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

Case No. MISSING
Regular Panel Decision

Elmont Open MRI & Diagnostic Radiology, P.C. v. New York Central Mutual Fire Insurance

Plaintiff Elmont Open MRI & Diagnostic Radiology, PC. sued defendant New York Central Mutual Fire Insurance Company (NYCMFIC) for overdue first-party no-fault benefits following a brain MRI performed on Abdelghani Kinane. NYCMFIC moved for summary judgment, asserting the action was premature because Elmont allegedly failed to respond to verification requests, thereby tolling NYCMFIC's time to pay or deny the claim. Elmont countered with an affidavit from its billing supervisor, Brijkumar Yamraj, and a certificate of mailing, proving the requested MRI films and information were sent to NYCMFIC on November 12, 2008. The court found Elmont's proof of mailing sufficient to establish a response, thus denying NYCMFIC's motion and subsequently granting summary judgment to Elmont upon searching the record.

No-fault insuranceVerification requestsSummary judgmentProof of mailingMedical benefitsInsurance claims processTolling of time limitMotor vehicle accidentRadiology fee scheduleBusiness records
References
24
Case No. ADJ10679103
Regular
Dec 14, 2017

LARRY SYKES vs. THE ANSCHUTZ CORPORATION, STARR INDEMNITY & LIABILITY COMPANY

The Workers' Compensation Appeals Board granted reconsideration of a prior finding of industrial injury to the applicant's lumbar spine. The Board found that the existing medical reporting from Dr. Hong, Dr. Jamasbi, and the PQME Dr. Schofferman did not constitute substantial evidence to support this lumbar spine injury finding. Therefore, the case is returned to the trial level to develop the record further on the lumbar spine injury issue.

Workers' Compensation Appeals BoardPetition for ReconsiderationIndustrial InjuryCervical SpineThoracic SpineLumbar SpineStagehandSecurity OfficerMedical Treatment RecordsSubstantial Evidence
References
0
Case No. ADJ10384099
Regular
Jan 29, 2018

RODOLFO RODRIGUEZ vs. ROBERT BOSCH AFTERMARKET DIVISION, ZURICH NORTH AMERICA

The Appeals Board granted reconsideration to amend the finding of fact, clarifying that the applicant sustained a compensable injury to his lumbar spine arising out of and occurring within the course of employment. While medical evidence supported the lumbar spine injury, the Board deferred the issue of lower extremities as an injured body part for further development. This decision affirmed the original finding regarding the lumbar spine, based on applicant's credible testimony and medical opinions from Drs. Hutchinson and Schaffzin.

AOE/COELumbar spineLower extremitiesPetition for ReconsiderationFinding of FactWCJMedical evidencePreexisting conditionAggravationLighting up
References
14
Case No. AD10769216
Regular
Dec 13, 2019

Richard Hovannisian vs. UCLA, Permissibly Self-Insured, Administered By SEDGWICK CMS

The WCAB granted reconsideration and deferred issues of lumbar spine injury and permanent disability from a prior award. The WCJ's decision relied on a QME report that failed to establish industrial causation for the lumbar spine injury and lacked sufficient explanation for departing from AMA Guides methodology for permanent disability ratings. The Board found these deficiencies meant the decision was not based on substantial medical evidence. Further proceedings are required for the QME to adequately address causation, rating methodology, and lumbar spine classification.

WCABPetition for ReconsiderationFindings of Fact & Awardindustrial injurylumbar spinepermanent disabilitysubstantial medical evidencedue processDisability Evaluation Unitpanel qualified medical evaluator
References
4
Case No. 2024 NY Slip Op 00599 [224 AD3d 428]
Regular Panel Decision
Feb 06, 2024

Matter of New Millennium Pain & Spine Medicine, P.C. v. Garrison Prop. & Cas. Ins. Co.

This case involves two appeals by New Millennium Pain & Spine Medicine, P.C. against Garrison Property & Casualty Insurance Company and GEICO Casualty Company. New Millennium sought to vacate master arbitration awards that denied its claims for no-fault benefits for medical services. The Supreme Court denied these applications. The Appellate Division, First Department, affirmed the Supreme Court's decisions, stating that an arbitrator's award will not be set aside unless it is irrational. The court also addressed the argument regarding a 20% wage offset in no-fault benefits, finding it unavailing under Insurance Law § 5102 (b). Ultimately, New Millennium was not entitled to attorneys' fees as it was not the prevailing party.

No-fault benefitsarbitration awardvacaturinsurance lawwage offsetappellate reviewmedical servicesno-fault policy exhaustionattorneys' feesCPLR Article 75
References
8
Case No. ADJ8413521
Regular
Apr 13, 2020

STEVEN KING vs. COUNTY OF SAN BERNARDINO

This Workers' Compensation Appeals Board case involves applicant Steven King's claims for injury arising out of and occurring in the course of employment, including bilateral shoulders, lumbar spine, cardiac system, hernia, skin disorder, hearing loss, and hypertension. The Board affirmed the finding of injury AOE/COE and the hypertension rating but remanded the case for further development of the record regarding the applicant's lumbar spine impairment. The administrative law judge's prior rejection of the Agreed Medical Examiner's (AME) supplemental opinion on lumbar spine disability was deemed an improper disregard of substantial medical evidence.

Workers' Compensation Appeals BoardPetition for ReconsiderationAmended Findings and Awardinjury arising out of and occurring in the course of employmentbilateral shoulderslumbar spinecardiac systemherniaskin disorderhearing loss
References
8
Case No. ADJ13002649, ADJ13002697
Regular
Oct 20, 2025

LORENZO TORRES vs. KOOS MANUFACTURING COMPANY, INC.; SAFETY NATIONAL CASUALTY COMPANY

The Workers' Compensation Appeals Board denied defendant's Petition for Reconsideration of a Joint Findings and Award (F&A) issued on July 21, 2025. The F&A, authored by a Workers' Compensation Judge, found that applicant Lorenzo Torres sustained injuries arising out of and in the course of employment (AOE/COE) to his lumbar spine and psyche (ADJ13002649), with the psychological injury not precluded by a good faith personnel action defense, resulting in temporary partial disability and 14% permanent disability to the lumbar spine. Additionally, applicant sustained AOE/COE injuries to his right and left shoulders (ADJ13002697), leading to 3% and 4% permanent disability respectively. Defendant challenged these findings, arguing insufficient evidence for the psyche injury, unjustified temporary partial disability, a lower lumbar spine impairment, and no industrial shoulder injury. The Appeals Board reviewed the matter, including the WCJ's Report and Recommendation, and found the WCJ's conclusions to be supported by substantial evidence. Consequently, the Board affirmed the original F&A and denied the reconsideration petition.

AOE/COEGood Faith Personnel Action DefensePsychological InjuryLumbar Spine InjuryShoulder InjuryTemporary Partial DisabilityPermanent DisabilityApportionmentQualified Medical EvaluatorSubstantial Evidence
References
11
Case No. ADJ790852
Regular
Apr 05, 2016

LAURA BREITIGAN vs. COUNTY OF RIVERSIDE

The Workers' Compensation Appeals Board granted the applicant's petition for reconsideration, amending the award to include attorney fees on accrued unpaid permanent disability benefits and correcting clerical errors. The Board denied the defendant's petition for reconsideration, upholding the finding of 100% permanent disability and injury to the lumbar spine. The defendant was also admonished for filing a document exceeding the page limit without prior permission. The applicant, a nurse, sustained industrial injuries to her thoracic spine, lumbar spine, and psyche.

Workers' Compensation Appeals BoardLaura BreitiganCounty of RiversideFindings and Awardindustrial injurythoracic spinelumbar spinepsychepermanent disabilityapportionment
References
0
Case No. ADJ3649169
Regular
Feb 14, 2013

BRUCE LIBERTY vs. LOS ANGELES UNIFIED SCHOOL DISTRICT; Permissibly Self-Insured

This case concerns an applicant's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) order denying his claim for lumbar spine injury. The applicant alleged a lumbar injury from a physical therapy incident following a compensable cervical and shoulder injury. The WCAB denied reconsideration, adopting the WCJ's report which relied on the Agreed Medical Examiner's (AME) opinion. The AME found no industrial injury to the lumbar spine, citing a lack of contemporaneous evidence and a history of degenerative disc disease. The WCAB determined the applicant's presented "new" evidence was either previously reviewed or unpersuasive, upholding the original award.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeniedBruce LibertyLos Angeles Unified School DistrictPermissibly Self-InsuredCase Number ADJ3649169Workers' Compensation Administrative Law JudgeAgreed Medical ExaminerLumbar Spine Injury
References
0
Case No. ADJ10954606
Regular
Mar 09, 2020

DORIT DAVIDOFF vs. UCLA MEDICAL CENTER, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board granted reconsideration to clarify findings of fact regarding industrial injury AOE/COE. The Board rescinded the previous decision and substituted a new Findings and Award to specifically address the stipulated injury to the lumbar spine, ensuring the award of permanent disability benefits was properly supported. The Board clarified that stipulations agreed upon by the parties should be treated as findings of fact to meet statutory requirements. The decision confirms permanent disability for the left ankle, thoracic spine, and lumbar spine, denies claims for neck and knee injuries, and orders further medical treatment and attorney fees.

Petition for ReconsiderationFindings and AwardIndustrial InjuryLumbar SpineThoracic SpineLeft AnkleAOE/COEStipulationJurisdictional FactsFindings of Fact
References
1
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