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

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 The WCAB rescinded the prior decision and returned the case for further proceedings, ordering the trial judge to obtain a report from Dr.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. 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
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. MISSING
Regular Panel Decision

Kelly v. State

Justice Hancock, Jr., in his dissenting opinion, agrees with the majority's decision for reversal but disagrees with their holding that the continuous treatment doctrine applies as a matter of law. He argues that the record presents questions of fact regarding the application of CPLR 214-a, specifically concerning whether the claimant's alleged visits to the Westchester County Ophthalmology Clinic constituted continuous treatment and if those visits were sufficiently associated with the initial treatment. The dissent emphasizes the need for a trial to determine the timeliness of the claim based on relevant evidence.

Continuous Treatment DoctrineStatute of LimitationsMedical MalpracticeCourt of Claims ActCPLR 214-aDissenting OpinionFactual QuestionsTimeliness of ClaimPrisoner HealthcareOphthalmology
References
3
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. 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. 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

In re Dolan

This contested special proceeding, commenced under Mental Hygiene Law § 9.60, sought the continuation of an assisted outpatient treatment (AOT) order for respondent Joan W. The court addressed three primary issues: the admissibility of hearsay statements from non-parties in hospital records, a motion to quash a subpoena for the respondent’s expert witness's notes, and the continuation of the AOT plan. The court ruled that hearsay statements relevant to diagnosis and treatment are admissible under the business records exception, extending the People v Ortega holding to Mental Hygiene Law hearings. Additionally, the motion to quash the subpoena for the expert’s notes was denied, as the respondent waived privilege by placing her condition in controversy. Ultimately, with the respondent's consent, the court granted the continuation of the AOT order for one year, retroactive to September 23, 2011.

Assisted Outpatient TreatmentMental Hygiene LawHearsay AdmissibilityBusiness Records ExceptionHospital RecordsMedical Diagnosis and TreatmentSocial Worker-Client PrivilegeWaiver of PrivilegeSubpoena QuashalKendra's Law
References
8
Case No. ADJ7286862, ADJ7604060
Regular
Sep 14, 2015

Kelly Tinsley vs. VERTIS COMMUNICATIONS, ACE USA INSURANCE

This case involves a denial of a defendant's petition for reconsideration regarding a workers' compensation award. The defendant's Utilization Review (UR) of the applicant's requested continued treatment at a residential rehabilitation center was deemed invalid by the Administrative Law Judge (ALJ) due to untimeliness in communication. The Workers' Compensation Appeals Board (WCAB) affirmed the ALJ's decision, finding the UR invalid because the defendant failed to prove timely communication to the physician as required by statute. Consequently, the WCAB upheld the award of continued treatment, deeming it reasonable and supported by substantial medical evidence.

Workers' Compensation Appeals BoardPetition for ReconsiderationUtilization ReviewUntimelinessRequest for AuthorizationTransitional Living CenterResidential ProgramPost-Acute Physical RehabilitationPsychiatric InjuryIndependent Medical Review
References
14
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
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