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

Case No. ADJ8094646
Regular
Jan 17, 2014

ALEJANDRINA BARRETO vs. OUT OF THE SHELL, SOUTHERN INSURANCE COMPANY, REPUBLIC INDEMNITY COMPANY, PHARMAFINANCE, LLC, HEALTHCARE FINANCE MANAGEMENT, LLC

This case involves lien claimants PharmaFinance and Healthcare Finance Management, and their representatives Landmark Medical Management and Brian Hall, who sought reconsideration of a decision disallowing their liens for medical treatment. The Appeals Board granted reconsideration solely to notice its intention to impose sanctions of up to $2,500 against the lien claimants and their representatives. This action is due to a pattern of allegedly filing petitions containing false statements about not receiving notices, which violates the Board's Rules of Practice and Procedure and Labor Code Section 5813. The Board found these claims not persuasive and indicative of a tactic to avoid responsibility.

Workers' Compensation Appeals BoardPetition for ReconsiderationSanctionsLien ClaimantsHearing RepresentativesIndustrial InjuryFindings and OrderCompromise and ReleaseNotice of IntentionLabor Code section 5813
References
0
Case No. MISSING
Regular Panel Decision

ABC Medical Management, Inc. v. GEICO General Insurance

The case addresses whether a plaintiff-assignee medical equipment supplier can recover no-fault first-party benefits when a chiropractor, rather than a physician, issued the prescription. Defendant GEICO General Insurance Company moved for summary judgment, arguing that Education Law § 6551 prohibits chiropractors from prescribing such items. The court denied GEICO's motion, ruling that chiropractors are permitted to prescribe TENS units, thermophore devices, and similar medical supplies, as these do not constitute 'drugs or medicines' under the Education Law. Furthermore, the court found that GEICO failed to properly present its medical necessity defense and that the contested issues should be determined by a trier of fact.

No-Fault BenefitsChiropractic PrescriptionMedical EquipmentEducation Law § 6551Summary JudgmentMedical NecessityTENS UnitThermophoreCervical CollarLumbar Support
References
29
Case No. ADJ6722110
Regular
Oct 11, 2013

SERGIO RODRIGUEZ vs. AIR COASTAL FLEET SERVICES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed an administrative law judge's order dismissing a lien claim for failure to pay the required activation fee. The lien claimant, Advance Care Specialist Medical Clinic, and its representatives, Innovative Medical Management and Louis Heard, sought reconsideration, which was granted. However, the Board found no good cause to overturn the dismissal. Subsequently, the Board imposed a $1,000 sanction against Innovative Medical Management and Louis Heard for their failure to respond to a notice of intent to impose sanctions.

Lien activation feeSanctionLabor Code section 5813Appeals Board Rule 10561ReconsiderationWCJ Order Dismissing Lien ClaimNotice of Intention to Impose SanctionsWorkers' Compensation Appeals BoardHearing RepresentativeMedical Clinic
References
0
Case No. VNO 0301388
Regular
Sep 05, 2007

JACQUELYN GREEN vs. GENERAL MOTORS CORPORATION, SEDGWICK CLAIMS MANAGEMENT

This case involves an employer's attempt to present non-medical evidence regarding the reasonableness of expenses for an applicant's home elevator. The Appeals Board granted removal, reversing the trial judge's exclusion of these exhibits and witnesses. The Board found that while the medical necessity of the elevator was stipulated, the "reasonable expense" of its installation was a valid issue for which non-medical evidence should be admissible.

removalevidentiary rulingnon-medical exhibitsmedical necessitydue processsubstantial prejudiceirreparable harmpermanent disabilitystipulated awardreasonable expense
References
0
Case No. ADJ9116549
Regular
Mar 13, 2020

EMMA MEDINA vs. SUNRISE RESTAURANT, LLC, DENNY'S RESTAURANT, CANNON COCHRAN MANAGEMENT SERVICES, CHUBB INSURANCE

This Workers' Compensation Appeals Board case concerns the reimbursement for lien claimant Preferred Scan's copy services. The Board granted reconsideration to clarify what constitutes medical-legal expenses and the reasonable value of copy services. The Appeals Board rescinded the original award and returned the matter for further proceedings, finding that certain copy services for medical records were properly considered medical-legal expenses. However, the reasoning for doubling the copy service fee schedule was insufficient and requires further development at the trial level.

Workers' Compensation Appeals BoardReconsiderationLien ClaimantCopy ServicesMedical-Legal ServicesCopy Service Fee ScheduleLabor CodeSubpoena Duces TecumExplanation of ReviewCompromise and Release
References
4
Case No. MISSING
Regular Panel Decision

Lapir v. Maimonides Medical Center

Olga Lapir sued her former employer, Maimonides Medical Center (MMC), and her union, Local 1199, under the Labor Management Relations Act. She alleged that MMC breached their collective bargaining agreement by terminating her employment without good cause and that the union failed to process her grievance, breaching its duty of fair representation. Lapir was fired as a blood bank technician after an incident where she assisted a doctor in locating special blood, violating hospital confidentiality and blood segregation policies. The court found that the union's investigation and defense were not arbitrary or in bad faith, and its decision not to pursue arbitration was rational, especially given Lapir's admitted misconduct. Consequently, the defendants' motions for summary judgment were granted, dismissing Lapir's complaint.

Labor RelationsDuty of Fair RepresentationSummary Judgment MotionWrongful Termination ClaimCollective BargainingGrievance ArbitrationHospital Blood Bank PolicyEmployee ConfidentialityUnion Due DiligenceFederal District Court
References
15
Case No. ADJ6713503
Regular
May 16, 2014

MATTHEW JENSON vs. PEPSI BOTTLING GROUP, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board denied the Petition for Reconsideration filed by South Lake Medical Center and its associated entities. The Board also dismissed the successive Petition for Reconsideration filed by Accurate Medical Assessment Rating Center (AMARC). AMARC's prior petition was already denied, and successive petitions are not permitted, requiring review by the Court of Appeals instead. The Board adopted the WCJ's Report and Recommendation in support of these decisions.

WCABLien ClaimantPetition for ReconsiderationLabor Code section 5813California Code of Regulations title 8 section 10561WCJSanctionsSuccessive PetitionOrder Denying Petitions for ReconsiderationWrit of Review
References
2
Case No. MISSING
Regular Panel Decision

Polanco v. Brookdale Hospital Medical Center

Plaintiffs Pearl Polanco, Carol McCarthy, and Wilma Steel-Lopez, former employees of The Brookdale Hospital Medical Center, brought claims under the New York Labor Law (NYLL) and the Fair Labor Standards Act (FLSA), alleging they were not paid for work performed during lunch breaks and after shifts. The defendant moved to dismiss, arguing that the state claims were preempted and federal claims precluded by the Labor Management Relations Act (LMRA). The court, presided over by Senior District Judge Jack B. Weinstein, denied the defendant's motion, concluding that the plaintiffs' NYLL and FLSA claims assert independent statutory rights that are neither preempted nor precluded by the LMRA.

Wage DisputesOvertime CompensationFair Labor Standards ActNew York Labor LawLabor Management Relations ActPreemption DoctrineClaim PreclusionMotion to DismissEmployee RightsStatutory Rights
References
23
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. 2016 NY Slip Op 00302 [135 AD3d 572]
Regular Panel Decision
Jan 19, 2016

Domaszowec v. Residential Management Group LLC

Plaintiff Tracy Domaszowec's decedent died from a fall while cleaning a window on the 13th floor of an apartment building. The Appellate Division, First Department, modified a Supreme Court order, granting plaintiff's motion for partial summary judgment on her Labor Law § 240 (1) claim against Residential Management Group LLC and 40 Fifth Avenue Corporation (40 Fifth defendants), the building owner and manager. The court found the decedent was engaged in "commercial window washing," thereby making Labor Law § 240 (1) applicable. The court affirmed the dismissal of Labor Law § 202 against Veronica Bulgari and Stephen Haimo due to lack of exclusive control, and common-law negligence claims against T&L Contracting of N.Y., Inc. and Greenpoint Woodworking Inc. due to the lack of an exception to the contractual obligation rule. Issues of fact precluded summary judgment on negligence claims against Panorama Windows, Ltd., and the doctrine of res ipsa loquitur was deemed inapplicable to certain defendants.

Window cleaner fatalityScaffold LawSummary judgment appealAppellate Division First DepartmentCommercial vs. routine window washingLabor Law applicabilityContractual tort liabilityRes ipsa loquitur in negligencePunitive damages dismissalExpert witness evidence
References
8
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