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Case Law Database

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

Case No. MISSING
Regular Panel Decision

Rechenberger v. Nassau County Medical Center

Edward Rechenberger suffered hip fractures and underwent two operations at Nassau County Medical Center in May 1982. Following a re-injury and later diagnosis, he learned the surgical hardware was improperly implanted, leading to further operations. Mr. Rechenberger sought leave to serve a late notice of claim against the medical center. The Supreme Court initially denied the motion, but the Appellate Division reversed this decision, finding that the hospital had actual knowledge of the essential facts of the claim within the statutory 90-day period through its own medical records. The court concluded that the delay in serving the notice of claim was not substantially prejudicial to the hospital, and thus, granted the petitioners leave to serve the late notice of claim.

Medical MalpracticeLate Notice of ClaimNassau CountyHip FractureSurgical ErrorContinuous Treatment DoctrineActual NoticePrejudiceAppellate ReviewMunicipal Corporation
References
11
Case No. ADJ11255525
Regular
Dec 02, 2019

GWENDOLYN JOHNIGAN vs. UC DAVIS MEDICAL CENTER

This case involves an applicant denied workers' compensation benefits for industrial injury to her right leg and knee, with the Workers' Compensation Appeals Board (WCAB) denying her petition for reconsideration. The WCAB adopted the administrative law judge's finding that the applicant did not sustain industrial injury, relying on a panel qualified medical evaluator's opinion that the work duties were insufficient to cause an injury. The applicant argued the medical evidence was not substantial and sought further development of the record. However, the WCAB found the applicant failed to meet her burden of proof with substantial medical evidence. A dissenting opinion argued the medical evidence was insubstantial and required further development.

Petition for ReconsiderationPanel Qualified Medical EvaluatorOrthopedistSubstantial Medical EvidenceFurther DevelopmentSupplemental ReportingDeposition TestimonyIndustrial InjuryRight LegRight Knee
References
4
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. ADJ8734628 ADJ9086734
Regular
Aug 12, 2016

PATRICIA CRUZ MALDONADO vs. WHITE MEMORIAL MEDICAL CENTER, ADVENTIST HEALTH

This case involves White Memorial Medical Center's petition for reconsideration of a Joint Findings and Award finding that applicant Patricia Cruz Maldonado sustained lumbar spine injuries arising out of and occurring in the course of employment as a registered nurse. The defendant argued the findings were erroneous due to alleged inconsistencies in applicant's testimony and a lack of substantial medical evidence for a cumulative injury. The Workers' Compensation Appeals Board denied the petition, upholding the Administrative Law Judge's credibility determinations and finding substantial medical evidence, specifically from Dr. Edwin Haronian, supporting the cumulative trauma injury. The Board emphasized that the WCJ observed the witness and considered all admitted evidence, and that deposition testimony not offered into evidence could not be relied upon.

WCABPetition for ReconsiderationJoint Findings and AwardWCJcredibility determinationsubstantial medical evidencecumulative traumalumbar spineregistered nurseprimary treating physician
References
5
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 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. 2015 NY Slip Op 00361 [124 AD3d 636]
Regular Panel Decision
Jan 14, 2015

Williams v. Jamaica Hospital Medical Center

The infant plaintiff alleged personal injuries resulting from a delayed transport by the City of New York's Emergency Medical Service during his mother's labor. Approximately four years after the alleged negligence, the plaintiff served a notice of claim and moved to have it deemed timely or for leave to serve a late notice. The Supreme Court granted the plaintiff's motion and denied the City's cross-motion to dismiss. The Appellate Division, Second Department, reversed this order, finding that the City did not acquire actual knowledge of the essential facts of the claim within the statutory 90-day period or a reasonable time thereafter. The court further determined that the plaintiff's delay substantially prejudiced the City's ability to defend the action and that the plaintiff failed to provide a reasonable excuse for the significant delay, noting that infancy alone without a demonstrated nexus to the delay was insufficient.

Late Notice of ClaimGeneral Municipal LawActual Knowledge RequirementPrejudice to MunicipalityReasonable Excuse for DelayInfancyPersonal InjuryMedical Malpractice AllegationAppellate ReviewMunicipal Negligence
References
13
Case No. MISSING
Regular Panel Decision

Palmer v. State University of New York Upstate Medical University

The claimant, an orthopedic hand surgeon, developed cervical radiculopathy and degenerative disc disease due to the physical strain of performing hand surgery and filed for workers' compensation benefits. His claim was controverted by the State University of New York Upstate Medical University and its carrier, as well as the Research Foundation of New York and its carrier. The Workers' Compensation Board determined that the claimant was a dual employee of both the University and the Foundation and that his condition constituted a causally related occupational disease. The University and its carrier appealed this decision. The appellate court affirmed the Board's findings, concluding there was substantial evidence to support both the dual employment status and the existence of a recognizable link between the claimant's condition and the distinctive features of his occupation.

Occupational DiseaseCervical RadiculopathyDegenerative Disc DiseaseDual EmploymentWorkers' Compensation BenefitsHand Surgery StrainMedical OpinionAppellate ReviewCausationEmployer Liability
References
8
Case No. ADJ869205 (SAC 0294976) ADJ302322 (SAC 0354178)
Regular
Oct 11, 2010

Patricia Rush vs. The Permanente Medical Group; Athens Administrators Concord

This case involves Patricia Rush claiming cumulative trauma injuries to her knees and back, among other body parts, against The Permanente Medical Group. The Workers' Compensation Appeals Board granted reconsideration because the Administrative Law Judge's findings of industrial causation for knee injuries lacked substantial medical evidence, with conflicting and uncertain Qualified Medical Evaluator opinions. The Board rescinded the prior findings and ordered further development of the medical record, suggesting an Agreed Medical Examiner or a court-appointed physician to resolve the causation issue for the knee injuries. The matter is returned to the trial level for a new final determination after the record is further developed on all issues, including injury causation.

Workers' Compensation Appeals BoardPermanente Medical GroupAthens Administratorscumulative trauma injurykneesbackshouldershandswristsindustrial causation
References
0
Case No. ADJ2270634 (VNO 0521616)
Regular
Aug 03, 2018

SHEVON THOMAS vs. POMONA VALLEY HOSPITAL MEDICAL CENTER, Administered by ADMINSURE, INC., SUBSEQUENT INJURIES BENEFITS TRUST FUND

This case concerns an applicant seeking benefits from the Subsequent Injuries Benefits Trust Fund (SIBTF) following a 2005 industrial injury that resulted in a 69% permanent disability and a substantial settlement. The applicant's claim for SIBTF benefits was denied because she failed to establish a prior "labor disabling" permanent disability that existed before the 2005 injury. The Appeals Board upheld the denial, finding that the applicant's evidence of prior symptoms, including a doctor's speculative impairment ratings, lacked substantial medical evidence and did not meet the strict requirements for establishing a pre-existing, labor-disabling condition. The Board emphasized that post-injury medical opinions, especially those based on hypotheticals and inadequate history, cannot retroactively establish a prior disability for SIBTF eligibility.

Subsequent Injuries Benefits Trust FundSIBTFlabor disablingpermanent partial disabilityLabor Code section 4751SB 899apportionmentpreexisting disabilityAMA Guides impairment ratingsretrospective prophylactic work restrictions
References
8
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