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Case Law Database

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

Case No. MISSING
Regular Panel Decision

Claim of Cummins v. North Medical Family Physicians

A claimant sustained a work-related back injury and sought continued medical treatment, which was initially authorized. Disputes over authorization led the claimant to retain an attorney. A Workers’ Compensation Law Judge authorized continued medical treatment but denied counsel fees, stating no "money passing" occurred. The Workers' Compensation Board upheld this decision. The claimant appealed, arguing the Board unconstitutionally applied Workers’ Compensation Law § 24, misinterpreted the statute regarding fee payment from medical benefits, and abused its discretion. The appellate court affirmed the Board's decision, ruling that counsel fees must be paid from "compensation," defined as a money allowance, and medical benefits are not considered "compensation" for this purpose, thus finding no abuse of discretion.

Workers' CompensationCounsel FeesAttorney FeesMedical TreatmentStatutory InterpretationConstitutional LawLienCompensation DefinitionAppellate ReviewBoard Decision
References
3
Case No. ADJ736188 (GOL 0099658)
Regular
Sep 22, 2017

Deanna Power vs. St. John's Regional Medical Center, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case concerns Deanna Power's claim for continued medical treatment, specifically prescription medications Xyrem and Lunesta, for a previous industrial injury. The employer denied authorization for these medications through Utilization Review (UR), and the applicant's subsequent Independent Medical Review (IMR) application was deemed untimely. The trial judge initially ordered continued treatment and directed the Administrative Director to process the IMR appeal, finding it timely. However, the Appeals Board granted reconsideration, finding the trial judge lacked jurisdiction to order treatment when a timely UR decision was issued and the applicant's sole recourse was the IMR process. The matter was returned to the trial level for a determination solely on the timeliness of the IMR appeal, not the medical necessity of the medications.

WCABPetition for ReconsiderationFindings of Fact and AwardXyremLunestaIndependent Medical ReviewIMRUtilization ReviewURprescription medications
References
3
Case No. MISSING
Regular Panel Decision

Lutheran Medical Center v. Hereford Insurance

Maher Kiswani, a livery car driver, was injured in an automobile accident and received medical treatment from Lutheran Medical Center. Lutheran, as Kiswani's assignee, sought payment from Hereford Insurance Company, the no-fault carrier, which refused to pay. After an initial arbitration where the Workers' Compensation Board determined Kiswani was not injured in the course of employment (without Hereford's notice), a second arbitration awarded Lutheran no-fault benefits. The Supreme Court, Kings County, vacated this arbitration award, ruling that Hereford should have been notified of the Workers' Compensation Board hearing. The appellate court affirmed the Supreme Court's decision, holding that a party not afforded an opportunity to participate in a Board hearing is not bound by its determination.

Arbitration AwardNo-Fault InsuranceWorkers' Compensation BoardDue ProcessNotice RequirementsVacated Arbitration AwardAppellate ReviewLivery Car DriverAutomobile AccidentMedical Benefits
References
3
Case No. MISSING
Regular Panel Decision

Perez v. Brookdale University Hospital & Medical Center

Eulalia Perez was admitted to Brookdale University Hospital on November 16, 2010, and treated for various medical conditions before being discharged on December 7. She died two days later. Her family, Ivan and Irma Perez, sued Brookdale and other defendants, alleging a violation of the Emergency Medical Treatment and Active Labor Act (EMTALA) and state-law claims of wrongful death and negligence. The court granted Brookdale's motion for summary judgment on the EMTALA claim, determining that the hospital fulfilled its EMTALA duties once Mrs. Perez was stabilized, and any subsequent issues were outside the statute's scope. Consequently, the court declined to exercise supplemental jurisdiction over the state-law claims, leading to the dismissal of all claims against all parties.

EMTALAEmergency Medical Treatment and Active Labor ActMedical MalpracticeNegligenceWrongful DeathSummary JudgmentSupplemental JurisdictionPatient DumpingHospital DischargeFederal Question Jurisdiction
References
8
Case No. ADJ1448881 (VNO 0460995)
Regular
Sep 06, 2017

CLEMENTE MEJIA vs. PACIFIC MAT, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) affirmed a prior decision disallowing the balance of a lien for medical treatment provided by Dr. Arroyo. The administrative law judge found Dr. Arroyo failed to prove the reasonableness of services beyond progress and permanent and stationary reports, and that he was adequately compensated for reasonable services. The WCAB held that Labor Code section 4600(b), requiring medical treatment to be consistent with the Medical Treatment Utilization Schedule (MTUS) to be considered reasonably required, applied retrospectively to all open cases, including this one. Therefore, the original decision disallowing the remaining portion of the lien was affirmed.

Workers' Compensation Appeals BoardLien claimantPetition for ReconsiderationFindings of FactOrderMedical treatment lienIndustrial injuryCumulative periodPermanent disabilityReasonableness of services
References
1
Case No. MISSING
Regular Panel Decision

Claim of Evevsky v. Liberty Mutual Group

This case involves an appeal from a Workers’ Compensation Board decision regarding a claimant's unauthorized medical treatment. The claimant, who sustained neck and shoulder injuries in 1993, had her case reopened in 2001 after the employer's carrier objected to her request for authorized massage therapy. Both the Workers’ Compensation Law Judge and the Board determined that the treatment was not authorized under Workers’ Compensation Law § 13-b, as the massage therapist was not Board-authorized nor supervised by an authorized physician. The appellate court reviewed the Board's decision, affirming that there was no legal basis to overturn the finding. The court also considered and dismissed the claimant's constitutional arguments as being without merit.

Workers' CompensationMedical TreatmentMassage TherapyAuthorizationBoard DecisionAppellate ReviewStatutory InterpretationPhysician SupervisionConstitutionalityPermanent Partial Disability
References
3
Case No. ADJ10168011
Regular
Sep 25, 2017

BELINDA GO vs. SUTTER SOLANO MEDICAL CENTER

This case involved an applicant who self-procured cervical spine surgery after her employer denied authorization, which was upheld by an Independent Medical Review. Despite the denial, the Workers' Compensation Appeals Board (WCAB) denied the employer's petition for reconsideration. The WCAB affirmed that injured workers are entitled to temporary and permanent disability for reasonable, self-procured medical treatment, even if initially unauthorized. The Board found the self-procured surgery was reasonable due to its positive outcome, and the Permanent Qualified Medical Evaluator's findings supported the disability award. The WCAB clarified that utilization review and independent medical review processes do not preclude temporary disability indemnity for self-procured treatment deemed reasonable.

Workers' Compensation Appeals BoardPetition for ReconsiderationUtilization Review (UR)Independent Medical Review (IMR)Self-Procured SurgeryTemporary Disability IndemnityPermanent DisabilityPanel Qualified Medical Evaluator (PQME)Medical Treatment DisputesLabor Code Section 4600
References
14
Case No. MISSING
Regular Panel Decision

Claim of Rodriguez v. Greenfield Die Casting

In September 1998, the claimant aggravated a back injury at work, leading to the filing of a C-2 and C-699 by the employer and carrier. Over seven years later, in 2006, the claimant filed a C-3, causing the case to be indexed. The carrier denied authorization for further medical treatment, arguing that liability had shifted to the Special Fund for Reopened Cases under Workers’ Compensation Law § 25-a. Both a Workers’ Compensation Law Judge and the Board found that liability had indeed shifted. The Special Fund appealed, contending that the claim was opened in 1998 and never truly closed. The court affirmed the Board’s determination, ruling that the carrier’s payments for medical treatment constituted an informal opening of the claim, which was subsequently deemed closed due to an eight-year period without compensation payments or contemplated proceedings, thereby justifying the shift in liability to the Special Fund.

Workers' Compensation BoardSpecial Fund LiabilityClaim IndexingInformal Claim OpeningClaim ClosureStatutory Time LimitsWorkers’ Compensation LawMedical Treatment CoverageAppellate AffirmationSubstantial Evidence Review
References
7
Case No. 2019 NY Slip Op 09336 [178 AD3d 1312]
Regular Panel Decision
Dec 26, 2019

Matter of Trusewicz v. Delta Envtl.

Claimant Roman Trusewicz filed for workers' compensation benefits alleging injuries from prolonged asbestos handling, having previously received treatment for the same body parts. At a hearing, the Workers' Compensation Law Judge (WCLJ) directed him to provide an open-ended HIPAA medical release for all treatment records, despite his request to limit it to only the claimed sites of injury. The Workers' Compensation Board upheld the WCLJ's decision. On appeal, the Appellate Division, Third Department, reversed, holding that the Board erred by requiring an unlimited medical release, as regulations specify that only a limited release for relevant medical records regarding the prior medical history of the body part or illness at issue is required.

Workers' compensationmedical recordsHIPAA releaseprior injurylimited releaseunlimited releaseemployer's rightsclaimant's rightsmedical treatmentBoard decision
References
2
Case No. MISSING
Regular Panel Decision
Jul 23, 1976

Lichtenstein v. Montefiore Hospital & Medical Center

This appeal concerns a wrongful death action filed by Ruth Lichtenstein against Montefiore Hospital and Medical Center. The plaintiff alleged the hospital's negligence in allowing her husband, Gary Lichtenstein, to escape from an open psychiatric unit, leading to his suicide. The appellate court found no evidence of negligence on the hospital's part regarding the patient's escape, overturning the prior verdict which awarded $400,000 in damages. The court deemed the damages excessive and ordered a new trial, providing guidance on issues like the inference of suicide and proximate cause.

Wrongful DeathNegligenceHospital LiabilityPsychiatric PatientSuicideElopementOpen Psychiatric UnitProximate CauseDamagesExcessive Verdict
References
7
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