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Case Law Database

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

Case No. ADJ3408326
Regular
Jan 07, 2013

MOISES MENDOZA vs. WORLD SUPER SERVICES, INC., TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award. The Board found that the lien claimant, Precision Occupational Medical Group, failed to meet its burden of proof. Specifically, the claimant did not demonstrate that the EMG/NCV study of the applicant's lower extremities was reasonable and necessary to treat the admitted left ankle injury. The matter was returned to the trial level with the lien claim disallowed.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardLien ClaimantReasonable and Necessary TreatmentBurden of ProofStipulations with Request for AwardMaximum Medical ImprovementEMG/NCV StudyLower Extremities
References
2
Case No. ADJ9 989540
Regular
Apr 13, 2016

FELIX GARCIA vs. EUREST FINE DINING, NATIONAL UNION FIRE INSURANCE COMPANY, GALLAGHER BASSETT SERVICES, INC.

The Workers' Compensation Appeals Board denied the applicant's petition for removal, upholding the administrative law judge's decision to allow a Qualified Medical Evaluator (QME) panel in neurology. The applicant argued this was prejudicial as his primary treating physician was a chiropractor, but the Board found he failed to demonstrate irreparable harm. The WCJ's report, which the Board adopted, noted that a neurologist was best qualified to evaluate potential radicular pain and nerve conduction studies. Therefore, removal was deemed an extraordinary remedy not warranted in this case.

Workers' Compensation Appeals BoardPetition for RemovalQualified Medical EvaluatorPrimary Treating PhysicianSpecialtyChiropracticNeurologyIndustrial InjuryRadicular PainEMG/NCS
References
4
Case No. 525453
Regular Panel Decision
Apr 05, 2018

Matter of Gullo v. Wireless Northeast

Claimant Vanessa L. Gullo, a quality assurance supervisor, filed for workers' compensation benefits due to bilateral carpal tunnel syndrome, which she attributed to her extensive computer use. A Workers' Compensation Law Judge initially found a causally-related occupational disease, but the Workers' Compensation Board subsequently reversed this decision, ruling that her condition was not employment-related. On appeal, the Appellate Division, Third Department, reversed the Board's decision, citing that the Board misread the record regarding the treating hand surgeon's opinion on causation. Specifically, the Board overlooked the surgeon's consistent opinion on causality after being informed of claimant's specific work duties and ignored a progress note detailing his examination and review of a nerve conduction study for left carpal tunnel syndrome. The matter was therefore remitted to the Workers' Compensation Board for further proceedings to properly assess the claim.

Carpal Tunnel SyndromeOccupational DiseaseWorkers' Compensation BenefitsCausalityMedical EvidenceTreating Physician OpinionIndependent Medical ExaminationBoard Decision ReversalAppellate ReviewRemittal for Further Proceedings
References
3
Case No. MISSING
Regular Panel Decision

Procter & Gamble Co. v. Ultreo, Inc.

The Procter & Gamble Company (P&G) sued Ultreo, Inc. for false advertising under the Lanham Act and the New York Consumer Protection Act, specifically challenging Ultreo's claims about its toothbrush technology. P&G sought the disclosure of five scientific studies conducted by Ultreo, arguing they were discoverable business documents. Ultreo resisted, claiming the studies were protected by attorney work product privilege. The court rejected Ultreo's argument, finding that the studies were a core part of Ultreo’s business plan to substantiate its advertising claims and would have been prepared regardless of anticipated litigation. Therefore, the court ordered Ultreo to produce the studies to P&G.

False advertisingLanham ActNew York Consumer Protection ActDiscovery disputeAttorney work productPrivilegeScientific studiesClinical researchLitigation anticipationBusiness plan
References
7
Case No. ADJ4322447 (LAO 0855360)
Regular
Aug 15, 2013

LEOPOLDO BENAVIDEZ vs. ANTONIO SANCHEZ, ALLSTATE, administered by SPECIALTY RISK SERVICES

The Workers' Compensation Appeals Board rescinded a prior award finding new and further disability for the applicant. The Board determined that the applicant's worsened spinal condition, as evidenced by an EMG study, predated the initial stipulated award. Therefore, it was not "new and further" disability as required to reopen the case under Labor Code section 5410. The Board also found no other "good cause" to reopen, as the applicant could have discovered and presented the EMG evidence before the original award.

Workers' Compensation Appeals BoardReconsiderationStipulated AwardNew and Further DisabilityPermanent Disability IndemnityLife PensionAgreed Medical Evaluator (AME)Lumbar Compression FracturePermanent DisabilityElectrodiagnostic Report (EMG)
References
9
Case No. MISSING
Regular Panel Decision

Intellective, Inc. v. Massachusetts Mutual Life Insurance

Plaintiff Intellective Inc. filed an antitrust action against five life insurance companies (the 'Working Group'), PricewaterhouseCoopers LLP (PwC), and Sagamore Advisors, alleging a conspiracy to monopolize the market for investment performance studies of life insurance companies. Intellective claimed the Working Group used restrictive 'Letter Agreements' to control proprietary data, preventing competition and Intellective's ability to create rival studies. Defendants moved to dismiss the complaint based on various legal doctrines, including the Noerr-Pennington Doctrine and lack of antitrust standing. The court granted the motions to dismiss against PwC and Sagamore entirely, finding no alleged anticompetitive conduct, and also dismissed Counts Three and Five against all defendants. However, the court denied the motion to dismiss against the Insurance Company Defendants, allowing Counts One, Two, Four, and Six to proceed against them.

Antitrust LawMonopolizationConspiracy to MonopolizeGroup BoycottSherman ActClayton ActDonnelly ActMotion to DismissAntitrust StandingNoerr-Pennington Doctrine
References
42
Case No. 2010 NY Slip Op 51549(U)
Regular Panel Decision

Milosevic v. O'Donnell

The motion court properly dismissed the fourth and fifth causes of action against Joost, which alleged negligence and intentional/wanton conduct. These claims failed under the theory of respondeat superior, as there was no evidence the coworker's alleged assault was within the scope of employment or condoned by Joost. Furthermore, the claims based on common-law negligence for sponsoring an event were also dismissed. The court found no allegations that Joost controlled the premises or was aware of the CFO's violent propensities when intoxicated. The decision highlighted that speculation about discovery would not prevent dismissal, and thus, the court did not need to address whether the claims were barred by the Workers' Compensation Law.

NegligenceRespondeat SuperiorAssaultEmployer LiabilityVicarious LiabilityCommon-Law NegligencePremises LiabilityWorkers' Compensation LawAppellate ReviewDismissal
References
4
Case No. MISSING
Regular Panel Decision
Jun 04, 2007

FCI Group, Inc. v. City of New York

This case involves an action brought by a contractor against the City of New York and the Department of Citywide Administrative Services (DCAS) for the balance due on a construction contract. The defendants contended that the plaintiff forfeited its right to further payment due to the attempted bribery of two city employees by the plaintiff's president. The Supreme Court initially denied the defendants' motion for summary judgment, but this Court reversed that decision. It found that the contract's narrow alternative dispute resolution clause was inapplicable to the dispute. Crucially, the Court concluded that the plaintiff was bound by the contract’s forfeiture provision and that its enforcement did not offend public policy, as the unlawful conduct was central to the performance of the contract, thereby barring recovery.

Construction ContractContract ForfeitureBriberyPublic PolicyAlternative Dispute Resolution (ADR)Summary JudgmentUnlawful GratuitiesEthical ConductContract InterpretationNew York City Charter
References
28
Case No. MISSING
Regular Panel Decision

Addei v. State Board for Professional Medical Conduct

A surgeon's medical license was revoked by the State Board for Professional Medical Conduct due to findings of moral unfitness from sexual harassment of co-workers and fraudulent practice on employment applications. The petitioner challenged this determination via a CPLR article 78 proceeding. The court upheld the Committee's jurisdiction and the findings of moral unfitness and fraud, dismissing claims of statutory vagueness. However, the court deemed the penalty of license revocation excessively harsh and "shocking to one’s sense of fairness" given mitigating factors, equivocal findings on the fraud charge, and no impact on patient care. Consequently, the court indicated that the severe penalty should not stand.

Professional MisconductLicense RevocationMoral UnfitnessFraudulent PracticeSexual HarassmentEmployment ApplicationsDue ProcessVague StatuteDisproportionate PenaltyCPLR Article 78
References
10
Case No. MISSING
Regular Panel Decision

Claim of Rivera v. North Central Bronx Hospital

The employer appealed a decision by the Workers’ Compensation Board, arguing that the Board incorrectly interpreted Workers’ Compensation Law § 13-a (7) by mandating reimbursement to the claimant’s doctor for an EMG test. The employer contended that since the claimant failed to use a specified provider as per statutory notice, it should not be obligated to pay. However, the court found no statutory or historical support for nonpayment as a remedy, noting that the law aims to provide swift benefits to injured employees and prevent providers from collecting directly from workers. The court emphasized that allowing the employer to avoid payment would harm medical providers and deter their participation in the workers’ compensation system. Consequently, the court affirmed the Board’s decision, requiring the employer to pay its in-network rate to the claimant's doctor.

Workers' Compensation LawEMG test reimbursementEmployer appealStatutory interpretationMedical provider paymentClaimant medical expensesSelf-insured employersDiagnostic testsLegislative intentBoard decision affirmed
References
7
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