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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

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. MISSING
Regular Panel Decision
Jun 29, 2004

Claim of Rothe v. United Medical Associates

This case involves an appeal from a Workers’ Compensation Board decision, filed on June 29, 2004. The Board reversed a Workers’ Compensation Law Judge's determination that the claimant, a physician with a permanent partial disability, had maintained an attachment to the labor market subsequent to September 18, 2002. The appellate court affirmed the Board's decision, finding that the claimant did not provide evidence demonstrating that his inability to obtain employment was caused by or related to his permanent partial disability. Consequently, the Board's conclusion that the claimant failed to maintain an attachment to the labor market was supported by substantial evidence.

Workers' Compensation AppealLabor Market AttachmentPermanent Partial DisabilityVoluntary WithdrawalAppellate ReviewSubstantial EvidencePhysician ClaimantEmployment SearchWorkers' Compensation Board ReversalJudicial Affirmation
References
5
Case No. ADJ8606940
Regular
Apr 18, 2013

ANGELICA PEREZ vs. PERMANENTE MEDICAL GROUP, INC.

The Workers' Compensation Appeals Board denied defendant's petition for removal or reconsideration regarding the applicant's entitlement to multiple Panel Qualified Medical Examiners (PQMEs). The defendant contested the procedural validity of the applicant's PQME requests, while the applicant asserted proper procedure was followed due to the defendant's lack of response to an Agreed Medical Examiner offer. The Board found that the February 4, 2013 notation was not a final order, as PQME requests remained pending with the Medical Unit. Therefore, the petition was denied without prejudice to the Medical Unit's future determination on the propriety of the PQME requests.

Panel Qualified Medical ExaminersPQMEPetition for RemovalPetition for ReconsiderationIndustrial InjuryCumulative InjuryAgreed Medical ExaminerAMEMedical UnitAdministrative Law Judge
References
0
Case No. MISSING
Regular Panel Decision
Feb 02, 1996

Doe v. United States

Plaintiffs Jane and John Doe filed an action under the Federal Tort Claims Act (FTCA) against the United States, seeking damages for injuries Jane Doe sustained after being pricked by an HIV-infected patient's needle during a phlebotomy rotation at the Buffalo Veterans’ Administration Medical Center (VAMC). The plaintiffs allege gross negligence, breach of contract, and wrongful disclosure of confidential information, claiming emotional distress and loss of consortium. The government moved to dismiss, asserting that the Federal Employees’ Compensation Act (FECA) provides the exclusive remedy, as a FECA claim for Ms. Doe's puncture wound had been accepted. The court denied the government's motion to dismiss but ordered a stay of proceedings, ruling that a substantial question exists regarding FECA's applicability and Ms. Doe's employee status, which must be definitively determined by the Secretary of Labor before the court can proceed with the FTCA claims.

Federal Tort Claims ActFederal Employees' Compensation ActSubject Matter JurisdictionSovereign ImmunityExclusive RemedyJudicial ReviewEmployee Status DisputeEmotional Distress ClaimLoss of ConsortiumMedical Negligence
References
8
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. 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. 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. 525474
Regular Panel Decision
Oct 03, 2019

Matter of Olaya v. United Parcel Serv. Inc.

Guillermo Olaya, a delivery driver, sustained three work-related injuries to his lower back, left leg, and right knee between 2009 and 2012 while working for United Parcel Service Inc. A Workers' Compensation Law Judge (WCLJ) established the right knee claim and awarded temporary disability, later finding his condition schedulable. The Workers' Compensation Board affirmed the WCLJ's decision, declining to consider Olaya's untimely supplemental submissions, and subsequently denied his application for reconsideration. The Appellate Division, Third Department, affirmed both Board decisions, finding no abuse of discretion in rejecting the late evidence and concluding that substantial evidence, including conflicting medical testimony, supported the Board's determination that Olaya's injuries were schedulable rather than warranting continuing disability benefits.

Workers' Compensation LawSchedule Loss of UseMaximum Medical ImprovementIndependent Medical ExaminationAppellate ReviewMedical EvidenceBoard DiscretionConsequential InjuryDisability BenefitsUntimely Submissions
References
17
Case No. ADJ3033041 (SBR 0286165)
Regular
Dec 09, 2014

MARIO MORALES, SR. vs. COUNTY OF SAN BERNARDINO

The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's petition to appeal an Independent Medical Review (IMR) determination. The petition was dismissed because it failed to comply with WCAB rules regarding caption information, service of process, verification, and specificity of grounds. Specifically, the applicant did not properly identify the defendant, failed to serve all parties or the IMR Unit, and did not verify the petition or provide detailed grounds for appeal. The WCAB emphasized that appeals must strictly adhere to procedural requirements, including filing at the correct venue and allowing for a WCJ decision before appealing to the Board.

Workers' Compensation Appeals BoardIndependent Medical ReviewUtilization ReviewPetition to ReopenStipulated AwardElectronic Adjudication Management SystemAdministrative DirectorWCAB Rules of Practice and ProcedureCalifornia Code of RegulationsLabor Code
References
0
Case No. MISSING
Regular Panel Decision

De Luca v. United Nations Organization

A former United Nations security officer filed a lawsuit against the United Nations and eight of its officials, alleging breach of contract, forgery, negligence, civil rights violations, and denial of medical benefits. The plaintiff claimed the U.N. failed to reimburse him for 1988 taxes, issued a fraudulent final pay statement with a forged signature, and unlawfully denied him continued health insurance coverage after his resignation. The defendants moved to dismiss the complaint, asserting immunity under international and federal law. The court denied the plaintiff's motion for default judgment and granted the defendants' motion to dismiss the complaint in its entirety with prejudice, finding that the United Nations and its officials were immune from the action for acts performed in their official capacities.

ImmunityInternational OrganizationsUnited NationsDiplomatic ImmunitySovereign ImmunityBreach of ContractEmployment LawTax ReimbursementMedical BenefitsOfficial Capacity
References
10
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