CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

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. VNO 513573
Regular
Apr 23, 2008

RICHARD FISCHINGER vs. RALPHS GROCERY COMPANY

The Workers' Compensation Appeals Board granted reconsideration, finding no evidence that the defendant failed to provide necessary medical treatment for the applicant's admitted industrial lung injury. The WCAB amended the findings to state that the defendant rendered all necessary medical treatment and deferred determination of Dr. Weingarten's lien claim. The award for further medical treatment was removed, and the issue of self-procured treatment was also reversed due to lack of supporting evidence.

Ralphs Grocery CompanySedgwick Claims Management ServicesRichard Fischingerpermanent disabilitylung injuryhypertensiondiabetesself-procured medical treatmentWCJFindings and Award
References
0
Case No. ADJ1812869 (SAC 0356491)
Regular
Nov 10, 2010

DIVINA EMANO vs. UC DAVIS MEDICAL CENTER; Permissibly Self-Insured, Adjusted by SEDGWICK, CMS

This case involves applicant Divina Emano claiming a left carpal tunnel injury against UC Davis Medical Center. The Workers' Compensation Appeals Board granted reconsideration and amended the previous decision. Specifically, Finding of Fact No. 8 was modified to clarify that while no further treatment is needed for the left carpal tunnel injury, other industrial injuries will require reasonable and necessary medical treatment. The Board expressed surprise at the defendant's contention regarding the carpal tunnel injury, noting their prior stipulation and a relevant physician's report.

WORKERS' COMPENSATION APPEALS BOARDDIVINA EMANOUC DAVIS MEDICAL CENTERSEDGWICK CMSOPINION AND ORDERGRANTING RECONSIDERATIONDECISION AFTER RECONSIDERATIONleft carpal tunnel injuryindustrial injuriesWCJ report
References
0
Case No. TI11911166
Regular
Aug 23, 2019

NICOLAS MERCADO vs. PARK WEST ENTERPRISES, INC., dba CO-WEST COMMODITIES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for ULLICO CASUALTY COMPANY

The Workers' Compensation Appeals Board (WCAB) denied CIGA's petition for reconsideration, upholding its prior decision that an additional bedroom is reasonable and necessary medical treatment for the applicant. The WCAB found substantial medical evidence from Dr. Vasile supports the need for a separate room due to the applicant's quadriplegia and sleep interruptions that worsen his health. While the separate room also benefits the applicant's wife, the WCAB concluded it is medically necessary for the applicant's own treatment and to improve his medical and functional status. The Board affirmed its authority to amend WCJ decisions and found Dr. Vasile's opinion more persuasive than the nurse case manager's.

Workers' Compensation Appeals BoardCIGAReconsideration OpinionHome ModificationAdditional BedroomMedical TreatmentQuadriplegiaTotal Permanent DisabilityPrimary Treating PhysicianDr. Vasile
References
8
Case No. MISSING
Regular Panel Decision

Colindres v. Carpenito

Plaintiff Rochelle Colindres sought a protective order to deny defendants' demand for a medical report from her former treating psychologist, Diane Henry, or alternatively, relief from compliance with Uniform Rules for Trial Courts § 202.17(b)(1). Colindres argued that the defendants waived their right to the report as the independent medical examination (IME) already occurred, and that obtaining the report would be an undue hardship since Henry ceased treatment due to Colindres' attendance issues. Defendants Mario Carpenito, Jr., City of White Plains, and White Plains Parking Department opposed, asserting that the report was necessary to clarify alleged injuries, prepare for cross-examination, and facilitate settlement, highlighting Colindres' complex medical history predating the incident. The court denied both branches of Colindres' motion, finding that the rule applies broadly to personal injury actions, defendants did not waive their entitlement, and Colindres failed to prove it was impossible to obtain the report. The court ordered Colindres to exchange a compliant medical report from Diane Henry by March 27, 2017.

protective ordermedical report disclosurediscovery disputepsychological treatmentindependent medical examinationCPLR 310322 NYCRR 202.17waiver of discoveryundue hardshippersonal injury damages
References
12
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. ADJ1718435 (MON 0341690) ADJ2131482 (MON 0340861)
Regular
May 10, 2017

JEROME MITCHELL vs. COMMUTER EXPRESS, GALLAGHER BASSETT

This case involves a lien claimant, RS Medical, seeking reconsideration after its $6,800.28 lien for medical treatment was disallowed by the WCJ. The WCJ found RS Medical failed to prove the treatment was reasonable and necessary for the admitted industrial injuries. The Appeals Board granted reconsideration, finding the WCJ erred by focusing solely on neck treatment when evidence indicated prescriptions were for multiple body parts, including admitted injuries. The matter is returned to the trial level for the WCJ to re-evaluate the medical evidence and determine the reasonableness and necessity of the treatment.

Lien ClaimReconsiderationWCJUtilization ReviewTENS deviceMedical TreatmentBurden of ProofSubstantial EvidenceReasonableness and NecessityIndustrial Injury
References
5
Case No. MISSING
Regular Panel Decision
May 14, 2014

Forest Rehabilitation Medicine PC v. Allstate Insurance

Plaintiff Forest Rehabilitation Medicine PC sued defendant Allstate to recover $3,490 for no-fault medical benefits provided to assignor Tracy Fertitta. The core issue was the medical necessity of "Calmare pain therapy" (scrambler therapy), a novel treatment. The court conducted a bench trial, hearing expert testimony from both sides. Dr. Ayman Hadhoud, for the defense, argued the treatment was not medically necessary, not cost-effective, and essentially a form of physical therapy. Dr. Jack D’Angelo, for the plaintiff, countered that the therapy, though new, had FDA approval, was used by the military, and reduced the assignor's pain levels. Applying the Frye standard, the court found the evidence regarding Calmare scrambler therapy reliable and ruled it was medically necessary for Ms. Fertitta's pain management. Consequently, judgment was awarded to the plaintiff, Forest Rehabilitation Medicine PC, for $3,490 plus attorney's fees and interest.

No-Fault InsuranceMedical NecessityCalmare Pain TherapyScrambler TherapyNovel TreatmentFrye StandardExpert TestimonyPain ManagementFDA ApprovalCervical Radiculopathy
References
14
Case No. ADJ10555511
Regular
Oct 03, 2018

MARIO GUDINO IBARRA vs. ASHLEY FURNITURE INDUSTRIES, INC., HARTFORD INSURANCE COMPANY, GALLAGHER BASSETT SERVICES, INC.

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, ruling that Truxtun Pharmacy failed to meet its burden of proof for reimbursement of its lien. The Board found that the pharmacy did not provide substantial medical evidence demonstrating the compound medications were reasonable and necessary under the Medical Treatment Utilization Schedule (MTUS). Specifically, the physician's report lacked necessary citations and the prescribed treatments were not recommended by the MTUS. Therefore, the lien claimant is entitled to no recovery on its lien.

Workers Compensation Appeals BoardAshley Furniture IndustriesHartford Insurance CompanyGallagher Bassett ServicesMario Gudino IbarraTruxtun PharmacyMedical Treatment Utilization ScheduleMTUSOfficial Medical Fee ScheduleOMFS
References
2
Case No. WCB No. 7990 5338
Regular Panel Decision

In the Matter of Maureen Kigin v. State of New York Workers' Compensation Board

Justice Rivera's dissenting opinion argues that the Workers’ Compensation Board overstepped its authority by implementing regulations that demand preapproval for medical services not listed in its guidelines, thereby presuming such unlisted treatments are not medically necessary. This approach, according to the dissent, obstructs prompt medical care, contradicts the Workers’ Compensation Law's pro-employee stance, and deviates from the legislative intent to ease access to diagnostic and treatment measures. The opinion contends that while the Board can create a pre-authorized list, it cannot use this power to impose a burden on claimants like Kigin to continually prove the medical necessity of treatments not on that list, especially when disputes historically allowed for post-treatment resolution.

Workers' Compensation LawMedical Treatment GuidelinesPre-authorization RegulationsVariance SchemeMedical NecessityBoard AuthorityAdministrative RegulationsClaimant Burden of ProofStatutory InterpretationLegislative Intent
References
13
Showing 1-10 of 9,928 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational