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

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. 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. 06-11-00094-CV
Regular Panel Decision
Jan 13, 2012

Christopher Castleberry v. New Hampshire Insurance Company

Christopher Castleberry appealed the dismissal of his case against New Hampshire Insurance Company. Castleberry sustained a work-related back injury in 2009, for which he received worker's compensation benefits. The insurer later contested coverage for medications for depression, chronic pain syndrome, chronic myofascial pain, and erectile dysfunction. The Division of Workers’ Compensation Review Board ruled that the compensable injury did not extend to these ailments. Castleberry sought judicial review, but the trial court granted the insurer's plea to the jurisdiction and dismissed the entire suit. The appellate court affirmed the dismissal of claims for depression, chronic pain syndrome, or myofascial pain syndrome, but reversed the judgment concerning the claim for medication for erectile dysfunction, remanding that issue for further proceedings.

Workers' CompensationJudicial ReviewPlea to JurisdictionAdministrative RemediesMedical BenefitsErectile DysfunctionChronic PainDepressionMyofascial PainAppellate Court
References
3
Case No. 06-11-00094-CV
Regular Panel Decision
Jan 13, 2012

Clyde Washington v. State

Christopher Castleberry appealed the dismissal of his case against New Hampshire Insurance Company, concerning a dispute over workers' compensation benefits for prescribed medications. Castleberry suffered a work-related back injury in 2009. The insurer later contested medications for depression, chronic pain syndrome, chronic myofascial pain, and erectile dysfunction. The Division of Workers' Compensation Review Board ruled against Castleberry regarding these ailments. The trial court subsequently granted the insurer's plea to the jurisdiction and dismissed the entire suit. The appellate court affirmed the dismissal of claims related to depression, chronic pain, and myofascial pain due to a lack of exhausted administrative remedies. However, it reversed and remanded the claim for erectile dysfunction medication, finding that the trial court improperly dismissed this issue, for which jurisdiction existed.

Workers' CompensationJurisdictionPlea to the JurisdictionAdministrative ReviewMedical BenefitsErectile DysfunctionChronic PainDepressionRemandAppellate Procedure
References
15
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. ADJ605947 (MON 0274664)
Regular
Feb 02, 2009

LESLIE CELLUCCI vs. FLORENCE MACHINE PRODUCTS, STATE COMPENSATION INSURANCE FUND

This case concerns a workers' compensation claim for injuries to the applicant's hands, upper extremities, and neck, resulting in chronic pain syndrome and a sleep disorder. The defendant disputed the extent of permanent disability and the diagnoses of chronic pain syndrome and sleep disorder. The Appeals Board affirmed the finding of industrial injury and the 85% permanent disability rating, including the diagnoses of chronic pain syndrome and sleep disorder. The Board also granted reconsideration to amend the award to include a life pension for the applicant, as required by law for an 85% permanent disability finding.

Workers' Compensation Appeals BoardLeslie CellucciFlorence Machine ProductsState Compensation Insurance FundADJ605947Opinion and Order Granting ReconsiderationFindings and AwardPermanent DisabilityChronic Pain SyndromeSleep Disorder
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. STK 0209780 STK 0209781
Regular
Feb 08, 2008

TAMARA JEAN STAFFORD vs. LODI UNIFIED SCHOOL DISTRICT, ALTERNATIVE SERVICE CONCEPTS

The Workers' Compensation Appeals Board denied the Lodi Unified School District's petition for reconsideration, affirming the administrative law judge's award of pain medications and trigger-point injections to applicant Tamara Jean Stafford. The Board found the defendant's utilization review physician improperly applied ACOEM guidelines, which primarily address acute injuries, to the applicant's chronic condition. The Board clarified that while ACOEM guidelines are presumptively correct, variances are permissible when reasonably required to cure and relieve an employee's injury effects, as demonstrated by the applicant's treating physician's recommendations.

Workers' Compensation Appeals BoardLodi Unified School DistrictAlternative Service ConceptsTamara Jean StaffordPetition for ReconsiderationFindings and AwardMedical TreatmentPrimary Treating PhysicianACOEM GuidelinesUtilization Review
References
9
Case No. 526425
Regular Panel Decision
Nov 15, 2018

Matter of Gasparro v. Hospice of Dutchess County

Mary Ann Gasparro, a claimant with a permanent partial disability from a 1995 work injury, moved to Nevada. In 2016, her employer's workers' compensation carrier objected to payments for topical pain relief products, LidoPro and Terocin patches, prescribed by a Nevada pain management specialist. The Workers' Compensation Board reversed a Workers' Compensation Law Judge's ruling, deciding that New York's Medical Treatment Guidelines apply to out-of-state treatment for nonresident claimants, a departure from its prior decisions. The Board found the prescribed medications were not in accordance with the guidelines due to concomitant use and duration. The Appellate Division, Third Department, affirmed the Board's decision, deeming its change in course rational and its application of the guidelines to out-of-state treatment reasonable. The court concluded that the Board's finding of medical necessity and non-compliance with guidelines was supported by substantial evidence.

Workers' CompensationMedical Treatment GuidelinesOut-of-State Medical CareNonresident ClaimantsPain ManagementTopical Pain ReliefLidoProTerocin PatchesAppellate DivisionBoard Reversal
References
12
Case No. ADJ6521264
Regular
Oct 11, 2013

ANGELA STUART-KNIGHTS vs. EMPLOYMENT DEVELOPMENT DEPARTMENT, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of an award finding the applicant sustained 66% permanent disability due to a cumulative trauma injury. The applicant argued that the Agreed Medical Examiner's (AME) report rebutted the permanent disability rating, particularly regarding her chronic pain syndrome. However, the WCAB affirmed the original award, deferring to the judge's credibility determination regarding the applicant's demeanor and testimony, which contradicted the AME's assessment of severe pain. Furthermore, the AME himself deferred to another physician on the issue of chronic pain, undermining his report's evidentiary value on that point.

WCABReconsiderationFindings of FactAwardAdministrative Law JudgeWCJCumulative TraumaPermanent DisabilityAMA GuidesAlmaraz/Guzman
References
4
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