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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

Claim of Cummins v. North Medical Family Physicians

A claimant sustained a work-related back injury and sought continued medical treatment, which was initially authorized. Disputes over authorization led the claimant to retain an attorney. A Workers’ Compensation Law Judge authorized continued medical treatment but denied counsel fees, stating no "money passing" occurred. The Workers' Compensation Board upheld this decision. The claimant appealed, arguing the Board unconstitutionally applied Workers’ Compensation Law § 24, misinterpreted the statute regarding fee payment from medical benefits, and abused its discretion. The appellate court affirmed the Board's decision, ruling that counsel fees must be paid from "compensation," defined as a money allowance, and medical benefits are not considered "compensation" for this purpose, thus finding no abuse of discretion.

Workers' CompensationCounsel FeesAttorney FeesMedical TreatmentStatutory InterpretationConstitutional LawLienCompensation DefinitionAppellate ReviewBoard Decision
References
3
Case No. ADJ736188 (GOL 0099658)
Regular
Sep 22, 2017

Deanna Power vs. St. John's Regional Medical Center, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case concerns Deanna Power's claim for continued medical treatment, specifically prescription medications Xyrem and Lunesta, for a previous industrial injury. The employer denied authorization for these medications through Utilization Review (UR), and the applicant's subsequent Independent Medical Review (IMR) application was deemed untimely. The trial judge initially ordered continued treatment and directed the Administrative Director to process the IMR appeal, finding it timely. However, the Appeals Board granted reconsideration, finding the trial judge lacked jurisdiction to order treatment when a timely UR decision was issued and the applicant's sole recourse was the IMR process. The matter was returned to the trial level for a determination solely on the timeliness of the IMR appeal, not the medical necessity of the medications.

WCABPetition for ReconsiderationFindings of Fact and AwardXyremLunestaIndependent Medical ReviewIMRUtilization ReviewURprescription medications
References
3
Case No. MISSING
Regular Panel Decision
Jan 28, 1985

Blythe v. City of New York

The case involves an appeal by plaintiffs from an order granting summary judgment to defendants in a medical malpractice action. The infant plaintiff developed a seizure disorder after injections at a Department of Health Clinic, leading to subsequent treatments at various hospitals, including Kings County Hospital. The plaintiffs filed a notice of claim in March 1981, alleging continuous treatment by the New York City Health and Hospitals Corporation (HHC). However, the Supreme Court, Kings County, found a 19-month hiatus in treatment between Kings County Hospital and Queens Hospital, ruling that the continuous treatment doctrine did not apply. Consequently, the appellate court affirmed the decision, holding that the notice of claim was untimely and the defendants' motion for summary judgment was properly granted.

Medical MalpracticeSummary JudgmentContinuous Treatment DoctrineStatute of LimitationsNotice of ClaimKings CountyAppellate DivisionHospital NegligenceInfant InjurySeizure Disorder
References
6
Case No. ADJ927657
Regular
Mar 24, 2009

SHERRI J. RODNEY-TROULLIER vs. TALBERT MEDICAL GROUP, ST. PAUL/TRAVELERS

In this workers' compensation case, the applicant sustained admitted injuries and was treating with Dr. Sobol within the defendant's Medical Provider Network (MPN). When Dr. Sobol was terminated from the MPN, the defendant failed to properly follow continuity of care procedures as required by law. Specifically, the defendant did not resolve the dispute regarding the applicant's need for continued treatment with Dr. Sobol through the required dispute resolution process under Labor Code section 4062. Therefore, the Appeals Board rescinded the prior order and found that the applicant is entitled to continue treatment, including surgery, with Dr. Sobol.

MPNcontinuity of careterminated providerserious chronic conditionLabor Code section 4616.2AD Rule 9767.10dispute resolutionDr. Sobolsurgery authorizationLabor Code section 4062
References
1
Case No. ADJ324819 (SAL 0120615) ADJ3483975 (SAL 0119560)
Regular
Jul 20, 2010

KATHERINE GONZALES vs. COUNTY OF MONTEREY, LIBERTY MUTUAL

This case concerns an injured worker's attempt to continue treatment with her physician, Dr. Klassen, after he left the defendant's Medical Provider Network (MPN). The defendant argued that the worker's condition did not meet the criteria for continued treatment with a non-MPN physician under Labor Code section 4616.2. The Workers' Compensation Appeals Board (WCAB) granted reconsideration because there was insufficient medical evidence to determine if the worker's condition qualified. The WCAB rescinded the prior decision and returned the case for further proceedings, ordering the trial judge to obtain a report from Dr. Klassen regarding the necessity of continued treatment.

Workers' Compensation Appeals BoardMPNMedical Provider NetworkLabor Code section 4616.2continuity of treatmentprimary treating physicianacute conditionserious chronic conditionterminal illnessauthorization
References
0
Case No. ADJ10223631
Regular
May 31, 2019

SOUNG UE KIM vs. ELITE 4 PRINT, INC., BENCHMARK INSURANCE COMPANY

The WCAB reconsidered an order regarding applicant's treatment outside the employer's Medical Provider Network (MPN). Applicant sought to continue treatment with a physician not in the MPN after the claim was initially denied and later accepted. The Board amended the prior order to clarify that applicant was "improperly" treating outside the MPN, finding that Labor Code section 4603.2(a)(2) does not apply when the employer exercises medical control after accepting the claim, absent a prior final determination of entitlement to an outside physician. One commissioner dissented, arguing the case should be remanded to determine if the employer's significant delays in accepting the claim constituted a failure to provide medical care, which would allow continued treatment outside the MPN.

MPNPetition for Reconsiderationbilateral upper extremity injuriesAdministrative Director Rule 9767.9Labor Code section 4603.2Agreed Medical Examinerprimary treating physicianAOE/COEtransfer of caremedical control
References
8
Case No. MISSING
Regular Panel Decision

Ogle v. State

This case involves a claimant who filed for medical malpractice and negligence against the State of New York, alleging that delayed treatment for tuberculosis during his incarceration led to paraplegia. The Court of Claims initially denied the State's motion to dismiss, applying the continuous treatment doctrine. On appeal, the higher court reversed this decision, asserting that the doctrine's application requires a relevant relationship between treating physicians or a continuous relationship between the claimant and initial physicians, rather than merely all providers being state employees. The court found questions of fact regarding the relevant relationship between the medical facilities involved (Ogdensburg, Samaritan, Upstate) that need to be determined by the Court of Claims. Therefore, the order of the Court of Claims was reversed, and the matter was remitted for further proceedings to determine the applicability of the continuous treatment doctrine.

medical malpracticenegligencecontinuous treatment doctrinetuberculosisspinal cord injuryparaplegiacorrectional facility inmatestatute of limitationsquestions of factappellate review
References
14
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. WCB No. 7990 5338
Regular Panel Decision

In the Matter of Maureen Kigin v. State of New York Workers' Compensation Board

Justice Rivera's dissenting opinion argues that the Workers’ Compensation Board overstepped its authority by implementing regulations that demand preapproval for medical services not listed in its guidelines, thereby presuming such unlisted treatments are not medically necessary. This approach, according to the dissent, obstructs prompt medical care, contradicts the Workers’ Compensation Law's pro-employee stance, and deviates from the legislative intent to ease access to diagnostic and treatment measures. The opinion contends that while the Board can create a pre-authorized list, it cannot use this power to impose a burden on claimants like Kigin to continually prove the medical necessity of treatments not on that list, especially when disputes historically allowed for post-treatment resolution.

Workers' Compensation LawMedical Treatment GuidelinesPre-authorization RegulationsVariance SchemeMedical NecessityBoard AuthorityAdministrative RegulationsClaimant Burden of ProofStatutory InterpretationLegislative Intent
References
13
Case No. MISSING
Regular Panel Decision
Apr 22, 2003

Marmol v. Green

The defendants Ernest Henry Kirchman and New York City Health & Hospitals Corporation appealed an order from the Supreme Court, Queens County, which denied their motion for summary judgment in a medical malpractice case. The defendants contended that the alleged malpractice occurred before the plaintiff's notice of claim and that the continuous treatment doctrine was inapplicable due to the time interval between visits. However, the plaintiff successfully raised a triable issue of fact concerning the interval between treatments, challenging the defendants' prima facie showing. Additionally, the court found an existing question regarding whether the parties considered the plaintiff's treatment complete. The appellate court affirmed the lower court's order, noting that the plaintiff consulting other physicians for a workers' compensation claim, encouraged by one defendant, did not necessarily indicate a loss of trust in the defendants.

Medical MalpracticeSummary JudgmentContinuous Treatment DoctrineNotice of ClaimAppealAppellate DivisionQueens CountyHospital LiabilityPhysician LiabilityWorkers' Compensation Claim
References
5
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