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

Case No. ADJ91 04682
Regular
Mar 15, 2016

NOEL CERVANTES vs. UCLA MEDICAL CENTER, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and awarded lien claimant Liberty Life Assurance reimbursement for $3,940.85 in short-term disability payments. The WCAB found that the lien claimant provided sufficient notice of its payments to UCLA Medical Center before UCLA paid overlapping temporary disability benefits. Legibility of a reimbursement agreement was deemed irrelevant when the parties stipulated to the payments made. Therefore, UCLA Medical Center was ordered to reimburse Liberty Life Assurance for these benefits under Labor Code section 4903.1.

Labor Code section 4903.1(a)Lien claimantPetition for ReconsiderationGroup disability policyReimbursement AgreementOverlapping disability paymentsNotice of lienTemporary disability benefitsShort-term disability paymentsCompromise and Release Agreement
References
1
Case No. ADJ10110716
Regular
May 26, 2017

JANELLE JAVANSHIR vs. UCLA MEDICAL CENTER

The Workers' Compensation Appeals Board (WCAB) denied UCLA Medical Center's Petition for Removal in the case of *Javanshir v. UCLA Medical Center*. Removal is an extraordinary remedy, granted only upon a showing of substantial prejudice or irreparable harm, and that reconsideration would not be an adequate remedy. The WCAB found that the defendant failed to meet this high burden of proof, relying on the Administrative Law Judge's analysis of the merits. Therefore, the petition was denied, and the case will proceed through the standard appeals process.

RemovalAppeals BoardWCJsubstantial prejudiceirreparable harmreconsiderationextraordinary remedyPetition for RemovalSEDGWICK CLAIMS MANAGEMENT SERVICESUCLA MEDICAL CENTER
References
2
Case No. MISSING
Regular Panel Decision

Queens Blvd. Medical, P.C. v. Travelers Indemnity Co.

The plaintiff, Queens Blvd. Medical, P.C., sought $950 in first-party no-fault benefits for biofeedback medical services provided to its assignor for lower back and chronic pain syndrome. The central issue at trial was the medical necessity of these services under Insurance Law § 5102 (a) (1). The plaintiff established a prima facie case with expert testimony from a board-certified neurologist affirming the medical appropriateness of biofeedback. The defendant insurance company failed to present admissible evidence to disprove medical necessity, as its expert was deemed incompetent to testify on biofeedback for back pain. Consequently, the court granted the plaintiff's motion for a directed verdict, awarding judgment for $950 along with statutory costs, interest, and attorney's fees.

No-fault benefitsMedical necessityBiofeedback treatmentExpert testimonyDirected verdictInsurance lawChronic pain syndromeBack injuryCPT codesBurden of proof
References
9
Case No. ADJ11129691
Regular
Oct 08, 2018

DALE ROWE vs. UCLA MEDICAL CENTER, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board denied the Petition for Reconsideration in the case of Dale Rowe vs. UCLA Medical Center. The Board adopted and incorporated the report of the workers' compensation administrative law judge, finding no grounds to overturn the original decision. Consequently, the petition to reconsider the prior ruling was denied.

WORKERS' COMPENSATION APPEALS BOARDADJ11129691UCLA MEDICAL CENTERSEDGWICK CLAIMS MANAGEMENT SERVICESPetition for ReconsiderationWCJ reportdeny reconsideration
References
0
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. ADJ3327542, ADJ7143228
Regular
Apr 12, 2018

ABIGAIL FURGOL vs. UCLA MEDICAL CENTER, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves an injured worker, Abigail Furgol, and her employer, UCLA Medical Center. The defendant sought reconsideration, arguing a specific 104-week limit on temporary disability payments from *Brower v. David Jones Construction* should apply. However, the Appeals Board denied reconsideration, finding that the cumulative injury date predates the statutory limit, making *Brower* inapplicable. The Board affirmed that Labor Code section 4650(b), as amended by SB 863, dictates payment calculations from the permanent and stationary date, which was stipulated in this case.

Labor Code § 4656(c)Brower v. David Jones Constructiontemporary disability indemnity104-week limitLabor Code § 4650(b)Senate Bill 863permanent disability indemnitypermanent and stationary dateVillagio Inn & Spa v. Workers' Comp. Appeals Bd. (Soto)cumulative injury
References
2
Case No. MISSING
Regular Panel Decision

Rechenberger v. Nassau County Medical Center

Edward Rechenberger suffered hip fractures and underwent two operations at Nassau County Medical Center in May 1982. Following a re-injury and later diagnosis, he learned the surgical hardware was improperly implanted, leading to further operations. Mr. Rechenberger sought leave to serve a late notice of claim against the medical center. The Supreme Court initially denied the motion, but the Appellate Division reversed this decision, finding that the hospital had actual knowledge of the essential facts of the claim within the statutory 90-day period through its own medical records. The court concluded that the delay in serving the notice of claim was not substantially prejudicial to the hospital, and thus, granted the petitioners leave to serve the late notice of claim.

Medical MalpracticeLate Notice of ClaimNassau CountyHip FractureSurgical ErrorContinuous Treatment DoctrineActual NoticePrejudiceAppellate ReviewMunicipal Corporation
References
11
Case No. MISSING
Regular Panel Decision
Feb 10, 2017

Mitchell v. SUNY Upstate Medical University

Plaintiff Robbie Mitchell sued SUNY Upstate Medical Center for alleged Title VII violations, including race discrimination and retaliation, after experiencing a series of adverse employment actions. These actions included reassignment, disciplinary notices (NODs), a mandatory medical examination, a formal counseling memorandum, a verbal dispute, and eventual termination. The defendant moved for summary judgment, arguing the plaintiff failed to establish a prima facie case for most claims and that their actions were based on legitimate, non-discriminatory reasons. The court granted summary judgment in favor of SUNY Upstate Medical Center, concluding that the plaintiff failed to provide sufficient evidence of discrimination or that retaliation was the but-for cause of the challenged employment actions, and consequently, the case was closed.

Title VIICivil Rights ActEmployment DiscriminationRetaliationSummary JudgmentAdverse Employment ActionMcDonnell Douglas FrameworkWorkplace ConductDisciplinary ActionPaid Administrative Leave
References
49
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
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