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

Case No. ADJ6639764
Regular
Sep 23, 2010

DENNIS MUSKRAT vs. CALIFORNIA MEN'S COLONY, SCIF STATE EMPLOYEES OXNARD

The Workers' Compensation Appeals Board granted reconsideration to eliminate a 25% penalty previously awarded. The penalty was based on the employer's denial of medial branch blocks, but the Board found the employer's request for clarification from the Agreed Medical Evaluator was reasonable. The AME had failed to cite evidence supporting the treatment recommendation, and the employer's inquiry was justified given this lack of basis. Therefore, the penalty was rescinded, and the employer was ordered to provide the necessary medical treatment.

Workers' Compensation Appeals BoardIndustrial InjuryLumbar SpineTemporary DisabilityMedical Branch BlocksUtilization ReviewAgreed Medical Evaluator (AME)Labor Code Section 5814PenaltyUnreasonable Delay
References
3
Case No. ADJ8115084
Regular
Jun 02, 2014

MARY HAYWORTH vs. KCI HOLDINGS USA, INC., FIDELITY AND GUARANTY INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, rescinding a prior finding that the applicant failed to establish a plainly erroneous fact in an Independent Medical Review (IMR) determination. The Board found the IMR decision was based on a plainly erroneous mistake of fact because it evaluated a request for dorsal medial branch block injections as though it were a request for facet injections, which are different procedures. Consequently, the medical treatment dispute is remanded to the Administrative Director for review by a different independent review organization or reviewer.

Workers' Compensation Appeals BoardIndependent Medical ReviewLabor Code Section 4610.5Plainly Erroneous Finding of FactMedical Treatment DisputeUtilization ReviewAdministrative DirectorDorsal Medial Branch BlockFacet InjectionsMTUS Guidelines
References
2
Case No. SAC 0348804
Regular
May 09, 2008

CHESTER WILLIAMSON vs. RADNOR HOLDINGS, dba WINCUP, AMERICAN HOME ASSURANCE, AIG CLAIMS SERVICES

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding the finding that his hip replacement surgery, which involved the removal of the femoral head, did not qualify as an amputation under Labor Code section 4656(c)(2)(C). Consequently, the applicant is limited to 104 weeks of temporary disability benefits. The Board followed its prior en banc ruling in *Cruz v. Mercedes-Benz*, which defined "amputation" as the severance of external body parts and not the removal of internal, non-projecting structures.

Labor Code section 4656(c)(1)amputation exceptiontemporary disability indemnityhip replacement surgeryfemoral head removalcommon sense interpretationCruz v. Mercedes-Benzen banc decisionRadnor HoldingsAIG Claims Services
References
2
Case No. MISSING
Regular Panel Decision

Claim of Zobel v. Chemung County

Claimant, a correction officer, sustained a torn medial meniscus in his right knee when turning to enter an elevator while completing his shift. He applied for workers’ compensation benefits, which the employer controverted, arguing the injury was idiopathic. A Workers’ Compensation Law Judge and the Board found the injury work-related, awarding benefits. The Appellate Division affirmed this decision, citing substantial evidence. They noted the claimant’s testimony, corroborated by an independent medical examiner, supported the finding that the injury resulted from a workplace accident.

Work-Related InjuryMedial Meniscus TearCorrection OfficerCourse of EmploymentIdiopathic DefenseSubstantial EvidenceAppellate AffirmationMedical Examiner ReportKnee InjuryElevator Accident
References
6
Case No. MISSING
Regular Panel Decision
Sep 23, 1988

Claim of Edmondson v. State Insurance Fund

The claimant, a payroll clerk, sustained a left hip injury after tripping at work in 1981, leading to multiple surgeries including a hip fusion and removal of the femoral head and neck, resulting in an 80% schedule loss of use of her left leg. The employer sought to apportion the disability due to a preexisting condition of avascular necrosis and a prior hip injury. However, the Workers' Compensation Board determined the 80% schedule loss was solely related to the compensable accident, a finding affirmed on appeal based on medical testimony that the orthopedic surgeon opined the preexisting condition was nondisabling and not progressive at the time of the accident.

Workers' CompensationHip InjurySchedule Loss of UseAvascular NecrosisApportionmentPreexisting ConditionMedical TestimonyOrthopedic SurgeryCausationState Insurance Fund
References
3
Case No. MISSING
Regular Panel Decision

Claim of Thompson v. New York Telephone Co.

A chauffeur's helper sustained a knee injury while descending stairs to exit her employer's premises after changing clothes. She was diagnosed with a torn medial meniscus. The Workers’ Compensation Board ruled the injury compensable as an accident arising out of and in the course of employment. The employer appealed, arguing the injury was not compensable because the claimant was not engaged in actual labor and the injury lacked a direct employment connection. The court affirmed the Board's decision, citing that the course of employment includes a reasonable amount of time for an employee to leave the premises after work. Furthermore, accidents occurring in the course of employment are presumed to arise out of employment, a presumption the employer failed to rebut with substantial evidence.

Knee InjuryCompensable InjuryCourse of EmploymentArising Out of EmploymentPresumptionAffirmationAppellate DivisionWorkers' Compensation BoardChauffeur's HelperPremises Liability
References
2
Case No. MISSING
Regular Panel Decision

Claim of Stewart v. P & C Food Markets, Inc.

A claimant, who worked as a cashier, developed persistent leg and hip pain diagnosed as a slipped femoral epiphysis requiring surgery in August 1990. Following surgery, he allegedly developed chronic low back pain and filed for workers' compensation benefits. While surgeons opined that neither the slipped hip nor back pain were work-related, chiropractors testified otherwise. The Workers’ Compensation Board ruled in the claimant's favor, finding a causal relationship for both conditions. The employer and its insurer appealed, raising an issue about the chiropractors' qualifications which was deemed not properly preserved. The Appellate Division affirmed the Board's decision, finding substantial evidence for the causal relationship.

Workers' CompensationCausal RelationshipSlipped Femoral EpiphysisBack PainChiropractor TestimonyMedical Expert QualificationSubstantial EvidenceAppellate ReviewEmployer AppealInsurance Carrier
References
4
Case No. MISSING
Regular Panel Decision

Claim of Banner v. Anheuser-Busch Companies

Claimant, a forklift operator, sought workers' compensation benefits for right knee and left hip injuries sustained in December 2005. After an initial award, the Workers' Compensation Board rescinded benefits, concluding that the disabling hip condition (avascular necrosis of the left femoral head) was not causally related to the work injury, based on an impartial specialist's report and other medical testimony. On appeal, the Court affirmed the Board's decision, finding that the Board's resolution of conflicting medical opinions on causation was supported by substantial evidence. The Court also found that the omission of claimant's testimony minutes was not reversible error, as the Board had ample medical evidence to consider.

Workers' Compensation AppealCausationAvascular NecrosisHip InjuryKnee InjuryConflicting Medical OpinionsSubstantial EvidenceWorkers' Compensation Board DecisionMedical EvidenceAppellate Review
References
8
Case No. MISSING
Regular Panel Decision
Oct 17, 2002

Ramos v. Port Authority

Plaintiff, an employee of a company contracted by the Port Authority, was injured while hanging tarps on the George Washington Bridge. He was instructed to climb without a safety harness or other safety devices like a man-lift or scaffold. While attempting to return, a railing cable gave way, causing him to fall 40 feet and sustain a femoral shaft fracture. The Supreme Court denied the plaintiff's motion for partial summary judgment regarding the Port Authority's liability under Labor Law § 240 (1). The appellate court reversed, finding the Port Authority failed to provide proper safety devices, constituting a per se violation of Labor Law § 240 (1), and remanded the case for further proceedings.

George Washington BridgeFall from heightConstruction accidentSummary judgmentAbsolute liabilitySafety devicesScaffoldSafety harnessRecalcitrant workerPersonal injury
References
9
Case No. MISSING
Regular Panel Decision

Liebman v. New Jersey Manufacturers Insurance

A physician, acting as plaintiff, brought a jury trial action against an insurance company, the defendant, under the New York State No-Fault Law to recover fees for surgical procedures and subsequent hospital visits, as well as attorneys' fees. The core dispute revolved around whether certain surgical procedures (arthroscopy, arthrotomy, excision of torn medial meniscus) were separate and distinct for billing purposes, and if post-operative hospital visits constituted reimbursable care or included follow-up care under the Workers’ Compensation Board medical fee schedule. The jury found arthroscopy and arthrotomy to be separate procedures, but arthrotomy and excision were not. They also determined the hospital visits were follow-up care. The court, finding the issues novel and unique, awarded the plaintiff $4,425 plus interest in attorneys' fees, exceeding the statutory maximum.

No-Fault LawInsurance ClaimMedical Billing DisputeAttorneys' FeesJury TrialSurgical ProceduresWorkers' Compensation ScheduleNovel and Unique IssuesOrthopedic SurgeryArthroscopy
References
7
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