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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

Matter of Castler v. National Grid

Claimant sustained a low back injury in 2006, receiving workers' compensation benefits. In 2013, chiropractor Douglas Van Vorst treated him for two exacerbations after incidents involving shoveling snow and lifting a kayak. The employer's carrier disputed the medical bills, arguing the treatments did not comply with Workers’ Compensation Board Medical Treatment Guidelines (MTG). A Workers’ Compensation Law Judge initially ruled in favor of the medical provider, but the Workers’ Compensation Board reversed, finding insufficient documentation for the exacerbation. On appeal, the court examined the documentation and found that Van Vorst adequately detailed how the exacerbations occurred, objective changes from baseline, expected treatments, and claimant's response, satisfying the MTG requirements. The court concluded that the Board’s finding lacked substantial evidence and therefore reversed the Board's decision, remitting the matter for further proceedings.

Medical Treatment GuidelinesExacerbation of InjuryLow Back InjuryChiropractic TreatmentObjective Functional ImprovementVariance Request12 NYCRR 324.212 NYCRR 324.3Substantial EvidenceRemittal
References
5
Case No. MISSING
Regular Panel Decision

Emspak v. Conroy

The defendants moved for a further bill of particulars regarding item 30 and requested the entire bill be verified by a union officer. The plaintiff's attorney acknowledged the omission for item 30 was an oversight and agreed to provide it. He argued his self-verification was proper under subdivision 3 of rule 99 of the Rules of Civil Practice, citing the plaintiff's absence from the county, and claimed defendants waived objection by not returning the bill within 24 hours. The court clarified that Rules 10 and 11 do not apply to verification. While an attorney can verify a bill of particulars under rule 117, the court ruled that merely stating the party is out of county is insufficient; the attorney must also detail the basis of their knowledge, especially given a prior order requiring an oath for inability to furnish particulars. The motion for a further bill was granted.

Bill of particularsVerificationAttorney verificationRules of Civil PracticeWaiverMotionCourt procedurePleadingSufficiency of verification
References
3
Case No. MISSING
Regular Panel Decision

Hojnowski v. Buffalo Bills, Inc.

David Hojnowski, a former equipment manager for the Buffalo Bills, sued his former employer alleging age discrimination under the Age Discrimination in Employment Act, New York State Human Rights Law, and violations of the Employee Retirement Income Security Act. The Buffalo Bills moved to dismiss the claims and compel arbitration, citing an arbitration clause in Hojnowski's employment contract. Hojnowski contended that the arbitration agreement was unenforceable due to the absence of arbitration rules and unconscionability. The court determined that the arbitration rules were sufficiently incorporated into the agreement and that the contract was not unconscionable. Consequently, the court granted the Bills' motion, compelling Hojnowski to arbitration and dismissing his complaint.

Arbitration AgreementEmployment LawAge DiscriminationERISANew York State Human Rights LawMotion to DismissContract EnforceabilityUnconscionability DefenseFederal Arbitration ActNFL Commissioner
References
25
Case No. ADJ8485371
Regular
Dec 01, 2014

MICHAEL (MIKE) STRATTON vs. SAN DIEGO CHARGERS, ZENITH NORTH AMERICA, BUFFALO BILLS

The Workers' Compensation Appeals Board reconsidered a prior decision regarding Michael Stratton's cumulative injury claim against the San Diego Chargers and Buffalo Bills. While the original judge found Stratton's claim against the Bills timely, the Board reversed this, determining it was barred by the statute of limitations. The Board found that neither employer breached a duty to notify Stratton of his workers' compensation rights at the time of his employment. Therefore, the statute of limitations was not tolled, and Stratton's claim against the Buffalo Bills is dismissed.

WCABStatute of LimitationsLabor Code Section 5405Date of InjuryTollingCumulative InjuryProfessional Football PlayerSan Diego ChargersBuffalo BillsZenith North America
References
17
Case No. ADJ-4279077 (SDO 0317244)
Regular
Jun 09, 2016

TINA BARONI vs. CITY OF OCEANSIDE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for RELIANCE NATIONAL INDEMNITY COMPANY

The Workers' Compensation Appeals Board (WCAB) issued a Decision After Removal ordering the striking of three sets of documents from the EAMS record. These documents pertained to San Diego Superior Court Case Number 37-2016-00006537-CU-IC-CTL and were submitted without objection. The WCAB previously issued a Notice of Intention to Strike these documents, stating they would be removed unless good cause to the contrary was shown. No objections were received from the parties or the identified attorneys.

Workers' Compensation Appeals BoardRemovalStriking DocumentsEAMS recordCalifornia Insurance Guarantee AssociationReliance National Indemnity CompanyLiquidationSan Diego Superior CourtObjectionGood Cause
References
1
Case No. ADJ4279077 (SDO 0317244)
Regular
May 05, 2018

TINA BARONI vs. CITY OF OCEANSIDE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for RELIANCE NATIONAL INDEMNITY COMPANY

The Workers' Compensation Appeals Board (WCAB) has removed this case for the stated intention to strike documents filed by attorney Adrienne D. Cohen, who is not of record. These documents, which include notices related to a San Diego Superior Court case and a petition for writ of prohibition, are deemed irrelevant and improperly filed. The WCAB asserts that California Superior Courts lack jurisdiction over the WCAB and that CIGA failed to utilize proper procedural remedies. The WCAB will strike the documents unless good cause is shown to the contrary within ten days.

Workers' Compensation Appeals BoardRemovalStriking DocumentsEAMS RecordCalifornia Insurance Guarantee AssociationReliance National Indemnity CompanyCity of OceansideAdrienne D. CohenNotice of Related CaseWrit of Prohibition
References
11
Case No. ADJ9615494
Regular
Oct 08, 2019

CARLOS SOTO TORRES vs. THE CLIFF RESTAURANT, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board rescinded an Amended Findings of Fact and Order because essential documentation regarding the timeliness of medical-legal billings and reviews was missing. Specifically, the record lacked proof of service for the provider's invoice, the defendant's initial Explanation of Review (EOR), and the subsequent second bill review. This prevented determination of whether the defendant timely objected to the bill and whether the provider timely requested a second review, necessitating further proceedings at the trial level.

Workers' Compensation Appeals BoardReconsiderationAmended Findings of Fact and OrderQualified Medical EvaluatorQMEDr. Payam MoazzazZenith Insurance CompanyStatute of LimitationsLabor Code section 4903.5Independent Bill Review
References
0
Case No. ADJ4653538
Regular
Jun 17, 2009

DAVID ZUBIA vs. EARTHWISE TRUCKING, GALLAGHER BASSETT SCOTTSDALE

The Appeals Board granted reconsideration to amend a prior decision, but otherwise affirmed it. The employer, Earthwise Trucking, appealed a penalty and interest assessed on an unpaid medical bill, arguing they paid at the "rate in effect" and the bill was not "properly documented." The Board found that the employer's stipulation of an outstanding balance meant they did not pay the full amount due under the Official Medical Fee Schedule (OMFS) within the statutory timeframe. The Board clarified that timely payment is required according to the OMFS rate in effect on the date of service, not based on the employer's internal bill review.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardLien ClaimantPenaltyInterestOfficial Medical Fee ScheduleOMFSProperly DocumentedStipulation
References
2
Case No. MISSING
Regular Panel Decision

Engstrum & Nourse-Stolte v. E.C. Ernst, Inc. (In re E.C. Ernst, Inc.)

E.C. Ernst, Inc. (Ernst), a debtor-in-possession in a Chapter XI bankruptcy proceeding, entered into a subcontract with Engstrom & Nourse-Stolte (ENS) for electrical work. After Ernst filed for bankruptcy, a Supplemental Agreement allowed Ernst to continue the project. ENS later filed a Proof of Claim for expenses, which Ernst moved to expunge or allow only as a general unsecured claim. Both parties filed cross-motions for summary judgment regarding the priority of ENS's claim and the interpretation of their agreements. Additionally, Ernst sought to expunge ENS's claim for failure to produce documents. The court denied both motions for summary judgment, citing disputes over the intent behind the Supplemental Agreement and potential breach of contract, and directed ENS to comply with document production.

Bankruptcy ActChapter XI ReorganizationExecutory ContractsSummary JudgmentDebtor-in-PossessionSubcontract AgreementProof of ClaimPriority ClaimContract InterpretationDocument Production
References
13
Case No. MISSING
Regular Panel Decision
Apr 21, 2004

Zenteno v. Geils

The defendants appealed an order from the Supreme Court, Westchester County, which granted the plaintiff's motion to restore a personal injury action to the trial calendar and for leave to serve a supplemental bill of particulars. The Appellate Division affirmed the order, finding that the plaintiff demonstrated a meritorious cause of action and a reasonable excuse for delay, citing extensive medical evaluations and difficulties obtaining authorization from the Workers’ Compensation Board. The court also determined that the defendants were not prejudiced by the restoration. Furthermore, an alleged agreement to proceed to arbitration was deemed unenforceable due to non-compliance with CPLR 2104 "open court" requirements. Finally, the Supreme Court's decision to grant leave for a supplemental bill of particulars was upheld, as it pertained to continuing consequences of existing injuries rather than new ones, aligning with CPLR 3043 [b].

Personal InjuryTrial Calendar RestorationSupplemental Bill of ParticularsArbitration Agreement EnforcementCPLR 2104CPLR 3043Medical ExaminationsWorkers' Compensation IssuesAppellate ReviewProcedural Motion
References
20
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