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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

General Electric Co. v. Kunze

Appellee Curtis T. Kunze was awarded damages by a jury after being discharged from his employment with General Electric Company and General Electric Supply Company in violation of Texas Worker’s Compensation Statutes, article 8307c. The damages included lost past and future wages and benefits, and exemplary damages for willful and malicious termination. General Electric appealed, contending that Kunze was fired for poor performance, not for filing a worker's compensation claim, and challenged the sufficiency of evidence for damages and the recoverability of exemplary damages. The appellate court affirmed the lower court's judgment, finding ample evidence to support the jury's findings of wrongful termination and the awarded damages. It also clarified that future lost wages are recoverable under the statute and that prejudgment interest was already factored into the damage awards.

Worker's CompensationWrongful TerminationRetaliatory DischargeExemplary DamagesLost WagesLost BenefitsFuture DamagesPrejudgment InterestEvidence AdmissibilityExpert Witness
References
9
Case No. MISSING
Regular Panel Decision

United States v. Perez

This Order addresses challenges by six defendants to the constitutionality of the Sentencing Reform Act of 1984 and the Sentencing Guidelines. District Judge Nowlin found that the Act violates the separation of powers doctrine and Article I, Section 7 of the U.S. Constitution, particularly concerning the composition and authority of the Sentencing Commission and the lack of presidential presentment for the Guidelines. The Court further ruled that the Sentencing Guidelines infringe upon defendants' due process rights by unduly restricting judicial discretion in sentencing and limiting the consideration of individual circumstances. While concluding the unconstitutional provisions could be severed, the Court directed that, pending appellate review, sentences for offenses committed after November 1, 1987, should be determined as if committed before that date, accounting for the absence of parole.

Sentencing Reform ActSentencing GuidelinesConstitutional LawSeparation of PowersArticle IDue ProcessJudicial DiscretionFederal Criminal JusticeJudicial IndependencePresentment Clause
References
42
Case No. MISSING
Regular Panel Decision

New York State Ass'n of Nurse Anesthetists v. Novello

This is a dissenting opinion challenging the majority's conclusion that an association of New York Certified Registered Nurse Anesthetists (CRNAs) lacks standing to sue the Commissioner of Health. The CRNAs challenged new 'Guidelines' which stipulate that CRNAs should provide services in office-based surgery only under supervision by a physician, dentist, or podiatrist 'qualified by law, regulation or hospital appointment to perform and supervise the administration of the anesthesia.' The dissent argues that the Guidelines, though presented as recommendations, are effectively regulations that will severely injure CRNAs' employment opportunities by requiring the presence of an anesthesiologist, making CRNAs redundant due to cost-prohibitive duplication of services. The dissenting judge criticizes the majority for deeming the CRNAs' evidence of economic harm as 'speculation' despite extensive factual showings from affidavits, asserting that precedent supports standing in such cases.

CRNA supervisionStandingGuidelines as regulationsEconomic injuryNurse anesthetistsAnesthesiologist supervisionOffice-based surgeryHealthcare regulationsJudicial dissentPhysician qualification
References
4
Case No. LAO 835734
Regular
Nov 19, 2007

MARINA SANCHEZ vs. KEELING PROPERTY, THE ZENITH INSURANCE COMPANY

The Appeals Board granted reconsideration and rescinded the WCJ's decision, finding insufficient evidence to support the award for the lien claimant's services. The Board determined that the WCJ failed to address whether the medical treatment was reasonably required and that neither party presented sufficient evidence regarding the reasonableness of the facility fees according to *Kunz* guidelines. The case was returned to the trial level for further proceedings to develop the record on these issues and for a new decision.

Wilshire Surgical CenterKeeling PropertyZenith Insurance CompanyMarina SanchezKunz v. Patterson Floor CoveringFindings and AwardPetition for Reconsiderationusual and customary feesoutpatient surgery facility feesreasonableness of charges
References
9
Case No. ADJ3747523 (POM 0264468)
Regular
Oct 17, 2008

RICHARD E. GONZALES vs. DEPARTMENT OF YOUTH AUTHORITY, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration and rescinded the WCJ's decision, returning the case to the trial level for further proceedings. The Board found the prior decision relied on an improper evidentiary basis by using a stipulation from a nearly identical case to determine the reasonableness of the facility fee. The matter must be re-evaluated with proper evidence and adherence to the guidelines set forth in *Scott Kunz v. Patterson Floor Coverings, Inc.* for determining reasonable facility fees.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationFacility FeeReasonable ChargesOfficial Medical Fee ScheduleLabor Code Section 4600Kunz GuidelinesEvidentiary BurdenDiagnostic Arthroscopy
References
3
Case No. CV-23-1298
Regular Panel Decision
May 30, 2024

In the Matter of the Claim of Michael Garofalo

Michael Garofalo, a lineman, sustained a left hand crush injury in January 2020 while working for Verizon New York, Inc. His workers' compensation claim was established. Following a permanency evaluation, his treating physician, Brian J. Harley, assessed a 35% schedule loss of use (SLU) of the left hand, using the 2012 New York State Guidelines for Determining Impairment. An independent medical examiner, Thomas R. Haher, initially concurred but later revised his opinion to 50% SLU based on the 2018 Guidelines. A Workers' Compensation Law Judge (WCLJ) adopted Harley's 35% SLU opinion, which the Workers' Compensation Board upheld. On appeal, the Appellate Division found that Harley improperly relied on the 2012 Guidelines instead of the applicable 2018 Guidelines, as the first medical evaluation occurred after January 1, 2018. The court determined that the Board's decision, relying on Harley's erroneous application of the guidelines, lacked substantial evidence. The decision was reversed, and the matter was remitted to the Workers' Compensation Board for a new determination of the appropriate SLU percentage.

Workers' CompensationSchedule Loss of UseLeft Hand InjuryMedical Guidelines2018 Impairment GuidelinesAppellate ReviewRemittalMedical Opinion ConflictTraumatic InjuryFractures
References
7
Case No. 526425
Regular Panel Decision
Nov 15, 2018

Matter of Gasparro v. Hospice of Dutchess County

Mary Ann Gasparro, a claimant with a permanent partial disability from a 1995 work injury, moved to Nevada. In 2016, her employer's workers' compensation carrier objected to payments for topical pain relief products, LidoPro and Terocin patches, prescribed by a Nevada pain management specialist. The Workers' Compensation Board reversed a Workers' Compensation Law Judge's ruling, deciding that New York's Medical Treatment Guidelines apply to out-of-state treatment for nonresident claimants, a departure from its prior decisions. The Board found the prescribed medications were not in accordance with the guidelines due to concomitant use and duration. The Appellate Division, Third Department, affirmed the Board's decision, deeming its change in course rational and its application of the guidelines to out-of-state treatment reasonable. The court concluded that the Board's finding of medical necessity and non-compliance with guidelines was supported by substantial evidence.

Workers' CompensationMedical Treatment GuidelinesOut-of-State Medical CareNonresident ClaimantsPain ManagementTopical Pain ReliefLidoProTerocin PatchesAppellate DivisionBoard Reversal
References
12
Case No. 2020 NY Slip Op 03966 [185 AD3d 1263]
Regular Panel Decision
Jul 16, 2020

Matter of McKay v. Southampton Hosp.

The case concerns an appeal by Jacqueline McKay (claimant) from a Workers' Compensation Board decision. The Board had affirmed a Workers' Compensation Law Judge (WCLJ) ruling to consider weaning the claimant from opioid medications based on an independent medical examiner's opinion under the Non-Acute Medical Treatment Guidelines (NAPMTG). The claimant argued that the Board exceeded its authority in promulgating these guidelines. The Appellate Division, Third Department, affirmed the Board's decision, holding that the Board properly exercised its broad regulatory power under the Workers' Compensation Law to issue the NAPMTG. The court found the guidelines rational and not unreasonable, arbitrary, capricious, or contrary to the statute, emphasizing that the NAPMTG furthered the aim of ensuring prompt and appropriate medical care for injured workers by expanding existing treatment guidelines to address comprehensive pain management, including the safe use of narcotics.

Medical Treatment GuidelinesOpioid WeaningRegulatory AuthorityAdministrative LawAppellate ReviewPain ManagementOccupational DiseasePermanent Partial DisabilityWorkers' Compensation BoardIndependent Medical Examination
References
5
Case No. 2021 NY Slip Op 03882
Regular Panel Decision
Jun 17, 2021

Matter of Fiato v. New York State Dept. of Transp.

In this workers' compensation case, Daniel Fiato appealed decisions regarding his schedule loss of use (SLU) award for a left knee injury. After a 2017 total knee replacement, the Workers' Compensation Board applied the 2018 Workers' Compensation Guidelines, determining a 35% SLU, which, accounting for a prior 20% SLU, resulted in a 15% award. Fiato argued for the application of the 2012 Guidelines. The Appellate Division, Third Department, affirmed the Board's decisions, ruling that the 2018 Guidelines were correctly applied as the first evaluation of the current SLU occurred after their effective date, aligning with legislative intent to reflect medical advances.

Workers' CompensationSchedule Loss of UseKnee InjuryMedical GuidelinesAppellate ReviewJurisdictionPrior AwardImpairment RatingLegislative MandateStatutory Interpretation
References
8
Case No. MISSING
Regular Panel Decision

Claim of Canfield v. Thompson & Johnson Equipment

The claimant appealed an amended decision by the Workers’ Compensation Board concerning benefits for a work-related hand injury. Following the amputation of two fingers, the claimant sought an award based on a 70% schedule loss of use of the right hand, arguing for an additional 'loading' percentage as described in the Board's medical guidelines. The Board, however, determined that 'loading' was already incorporated into the percentage losses specified for multiple digit amputations in their guidelines. Consequently, the claimant's award was modified to reflect a 35% schedule loss of use. The appellate court affirmed the Board's amended decision, finding a rational basis for its interpretation of the medical guidelines.

Schedule Loss of UseWorkers' Compensation BenefitsAmputationMedical GuidelinesLoading CalculationRight Hand InjuryAppellate ReviewStatutory InterpretationWork-related AccidentJudicial Affirmation
References
1
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