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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

Kelly v. State

Justice Hancock, Jr., in his dissenting opinion, agrees with the majority's decision for reversal but disagrees with their holding that the continuous treatment doctrine applies as a matter of law. He argues that the record presents questions of fact regarding the application of CPLR 214-a, specifically concerning whether the claimant's alleged visits to the Westchester County Ophthalmology Clinic constituted continuous treatment and if those visits were sufficiently associated with the initial treatment. The dissent emphasizes the need for a trial to determine the timeliness of the claim based on relevant evidence.

Continuous Treatment DoctrineStatute of LimitationsMedical MalpracticeCourt of Claims ActCPLR 214-aDissenting OpinionFactual QuestionsTimeliness of ClaimPrisoner HealthcareOphthalmology
References
3
Case No. ADJ10104251 ADJ10104255
Regular
Aug 01, 2017

MARCELINO PALMA vs. EVAN HUMPHREYS LANDSCAPE DEVELOPMENT, FIRST COMP dba MARKEL INSURANCE SERVICES

The Workers' Compensation Appeals Board denied a petition for removal by defendant Markel Insurance Company. The defendant sought removal due to the WCJ ordering two additional Qualified Medical Evaluation (QME) panels in ophthalmology and psychology, arguing it caused prejudice and cost. However, the Board found no substantial prejudice or irreparable harm, noting the defendant's counsel explicitly stated "No, your Honor" when asked for objections to the orders. The decision to develop the record via additional QMEs was within the WCJ's discretion.

Petition for RemovalWorkers' Compensation Appeals BoardQualified Medical EvaluationOphthalmologyPsychologyWCJ discretionsubstantial prejudiceirreparable harmLabor Code Section 3600(a)(10)specific injury
References
3
Case No. ADJ2472893 (MON 0312714)
Regular
Jul 07, 2009

GABRIEL VALDEZ vs. KNOLLS ASSOCIATES, LLC, STATE COMPENSATION INSURANCE FUND

This case concerns the applicable permanent disability rating schedule for an admitted industrial injury that occurred in 2003. The defendant sought reconsideration, arguing the 2005 Schedule should apply. However, the Board denied reconsideration, upholding the Workers' Compensation Judge's decision to use the 1997 Schedule. This was based on a pre-2005 medical report by Dr. Richlin, which provided substantial evidence of the existence of permanent ophthalmological disability factors and work restrictions. The defendant's selective quoting of Dr. Richlin's report was found to be an incomplete representation of the evidence.

Workers' Compensation Appeals BoardIndustrial InjuryPermanent Disability1997 Schedule2005 ScheduleMedical-Legal ReportSubstantial EvidenceLabor Code Section 4660(d)Ocular DisabilitySubjective Factors
References
8
Case No. ADJ10583010
Regular
Mar 14, 2019

BLANCA RUANO vs. JACKSON ENGINEERING CO., MIDDLESEX INSURANCE CO.

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding the WCJ's Finding and Award. The applicant sought additional QME panels in internal medicine and ophthalmology, claiming the existing record lacked substantial evidence for injury AOE/COE to her eyes and digestive system. However, the Board found no good cause for further development, noting neither the AME nor treating physicians recommended these specialties, and the applicant failed to demonstrate due diligence in pursuing discovery for these body parts. Therefore, the applicant's petition for reconsideration was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardAOE/COEUpper ExtremitiesBilateral ElbowsBilateral WristsQualified Medical Evaluator (QME)Internal MedicineOphthalmology
References
8
Case No. ADJ18210611
Regular
May 08, 2025

ELENITA JOVER vs. COUNTY OF SAN BERNARDINO DEPARTMENT OF PUBLIC HEALTH

Elenita Jover, a licensed vocational nurse, sought reconsideration of a Findings and Award that denied her request for additional Qualified Medical Evaluation (QME) panels. The initial F&A found injuries to her cervical and lumbar spine, shoulders, and right thumb, but not to other claimed body parts like stress, psyche, or internal systems. The Appeals Board granted the petition, rescinded the original F&A, and ordered additional QME panels for pulmonology, internal medicine (diabetes), ophthalmology, ENT, and neurology, returning the case to the trial level for further proceedings. This decision was based on the original QME's recommendation for further evaluations and the need to develop the evidentiary record to ensure substantial justice.

Petition for ReconsiderationQualified Medical EvaluationLicensed Vocational NurseArising out of and in the course of employmentPermanent DisabilityDue ProcessPulmonologistInternistOphthalmologistOtolaryngologist
References
7
Case No. ADJ9318348
Regular
Aug 06, 2019

JENNIFER MCMULLEN vs. SPORTSMARK, XL SPECIALTY INSURANCE COMPANY, GALLAGHER BASSETT SERVICES

This case concerns an applicant claiming injury AOE/COE to multiple body parts, including the pituitary gland and cognitive loss, resulting in headaches. The Workers' Compensation Appeals Board (WCAB) rescinded the original Findings, Award, and Orders (FA&O) due to deficiencies in the medical evidence regarding permanent disability. The WCAB found Dr. Anderson's impairment ratings lacked substantial evidence and ordered further development of the record, including potential re-evaluation by Dr. Anderson and specialized opinions from ophthalmology and neuropsychology. The Board also upheld the prior finding of injury AOE/COE to the psyche, denying defendant's request to withdraw from that stipulation.

Workers' Compensation Appeals BoardOpinion and Decision After ReconsiderationInjury AOE/COEFindings Award and OrdersPermanent DisabilityLabor Code Section 4662Sub Rosa SurveillanceQualified Medical Evaluator (QME)StipulationsFurther Development of the Record
References
0
Case No. MISSING
Regular Panel Decision
Apr 17, 1997

In re HTA of New York, Inc.

HTA of New York, Inc., a home referral agency connecting patients with therapists, appealed a decision by the Unemployment Insurance Appeal Board that classified its therapists as employees, leading to additional unemployment insurance contributions. The core issue was whether HTA exercised sufficient direction and control over the therapists to establish an employer-employee relationship, as opposed to an independent contractor status. The Court distinguished this case from prior precedents like *Matter of Concourse Ophthalmology Assocs. (Roberts)* and *Matter of Goldstein, P. C. (Roberts)*, where employers exerted substantial control over key aspects of professional services. In contrast, HTA's involvement was largely limited to referral and fee collection, with therapists maintaining autonomy over their work, schedules, patient acceptance, and supplies, operating under contracts that affirmed their independent business entity status. The Court concluded that substantial evidence did not support an employer-employee relationship, reversing the Board's decision and remitting the case for further proceedings.

Unemployment InsuranceEmployer-Employee RelationshipIndependent ContractorTherapistsHome Referral AgencyProfessional ServicesControl TestAdministrative AppealLabor LawContract Terms
References
2
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