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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

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

Claim of Evevsky v. Liberty Mutual Group

This case involves an appeal from a Workers’ Compensation Board decision regarding a claimant's unauthorized medical treatment. The claimant, who sustained neck and shoulder injuries in 1993, had her case reopened in 2001 after the employer's carrier objected to her request for authorized massage therapy. Both the Workers’ Compensation Law Judge and the Board determined that the treatment was not authorized under Workers’ Compensation Law § 13-b, as the massage therapist was not Board-authorized nor supervised by an authorized physician. The appellate court reviewed the Board's decision, affirming that there was no legal basis to overturn the finding. The court also considered and dismissed the claimant's constitutional arguments as being without merit.

Workers' CompensationMedical TreatmentMassage TherapyAuthorizationBoard DecisionAppellate ReviewStatutory InterpretationPhysician SupervisionConstitutionalityPermanent Partial Disability
References
3
Case No. ADJ1885105
Regular
Dec 16, 2010

SCOTT SIMONS vs. SUPERHEAT SERVICES, INC., SPECIALTY RISK PLEASANTON

The Appeals Board denied the applicant's petition for reconsideration regarding penalties and attorney fees, finding no evidence of unreasonable delay by the defendant. The Board granted the defendant's petition in part, reversing the order for a medical-legal examination by Dr. Sadoff for left knee surgery due to an underdeveloped record. However, the Board affirmed the WCJ's award of significant medical treatments, including home care, a motorized wheelchair, and neurological treatment for dementia, finding the treating physician's opinions more persuasive than utilization review denials. Finally, the Board clarified that transportation expenses are only for medical and medical-legal appointments, not legal ones.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardFurther Medical TreatmentDr. DeSallesDr. SadoffHome CareMotorized WheelchairTilt-Table TestENG Study
References
12
Case No. ADJ18498378
Regular
Oct 27, 2025

MARIA VENEGAS vs. MARATHON PETROLEUM COMPANY, ACE AMERICAN INSURANCE

Lien claimant, Premier Psychological Services, sought reconsideration of a Findings and Order from July 30, 2025, which denied its lien for medical-legal and medical treatment expenses. The Workers' Compensation Appeals Board (WCAB) granted the petition for reconsideration, rescinded the original F&O, and returned the matter to the trial level for further proceedings. The Board found that the medical-legal expenses were incurred for a contested claim and that the medical report from Dr. Mark Michaels constituted substantial medical evidence for an injury arising out of and in the course of employment, despite some curable deficiencies regarding interpreter information. The WCAB ordered further consideration of the medical treatment expenses and a potential updated utilization review.

Premier Psychological ServicesAdjudication Number ADJ18498378Opinion and Order Granting Petition for ReconsiderationDecision After ReconsiderationLien ClaimantPrimary Treating Physician (PTP)Dr. Mark MichaelsInjury Arising Out of and In the Course of Employment (AOE/COE)PsycheMedical-Legal Report
References
21
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. ADJ2337190 (LAO 0829672) ADJ3193895 (LAO 0829673) ADJ187762 (LAO 0829674)
Regular
Apr 21, 2009

OLIVIA HUERTA vs. GMP LABORATORIES, STATE COMPENSATION INSURANCE FUND

This case involves a lien claimant, Dr. Elena Konstat, seeking reconsideration of a Workers' Compensation Appeals Board decision that limited reimbursement for her medical-legal reports. The Board found that the original decision erred in disallowing two of Dr. Konstat's three medical-legal reports. The Board clarified that the Official Medical Fee Schedule for treatment rates does not apply to medical-legal expenses, and the testimony of the defendant's lien negotiator was not substantial evidence. Consequently, the Board granted reconsideration, rescinded the original finding, and substituted a new finding allowing reimbursement for all three of Dr. Konstat's medical-legal reports, with the exact amounts, penalties, and interest to be determined.

Medical-legal lienReconsiderationFindings and AwardIndustrial injuryNervous system injuryPsycheLicensed clinical psychologistMedical-legal expensesOfficial Medical Fee Schedule (OMFS)Compromise and Release (C&R)
References
1
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. 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. ADJ2754339, ADJ2982695
Regular
Feb 22, 2023

VIRGINA VASQUEZ vs. KING MEAT, INC., FREMONT INSURANCE COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION (CIGA)

The Workers' Compensation Appeals Board denied a petition for reconsideration filed by CIGA. CIGA challenged a prior finding that allowed payment for medical treatment and a specific medical-legal report by Dr. Konstat. The Board adopted the Workers' Compensation Judge's report, which found that Dr. Konstat's treatment was reasonable and necessary, and that her 2007 medical-legal report was properly requested. The Board also determined that the prior judge's findings on reasonableness were binding in the subsequent lien trial.

CIGAPetition for ReconsiderationLien ClaimantPrimary Treating PhysicianMedical-Legal ReportsSelf-Procured TreatmentUtilization ReviewLabor Code section 4620Rules 9785(e)(3)Rules 9785(e)(4)
References
4
Case No. ADJ5096605
Regular
May 28, 2013

JACK ODAY vs. WICKES LUMBER CORP., TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior decision that deemed a defense medical report admissible but insufficient to justify denial of treatment and ordered treatment consistent with the applicant's treating physician. The WCAB found both Dr. Lipton's report inadmissible as substantial evidence due to its age and lack of examination, and Dr. Dayton's treatment recommendations deficient for not specifying industrial injury causation. Consequently, the WCAB rescinded the previous order, returning the case for further development of the record to determine necessary industrial injury treatment and to allow for a proper medical-legal evaluation. The Board denied removal but granted reconsideration to correct the procedural and substantive issues regarding medical evidence and treatment authorization.

Workers' Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationFindings and OrderAdministrative Law JudgeMedical TreatmentStipulated AwardPrimary Treating PhysicianQualified Medical EvaluatorMedical-Legal Evaluation
References
10
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