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Case Law Database

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

Case No. MISSING
Regular Panel Decision

Giles v. Gi Yi

The dissenting opinion by Justice Whalen challenges the majority's interpretation of 22 NYCRR 202.17, which mandates personal injury plaintiffs to secure an expert witness report on causation and provide it to the defense prior to the defendant's medical examination of the plaintiff. Whalen argues this requirement is an undue burden and is not explicitly outlined within the regulation's scope. The dissent emphasizes that 22 NYCRR 202.17 (b) (1) only requires disclosure of reports from 'medical providers who have previously treated or examined the party seeking recovery,' distinct from expert reports generated solely for litigation purposes. Furthermore, Justice Whalen asserts that expert disclosure is governed by CPLR 3101 (d), which does not necessitate such early disclosure, and finds that the Supreme Court's decision to compel was an abuse of discretion, concluding that Nero v Kendrick was wrongly decided.

Expert Witness DisclosureCausationMedical ExaminationPersonal InjuryCivil Procedure Law and Rules (CPLR)Uniform Civil Rules for the Supreme Court and County Court (22 NYCRR)Dissenting OpinionJudicial DiscretionPreclusionLitigation Expenses
References
2
Case No. MISSING
Regular Panel Decision

Equal Employment Opportunity Commission v. Grief Bros.

This employment discrimination case, filed July 1, 2002, involves Michael Sabo (Plaintiff) who alleges constructive discharge based on sexual harassment and claims severe emotional pain and suffering. The Defendant moved for a mental examination of Sabo under Fed.R.Civ.P. 35 and to compel the production of his medical records. Sabo alleged severe humiliation, anxiety, depression, loss of self-esteem, sleeplessness, and weight gain, and admitted to a history of depression, past suicide attempts, and current psychiatric treatment with prescribed medications. The court granted the Defendant's motions, finding that Sabo had placed his mental condition in controversy due to the nature and severity of his claims and his medical history, justifying both the examination and the production of relevant medical records. The court also granted Defendant's request for costs associated with compelling the medical records, but denied the request for costs related to the Rule 35 motion itself, and denied Plaintiff's request for counsel or recording during the examination.

Employment DiscriminationSexual HarassmentConstructive DischargeEmotional DistressMental ExaminationRule 35Medical RecordsDepressionSuicide AttemptsCompensatory Damages
References
11
Case No. MISSING
Regular Panel Decision
Feb 08, 1994

People v. France

This is a combined decision addressing motions to vacate homicide convictions in six separate cases. The defendants argued that the prosecutor failed to disclose dictation audiotapes made by the New York City Medical Examiner, which they claimed constituted 'Rosario' material. The court denied the motions, ruling that the Medical Examiner's Office is an independent agency, and therefore, the audiotapes were not under the control of the District Attorney and not 'Rosario' material. The decision further clarifies that CPL article 240 provides for pretrial discovery of written reports but not dictation tapes, unless they contain exculpatory material. The court emphasized the Medical Examiner's role as an independent expert, distinct from 'event' or law enforcement witnesses, and concluded that their dictation tapes are not 'statements' within the 'Rosario' jurisprudence.

Rosario materialDiscovery rulesCPL 440.10 motionHomicide convictionMedical Examiner audiotapeAutopsy reportProsecutorial dutyDuplicative equivalentIndependent agencyCPL Article 240
References
31
Case No. MISSING
Regular Panel Decision
Oct 14, 2008

Westchester Medical Center v. Lincoln General Insurance

The plaintiff appealed an order from the Supreme Court, Nassau County, which denied its motion for summary judgment to recover no-fault medical benefits. The appellate court reversed the order, granting the plaintiff's motion. The plaintiff successfully demonstrated a prima facie case by showing that statutory billing forms were mailed and received, and the defendant failed to either pay or deny the claim within the 30-day period. The court rejected the defendant's arguments that letters advising of an investigation tolled the statutory period and that the period was tolled pending a no-fault application. Additionally, defenses related to Workers' Compensation benefits or the assignor's failure to appear at an examination under oath were found insufficient to defeat the medical provider's right to benefits.

no-fault insurancemedical benefitssummary judgmentinsurance contractstatutory periodtimely denialworkers' compensationpolicy conditionpreclusion remedyappellate review
References
19
Case No. ADJ7784334
Regular
Jul 17, 2013

ESTEBAN ESCOBAR vs. UCLA MEDICAL CENTER

The Appeals Board granted reconsideration and reversed the trial judge's finding of no industrial injury. The Board found that the applicant sustained a cumulative injury to his right upper extremity, supported by the unrebutted medical opinion of a Qualified Medical Examiner. Compensation is not barred by the post-termination defense as the date of injury, per Labor Code Section 5412, occurred after the applicant's termination date. The case is returned to the trial level for further proceedings.

Post-termination defenseLabor Code section 3600(a)(10)Section 5412Cumulative injuryRight upper extremityIndustrial injuryPQMEKenneth ScheffelsM.D.Reconsideration
References
0
Case No. ADJ8606940
Regular
Apr 18, 2013

ANGELICA PEREZ vs. PERMANENTE MEDICAL GROUP, INC.

The Workers' Compensation Appeals Board denied defendant's petition for removal or reconsideration regarding the applicant's entitlement to multiple Panel Qualified Medical Examiners (PQMEs). The defendant contested the procedural validity of the applicant's PQME requests, while the applicant asserted proper procedure was followed due to the defendant's lack of response to an Agreed Medical Examiner offer. The Board found that the February 4, 2013 notation was not a final order, as PQME requests remained pending with the Medical Unit. Therefore, the petition was denied without prejudice to the Medical Unit's future determination on the propriety of the PQME requests.

Panel Qualified Medical ExaminersPQMEPetition for RemovalPetition for ReconsiderationIndustrial InjuryCumulative InjuryAgreed Medical ExaminerAMEMedical UnitAdministrative Law Judge
References
0
Case No. ADJ1434238 (SFO 0461609)
Regular
Jul 18, 2012

DANIEL PRATHER vs. CITY AND COUNTY OF SAN FRANCISCO

The Workers' Compensation Appeals Board granted reconsideration to review the administrative law judge's (WCJ) findings on permanent disability and apportionment. The Board rescinded the original award, finding that neither the applicant's treating physician nor the defense qualified medical examiner provided substantial medical evidence on apportionment. Due to complex medical issues and inadequate development of the record, the case is returned to the trial level for further proceedings, including the potential selection of an Agreed Medical Examiner or a physician appointed by the Board.

Workers Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPermanent DisabilityApportionmentQualified Medical Examiner (QME)Substantial Medical EvidenceLabor Code §4663Cumulative TraumaSpine Injury
References
9
Case No. MISSING
Regular Panel Decision

Yklik Medical Supply, Inc. v. Allstate Insurance

Plaintiff Yklik Medical Supply, Inc., a medical supply provider, sued Allstate Insurance Company to recover $317 in unpaid medical bills for equipment supplied to its assignor, Tammy Agosto. Yklik moved for summary judgment, asserting proper bill submission and Allstate's failure to timely pay or deny the claim. Allstate argued that the charges exceeded the Workers' Compensation fee schedule and that a partial payment had been made. The court found that Yklik established a prima facie case. The central issue was whether Allstate's fee schedule defense was precluded due to its failure to issue a timely denial within 30 days as mandated by Insurance Law § 5106 (a) and 11 NYCRR 65-3.5. The court ruled that since Allstate waited 56 days to send its denial, it was precluded from raising the fee schedule defense, and therefore, summary judgment was granted to the plaintiff.

No-fault insurancesummary judgmenttimely denialfee schedulepreclusion ruleinsurance lawmedical supplybilling practicespersonal injury protectionassignor
References
19
Case No. MISSING
Regular Panel Decision

Fraser v. Brunswick Hospital Medical Center, Inc.

In this medical malpractice action, the defendant The Brunswick Hospital Medical Center, Inc. appealed an order that granted the plaintiff’s motion to strike its workers’ compensation coverage defense. Concurrently, the plaintiff cross-appealed the dismissal of the complaint against defendant S. Fong. The appellate court affirmed the decision to strike the workers’ compensation defense for The Brunswick Hospital Medical Center, Inc., citing its participation and lack of appeal in the prior Workers’ Compensation Board hearing. However, the dismissal of the complaint against S. Fong was reversed, as S. Fong was not present at the Board hearing, thus preclusion did not apply, and a triable issue of fact existed regarding whether the injury was employment-related. The court also rejected S. Fong's argument regarding the absence of a doctor-patient relationship.

Medical MalpracticeWorkers' CompensationAffirmative DefenseSpecial EmployeeCoemployeePreclusive EffectTriable Issue of FactDoctor-Patient RelationshipAppellate ReviewHospital Liability
References
7
Case No. ADJ7787692, ADJ7787693
Regular
Jan 14, 2016

Elizabeth Sauseda vs. The Permanente Medical Group, Inc.

This case involves the defendant's petition for removal, seeking to replace a Qualified Medical Evaluator (QME) in psychology due to alleged reporting delays. The Workers' Compensation Appeals Board (WCAB) denied the petition, upholding the administrative law judge's (WCJ) decision. The WCAB adopted the WCJ's recommendation, finding that a new QME examination would not proceed and the existing QME would remain. The issue of the defendant's personnel actions as a good faith defense remains for the trial judge's determination.

Petition for RemovalQualified Medical EvaluatorPanel QMEAdministrative Law JudgeSupplemental ReportReplacement QME PanelMandatory Settlement ConferenceGood Faith Personnel DefenseWCJ ReportMedical Unit
References
0
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