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

Case No. ADJ1122368 (SJO 0223390)

Regular

Mar 24, 2015

MINH LY vs. LORAL SPACE SYSTEMS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for RELIANCE NATIONAL INDEMNITY COMPANY, in liquidation

The Appeals Board granted removal and rescinded the WCJ's order taking the case off calendar, holding that the applicant is entitled to an expedited hearing regarding the denial of Lyrica prescription refills. The WCJ erred by prematurely determining that utilization review (UR) was timely and jurisdictionally barred further proceedings, without allowing evidence and a hearing. The Board emphasized that the applicant has a right to an expedited hearing to contest UR decisions, challenge their applicability, or present evidence of changed circumstances. The case was returned to the trial level for an expedited hearing and a new decision based on the record.

Utilization ReviewIndependent Medical ReviewPetition for RemovalExpedited HearingOrder Taking Case Off CalendarPrescription MedicationLyricaDue ProcessLabor Code Section 5310Dubon II

References

Case No. 2021 NY Slip Op 02211 [193 AD3d 1222]

Regular Panel Decision

Apr 08, 2021

Matter of Morano v. Hawthorn Health Multicare Ctr.

Cynthia Morano suffered a work-related back injury in May 2014, leading to three lumbar spine surgeries. Her treating physician requested a variance to prescribe Lyrica and continued other medications, including gabapentin, which the employer's workers' compensation carrier denied. The carrier argued these medications were not causally related to the work injury because they were prescribed before the injury. However, the Workers' Compensation Law Judge and subsequent Board panels found the medications to be causally related. The Appellate Division affirmed the Board's decision, ruling that substantial evidence supported the finding that the medications were necessary for Morano's recovery from her work injury, making the carrier liable for the costs.

Workers' CompensationBack InjuryPain MedicationLyricaGabapentinCausal RelationshipMedical Treatment GuidelinesAppellate ReviewCarrier LiabilityConflicting Medical Evidence

References

Case No. 2018-01-0702

Regular Panel Decision

Dec 16, 2019

Mollica, Gena M. v. EHHI Holdings, Inc. DBA Advanced Home Care Management, Inc. DBA Encompass Home Health

Ms. Mollica requested medical and temporary disability benefits from EHHI Holdings, Inc., which had accepted her back injury but failed to provide orthopedist treatment and denied her claim that the medication Lyrica aggravated a pre-existing mental condition. The Court found Ms. Mollica entitled to the requested benefits. It ordered EHHI to authorize psychiatric evaluation with Dr. Sandvi and orthopedic treatment with Dr. Caputo, reimburse out-of-pocket medical expenses incurred for her mental condition, and pay past and ongoing temporary total disability benefits. Additionally, EHHI was required to respond regarding a potential twenty-five percent penalty for non-payment of temporary disability benefits.

Temporary Total DisabilityMedical Treatment AuthorizationPre-existing Mental Health ConditionDrug AggravationLyrica Side EffectsPsychiatric EvaluationOrthopedic ReferralCausation StandardPhysician Opinion PresumptionPenalty for Non-payment

References

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MINH LY vs. LORAL SPACE SYSTEMS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for RELIANCE NATIONAL INDEMNITY COMPANY, in liquidation

Utilization ReviewIndependent Medical ReviewPetition for RemovalExpedited HearingOrder Taking Case Off CalendarPrescription MedicationLyricaDue ProcessLabor Code Section 5310Dubon II

Matter of Morano v. Hawthorn Health Multicare Ctr.

Workers' CompensationBack InjuryPain MedicationLyricaGabapentinCausal RelationshipMedical Treatment GuidelinesAppellate ReviewCarrier LiabilityConflicting Medical Evidence

Mollica, Gena M. v. EHHI Holdings, Inc. DBA Advanced Home Care Management, Inc. DBA Encompass Home Health