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

Case No. ADJ1700793 (SAC 0307437) ADJ3714832 (SAC 0307399)
Regular
Jun 13, 2011

JUANITA BRADLEY (Deceased) vs. COUNTY OF PLACER

This case involves a dispute over liability for a medical-legal report cost. The defendant seeks reconsideration of a prior award holding them responsible for Dr. Adelberg's $4,237.50 report. The defendant argues the judge ignored a prior order for an Agreed Medical Evaluation (AME) and that the applicant's attorney improperly proceeded with Dr. Adelberg's exam. The Board granted reconsideration, preliminarily finding it may be inequitable to place the full cost on the defendant, and intends to split the expense between the defendant and applicant's attorney. A dissenting opinion argues the defendant's own correspondence shows an ongoing dispute regarding the AME, supporting the original award of liability.

Workers' Compensation Appeals BoardReconsiderationMedical-Legal ReportAgreed Medical EvaluationQualified Medical EvaluatorJoint Findings and AwardLabor Code Section 4062(a)Stipulation and OrderEquitable PowersLien Claimant
References
1
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

Legal Aid Society v. Association of Legal Aid Attorneys

The Legal Aid Society sought a preliminary injunction against the Association of Legal Aid Attorneys and its officers to prevent the disciplining of striking union members who crossed picket lines. The plaintiff also claimed tortious interference and a civil rights conspiracy under 42 U.S.C. § 1985(3) on behalf of itself, non-striking attorneys, and indigent clients. The District Court denied the injunction, finding several impediments to success on the merits. These included the NLRB's primary jurisdiction, the Norris-LaGuardia Act's prohibitions, and the plaintiff's lack of standing for third-party claims. Furthermore, the court determined that the conspiracy allegations under Section 1985(3) were conclusory and lacked substantial merit.

Labor DisputePreliminary InjunctionUnion DisciplinePicket LinesNational Labor Relations Act (NLRA)Norris-LaGuardia ActStanding (Law)Conspiracy (Law)Civil Rights (42 U.S.C. § 1985(3))Tortious Interference
References
32
Case No. MISSING
Regular Panel Decision

Goldberg v. Edson

The plaintiffs appealed two orders from the Supreme Court, Rockland County. The first order, dated January 5, 2006, granted summary judgment to defendants Page Edson and the County of Rockland, dismissing the complaint against them regarding claims of legal and medical malpractice. The second order, dated January 23, 2006, granted summary judgment to defendant Elizabeth O’Connor, dismissing the complaint against her for legal malpractice. The appellate court affirmed both orders, finding that Edson and the County were immune from liability under Social Services Law § 419 for reporting suspected child abuse and removing a child, and that O’Connor was not negligent in her legal services.

Legal MalpracticeMedical MalpracticeSummary JudgmentChild Abuse ReportingSocial Services LawImmunityMandated ReportersAppellate ReviewGood FaithNegligence
References
6
Case No. MISSING
Regular Panel Decision
Apr 07, 1988

De Coste v. Champlain Valley Physicians Hospital

Decedent, Darwin A. De Coste, experienced chest pain and elevated blood pressure, leading him to Champlain Valley Physicians Hospital where he was seen by Dr. William Amsterlaw. Amsterlaw diagnosed reflux esophagitis despite an abnormal electrocardiogram, discharging De Coste, who subsequently suffered a fatal cardiopulmonary arrest 12 hours later. The administrator of De Coste's estate filed a wrongful death action, alleging medical malpractice and that the misdiagnosis was the proximate cause of death. A jury awarded pecuniary damages and funeral expenses, which the defendants appealed. The appellate court affirmed the verdict, finding rational support for the jury's malpractice finding and rejecting the defendants' argument to reduce the award by Social Security benefits due to the effective date of CPLR 4545 (c).

Medical MalpracticeWrongful DeathProximate CauseCollateral Source RuleCPLR 4545Jury VerdictEmergency Room CareMisdiagnosisArteriosclerosisMyocardial Infarction
References
3
Case No. ADJ7494202
Regular
May 08, 2018

Antonio Alvarez vs. Exodus Power Sweeping/Exodus Property Maintenance, State Compensation Insurance Fund

This case involves a lien claimant seeking reconsideration of an order denying their petition for sanctions and costs. The denial was based on a previous en banc decision regarding medical-legal expenses, which the lien claimant argues is inapplicable. The Appeals Board granted reconsideration, finding the lien claimant's petition was for sanctions and costs incurred in preparing the petition, not for the underlying interpreting services as medical-legal costs. Therefore, the matter is returned to the WCJ for a decision on the merits of the petition.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for SanctionsPetition for CostsLien ClaimantWCJLabor Code Section 5813Labor Code Section 5811Appeals Board Rule 10451.3Medical-Legal Expenses
References
1
Case No. ADJ13114480
Regular
Mar 28, 2023

ANABEL VILLANUEVA vs. EPIPHANY CARE HOMES, INC., BERKSHIRE HATHAWAY HOMESTATE COMPANIES

The Workers' Compensation Appeals Board denied reconsideration of a cost petitioner's request for reimbursement of medical-legal expenses and attorney fees. The Board adopted the WCJ's report, which found the primary medical-legal costs were paid. The WCJ also determined that the cost petitioner failed to prove bad faith actions or tactics by the defendant to warrant additional fees or sanctions. Furthermore, the Board noted the petitioner improperly attached documents to their reconsideration petition, violating procedural rules.

WCABPetition for ReconsiderationCost PetitionerMedical-Legal ExpensesOrder of ReimbursementLabor Code § 4622Labor Code § 5813Bad Faith ActionsCCR § 10786Sanctions
References
5
Case No. ADJ7207727
Regular
Jul 30, 2013

LEE LUJAN vs. HOME LIVING SOLUTIONS, FIRST COMP

The Workers' Compensation Appeals Board denied reconsideration of a prior decision. The petition for reconsideration was filed by Lopez and Associates, a copy service, who contended their petition for costs was erroneously dismissed. The administrative law judge (ALJ) dismissed the petition based on the *Martinez* decision, which held that claims for medical-legal expenses cannot be filed as a petition for costs. The Board noted that Lopez and Associates may file a new petition under Labor Code 4622 for recovery of medical legal costs, potentially including penalties and interest.

WCABReconsiderationPetition for ReconsiderationMedical-legal costsLabor Code 4903.06Lien claimantCopy serviceEn Banc decisionMartinez decisionPetition for costs
References
1
Case No. ADJ7427357; ADJ7427846 ADJ7427807; ADJ7427721 ADJ7427560; ADJ7429915 ADJ7429913; ADJ7429912 ADJ7427816; ADJ7427731 ADJ7427716; ADJ7427554 ADJ7429914; ADJ7427420
Regular
Apr 12, 2012

DELVIN WILLIAMS vs. SAN FRANCISCO 49ERS and ARGONAUT INSURANCE COMPANY and FIREMAN'S FUND INSURANCE COMPANY, MIAMI DOLPHINS, Permissibly Self-Insured, Administered by MULTI-LINE CLAIMS SERVICE, GREEN BAY PACKERS and HIGHLANDS INSURANCE GROUP, in Receivership

This case concerns a professional football player seeking reimbursement for medical-legal costs incurred in his workers' compensation claims against multiple teams. The Appeals Board granted the applicant's petition for removal, rescinding a prior order that denied these costs. The Board held that a statute of limitations defense does not bar reimbursement of reasonable medical-legal expenses if the applicant is determined to be an employee. However, subject matter jurisdiction issues with certain defendants require further adjudication, and the San Francisco 49ers, who do not dispute jurisdiction, are ordered to reimburse these costs pending further proceedings.

Petition for RemovalMedical-Legal CostsStatute of LimitationsSubject Matter JurisdictionAffirmative DefenseCumulative Trauma InjurySpecific InjuriesDeclaration of Readiness to ProceedMandatory Settlement ConferencePretrial Conference Statement
References
6
Case No. MISSING
Regular Panel Decision

King's Medical Supply Inc. v. Travelers Property Casualty Corp.

The plaintiff, a provider of medical supplies, moved for summary judgment seeking $2,522.86 in unpaid no-fault benefits for equipment provided to its assignors. The defendant insurer had made partial payments, asserting 'reasonable and customary fees' or technical denials, contrary to the plaintiff's interpretation of reimbursement based on 150% of documented cost. The court denied the plaintiff's motion, ruling that the plaintiff failed to establish a prima facie case by providing admissible evidence of the actual 'documented cost' of the medical supplies. The court clarified that while the regulation specifies '150 percent of the documented cost,' insurers cannot unilaterally introduce additional 'reasonable or customary cost' requirements, but the plaintiff's inability to sufficiently document their costs was fatal to their motion.

Summary JudgmentNo-Fault BenefitsMedical SuppliesMedical EquipmentInsurance LawDocumented CostPrima Facie CaseReimbursementRegulation InterpretationProvider Costs
References
13
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