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

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

Claim of Steuber v. Home Properties, Inc.

Claimant applied for workers' compensation benefits after a March 2010 work fall, establishing injuries to his back, left knee, and left hip. After thoracic spine surgery in 2011, the employer and its workers' compensation carrier objected to coverage, arguing it was not causally connected to the initial claim. The Workers’ Compensation Board agreed, a decision which the appellate court affirmed. The court credited an independent medical examiner's opinion that the thoracic condition and subsequent falls were unrelated to the compensable accident, despite the claimant's orthopedic surgeon's testimony suggesting otherwise.

Workers' Compensation BenefitsCausal RelationThoracic Spine InjuryDegenerative ConditionIndependent Medical ExaminationSubsequent FallsBoard DecisionAppellate ReviewCredibility AssessmentSubstantial Evidence
References
3
Case No. SBR 0332538
Regular
Mar 28, 2009

RUBY JONES vs. STATE OF CALIFORNIA / DEPARTMENT OF MENTAL HEALTH, STATE COMPENSATION INSURANCE FUND, PREMIER OUTPATIENT SURGERY CENTER, INC.

The Appeals Board granted reconsideration, rescinded the prior order, and returned the case for further proceedings on the reasonableness of Premier Outpatient Surgery Center's (POSC) $\$16,578.00$ lien claim for surgical services. While POSC was properly licensed as a surgical clinic and did not require a fictitious-name permit, the Appeals Board found the record insufficient to establish the reasonableness of the charged fee, noting a significant disparity between the billed amount and what was paid based on Medicare rates. The Board also rescinded the award of attorney's fees to POSC's counsel, finding no basis for such an award under Labor Code sections 5811 or 5813.

Workers' Compensation Appeals BoardRuby JonesState Compensation Insurance FundPremier Outpatient Surgery Centerfictitious-name permitMedical Board of CaliforniaDepartment of Health Servicessurgical clinic licenseoutpatient settingreasonable fee
References
6
Case No. ANA 0356755
Regular
Aug 22, 2007

YAZMINA VERDUZCO vs. EXECUTIVE AIR WASH, INC., STATE COMPENSATION INSURANCE FUND

This case involves a lien claim by Outpatient Spine & Surgery Center (OSSC) for over $74,000 in surgical services. The original ruling disallowed the lien, finding OSSC failed to prove it had a fictitious name permit from the Medical Board. The Appeals Board rescinded this decision, remanding the case for further proceedings to determine OSSC's compliance with licensure and accreditation requirements and the reasonableness of its charges.

Fictitious Name PermitMedical BoardLien ClaimantOutpatient SettingAccreditationBusiness and Professions CodeLicensureBurden of ProofRescindReturn to Trial Level
References
3
Case No. ANA 0364557
Regular
May 05, 2008

ROSENDO HERNANDEZ vs. SOUTH COAST TOYOTA, FARMERS INSURANCE COMPANY

This case summary is for a lawyer: The Workers' Compensation Appeals Board granted the petition for reconsideration filed by lien claimant Outpatient Spine and Surgery Center. This action was taken due to statutory time constraints and an initial review indicating the need for further study of the factual and legal issues to ensure a just and reasoned decision. Pending the issuance of a Decision After Reconsideration, all communications must be directed to the Reconsideration Unit in San Francisco.

Workers' Compensation Appeals BoardPetition for ReconsiderationLien ClaimantOutpatient Spine and Surgery CenterStatutory Time ConstraintsFactual and Legal IssuesDecision After ReconsiderationReconsideration UnitRonnie G. CaplaneFrank M. Brasf
References
0
Case No. ADJ4055531 (OXN 0131530) ADJ1549173 (OXN 0137643) ADJ2511069 (OXN 0139174)
Regular
Jan 11, 2011

DAWN MESSI vs. STEPHEN MITNICK, STATE FARM FIRE & CASUALTY, CUNNINGHAM & LANDSEN, STATE COMPENSATION INSURANCE FUND, VAN SICKLE & ROWLEY, EMPLOYERS COMPENSATION INSURANCE COMPANY

This case involves a lien claimant, Westlake Spine & Outpatient Surgery Center, seeking reconsideration of an order denying its lien and imposing sanctions on its attorney. The Appeals Board rescinded the original findings, finding that the lien claimant may not have received adequate notice of the hearing and was thus denied due process. The matter is returned to the WCJ for a new hearing on the merits of the lien claim and the sanctions issue, with proper notice and opportunity to be heard for all parties.

Workers' Compensation Appeals BoardLien claimantReconsiderationJoint Findings & OrdersNotice of Intent to SubmitSanctionsBad faith tacticsObjection to NOIMinutes of HearingCompromise and Release
References
8
Case No. ADJ2275449 (LAO 0830768), ADJ4469784 (LAO 0822612)
Regular
May 21, 2009

, NOEMY LORENZANA, vs. UNITED AIRLINES, permissibly self-insured,

The Workers' Compensation Appeals Board granted reconsideration of an order that dismissed a lien claim by Outpatient Spine and Surgery Center. The Board found the lien claimant's petition for reconsideration to be timely filed. It determined the WCJ's original dismissal order was improperly issued as it did not account for the five-day extension for mail service and lacked evidence of consent for facsimile service. Consequently, the Board rescinded the dismissal order and returned the matter for further proceedings and a new decision.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationWCJDismissal OrderTimelinessPetition for ReconsiderationService by MailService by FacsimileCalifornia Code of Regulations
References
2
Case No. ADJ3010720 (OXN 0128433) ADJ2325811 (OXN 0140121)
Regular
Nov 17, 2008

JACK WOESSNER vs. BLUE CROSS OF CALIFORNIA, ZURICH OF NORTH AMERICA

This case concerns a dispute over the reasonable value of services provided by a lien claimant, Westlake Spine & Outpatient Surgery Center, to the applicant. The Workers' Compensation Appeals Board (WCAB) rescinded the prior award and determined that the reasonable fee for services rendered on three specific dates in 2003 was $844.77 per date. Additionally, the WCAB imposed a 15% penalty and interest on any payments not made in a timely manner, as required by Labor Code section 4603.2(b).

Workers' Compensation Appeals BoardReconsiderationLien ClaimantReasonable ValueOutpatient Surgery CenterFee ScheduleExpert WitnessBurden of ProofPenaltiesInterest
References
3
Case No. ADJ964606 (OXN 0129495) ADJ800629 (OXN 0143959)
Regular
Jun 30, 2010

MARIA DE LOS ANGELES SEGURA vs. TECHNICOLOR, CHUBB GROUP LOS ANGELES, SPECIALTY RISK LA HABRA

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior award, and found that Westlake Spine and Outpatient Surgery Center's lien was barred by the statute of limitations under Labor Code section 4903.5(a). Westlake provided services in January 2005, but only filed its lien in January 2008, over five years after the injury date and more than six months after the approval of a compromise and release agreement. The Board found Westlake's delay and failure to properly file and serve its lien estopped it from recovery. Therefore, Westlake is not entitled to further reimbursement beyond the amount already paid.

Workers Compensation Appeals BoardLien ClaimStatute of LimitationsLachesReconsiderationIndustrial InjuryReimbursementLabor Code Section 4903.5Compromise and ReleaseMandatory Settlement Conference
References
0
Case No. ADJ10679103
Regular
Dec 14, 2017

LARRY SYKES vs. THE ANSCHUTZ CORPORATION, STARR INDEMNITY & LIABILITY COMPANY

The Workers' Compensation Appeals Board granted reconsideration of a prior finding of industrial injury to the applicant's lumbar spine. The Board found that the existing medical reporting from Dr. Hong, Dr. Jamasbi, and the PQME Dr. Schofferman did not constitute substantial evidence to support this lumbar spine injury finding. Therefore, the case is returned to the trial level to develop the record further on the lumbar spine injury issue.

Workers' Compensation Appeals BoardPetition for ReconsiderationIndustrial InjuryCervical SpineThoracic SpineLumbar SpineStagehandSecurity OfficerMedical Treatment RecordsSubstantial Evidence
References
0
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