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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

NYSA-ILA Medical & Clinical Services Fund Ex Rel. Capo v. Catucci

The NYSA-ILA Medical & Clinical Services Fund, an employee medical services fund, sued Sabato Catucci and his three sons for allegedly withholding payments from Saleo Trucking Corporation to the fund. This action followed a prior judgment against the corporation for delinquent contributions. The plaintiff sought to hold the defendants personally liable under alter ego, breach of ERISA fiduciary duty, and embezzlement theories. The court granted summary judgment to the plaintiff on the breach of ERISA fiduciary duty claim against Sabato Catucci, finding him to be a fiduciary who misused plan assets. However, claims against his sons were dismissed due to lack of sufficient control over the corporation. The alter ego claim against Sabato Catucci will proceed to trial, and the embezzlement claim was dismissed for not supporting a private civil cause of action.

ERISA Fiduciary DutyAlter Ego LiabilityCorporate Veil PiercingDelinquent ContributionsSummary JudgmentEmployee Benefit PlanMultiemployer FundSelf-DealingCorporate ControlLabor Law
References
32
Case No. ADJ4702564 (RDG 0094598) ADJ6944237
Regular
Apr 17, 2018

CLAUDETTE GILBERT vs. DEPARTMENT OF SOCIAL SERVICES, INHOME SUPPORTIVE SERVICES, YORK RISK SERVICES, ADVENTIST HEALTH OF CALIFORNIA, LIBERTY MUTUAL INSURANCE COMPANY

This case concerns a dispute over reimbursement for medical expenses following two lumbar spine injuries sustained by the applicant. The Department of Social Services (IHSS) sought reimbursement from Liberty Mutual Insurance Company for treatment costs after the applicant's 2008 injury, arguing the 1999 injury contributed to the need for care. However, the Appeals Board found Dr. Sommer's medical opinions lacked substantiality due to inconsistent apportionment and a failure to adequately explain the causal link between the 1999 injury and the 2008 treatment needs. Consequently, IHSS failed to meet its burden of proof, and their claims for reimbursement and shared medical expenses were denied.

Workers' Compensation Appeals BoardReconsiderationIn-Home Supportive Services (IHSS)Legally UninsuredYORK RISK SERVICESADVENTIST HEALTH OF CALIFORNIALIBERTY MUTUAL INSURANCE COMPANYlumbar spine injuryapportionmentmedical opinions
References
0
Case No. ANA 0372945 ANA 0380241
Regular
May 06, 2008

OLGA A. SALDAÑA vs. 3M ESPE, LIBERTY MUTUAL INSURANCE COMPANY, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board reversed a prior decision, finding that interpreter services are reimbursable under Labor Code section 4600 when recommended or required by a treating physician. The Board determined that these services are considered part of the overall medical treatment benefit, analogous to transportation costs. Therefore, the lien claimant, Certified Interpreters, is entitled to payment for services rendered at both medical-legal evaluations and applicant's medical treatment appointments.

Labor Code section 4600interpreter servicesmedical-legal expensesmedical treatmentCertified InterpretersWorkers' Compensation Appeals Boardadministrative law judgereconsiderationAD Rule 9795.3case law
References
7
Case No. ADJ15329380
Regular
Oct 31, 2025

BERTHA VALERIO vs. KIMCO STAFFING SERVICES, INC.; XL INSURANCE

Defendant sought reconsideration of a Findings and Award (F&A) from August 5, 2025, concerning an injury sustained by applicant Bertha Valerio on September 9, 2021. The F&A found that applicant's injury was AOE/COE, defendant failed to prove improper treatment outside the Medical Provider Network (MPN), and lien claimant Joyce Altman Interpreting, Inc. established their market rate for interpreting services. Defendant contended that medical treatment and interpreter services were unreasonable due to treatment outside the MPN and failure to adhere to MTUS/ACOEM guidelines, and that the market rate for interpreter services was not properly established. The Appeals Board denied the petition, agreeing with the WCJ that defendant failed to sustain its burden of proof on the MPN issue, the MTUS/ACOEM guideline issue was not raised at trial, and lien claimant properly established their market rate.

WCABPetition for ReconsiderationFindings and AwardMedical Provider NetworkMPNRequests for AuthorizationRFAsLien ClaimantMarket RateLabor Code Section 4600
References
10
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

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. ADJ2500591 (MON 0340362) ADJ1965867 (LBO 0302615)
Regular
May 13, 2011

Kenneth Tarvin vs. ROADWAY EXPRESS, Administered by GALLAGHER BASSET SERVICES

This case involves a lien claimant, Dr. Kenneth Webb, seeking reconsideration of a decision that limited his reimbursement for applicant Kenneth Tarvin's medical treatment. Dr. Webb argued for reimbursement for more than the allowed 24 visits, citing two separate injuries and post-surgical treatment exemptions. However, the Appeals Board denied his petition, finding insufficient substantial medical evidence to rebut the established treatment guidelines or support treatment for the cumulative trauma claim. The Board affirmed the original finding of entitlement to payment for 22 treatments at the reasonable value of services rate.

Workers' Compensation Appeals BoardPetition for ReconsiderationLien ClaimantFindings of Fact and OrderReasonable Value of Services (RVS)Labor Code 4604.5(d)(1)24 visit capIndustrial InjuryCumulative TraumaCompromise and Release (C&R)
References
8
Case No. ADJ4189084 (AHM 0150210), ADJ2609035 (MON 0237343), ADJ2256301 (MON 0237524), ADJ4536480 (MON 0315454)
Regular
Feb 05, 2015

Dennis Pasquel vs. The Boeing Company, ACE American Insurance Company, Sedgwick Claims Management Services, Inc.

The Workers' Compensation Appeals Board overturned a judge's decision and allowed a lien for medical treatment provided by Dr. Powers at Griffin Medical Group. The Board found that while Dr. Powers was listed in the employer's Medical Provider Network (MPN) at a specific facility, there was no explicit restriction in the MPN listing prohibiting him from treating patients elsewhere. The Board concluded that contract disputes between a physician and an MPN provider should not prevent payment for medically necessary treatment when the MPN itself acknowledged the physician as a provider. This decision allows Griffin Medical Group to be paid for Dr. Powers' services rendered at their facility.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNLien claimantPrimary treating physicianJoint Findings and OrderReconsiderationStipulated awardsCumulative trauma injuryIndependent Contractor Agreement
References
3
Case No. MISSING
Regular Panel Decision

Volt Technical Services Corp. v. Immigration & Naturalization Service

Plaintiff Volt Technical Services Corp. applied for H-2 visas for nuclear start-up technicians, which the Immigration and Naturalization Service (INS) denied, asserting the need was permanent, not temporary. After the denial was affirmed on appeal, Volt filed suit, alleging the INS's decision was arbitrary and capricious. The court upheld the INS's interpretation of the Immigration and Nationality Act § 101(a)(15)(H)(ii), which requires the employer's need for services to be temporary, not just the individual assignments. Finding that Volt demonstrated a recurring need for such technicians over several years, the court granted the INS's motion for judgment on the pleadings and denied Volt's.

Immigration LawH-2 visasNonimmigrant WorkersTemporary EmploymentImmigration and Nationality ActAdministrative Procedures ActDeclaratory Judgment ActAgency InterpretationJudicial ReviewNuclear Industry
References
5
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