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

Case No. ADJ12728611
Regular
Apr 09, 2020

MARTIN JACOBO vs. COKE FARM, RISICO CLAIMS MANAGEMENT

The Workers' Compensation Appeals Board granted the defendant's Petition for Removal because the WCJ exceeded their authority by invalidating a Qualified Medical Examiner (QME) solely based on the specialty of occupational medicine for a post-surgical knee evaluation. The Board determined that an occupational medicine physician is appropriately qualified to assess such injuries according to DWC guidelines. Therefore, the WCJ's decision was rescinded, and the case was returned for further proceedings, suspending action on the Compromise and Release agreement pending further development.

Petition for RemovalPanel Qualified Medical ExaminerPQMEOccupational MedicineToxicologyPost-surgical kneeLabor Code section 4062.2(b)Administrative Director Rule 35.5Scope of practiceClinical competence
References
6
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. MISSING
Regular Panel Decision

Diaz v. New York Downtown Hospital

The dissenting opinion by Mazzarelli, J., joined by Saxe, J., argues against granting summary judgment to New York Downtown Hospital in a case involving alleged sexual misconduct during a vaginal sonogram. The dissent asserts that the plaintiff's expert radiologist provided sufficient evidence, based on 1995 American College of Radiology (ACR) and American Institute of Ultrasound in Medicine (AIUM) guidelines, indicating the hospital's deviation from the standard of care by not ensuring a female chaperone was present. Mazzarelli, J., contends that these national guidelines explicitly recognized the risk of such misconduct and constitute generally accepted industry standards. The dissent also distinguishes the present case from precedents cited by the majority, emphasizing the probative value of expert testimony regarding custom and practice. Furthermore, it challenges the majority's unforeseeability argument, concluding that the guidelines delineated a foreseeable risk, thus necessitating the denial of the defendant's motion for summary dismissal.

Medical MalpracticeStandard of CareExpert TestimonySummary JudgmentDissenting OpinionRadiologySonogramHospital NegligenceProfessional GuidelinesSexual Misconduct
References
15
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

Hartman v. Bell

This case involves an appeal concerning a contract for the sale of a medical practice. A plaintiff physician agreed to sell his practice to defendant physicians, with payment contingent on a percentage of industrial medicine income over three years, including a minimum payment, and further payments for six months thereafter. The Supreme Court, Queens County, granted the defendants' cross motion for summary judgment, dismissing the complaint against them. The appellate court affirmed this decision, finding the agreement constituted an illegal fee-splitting arrangement under Education Law § 6509-a. The court emphasized that the law would not provide relief to parties involved in illegal arrangements, upholding public policy.

Fee-splittingMedical Practice SaleBreach of ContractSummary JudgmentUnjust EnrichmentPublic PolicyIllegal ContractProfessional Medical GroupAppellate DecisionContract Law
References
3
Case No. ADJ1798944 (LBO 0326931)
Regular
Jun 13, 2018

MARIA FIGUEROA vs. HELP NET, INC., STATE COMPENSATION INSURANCE FUND

This case concerns a lien claimant's petition for reconsideration of a WCJ's decision disallowing his lien for chiropractic services provided between 2001 and 2005. The Appeals Board rescinded the WCJ's decision, finding the claimant's petition timely due to defective service. Crucially, the Board determined that the Medical Treatment Utilization Schedule (MTUS) was improperly applied; instead, the American College of Occupational and Environmental Medicine (ACOEM) guidelines, in effect during the treatment period, should govern the determination of reasonable and necessary care. The matter is remanded to the WCJ for further proceedings consistent with the ACOEM guidelines.

Workers' Compensation Appeals BoardLien ClaimantPetition for ReconsiderationFindings and OrderMedical Treatment Utilization Schedule (MTUS)American College of Occupational and Environmental Medicine (ACOEM)Labor Code Section 4600(b)SB 899Compromise and ReleaseAgreed Medical Examiner (AME)
References
3
Case No. 2020 NY Slip Op 04896 [186 AD3d 1770]
Regular Panel Decision
Sep 03, 2020

Matter of Wen Liu v. Division of Gen. Internal Medicine, Mount Sinai Sch. of Medicine

Wen Liu, a data programming analyst, filed for workers' compensation benefits in May 2010, claiming a neck injury from a June 5, 2008 fall at work due to dizziness. The employer failed to timely file a notice of controversy, but a Workers' Compensation Law Judge (WCLJ) disallowed the claim, finding no causal connection between the injuries and employment. The Workers' Compensation Board upheld this decision, which the claimant appealed. The Appellate Division affirmed the Board's decision, emphasizing that the employer's procedural failure did not absolve the claimant of proving a causal relationship. Substantial evidence supported the Board's rejection of the claimant's medical proof, as emergency room records contradicted her later descriptions of the incident and indicated pre-existing conditions.

Workers' CompensationCausationMedical EvidenceTimely NoticeBurden of ProofInjuryFallDizzinessNeck InjuryCarpal Tunnel Syndrome
References
7
Case No. 2017 NY Slip Op 06635
Regular Panel Decision
Sep 26, 2017

Hamburg v. New York University School of Medicine

Plaintiff, Carole Hamburg, M.D., sued New York University School of Medicine for age discrimination under the New York City Human Rights Law and for breach of contract after her employment was not renewed. The Supreme Court granted NYU summary judgment on the age discrimination claim but denied it for the breach of contract claim. On appeal, the Appellate Division, First Department, affirmed the dismissal of the age discrimination claim, finding no evidence of discriminatory intent in NYU's restructuring and phase-out of the general radiology section. The court further modified the lower court's decision, granting summary judgment to NYU on the breach of contract claim, ruling that Dr. Hamburg was not contractually entitled to a year's notice of non-renewal as her non-tenure-eligible position automatically terminated unless renewed. Consequently, the entire complaint was dismissed.

Age DiscriminationEmployment ContractFaculty EmploymentUniversity AdministrationDepartment RestructuringSummary JudgmentAppellate ReviewContract InterpretationTenure-EligibleNon-Tenure Track
References
19
Case No. MISSING
Regular Panel Decision

Icahn School of Medicine at Mount Sinai v. Neurocrine Biosciences, Inc.

The plaintiff, Icahn School of Medicine at Mount Sinai, moved to strike several affirmative defenses and dismiss corresponding counterclaims brought by the defendant, Neurocrine Biosciences, Inc. The core dispute involves a patent license agreement and an alleged unlicensed sublicense by Neurocrine to AbbVie. The court granted Mt. Sinai's motion, striking Neurocrine's affirmative defenses for patent invalidity, non-infringement, and patent misuse. The decision emphasized that Neurocrine was estopped from challenging patent validity due to prior benefits from the license and clarified that Mt. Sinai's damages claim was for breach of contract, not future royalties. Consequently, Neurocrine's related declaratory judgment counterclaims were also dismissed.

Patent invalidityNon-infringementPatent misuseBreach of contractLicense agreementSublicenseDeclaratory judgmentMotion to strikeAffirmative defensesEstoppel
References
23
Case No. ADJ9074552; ADJ9074553
Regular
Jul 01, 2014

VINCENT HERNANDEZ vs. COUNTY OF MONTEREY, INTERCARE HOLDINGS INSURANCE SERVICES, INC.

The Workers' Compensation Appeals Board dismissed the applicant's Petition for Removal regarding the selection of an Occupational Medicine QME panel. The Board adopted the WCJ's report, which found that the defendant's request for an Occupational Medicine QME panel complied with Labor Code Section 4062.2. The report reasoned that Title 8 California Code of Regulations Section 31.1(b)'s requirement for supporting documentation for specialty changes does not invalidate a request if not provided. Additionally, the Board found the applicant's arguments regarding an unfair advantage and the WCJ's interpretation of Section 31.1 to be misplaced.

Workers' Compensation Appeals BoardPetition for RemovalWCJQME panelOccupational MedicineTitle 8 California Code of Regulations Section 31.1Labor Code Section 4062.2Treating PhysicianPhysical Medicine and RehabilitationMedical Unit
References
1
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