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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

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. MISSING
Regular Panel Decision

Rozewicz v. New York City Health & Hospitals Corp.

This opinion addresses a complex medical malpractice case involving the death of Mrs. Rosewicz, a Jehovah's Witness, who refused blood transfusions due to religious beliefs. Justice Lehner explores three categories of relevant legal precedents: government benefit denials for religious refusal of treatment, tortfeasor liability and mitigation of damages, and malpractice claims where a patient refused life-saving treatment on religious grounds. The court declines to charge the jury on mitigation of damages, deeming it inappropriate for this specific case. Instead, the judge rules that the jury will be instructed on the principles of assumption of risk and comparative fault, allowing for the apportionment of liability between the defendant's alleged negligence and the decedent's refusal of blood transfusions, consistent with decisions in Shorter v Drury and Corlett v Caserta.

Medical MalpracticeReligious FreedomBlood Transfusion RefusalJehovah's WitnessAssumption of RiskComparative FaultMitigation of DamagesWrongful DeathJury InstructionsNegligence
References
12
Case No. ADJ7555799 (MF) ADJ7561888
Regular
Sep 08, 2017

REYNA PANIAGUA vs. T & R BANGI'S AGRICULTURAL SERVICES, INC., SEABRIGHT INSURANCE, administered by ENSTAR GROUP, STATE COMPENSATION INSURANCE FUND

This case involves an applicant seeking reconsideration of a finding that her employer did not refuse to provide medical treatment. The applicant's designated Medical Provider Network (MPN) physicians were unable to treat her, leading to delays and her eventual notification that a provider was no longer accepting new patients. Despite the applicant's frustration and inability to secure treatment within the MPN, the Board affirmed the original finding. The Board concluded there was insufficient evidence that the defendant neglected or refused to provide the requested medical treatment.

Workers Compensation Appeals BoardMedical Provider Network (MPN)Primary Treating Physician (PTP)Self-Procured TreatmentNeglect or Refusal to Provide TreatmentStipulations With Request for AwardCompromise and ReleaseExpedited HearingDeclaration of David KestnerCentral Valley Occupational Medical Group (CVO)
References
2
Case No. ADJ736188 (GOL 0099658)
Regular
Sep 22, 2017

Deanna Power vs. St. John's Regional Medical Center, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case concerns Deanna Power's claim for continued medical treatment, specifically prescription medications Xyrem and Lunesta, for a previous industrial injury. The employer denied authorization for these medications through Utilization Review (UR), and the applicant's subsequent Independent Medical Review (IMR) application was deemed untimely. The trial judge initially ordered continued treatment and directed the Administrative Director to process the IMR appeal, finding it timely. However, the Appeals Board granted reconsideration, finding the trial judge lacked jurisdiction to order treatment when a timely UR decision was issued and the applicant's sole recourse was the IMR process. The matter was returned to the trial level for a determination solely on the timeliness of the IMR appeal, not the medical necessity of the medications.

WCABPetition for ReconsiderationFindings of Fact and AwardXyremLunestaIndependent Medical ReviewIMRUtilization ReviewURprescription medications
References
3
Case No. MISSING
Regular Panel Decision

Claim of Wilkins v. New York Power Authority

The claimant, a lineman, sustained a shoulder injury in July 2007. Despite a diagnosis of biceps tendonitis and adhesive capsulitis, he declined prescribed medication and discontinued physical therapy, not missing work. He subsequently applied for workers’ compensation benefits based on a 45% schedule loss of use. A Workers’ Compensation Law Judge initially denied benefits, citing the claimant's unreasonable refusal of treatment. The Workers’ Compensation Board reversed, finding the refusal reasonable. However, the appellate court reversed the Board's decision, concluding that the Board’s determination was not supported by substantial evidence given the unanimous medical opinion that treatment was needed and claimant's refusal was unreasonable, remitting the matter for further proceedings.

Shoulder InjuryBiceps TendonitisAdhesive CapsulitisSchedule Loss of UseRefusal of Medical TreatmentUnreasonable RefusalWorkers' Compensation BenefitsMedical OpinionSubstantial EvidenceAppellate Review
References
3
Case No. MISSING
Regular Panel Decision

Perez v. Brookdale University Hospital & Medical Center

Eulalia Perez was admitted to Brookdale University Hospital on November 16, 2010, and treated for various medical conditions before being discharged on December 7. She died two days later. Her family, Ivan and Irma Perez, sued Brookdale and other defendants, alleging a violation of the Emergency Medical Treatment and Active Labor Act (EMTALA) and state-law claims of wrongful death and negligence. The court granted Brookdale's motion for summary judgment on the EMTALA claim, determining that the hospital fulfilled its EMTALA duties once Mrs. Perez was stabilized, and any subsequent issues were outside the statute's scope. Consequently, the court declined to exercise supplemental jurisdiction over the state-law claims, leading to the dismissal of all claims against all parties.

EMTALAEmergency Medical Treatment and Active Labor ActMedical MalpracticeNegligenceWrongful DeathSummary JudgmentSupplemental JurisdictionPatient DumpingHospital DischargeFederal Question Jurisdiction
References
8
Case No. 07-CV-6149L
Regular Panel Decision
Feb 18, 2010

Johnson v. THE UNIVERSITY OF ROCHESTER MEDICAL CENTER

Plaintiffs Keith Johnson, M.D., and Laura Schmidt, R.N., filed a qui tam action under the False Claims Act against the University of Rochester Medical Center and Strong Memorial Hospital. They alleged defendants defrauded the government by submitting false claims for anesthesiology services under Medicare/Medicaid, claiming physician supervision when it was absent. Johnson also alleged retaliatory discharge for reporting violations, and Schmidt claimed retaliation for refusing to alter medical records. The defendants moved to dismiss, arguing failure to plead fraud with particularity under Fed. R. Civ. P. 9(b) and failure to state a claim under Rule 12(b)(6). Johnson cross-moved to amend the complaint to add claims of libel per se and prima facie tort against Dr. Lustik. The court granted the defendants' motion to dismiss, finding that the plaintiffs failed to allege that any fraudulent bills were actually presented to Medicare/Medicaid. The retaliation claims were also dismissed because the complaints were not made in furtherance of a qui tam action. Johnson's motion to amend was denied as frivolous and in bad faith. Defendants' request for sanctions was denied without prejudice.

False Claims ActQui TamMedicare FraudMedicaid FraudRetaliatory DischargePleading StandardsRule 9(b)Motion to DismissLeave to AmendLibel
References
28
Case No. ADJ1226686 (WCK 60788)
Regular
Oct 29, 2008

CATHY BAKER vs. JAMES H. KHOE, D.D.S., ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board corrected a clerical error in a prior decision, specifically changing a finding from "Defendant did unreasonably delay or refuse medical treatment" to "Defendant did *not* unreasonably delay or refuse medical treatment." This correction was made after the defendant alerted the Board to the mistake, and the Board exercised its authority to correct clerical errors at any time. Consequently, the defendant's petition for reconsideration was dismissed as moot.

WORKERS' COMPENSATION APPEALS BOARDCLERICAL ERRORPETITION FOR RECONSIDERATIONLABOR CODE § 5814MEDICAL TREATMENTDELAYREFUSALDECISION AFTER RECONSIDERATIONCORRECTINGDISMISSAL
References
1
Case No. ADJ6958632
Regular
Jun 16, 2010

CRUSTINA MEDRANO vs. LOS ALTOS FARMS, LLC, ZENITH

The Appeals Board granted Zenith Insurance's petition for reconsideration, reversing the WCJ's award of self-procured medical treatment. The Board found that the applicant received proper notification of Zenith's Medical Provider Network (MPN) at the time of her injury. Furthermore, the Board determined that the applicant knew or should have known she was being treated within the MPN and that any alleged lack of notice did not result in a neglect or refusal to provide reasonable medical treatment. Therefore, the applicant is not entitled to reimbursement for self-procured treatment outside the MPN.

MPNMedical Provider NetworkreconsiderationFindings Award and OrderZenith Insurance CompanyLabor Code section 4600self-procured medical treatmentKnight v. United Parcel Servicenotice requirementsneglect or refusal
References
2
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