSubstantial evidence reviewAppellate DivisionWorkers' Compensation BoardPre-existing conditionCredibility of physiciansBurden of proofMotor vehicle accident
References
13
Showing 1-10 of 254 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational