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

Case No. ADJ7307502
Regular
Jul 11, 2011

GABRIELA NAVARRO vs. VENGROFF WILLIAMS ASSOCIATES, STATE COMPENSATION INSURANCE FUND

This case concerns an applicant seeking Lap Band surgery for an industrial injury. The Workers' Compensation Appeals Board (WCAB) denied the petition for reconsideration of the administrative law judge's decision. The applicant's primary argument was that an Agreed Medical Examiner (AME) supported the surgery's reasonableness and benefits. However, the WCAB found the AME's testimony contradictory and lacking specific evidence that Lap Band surgery was "reasonably required to cure or relieve" the effects of the industrial injury. Furthermore, the WCAB noted the AME's expressed lack of expertise regarding bariatric surgery and a timely utilization review that did not support the surgery.

Workers Compensation Appeals BoardGabriela NavarroVengroff Williams AssociatesState Compensation Insurance FundLap Band surgeryIndustrial injuryAgreed Medical EvaluatorStephen WertheimerM.D.Utilization Review
References
1
Case No. MISSING
Regular Panel Decision
Jun 02, 2008

Claim of Laezzo v. New York State Thruway Authority

The claimant suffered a work-related slip and fall in 2002, leading to injuries including his head, neck, back, and knees. His morbid obesity contributed to his back and knee issues, prompting him to seek authorization for gastric bypass surgery. The Workers’ Compensation Law Judge approved the surgery, a decision affirmed by the Workers’ Compensation Board, which found the surgery causally related to the compensable injuries. The employer and its carrier appealed, challenging the causal link. The court affirmed the Board's decision, noting substantial evidence that the claimant's weight gain was a result of the sedentary lifestyle imposed by his injuries, and that the surgery would aid in his recovery.

Workers' CompensationConsequential InjuryGastric Bypass SurgeryMorbid ObesityMedical Treatment AuthorizationCausationKnee InjuryBack InjurySedentary LifestyleBoard Decision Appeal
References
2
Case No. MISSING
Regular Panel Decision

Claim of Casiano v. CCIP/Union Settlement Home Care

In March 2001, claimant sustained a work-related back injury. Neurosurgeon Richard J. Radna recommended and performed decompression surgery despite the workers' compensation carrier denying preauthorization for the procedure. Both a Workers’ Compensation Law Judge and the Workers’ Compensation Board subsequently ruled that the surgery was not medically necessary, thereby absolving the carrier of liability for its cost. Claimant and Radna appealed this determination to the appellate court. Radna's appeal was dismissed due to lack of standing, and the Board's decision was affirmed, as it was within its purview to resolve the conflicting medical evidence presented by Radna and the carrier's neurosurgeon regarding the necessity of the surgery.

Workers' Compensation LawMedical NecessitySurgical ProcedurePreauthorization DenialNeurological InjuryConflicting Medical OpinionsAppellate ReviewStanding IssueCarrier LiabilityBack Injury
References
3
Case No. LAO 0811779, LAO 0811780
Regular
Mar 06, 2008

ELENA BLANKEVOORT vs. HUNTINGTON MEMORIAL HOSPITAL, S&B SURGERY CENTER

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a trial judge's order disallowing a lien claim from S&B Surgery Center. The WCAB found that while S&B Surgery Center did have a required "surgical clinic" license, it failed to prove compliance with fictitious business name filing requirements. However, the WCAB returned the case to the trial level for further proceedings, allowing S&B Surgery Center an opportunity to correct this procedural defect to recover on its lien.

Fictitious business nameLien claimantSurgical clinic licenseBusiness and Professions Code section 17910Medical BoardDepartment of Health ServicesBurden of proofReconsiderationWorkers' Compensation Appeals BoardOutpatient setting
References
12
Case No. MISSING
Regular Panel Decision
Apr 25, 1979

Woodward v. Black Clawson/Dilts Div.

The Workers' Compensation Board found the claimant's cardiac disability and surgery were causally related to an accidental injury on January 12, 1972, based on the testimony of Dr. A. Black. The court affirmed this decision, finding substantial evidence in the record to support the board's determination. Costs were awarded to the Workers’ Compensation Board against the employer and its insurance carrier.

cardiac disabilitycardiac surgeryaccidental injurycausal relationshipmedical testimonyWorkers' Compensation Boardappeal affirmedemployer liabilityinsurance carrier liabilitysubstantial evidence
References
0
Case No. MISSING
Regular Panel Decision

Fernandez v. North Shore Orthopedic Surgery & Sports Medicine, P.C.

Frank Fernandez, an x-ray technician, sued his former employer, North Shore Orthopedic Surgery & Sports Medicine, P.C., for retaliation under Title VII after filing a national origin discrimination complaint. A jury found in favor of Fernandez, awarding back pay, front pay, and punitive damages. North Shore subsequently moved for judgment as a matter of law, a new trial, and to modify the damage awards. The court denied North Shore's motions for judgment and a new trial, affirmed the jury's back pay award, but vacated and reduced the front pay award from $160,000 to $50,000, and the punitive damages award from $100,000 to $50,000.

RetaliationTitle VIIEmployment DiscriminationBack PayFront PayPunitive DamagesMitigation of DamagesFederal Rules of Civil ProcedureJudicial DiscretionEquitable Relief
References
27
Case No. MISSING
Regular Panel Decision

Meyers v. Epstein

This case concerns a motion in limine filed by the plaintiffs, Samara Meyers and her parents, in a 'ghost surgery' case. The plaintiffs allege that a different surgeon, Dr. Ira Richmond Abbott, performed brain surgery on Samara than the one they consented to, Dr. Fred Epstein. Following the surgery, Samara experienced severe complications including left side paralysis and cognitive impairments. The plaintiffs sought to recover damages for these complications, arguing that they were proximately caused by the unauthorized surgery. However, the court denied their motion, ruling that under New York law, a plaintiff cannot recover for injuries that would have foreseeably resulted from the surgery even if performed by the consented doctor, especially without evidence of negligent performance. The court limited potential recovery to nominal damages and mental anguish for the unauthorized act itself, not the inherent risks or consequences of the surgery.

Ghost surgeryBatteryMedical malpracticeInformed consentCausationDamagesMotion in limineBrain surgery complicationsProximate causeIntentional torts
References
18
Case No. MISSING
Regular Panel Decision

Claim of Prescott v. Town of Lake Luzerne

A claimant fell off a dump truck at work in February 2008, landing on his right buttock and injuring his hip. The injury led to surgery in May 2008 to remove heterotopic bone and subsequent two-stage hip replacement revision surgeries in November 2008 and February 2009 due to an infection. The Workers’ Compensation Board found the initial surgery and subsequent revisions causally related to the work fall and supported compensation awards. The employer appealed, arguing that an independent medical examination (IME) was improperly precluded and that the initial surgery lacked proper authorization. The Appellate Division affirmed the preclusion of the IME due to untimeliness and upheld the causal relationship findings for the injury and subsequent surgeries. However, the court reversed the Board's determination that the May 2008 surgery was properly authorized, remitting that specific issue for further proceedings, while affirming all other appealed decisions.

Causal RelationshipIndependent Medical Examination (IME)Evidence PreclusionSurgery AuthorizationHip InjuryHeterotopic OssificationMedical Opinion ConflictDue ProcessRemittiturEmployer Liability
References
8
Case No. ADJ900432 (SAC 0323091)
Regular
Dec 30, 2011

MARLENE COPUS vs. NORTH SACRAMENTO ELEMENTARY SCHOOL DISTRICT

This case involves a dispute over the necessity of spinal surgery for an applicant who sustained a cumulative trauma injury to her neck and back. While the applicant's treating physician recommended surgery, a second opinion physician disagreed, citing a lack of nerve root compression. The Appeals Board found that the medical evidence was insufficient to determine the necessity of surgery, particularly in light of ACOEM Practice Guidelines which generally recommend against surgery without nerve root compression. Therefore, the Board rescinded the prior award and remanded the case to appoint an independent physician to evaluate the applicant and determine the reasonableness and necessity of the proposed surgery.

Workers' Compensation Appeals BoardMarlene CopusNorth Sacramento Elementary School Districtcumulative traumaspinal surgerynerve root impingementcervical stenosisDr. OrisekDr. GregoriusACOEM Practice Guidelines
References
4
Case No. SBR 0332538
Regular
Mar 28, 2009

RUBY JONES vs. STATE OF CALIFORNIA / DEPARTMENT OF MENTAL HEALTH, STATE COMPENSATION INSURANCE FUND, PREMIER OUTPATIENT SURGERY CENTER, INC.

The Appeals Board granted reconsideration, rescinded the prior order, and returned the case for further proceedings on the reasonableness of Premier Outpatient Surgery Center's (POSC) $\$16,578.00$ lien claim for surgical services. While POSC was properly licensed as a surgical clinic and did not require a fictitious-name permit, the Appeals Board found the record insufficient to establish the reasonableness of the charged fee, noting a significant disparity between the billed amount and what was paid based on Medicare rates. The Board also rescinded the award of attorney's fees to POSC's counsel, finding no basis for such an award under Labor Code sections 5811 or 5813.

Workers' Compensation Appeals BoardRuby JonesState Compensation Insurance FundPremier Outpatient Surgery Centerfictitious-name permitMedical Board of CaliforniaDepartment of Health Servicessurgical clinic licenseoutpatient settingreasonable fee
References
6
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