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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

Long Island Neurological Assocs., P.C. v. Highmark Blue Shield & Reed Smith LLP

Plaintiff Long Island Neurological Associates, P.C. sued Highmark Blue Shield and Reed Smith LLP for under-reimbursement of surgical services under ERISA. The case involved a 4-year-old patient who received complex out-of-network surgery from Dr. Schneider due to the unavailability of in-network providers. Highmark significantly under-reimbursed the billed amount and denied multiple appeals, failing to provide requested documentation. The patient's parents assigned their rights to the Plaintiff, leading Defendants to move for dismissal, asserting an anti-assignment provision in their Administrative Service Agreement (ASA). The Court denied the motion, ruling that the ASA is not an ERISA plan document and thus its anti-assignment clause is not binding on plan participants, confirming Plaintiff's standing. The Rule 12(b)(6) motion was also denied as abandoned.

ERISAMotion to DismissAnti-assignment clauseAdministrative Service Agreement (ASA)Plan DocumentSubject Matter JurisdictionStandingUnder-reimbursementOut-of-network providerHealth Insurance
References
27
Case No. MISSING
Regular Panel Decision

In re Anonymous

This case concerns an adoption proceeding in Nassau County for a neurologically handicapped child. The petitioners, an approved adoptive family, sought to finalize the adoption. Former foster parents, the intervenors, challenged this, claiming a statutory preference for adoption due to their long-term care of the child. The court found that the intervenors had previously declined to adopt the child and failed to take affirmative steps to gain statutory preference while the child was in their care. The decision emphasized that intervention rights apply to current foster parents in custody disputes, and ultimately, the court prioritized the child's best interests by granting the petitioners' adoption application.

AdoptionFoster CareChild WelfareNeurological HandicapBest Interests of ChildInterventionStatutory PreferenceSocial Services LawAgency Discretion
References
3
Case No. MISSING
Regular Panel Decision
May 20, 2007

Guzman v. 4030 Bronx Boulevard Associates L.L.C.

This appeal concerns the preclusion of expert testimony from a neuropsychologist, Dr. Elkhonon Goldberg, regarding the causation of infant plaintiff Tyrone Guzman's neurological deficits. The plaintiff has a history of multiple head traumas, and the lawsuit stems from alleged injuries sustained during a bathroom ceiling collapse. The trial court precluded Dr. Goldberg's testimony due to a lack of objective medical foundation to establish that the June 2001 incident was the proximate cause, subsequently dismissing the complaint. The appellate court agreed with the preclusion of testimony on causation but found an abuse of discretion in denying a continuance to allow plaintiffs to secure another medical expert. The matter was reversed and remanded for further proceedings.

Expert TestimonyNeuropsychologyTraumatic Brain InjuryCausationMotion in LimineContinuanceAppellate ProcedureEvidentiary StandardPersonal InjuryHead Trauma
References
22
Case No. ADJ9379623
Regular
May 18, 2018

ETHERY AMARI vs. CHILDREN'S HOSPITAL OF LOS ANGELES

The Workers' Compensation Appeals Board granted the applicant's petition for removal, rescinding a prior order that denied her request for an additional neurology Qualified Medical Evaluator (QME). The applicant sustained admitted injuries including to her spine and shoulder, and also claimed headaches. Her treating physician recommended a neurology consult twice, and the applicant testified about worsening headaches post-injury. The Board found that these factors constituted good cause and demonstrated significant prejudice, warranting the appointment of a neurology QME panel.

Petition for RemovalPanel Qualified Medical EvaluatorNeurology QMEWCABFindings and OrderIndustrial InjuryCervical SpineLumbar SpineHeadachesPrimary Treating Physician
References
1
Case No. ADJ3218661 (OAK 0339889)
Regular
Feb 07, 2011

CHANCE ROLLINS vs. JOHN MARTIN STABLES, INC.; AMERICAN HOME ASSURANCE administered by AIG, CLAIMS SERVICES

The Appeals Board vacated its prior order granting reconsideration and dismissed the defendant's petition for reconsideration, finding the WCJ's ruling was not a final order. However, the Board granted removal, rescinded the WCJ's order, and denied the applicant's request for a neurology consultation under Labor Code §4601(a). The matter was returned to the trial level with instructions to issue an order for a new QME panel in neurology, as Dr. Jamasbi's request for a consultative neurological evaluation constituted good cause for a new panel under 8 Cal. Code Regs. §31.7. Attorney fees for the ex parte communication were upheld.

WCABPetition for ReconsiderationPetition for RemovalLabor Code 4601(a)Labor Code 4062.3QMEAgreed Medical EvaluatorNeurological ConsultMedical DirectorSpecialty Panel
References
0
Case No. MISSING
Regular Panel Decision

Burger v. Bladt

The infant plaintiff suffered personal injuries resulting in serious learning disabilities and neurological problems following a collision. The defendant moved to compel additional medical examinations by a psychologist, psychiatrist, and a teacher of the neurologically handicapped, as well as a parent intake evaluation by a psychiatric social worker, after the plaintiffs refused to submit to more than a single examination. The Supreme Court partially denied this motion, deeming it overly burdensome. On appeal, the order was modified to grant the defendant's request for an examination by Annella Stevens, a teacher of the neurologically handicapped, and an interview by a psychiatric social worker to obtain the child's developmental history, affirming the order as modified.

Personal InjuryMedical ExaminationDiscoveryAppellate ProcedureInfant PlaintiffNeurological ProblemsLearning DisabilitiesSupreme CourtPre-Trial DiscoveryCourt Order Modification
References
4
Case No. MISSING
Regular Panel Decision

Wilmerding v. O'Dwyer

The plaintiff, identified as a taxpayer, initiated an action seeking to prevent the City of New York and its Board of Transportation from issuing and selling budget notes. The purpose of these notes was to cover a significant deficit resulting from retroactive wage increases approved for subway employees. The central legal question involved the interpretation of the Local Finance Law, specifically whether the deficit qualified as an 'expenditure' with financing limitations or a 'claim which may be settled or compromised,' allowing for unlimited funding. The court affirmed the denial of the plaintiff's motion for an injunction and dismissed the complaint, concluding that the subway deficit constituted a mandatory claim subject to settlement or compromise under the Local Finance Law, thereby permitting the issuance of the budget notes.

Municipal FinanceBudget NotesSubway OperationsLocal Finance LawStatutory InterpretationWage IncreasesPublic EmployeesTaxpayer ActionInjunctionCity of New York
References
10
Case No. MISSING
Regular Panel Decision

Hudacs v. Frito-Lay, Inc.

The New York Court of Appeals affirmed the Appellate Division's decision, holding that Frito-Lay, Inc. did not violate Labor Law § 193 by requiring its route salespeople to reimburse the company for unremitted funds collected from customers. The court determined that these repayments were distinct from wage deductions, which are prohibited by the statute, and instead represented the full remittance of company funds temporarily entrusted to employees. The case originated from an order by the Commissioner of Labor, alleging a violation of Labor Law § 193, which was subsequently revoked by the Industrial Board of Appeals. While the Supreme Court initially reinstated the Commissioner's order, the Appellate Division reversed, finding the Board's interpretation rational. The core issue revolved around the interpretation of Labor Law § 193, specifically whether requiring employees to make up account deficits constituted an unauthorized deduction from wages or a separate transaction for the repayment of company funds. The Court emphasized that Frito-Lay allowed setoffs for deficits not attributable to the failure to fully remit funds, such as damaged products or theft, aligning with the statutory purpose of placing certain risks on the employer. Ultimately, the Court concluded that under the unique factual circumstances where employees convert company funds to their own accounts before remitting, the requirement to make up deficits did not contravene Labor Law § 193, as the funds were never wages.

Wage DeductionLabor Law § 193Employer Reimbursement PolicyRoute SalespeopleUnremitted FundsIndustrial Board of AppealsCollective BargainingNational Labor Relations Act (NLRA)Statutory InterpretationEmployee Accountability
References
10
Case No. ADJ3403193 (RIV 0072531)
Regular
Sep 08, 2009

PERRY NICKLE vs. MESA CONTRACTING CORPORATION, SEABRIGHT INSURANCE

The Appeals Board granted reconsideration, rescinding the original award and substituting a new one. The Board found that the applicant did not sustain a hearing loss injury but did sustain neurological and orthopedic permanent disability. They determined that 60% of the orthopedic disability and 50% of the neurological disability were non-industrial, resulting in a revised permanent disability award of 31%. The Board also confirmed the applicant's entitlement to a cane and further medical treatment based on expert medical opinions.

Workers' Compensation Appeals BoardReconsiderationApportionmentAgreed Medical EvaluatorQualified Medical EvaluatorPermanent DisabilityNeurological DisabilityOrthopedic DisabilityHearing LossDegenerative Disease
References
2
Case No. ADJ8967872
Regular
Jan 31, 2018

FERNANDO FERNANDEZ vs. HALEX CORPORATION, EVEREST NATIONAL INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the applicant's Petition for Removal, rescinding a prior finding that denied a neurology PQME. The Board found that there was ample evidence, including a treater's recommendation and the applicant's medical history of a stroke, to support the request. The WCAB determined that denial of the PQME would cause significant prejudice and irreparable harm to the applicant. Therefore, an order was issued granting the applicant's request for an additional neurology Qualified Medical Evaluator panel.

Petition for RemovalPanel Qualified Medical EvaluatorNeurology PQMEIndustrial InjuryIntracranial HemorrhageAnticoagulationPulmonary EmbolismsDeep Venous ThrombosisStrokePrimary Treating Physician
References
3
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