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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
Jun 02, 2008

Claim of Laezzo v. New York State Thruway Authority

The claimant suffered a work-related slip and fall in 2002, leading to injuries including his head, neck, back, and knees. His morbid obesity contributed to his back and knee issues, prompting him to seek authorization for gastric bypass surgery. The Workers’ Compensation Law Judge approved the surgery, a decision affirmed by the Workers’ Compensation Board, which found the surgery causally related to the compensable injuries. The employer and its carrier appealed, challenging the causal link. The court affirmed the Board's decision, noting substantial evidence that the claimant's weight gain was a result of the sedentary lifestyle imposed by his injuries, and that the surgery would aid in his recovery.

Workers' CompensationConsequential InjuryGastric Bypass SurgeryMorbid ObesityMedical Treatment AuthorizationCausationKnee InjuryBack InjurySedentary LifestyleBoard Decision Appeal
References
2
Case No. MISSING
Regular Panel Decision

Claim of Casiano v. CCIP/Union Settlement Home Care

In March 2001, claimant sustained a work-related back injury. Neurosurgeon Richard J. Radna recommended and performed decompression surgery despite the workers' compensation carrier denying preauthorization for the procedure. Both a Workers’ Compensation Law Judge and the Workers’ Compensation Board subsequently ruled that the surgery was not medically necessary, thereby absolving the carrier of liability for its cost. Claimant and Radna appealed this determination to the appellate court. Radna's appeal was dismissed due to lack of standing, and the Board's decision was affirmed, as it was within its purview to resolve the conflicting medical evidence presented by Radna and the carrier's neurosurgeon regarding the necessity of the surgery.

Workers' Compensation LawMedical NecessitySurgical ProcedurePreauthorization DenialNeurological InjuryConflicting Medical OpinionsAppellate ReviewStanding IssueCarrier LiabilityBack Injury
References
3
Case No. LAO 0811779, LAO 0811780
Regular
Mar 06, 2008

ELENA BLANKEVOORT vs. HUNTINGTON MEMORIAL HOSPITAL, S&B SURGERY CENTER

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a trial judge's order disallowing a lien claim from S&B Surgery Center. The WCAB found that while S&B Surgery Center did have a required "surgical clinic" license, it failed to prove compliance with fictitious business name filing requirements. However, the WCAB returned the case to the trial level for further proceedings, allowing S&B Surgery Center an opportunity to correct this procedural defect to recover on its lien.

Fictitious business nameLien claimantSurgical clinic licenseBusiness and Professions Code section 17910Medical BoardDepartment of Health ServicesBurden of proofReconsiderationWorkers' Compensation Appeals BoardOutpatient setting
References
12
Case No. ADJ11861160
Regular
Oct 25, 2019

ADRIANA MARTINEZ vs. AVITUS, AMERICAN ZURICH INSURANCE COMPANY, GALLAGHER BASSETT SERVICES

This case involves a dispute over the selection of Qualified Medical Evaluator (QME) panels for an applicant with claimed injuries to multiple body parts. The Workers' Compensation Appeals Board (WCAB) granted the applicant's petition for removal, rescinded the prior decision, and found that the applicant's chiropractic QME panel request was proper while the defendant's orthopedic surgery panel request was improper. The WCAB determined that chiropractic medicine is the appropriate specialty and struck the orthopedic surgery panel, ordering the parties to proceed with the chiropractic QME. The WCAB clarified that while chiropractors cannot perform surgery or prescribe medication, they are qualified to evaluate injuries within their scope of practice.

QME panel disputeremoval petitionchiropractic specialtyorthopedic surgery specialtyLabor Code 4062.2Medical Directoradministrative law judgeWorkers' Compensation Appeals Boardproper panel selectioninvalid panel request
References
9
Case No. 525196
Regular Panel Decision
Apr 26, 2018

Matter of Derouchie v. Massena W. Wc Smelter

Claimant Gerry J. Derouchie sustained injuries on February 18, 2015, including to his right knee and left hip, after stepping into a pothole on his employer's premises. He filed for workers' compensation benefits, and his case was established for multiple injuries. Having prior injuries and surgeries, claimant sought authorization for total right knee and left hip replacement surgeries, which the employer and carrier denied. A Workers' Compensation Law Judge (WCLJ) granted the authorization, and the Workers' Compensation Board affirmed, finding a causal relationship between the February 2015 accident and the need for surgeries. The Appellate Division, Third Department, affirmed the Board's decision, citing substantial evidence and deference to the Board's assessment of medical witness credibility.

Workers' Compensation BenefitsCausal RelationshipKnee Replacement SurgeryHip Replacement SurgeryPreexisting ConditionsAggravation of InjuryMedical AuthorizationSubstantial EvidenceCredibility AssessmentAppellate Review
References
10
Case No. 532932
Regular Panel Decision
Jan 06, 2022

In the Matter of the Claim of Thomas Lazalee

Claimant Thomas Lazalee, a truck driver, had established work-related occupational diseases in both hands, undergoing multiple surgeries between 2018 and 2019. His treating physician, Raymond Stefanich, periodically classified him as temporarily totally disabled post-surgery, during which time the employer, Wegman's Food Markets, Inc., voluntarily paid temporary total disability benefits. At an April 2020 hearing, the employer accepted an amendment to the claim but requested to cross-examine Dr. Stefanich regarding the degree of disability following the October 2019 surgery. Both the Workers' Compensation Law Judge and the Board denied this request as untimely. The Appellate Division affirmed the Board's decision, finding that the employer's request was untimely and disingenuous, given their prior voluntary payments and the uncontroverted medical reports.

Occupational DiseaseCarpal Tunnel SyndromeTrigger ThumbTemporary Total DisabilityCross-Examination RequestUntimely RequestTreating PhysicianMedical Report AdmissibilityWorkers' Compensation Board DecisionAppellate Review
References
8
Case No. ADJ3383603 (VNO 0401532)
Regular
Jul 14, 2010

Abraham Burke vs. Mansur Industries, Inc., St. Paul Travelers

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior finding that terminated Abraham Burke's temporary disability benefits. The Board found that Burke's delay in deciding to undergo complex cervical surgery was reasonable given the severity of his condition and the need for multiple expert opinions. Consequently, Burke was found to continue to be temporarily totally disabled pending his recovery from the surgery, and the defendant's petition to terminate benefits was denied.

Temporary disabilityReconsiderationFindings and AwardAgreed Medical Examinersurgical interventioncervical spinefusionhardware removalkyphotic deformityplastic surgeon
References
0
Case No. ADJ4043236
Regular
Aug 26, 2010

ELIZABETH MINNIS vs. SANTA BARBARA CHAMBER ORCHESTRA SOCIETY, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding the administrative law judge's decision to deny a requested epidural steroid injection (ESI). The applicant, injured in 2007, sought a new ESI, claiming prior injections offered temporary relief and avoided more aggressive surgery. However, the Board found insufficient evidence that the proposed ESI was reasonable and necessary, noting the applicant’s pain returned and previous injections provided no substantial relief according to medical evaluations. The Board also noted the applicant had already received multiple ESIs, exceeding typical guideline recommendations, and that surgery had been authorized as an alternative treatment.

Workers' Compensation Appeals BoardReconsiderationEpidural steroid injectionMedical treatmentIndustrial injuryLow backPalliative careSurgeryPhysician's assistantUtilization review
References
0
Case No. MISSING
Regular Panel Decision

Park v. City of New York

In a personal injury action arising from a construction site accident, the Supreme Court, New York County, initially reduced a jury's award for past pain and suffering from $1,500,000 to $600,000. On appeal, the order was unanimously modified by the Appellate Division. The appellate court further directed a new trial on future pain and suffering unless the plaintiff agreed to a reduction of the award from $800,000 to $400,000. The decision was based on a comparison to similar cases involving comminuted elbow/arm fractures, multiple surgeries, and permanent limitations, while noting the plaintiff's non-dominant wrist fracture added little value as it resolved without surgery.

Personal InjuryConstruction Site AccidentDamagesPain and SufferingJury Award ReductionAppellate ReviewFractureElbow InjuryWrist InjuryStipulation
References
5
Case No. 532932
Regular Panel Decision
Jan 06, 2022

Matter of Lazalee v. Wegman's Food Mkts., Inc.

Claimant Thomas Lazalee, a truck driver, established claims for work-related occupational diseases in both hands, undergoing multiple surgeries. The employer, Wegman's Food Markets, Inc., initially paid temporary total disability benefits but later sought to cross-examine treating physician Raymond Stefanich regarding the degree of disability following a 2019 surgery. A Workers' Compensation Law Judge and the Board denied the employer's request as untimely, noting the employer had accepted liability and paid benefits for months without challenging the disability status. The Appellate Division, Third Department, affirmed the Board's decision, finding no basis to disturb the finding that the request for cross-examination was untimely, thereby waiving the employer's right.

Workers' Compensation Board DecisionOccupational Disease ClaimCarpal Tunnel SyndromeTrigger ThumbTemporary Total Disability BenefitsEmployer's Right to Cross-ExamineTimeliness of RequestMedical ReportsWaiver of RightsAppellate Review of Board Decision
References
7
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