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

Case No. ADJ4322447 (LAO 0855360)
Regular
Aug 15, 2013

LEOPOLDO BENAVIDEZ vs. ANTONIO SANCHEZ, ALLSTATE, administered by SPECIALTY RISK SERVICES

The Workers' Compensation Appeals Board rescinded a prior award finding new and further disability for the applicant. The Board determined that the applicant's worsened spinal condition, as evidenced by an EMG study, predated the initial stipulated award. Therefore, it was not "new and further" disability as required to reopen the case under Labor Code section 5410. The Board also found no other "good cause" to reopen, as the applicant could have discovered and presented the EMG evidence before the original award.

Workers' Compensation Appeals BoardReconsiderationStipulated AwardNew and Further DisabilityPermanent Disability IndemnityLife PensionAgreed Medical Evaluator (AME)Lumbar Compression FracturePermanent DisabilityElectrodiagnostic Report (EMG)
References
9
Case No. MISSING
Regular Panel Decision

Claim of Rivera v. North Central Bronx Hospital

The employer appealed a decision by the Workers’ Compensation Board, arguing that the Board incorrectly interpreted Workers’ Compensation Law § 13-a (7) by mandating reimbursement to the claimant’s doctor for an EMG test. The employer contended that since the claimant failed to use a specified provider as per statutory notice, it should not be obligated to pay. However, the court found no statutory or historical support for nonpayment as a remedy, noting that the law aims to provide swift benefits to injured employees and prevent providers from collecting directly from workers. The court emphasized that allowing the employer to avoid payment would harm medical providers and deter their participation in the workers’ compensation system. Consequently, the court affirmed the Board’s decision, requiring the employer to pay its in-network rate to the claimant's doctor.

Workers' Compensation LawEMG test reimbursementEmployer appealStatutory interpretationMedical provider paymentClaimant medical expensesSelf-insured employersDiagnostic testsLegislative intentBoard decision affirmed
References
7
Case No. ADJ3408326
Regular
Jan 07, 2013

MOISES MENDOZA vs. WORLD SUPER SERVICES, INC., TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award. The Board found that the lien claimant, Precision Occupational Medical Group, failed to meet its burden of proof. Specifically, the claimant did not demonstrate that the EMG/NCV study of the applicant's lower extremities was reasonable and necessary to treat the admitted left ankle injury. The matter was returned to the trial level with the lien claim disallowed.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardLien ClaimantReasonable and Necessary TreatmentBurden of ProofStipulations with Request for AwardMaximum Medical ImprovementEMG/NCV StudyLower Extremities
References
2
Case No. MISSING
Regular Panel Decision

Procter & Gamble Co. v. Ultreo, Inc.

The Procter & Gamble Company (P&G) sued Ultreo, Inc. for false advertising under the Lanham Act and the New York Consumer Protection Act, specifically challenging Ultreo's claims about its toothbrush technology. P&G sought the disclosure of five scientific studies conducted by Ultreo, arguing they were discoverable business documents. Ultreo resisted, claiming the studies were protected by attorney work product privilege. The court rejected Ultreo's argument, finding that the studies were a core part of Ultreo’s business plan to substantiate its advertising claims and would have been prepared regardless of anticipated litigation. Therefore, the court ordered Ultreo to produce the studies to P&G.

False advertisingLanham ActNew York Consumer Protection ActDiscovery disputeAttorney work productPrivilegeScientific studiesClinical researchLitigation anticipationBusiness plan
References
7
Case No. ADJ6550105; ADJ6777358 ADJ6777361; ADJ6976802
Regular
Jun 24, 2014

ESTHER GARCIA vs. ANTELOPE VALLEY UNION HIGH SCHOOL DISTRICT, YORK INSURANCE SERVICES GROUP

This case involves an applicant with multiple workers' compensation claims. At a mandatory settlement conference, the judge ordered a sleep study, which the defendant challenged. The Appeals Board granted the defendant's petition for removal, finding the order for the sleep study premature. The Board rescinded the sleep study order, stating that such an order cannot be made before the case is tried or submitted, and before it's established that specific medical opinions are deficient.

Petition for RemovalDecision After RemovalMandatory Settlement ConferenceSleep StudyDiscovery OrderMedical Record AugmentationPanel Qualified Medical EvaluatorThreshold MatterDevelop the RecordAdmission of Evidence
References
0
Case No. ADJ9870999
Regular
Feb 13, 2017

ROBIN SMITH vs. CITY OF SUNNYVALE

This case involves a firefighter claiming breast cancer arose from employment exposure to carcinogens, triggering a statutory presumption of industrial causation under Labor Code section 3212.1. The employer sought to rebut this presumption by arguing a medical examiner found no studies linking applicant's specific exposures to breast cancer. However, the Appeals Board denied reconsideration, affirming that the employer failed to prove there is *no reasonable link* between workplace carcinogen exposure and the applicant's cancer, a higher bar than simply the absence of direct scientific studies. The Board reiterated that an employer must affirmatively demonstrate a lack of reasonable connection, not just highlight a lack of studies supporting causation.

Labor Code section 3212.1presumption of industrial causationpublic safety officerfirefightercarcinogen exposurebreast cancerdisputable presumptioncontroverted evidencereasonable linkburden of proof
References
3
Case No. MISSING
Regular Panel Decision

Smith v. Dow Chemical Co.

Plaintiff filed a motion to compel discovery from defendants Dow and PPG regarding documents related to ongoing research studies on the harmful effects of vinyl chloride, which her deceased husband William Smith was allegedly exposed to. Defendants countered with a motion for a protective order, citing a qualified researcher's/scholar's privilege and arguing that the incomplete studies were irrelevant and inadmissible under Daubert standards. The court granted plaintiff's motion to compel, finding that defendants failed to provide sufficient information to establish a privilege claim and that arguments concerning the admissibility of incomplete studies were premature. The court also denied defendants' motion for a protective order, instructing defendants to produce the requested documents.

DiscoveryResearcher's PrivilegeScholar's PrivilegeMotion to CompelProtective OrderVinyl Chloride ExposureScientific StudiesExpert TestimonyAdmissibility of EvidenceFederal Rules of Civil Procedure
References
17
Case No. MISSING
Regular Panel Decision

In re V. R. P-L.

The petitioners sought certification as qualified adoptive parents for M.EL. under Domestic Relations Law § 115-d, aiming to satisfy USCIS home study requirements for an I-600 petition. The USCIS had previously rejected their independent social worker's home study and suggested either an authorized agency home study or a DRL § 115-d certification. The court, however, determined that DRL § 115-d was inappropriate for foreign-born children sought for adoption as orphans, and that such cases fall under DRL § 115-a. Despite the USCIS's guidance and the petitioners' time constraints, the court was compelled by state law to dismiss the petition due to its reliance on the incorrect statutory section.

AdoptionPrivate Placement AdoptionForeign AdoptionOrphanUSCISI-600 PetitionHome StudyDomestic Relations LawNew York Family CourtStatutory Construction
References
8
Case No. 2021 NY Slip Op 03888 [195 AD3d 1270]
Regular Panel Decision
Jun 17, 2021

Matter of Spence v. State Univ. of N.Y.

This case involves an appeal concerning a salary increase for nurses at Stony Brook University Hospital, initiated by the State University of New York. Petitioners, including Wayne Spence and the New York State Public Employees Federation, argued that the salary adjustments violated Education Law and Civil Service Law due to an inadequate study, and Executive Law and the Age Discrimination in Employment Act due to disparate impact on older nurses. The Supreme Court dismissed the petition, finding the study sufficient and the age discrimination claims procedurally deficient. The Appellate Division affirmed this dismissal, concluding that the study was representative, the nonuniform pay differential was permissible under Education Law, and the age discrimination claims failed because petitioners did not file with the EEOC and the pay adjustments were based on a legitimate non-age factor.

Wage ratesPay differentialsNurse salariesAge discriminationCPLR article 78State University of New YorkPublic Employees FederationStony Brook University HospitalEducation Law § 355-aCivil Service Law § 130
References
15
Case No. ADJ6484208
Regular
Aug 21, 2018

ERIK LOPEZ vs. SERFIN CONSTRUCTION, INC., STATE COMPENSATION INSURANCE FUND

The WCAB granted reconsideration and rescinded the prior order, finding that lien claimant South Bay Neurological Diagnostic Center was not entitled to reimbursement for a sleep study. The Board determined the sleep study and associated reports were not valid medical-legal expenses because they were not requested by a medical-legal evaluator and were not incidental to the production of a medical-legal report capable of proving or disproving a disputed medical fact. Therefore, the lien claim was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderAdministrative Law Judgeindustrial injurysleep disorderlien claimantmedical-legal expenseAgreed Medical Evaluator (AME)Report and Recommendation
References
1
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