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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

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
Feb 10, 2017

Mitchell v. SUNY Upstate Medical University

Plaintiff Robbie Mitchell sued SUNY Upstate Medical Center for alleged Title VII violations, including race discrimination and retaliation, after experiencing a series of adverse employment actions. These actions included reassignment, disciplinary notices (NODs), a mandatory medical examination, a formal counseling memorandum, a verbal dispute, and eventual termination. The defendant moved for summary judgment, arguing the plaintiff failed to establish a prima facie case for most claims and that their actions were based on legitimate, non-discriminatory reasons. The court granted summary judgment in favor of SUNY Upstate Medical Center, concluding that the plaintiff failed to provide sufficient evidence of discrimination or that retaliation was the but-for cause of the challenged employment actions, and consequently, the case was closed.

Title VIICivil Rights ActEmployment DiscriminationRetaliationSummary JudgmentAdverse Employment ActionMcDonnell Douglas FrameworkWorkplace ConductDisciplinary ActionPaid Administrative Leave
References
49
Case No. MISSING
Regular Panel Decision
Oct 17, 2012

Douyon v. NY Medical Health Care, P.C.

Plaintiff Gabrielle Douyon sued Seymour Schneider, N.Y. Medical Health Care, P.C., Faraidoon Daniel Golyan, M.D., and Kourosh Golyan, alleging unfair debt collection practices under the FDCPA and NY GBL § 349, along with intentional infliction of emotional distress and negligence. The lawsuit stemmed from attempts to collect an alleged medical debt following Douyon's emergency heart surgery performed by Dr. Golyan. Both parties sought summary judgment. The court granted Plaintiff partial summary judgment on FDCPA violations related to statutory disclosures and a threatening voicemail. However, many other FDCPA and NY GBL claims were denied due to factual disputes, and the intentional infliction of emotional distress claim was dismissed for lack of medical evidence, with negligence claims partially allowed to proceed on the basis of fear for physical safety.

Fair Debt Collections Practices ActNew York General Business Law § 349Debt CollectionSummary JudgmentEmotional DistressNegligenceAgency RelationshipVicarious LiabilityFreelance Debt CollectorUnfair and Deceptive Practices
References
105
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. 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. ADJ3156337 (FRE 0209931) ADJ4199467 (FRE 0209932)
Regular
Nov 20, 2008

FRANK FLORES vs. NICKEL'S PAYLESS STORES, WAUSAU INSURANCE COMPANIES, EVEREST NATIONAL INSURANCE COMPANY, AMERICAN COMMERCIAL CLAIMS ADMINSITRATORS

The Workers' Compensation Appeals Board granted reconsideration of an award for a 1999 right foot and ankle injury, specifically addressing the defendant's claims of error in permanent disability calculation without apportionment and the exclusion of medical evidence. The Board intends to admit the Agreed Medical Evaluator's reports into evidence, which the WCJ had previously excluded. This decision will allow the Board to review all relevant medical evidence before making a final determination on apportionment and the applicant's claimed injuries.

Workers Compensation Appeals BoardIndustrial InjuryPermanent Partial DisabilityApportionmentAgreed Medical EvaluatorSubstantial Medical EvidenceAdmissibility of EvidencePetition for ReconsiderationAmended Findings Award and OrderMinutes of Hearing
References
0
Case No. 19 Misc 3d 1104(A), 2008 NY Slip Op 50546(U)
Regular Panel Decision

Westchester Medical Center v. American Transit Insurance

This case involves an appeal in an action to recover no-fault medical payments. The plaintiff, Westchester Medical Center (WMC), as assignee of Daphne McPherson, sought summary judgment against American Transit Insurance Company, arguing that the defendant failed to timely pay or deny benefits. The Supreme Court initially granted WMC summary judgment. However, the appellate court reversed this judgment, finding that the defendant had presented a prima facie case for a timely request for additional verification, which effectively tolled the period for denying the claim. The defendant's denial was based on the premise that McPherson might be entitled to workers' compensation benefits. While reversing the summary judgment for WMC, the appellate court declined the defendant's request for summary judgment or referral to the Workers' Compensation Board due to insufficient evidence from the defendant regarding workers' compensation eligibility.

No-fault medical paymentsInsurance disputeSummary judgment reversalTimely denialAdditional verificationWorkers' compensation eligibilityAppellate DivisionAssignee claimMotor vehicle accidentCivil Practice Law and Rules
References
6
Case No. MISSING
Regular Panel Decision
Aug 10, 2012

Williams v. Woodhull Medical & Mental Health Center

Valerie E. Williams filed an action against Woodhull Medical and Mental Health Center and other defendants, alleging discrimination and retaliation under federal and state laws, including Title VII and 42 U.S.C. §§ 1981, 1983, 1985, and 1986. Magistrate Judge Lois Bloom issued a Report and Recommendation, advising to grant the defendants' motion for summary judgment on all claims. Plaintiff Williams filed objections to the R&R, particularly contesting the recommendation on her Title VII retaliation claim. District Judge Nicholas G. Garaufis, upon de novo review of the contested portions and clear error review of the uncontested, adopted the R&R in its entirety. The court granted summary judgment to the defendants, finding no genuine dispute of material fact regarding Williams's claims, specifically noting a lack of causal connection for retaliation and insufficient evidence for a hostile work environment or due process violations.

Employment DiscriminationTitle VII RetaliationSummary JudgmentProcedural Due ProcessHostile Work EnvironmentMedical Negligence AllegationsPublic Health LawHospital EmploymentMagistrate Judge ReviewFederal Rules of Civil Procedure 56
References
80
Case No. ADJ9826556
Regular
Aug 05, 2016

Spencer Bachus vs. John F. Kennedy Memorial Hospital, Hi-Desert Medical Center

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a prior decision finding applicant sustained a work-related viral meningitis injury. Defendants argued insufficient medical evidence linked the injury to employment and that the identified virus was not definitively work-acquired. The WCAB determined the existing medical evidence, particularly the Qualified Medical Evaluator's opinions, did not sufficiently establish a special risk of exposure due to the applicant's specific job duties. The case was returned for further development of the record, including a more detailed analysis of the applicant's job tasks and potential exposure risks, and potentially a new medical evaluation by an infectious disease specialist.

Workers' Compensation Appeals BoardViral meningitisIndustrial injuryDual employmentPanel Qualified Medical Evaluator (PQME)Substantial medical evidenceCausationSpecial riskFurther proceedingsRescinded
References
0
Case No. MISSING
Regular Panel Decision

Rothe v. United Medical Associates

The claimant, a physician, sought workers’ compensation benefits for a work-related left foot and ankle injury. After an initial award, the employer and carrier requested a suspension of payments, arguing insufficient medical evidence of continued disability. The Workers’ Compensation Board subsequently rescinded benefits for the period of March 10, 2002, through September 18, 2002. This was due to the claimant's failure to submit timely and physician-signed medical progress reports, as required by law. The appellate court affirmed the Board's decision, emphasizing that physician's assistant reports do not constitute competent medical evidence of continuing disability and that the Board was not obliged to consider late submissions.

Workers' CompensationMedical EvidenceDisability BenefitsProgress ReportsPhysician's Assistant ReportCompetent Medical EvidenceC-4 ReportsAppellate ReviewUntimely SubmissionContinuing Disability
References
5
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