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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

Lutheran Medical Center v. Hereford Insurance

Maher Kiswani, a livery car driver, was injured in an automobile accident and received medical treatment from Lutheran Medical Center. Lutheran, as Kiswani's assignee, sought payment from Hereford Insurance Company, the no-fault carrier, which refused to pay. After an initial arbitration where the Workers' Compensation Board determined Kiswani was not injured in the course of employment (without Hereford's notice), a second arbitration awarded Lutheran no-fault benefits. The Supreme Court, Kings County, vacated this arbitration award, ruling that Hereford should have been notified of the Workers' Compensation Board hearing. The appellate court affirmed the Supreme Court's decision, holding that a party not afforded an opportunity to participate in a Board hearing is not bound by its determination.

Arbitration AwardNo-Fault InsuranceWorkers' Compensation BoardDue ProcessNotice RequirementsVacated Arbitration AwardAppellate ReviewLivery Car DriverAutomobile AccidentMedical Benefits
References
3
Case No. MISSING
Regular Panel Decision

Queens Blvd. Medical, P.C. v. Travelers Indemnity Co.

The plaintiff, Queens Blvd. Medical, P.C., sought $950 in first-party no-fault benefits for biofeedback medical services provided to its assignor for lower back and chronic pain syndrome. The central issue at trial was the medical necessity of these services under Insurance Law § 5102 (a) (1). The plaintiff established a prima facie case with expert testimony from a board-certified neurologist affirming the medical appropriateness of biofeedback. The defendant insurance company failed to present admissible evidence to disprove medical necessity, as its expert was deemed incompetent to testify on biofeedback for back pain. Consequently, the court granted the plaintiff's motion for a directed verdict, awarding judgment for $950 along with statutory costs, interest, and attorney's fees.

No-fault benefitsMedical necessityBiofeedback treatmentExpert testimonyDirected verdictInsurance lawChronic pain syndromeBack injuryCPT codesBurden of proof
References
9
Case No. MISSING
Regular Panel Decision

Claim of Grugan v. The Record

Claimant sustained a work-related injury to her left hand in 2007, leading to a dispute over whether she should receive a permanent partial disability classification or a schedule loss of use award. The Workers’ Compensation Board ultimately issued a 15% schedule loss of use award, which the claimant appealed. The Appellate Division affirmed the Board's decision, finding that substantial evidence supported the determination. The court noted that claimant had reached maximum medical improvement and her condition was stable, factors supporting a schedule loss of use award. Conflicting medical opinions from the treating orthopedist and an independent medical examiner were resolved by the Board within its discretion.

Schedule Loss of UsePermanent Partial DisabilityWorkers' Compensation BoardMedical EvidenceIndependent Medical ExaminationTreating PhysicianAppellate ReviewBoard DiscretionMaximum Medical ImprovementConflicting Medical Opinions
References
3
Case No. MISSING
Regular Panel Decision

Beth Israel Medical Center v. 1199/S.E.I.U. United Healthcare Workers East

Beth Israel Medical Center (BIMC) petitioned to vacate an arbitration award concerning a labor dispute over wage differentials for registered nurses on flex-time schedules at its Kings Highway Division. Local 1199, the nurses' union, moved to confirm the award. The dispute arose when BIMC discontinued pro-rata wage differentials for day shift nurses, arguing a 2002 Memorandum of Agreement (MOA) adopted a different plan. The arbitrator found for Local 1199, concluding the 2002 MOA did not alter the longstanding practice established in prior MOAs. BIMC argued the arbitrator exceeded his power and violated public policy; however, the court denied BIMC's petition and granted Local 1199's motion, affirming the arbitrator's decision that drew its essence from the collective bargaining agreement.

Labor DisputeArbitration AwardWage DifferentialsCollective Bargaining AgreementFlex-Time ScheduleRegistered NursesNew YorkFederal CourtLMRAContract Interpretation
References
14
Case No. ADJ17547374
Regular
Oct 16, 2025

WARREN P. HARVEY vs. SOCAL MACHINE, INC., TRUCK INSURANCE EXCHANGE, FARMERS INSURANCE

The Workers' Compensation Appeals Board considered applicant Warren P. Harvey's petition for reconsideration regarding the equitable hourly reimbursement rates for in-home health care provided by his spouse, asserting errors in the WCJ's rate calculation and attorneys' fees. After an unsuccessful settlement conference, the parties filed Stipulations With Request for Award, agreeing to permanent total disability and further medical treatment for the applicant, though these stipulations did not resolve the reconsideration issues. The Board approved these stipulations, finding them adequate and in the applicant's best interest, and issued an award based upon them, which included specific disability indemnity, medical treatment, and attorney's fees. The Board also commended the parties for resolving some important issues and urged them to continue efforts on the remaining disputes.

Equitable hourly reimbursement ratesIn-home health careCaregiver dutiesNursing dutiesCommunity HHC providerPetition for reconsiderationStipulations With Request for AwardPermanent total disabilityTemporary disability indemnityAttorneys' fee
References
0
Case No. ADJ2726907 (VNO 0451280) ADJ4695107 (VNO 0451268) ADJ2158317 (VNO 0451264)
Regular
Feb 25, 2011

EDWARD DANIELS vs. UCLA MEDICAL CENTER, PROVIDENCE ST. JOSEPH MEDICAL CENTER, SEDGWICK CMS/AMERICAN HOME ASSURANCE

The Workers' Compensation Appeals Board granted reconsideration to modify a prior award. The Board found that the Administrative Law Judge erred by not adopting the opinion of a defense medical evaluator, Dr. Appleton, regarding the applicant's psychiatric disability. Consequently, the Board amended the award to reflect that the applicant's injury did not cause psychiatric disability, reducing the total permanent disability from 70% to 65%. This decision aligns the award with Dr. Appleton's findings and the applicant's own testimony, which supported no ratable psychiatric impairment.

WCABReconsiderationAmended Joint Findings and AwardPermanent DisabilityLumbosacral SpinePsycheQualified Medical EvaluatorWork FunctionsApportionmentSubstantial Evidence
References
0
Case No. ADJ9556841
Regular
Aug 15, 2016

SOFIA RIOS vs. TULARE REGIONAL MEDICAL CENTER, ALPHA FUND

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration of an award to Sofia Rios. The Board found that the Qualified Medical Evaluator did not engage in ex parte communication by sending a questionnaire and that his reports constituted substantial medical evidence. The employer's arguments that the doctor relied on personal anecdotes and an inaccurate assessment of lift team availability were rejected. The Board affirmed the original award based on the substantial evidence in the medical reports.

Workers' Compensation Appeals BoardPetition for ReconsiderationPanel Qualified Medical EvaluatorEx Parte CommunicationSubstantial Medical EvidenceLabor Code Section 5909TollingReasonable Medical ProbabilityInadequate Medical HistoriesCausation Analysis
References
5
Case No. MISSING
Regular Panel Decision
Jul 23, 1976

Lichtenstein v. Montefiore Hospital & Medical Center

This appeal concerns a wrongful death action filed by Ruth Lichtenstein against Montefiore Hospital and Medical Center. The plaintiff alleged the hospital's negligence in allowing her husband, Gary Lichtenstein, to escape from an open psychiatric unit, leading to his suicide. The appellate court found no evidence of negligence on the hospital's part regarding the patient's escape, overturning the prior verdict which awarded $400,000 in damages. The court deemed the damages excessive and ordered a new trial, providing guidance on issues like the inference of suicide and proximate cause.

Wrongful DeathNegligenceHospital LiabilityPsychiatric PatientSuicideElopementOpen Psychiatric UnitProximate CauseDamagesExcessive Verdict
References
7
Case No. MISSING
Regular Panel Decision

Claim of Cummins v. North Medical Family Physicians

A claimant sustained a work-related back injury and sought continued medical treatment, which was initially authorized. Disputes over authorization led the claimant to retain an attorney. A Workers’ Compensation Law Judge authorized continued medical treatment but denied counsel fees, stating no "money passing" occurred. The Workers' Compensation Board upheld this decision. The claimant appealed, arguing the Board unconstitutionally applied Workers’ Compensation Law § 24, misinterpreted the statute regarding fee payment from medical benefits, and abused its discretion. The appellate court affirmed the Board's decision, ruling that counsel fees must be paid from "compensation," defined as a money allowance, and medical benefits are not considered "compensation" for this purpose, thus finding no abuse of discretion.

Workers' CompensationCounsel FeesAttorney FeesMedical TreatmentStatutory InterpretationConstitutional LawLienCompensation DefinitionAppellate ReviewBoard Decision
References
3
Case No. ADJ1357794 (VNO 0359450)
Regular
Apr 06, 2016

JANET RILEY vs. COUNTY OF LOS ANGELES/ LAUSC MEDICAL CENTER

The Workers' Compensation Appeals Board granted reconsideration to amend a previous award. The Board found that applicant Janet Riley's January 5, 2011 stroke was a compensable consequence of her admitted industrial cumulative trauma injury to her internal and psyche. However, the Board deferred the issue of temporary total disability, citing insufficient medical evidence to establish the specific period of disability. The original award of temporary disability indemnity and further medical treatment was modified to reflect these decisions.

Workers' Compensation Appeals BoardJanet RileyCounty of Los AngelesLAUSC Medical Centercumulative traumainternal and psyche injurycentral operative techniciantemporary disability indemnitystrokeindustrial stress
References
0
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