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Case Law Database

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

Case No. ADJ1088522 (RIV 0015524)
Regular
Jan 03, 2013

SAMANTHA VAN DUINHOVEN vs. SPA HOTEL & CASINO, CALIFORNIA CASUALTY, Administered by GAB ROBINS NORTH AMERICA

This case involved an applicant who claimed industrial injury to her neck, back, left shoulder, psyche, and associated chronic pain syndrome, resulting in a finding of permanent total disability. The defendant sought reconsideration, arguing the medical evidence did not support injury to the low back or a diagnosis of chronic pain syndrome. The Appeals Board reversed the findings on the low back and chronic pain syndrome, finding no substantial evidence to support them. Consequently, the applicant's permanent disability award was amended to 70%, based on ratings for her neck, left shoulder, and psyche.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPermanent Total DisabilityChronic Pain SyndromeAgreed Medical EvaluatorQualified Medical EvaluatorMedical Record ReviewIndustrial InjuryPermanent Disability Indemnity
References
0
Case No. ADJ605947 (MON 0274664)
Regular
Feb 02, 2009

LESLIE CELLUCCI vs. FLORENCE MACHINE PRODUCTS, STATE COMPENSATION INSURANCE FUND

This case concerns a workers' compensation claim for injuries to the applicant's hands, upper extremities, and neck, resulting in chronic pain syndrome and a sleep disorder. The defendant disputed the extent of permanent disability and the diagnoses of chronic pain syndrome and sleep disorder. The Appeals Board affirmed the finding of industrial injury and the 85% permanent disability rating, including the diagnoses of chronic pain syndrome and sleep disorder. The Board also granted reconsideration to amend the award to include a life pension for the applicant, as required by law for an 85% permanent disability finding.

Workers' Compensation Appeals BoardLeslie CellucciFlorence Machine ProductsState Compensation Insurance FundADJ605947Opinion and Order Granting ReconsiderationFindings and AwardPermanent DisabilityChronic Pain SyndromeSleep Disorder
References
0
Case No. 2024 NY Slip Op 00599 [224 AD3d 428]
Regular Panel Decision
Feb 06, 2024

Matter of New Millennium Pain & Spine Medicine, P.C. v. Garrison Prop. & Cas. Ins. Co.

This case involves two appeals by New Millennium Pain & Spine Medicine, P.C. against Garrison Property & Casualty Insurance Company and GEICO Casualty Company. New Millennium sought to vacate master arbitration awards that denied its claims for no-fault benefits for medical services. The Supreme Court denied these applications. The Appellate Division, First Department, affirmed the Supreme Court's decisions, stating that an arbitrator's award will not be set aside unless it is irrational. The court also addressed the argument regarding a 20% wage offset in no-fault benefits, finding it unavailing under Insurance Law § 5102 (b). Ultimately, New Millennium was not entitled to attorneys' fees as it was not the prevailing party.

No-fault benefitsarbitration awardvacaturinsurance lawwage offsetappellate reviewmedical servicesno-fault policy exhaustionattorneys' feesCPLR Article 75
References
8
Case No. MISSING
Regular Panel Decision
Jun 25, 2001

Claim of Ritton v. AT&T—New York

Claimant appealed an amended Workers' Compensation Board decision concerning her disability rate. She had established occupational diseases including bilateral carpal tunnel syndrome, myofascial pain syndrome, thoracic outlet, and neck, arm, and shoulder injuries. Initially receiving total disability benefits, the Board later found only a mild to moderate disability for the period from March 1998 to September 1999, crediting the employer's physician, Syed Ehtisham, over the claimant's physician, Michael Lax. The court affirmed the Board's decision, finding substantial evidence to support the mild to moderate disability finding and upholding the Board's authority in resolving conflicting medical opinions.

Workers' CompensationDisability BenefitsCarpal Tunnel SyndromeMyofascial Pain SyndromeThoracic Outlet SyndromeMedical TestimonyConflicting Medical EvidenceAppellate ReviewCredibility DeterminationOccupational Disease
References
2
Case No. MISSING
Regular Panel Decision

Matter of Bland v. Gellman, Brydges & Schroff

This case involves consolidated appeals from several decisions by the Workers’ Compensation Board concerning a claimant. The appeals address issues such as a variance request for aquatic therapy for thoracic outlet syndrome, the causal relationship of fibromyalgia and myofascial pain syndrome, the degree of partial impairment and loss of wage-earning capacity, entitlement to Botox therapy for migraines, and reimbursement for medical and travel expenses. The Court affirmed the Board's findings regarding the application of Shoulder Injury Medical Treatment Guidelines, the denial of aquatic therapy, the lack of causal relationship for fibromyalgia, the 50% loss of wage-earning capacity, and the denial of reconsideration for medical/travel expenses and labor market attachment. One appeal related to fibromyalgia care and Botox therapy was dismissed as the claimant was no longer aggrieved.

Workers' CompensationAppellate ReviewAquatic TherapyThoracic Outlet SyndromeFibromyalgiaMyofascial Pain SyndromeWage-Earning CapacityMedical Treatment GuidelinesVariance RequestReconsideration
References
23
Case No. MISSING
Regular Panel Decision
May 05, 2000

Pain Resource Center v. Travelers Insurance

This case addresses a dispute regarding the payment of first-party no-fault benefits to a health provider, Pain Resource Center, as the assignee of John Hiotis, who was injured in an auto accident. The defendant, Travelers Ins. Co., challenged the validity of the assignment and the necessity of the medical services provided. The court affirmed the validity of the assignment under New York's Insurance Law and related regulations. However, based on conflicting expert testimonies, the court limited the compensable medical services to six hours and awarded the plaintiff $566.10, along with statutory interest and attorney's fees.

No-Fault InsuranceFirst-Party BenefitsAssignment ValidityMedical ServicesPeer ReviewInsurance LawHealth Provider ClaimAutomobile AccidentDamagesStatutory Interpretation
References
5
Case No. MISSING
Regular Panel Decision

Universal Acupuncture Pain Services, P.C. v. Lumbermens Mutual Casualty Co.

The New York court addresses a motion for reargument by Universal Acupuncture Pain Services, P.C. against Lumbermens Mutual Casualty Company concerning no-fault insurance claims. The central legal question is whether an expert witness's peer review report, created after a timely denial of a no-fault claim, can be admitted at trial, specifically under the Cirucci precedent regarding the specificity of denial grounds. The court grants the motion for reargument but upholds its initial ruling, which granted partial summary judgment on one of five claims. It clarifies that the expert's testimony must be strictly limited to the "concurrent or excessive care" ground initially stated by the insurer, excluding any new grounds like "medical necessity" not specified in the original denial. The court emphasizes that the issue of whether different treatment modalities constitute concurrent care for the same condition requires a trial for factual determination.

No-Fault InsurancePeer ReviewExpert Witness TestimonySummary Judgment MotionInsurance Law InterpretationSpecificity of DenialConcurrent Medical CareAcupuncture TreatmentChiropractic TreatmentPhysical Therapy
References
7
Case No. ADJ2554534
Regular
Jan 03, 2023

WENDY COLLIE vs. STATE OF CALIFORNIA, EMPLOYMENT DEVELOPMENT DEPARTMENT, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration of a prior award. The initial award found the applicant sustained an injury AOE/COE to multiple body parts, resulting in permanent total disability without apportionment. The employer argued the finding of chronic pain syndrome was improper, and that the WCJ ignored credibility issues and apportionment opinions. The Appeals Board found substantial medical evidence supported the chronic pain syndrome diagnosis and that the employer failed to provide sufficient evidence for apportionment of permanent disability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings Award and OrderAdministrative Law JudgeInjury AOE/COELumbar SpineCervical SpineLeft ShoulderRight HipRight Knee
References
20
Case No. ADJ237483
Regular
Nov 13, 2012

RAYEK J. FAHOUM vs. KAISER FOUNDATION HOSPITAL

The Workers' Compensation Appeals Board denied Rayek J. Fahoum's petition for reconsideration, upholding the findings of the Workers' Compensation Judge. The Judge's report found Fahoum sustained industrial injury to his neck and low back with secondary chronic pain syndrome, awarding 41% permanent disability. This decision relied on the opinions of the Agreed Medical Examiner and Dr. Renee Rinaldi, who concluded Fahoum experienced symptom magnification and that his condition was chronic pain syndrome, not fibromyalgia as claimed by Dr. Allen Salick. The Board extended great weight to the Judge's credibility findings regarding the medical opinions.

Workers' Compensation Appeals BoardReconsideration DeniedAgreed Medical ExaminerSubstantial Medical EvidenceFibromyalgiaChronic Pain SyndromeSymptom MagnificationOrthopedic InjuryLumbosacral StrainCervical Strain
References
4
Case No. ADJ6776516
Regular
May 30, 2017

FRANCIS HARGREAVES vs. SOUTHWEST AIRLINES, ACE USA INSURANCE CO.

This case involves an applicant seeking workers' compensation benefits for injuries sustained on the job, including to his back, left shoulder, left wrist, and psyche, as well as complex regional pain syndrome, coronary artery disease, and a sleep disorder. The defendant sought reconsideration of the initial award, arguing that the medical evidence did not support the $90\%$ permanent disability finding. The Appeals Board granted reconsideration, affirming the findings of injury and treatment for Complex Regional Pain Syndrome but reducing the permanent disability to $88\%$ by excluding the sleep disorder impairment due to insufficient objective evidence. The applicant's permanent disability payments were recalculated and ordered to commence from January 21, 2011.

Workers' Compensation Appeals BoardFrancis HargreavesSouthwest AirlinesACE USA Insurance Co.Sedgwick CMSADJ6776516Opinion and Order Granting Petition for ReconsiderationFindings Award and OrderAOE/COEback injury
References
1
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