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

Case No. ADJ3035107 (SAC 0251655), ADJ9373621
Regular
Dec 15, 2017

Susan Petrillo vs. Sierra Nevada Memorial Hospital, California Insurance Guarantee Association, Fremont Compensation Insurance Company, Sedgwick Claims Management Services, Sierra Memorial Miners Hospital, American Zurich Insurance Company, Tristar Risk Management, Siera Nevada Memorial Hospital

The Appeals Board granted removal to amend a WCJ's decision, specifically deleting a finding that excluded PQME Dr. Amster's evidence. CIGA sought removal arguing the exclusion of Dr. Amster's reports, which supported its claim of a later cumulative trauma injury, caused prejudice. The Board found Dr. Amster was improperly selected as PQME due to CIGA's procedural errors but affirmed the need for further development of the medical record through Dr. Abelow's supplemental report. While granting removal to correct the exclusion of Amster, the Board affirmed the rest of the WCJ's F&O.

Workers' Compensation Appeals BoardPetition for RemovalFindings of Fact and OrderPanel Qualified Medical Evaluator (PQME)California Insurance Guarantee Association (CIGA)Fremont Compensation Insurance CompanyliquidationSedgwick Claims Management ServicesAmerican Zurich Insurance CompanySupplemental Report
References
4
Case No. ADJ8040191
Regular
Sep 18, 2013

JOEL GOODEN vs. HILLS PET NUTRITION, INC., ACE AMERICAN INSURANCE COMPANY

The defendant petitioned for removal, seeking to overturn an order vacating submission of the case for further medical record development. The administrative law judge (WCJ) had vacated submission to review PQME reports from Dr. Georgis and Dr. Francisco. The WCJ subsequently took the matter off calendar to allow parties to obtain a supplemental report from the PQME reviewing Dr. Francisco's report. As the issue raised by the defendant's petition is now moot due to the subsequent order, the Appeals Board dismissed the Petition for Removal.

Petition for RemovalVacating SubmissionPQMESupplemental ReportWCJOff CalendarMootAppeals BoardWorkers' CompensationCase Development
References
0
Case No. ADJ7785936
Regular
Feb 28, 2014

LISA VALDEZ vs. SAINT HELENA HOSPITAL

The Workers' Compensation Appeals Board reversed a prior order denying a lien claimant's fee, allowing payment for a psychiatric consultation. The Panel Qualified Medical Examiner (PQME) Dr. Burt reasonably requested the consultation with Dr. Goldfield under former AD Rule 32, which permitted PQMEs to obtain necessary consultations. The defendant failed to investigate the potential psychiatric component of the applicant's industrial injury as required by AD Rule 10109, despite being notified by the PQME. Therefore, the Board found that Dr. Goldfield should be compensated for services rendered in the interest of substantial justice.

AD Rule 32Panel Qualified Medical Examiner (PQME)psychiatric consultationlien claimantindustrial injuryregistered nursepermanent disabilityfuture medical treatmentreconsiderationsubstantial justice
References
0
Case No. MISSING
Regular Panel Decision
Sep 29, 1999

Faele v. New York City Health & Hospitals Corp.

Plaintiff Rosemary Faele, a nurse at Coney Island Hospital, sustained an eye irritation and received brief examinations from defendants Dr. Barry Eppinger and Dr. An-nan Das in the hospital's emergency room. Her condition worsened, and she was later diagnosed with a severe eye infection by a private ophthalmologist. Though compensated via Workers' Compensation, Faele and her husband initiated a medical malpractice action against the doctors and the New York City Health and Hospitals Corporation. The Supreme Court dismissed the complaint by granting summary judgment to the defendants. The appellate court affirmed this decision, ruling that a sufficient nexus existed between Faele's employment and the alleged malpractice, thereby precluding a common-law malpractice claim and limiting her recourse to Workers' Compensation.

Medical MalpracticeWorkers' Compensation PreclusionSummary Judgment AffirmationEmployment-Related InjuryHospital LiabilityEmergency Medical TreatmentAppellate Division DecisionPersonal InjuryDoctor-Patient NexusConey Island Hospital
References
4
Case No. ADJ8979705
Regular
Oct 01, 2016

VENANCIO GALLEGOS vs. ROSE & SHORE RITE WAY RR MEAT PACKERS, INCORPORATED/RITE-WAY MEAT PACKERS, INCORPORATED, EVEREST NATIONAL INSURANCE COMPANY

The Appeals Board granted defendant's Petition for Removal, rescinding the WCJ's order to further develop the record. This decision was based on the WCJ's premature order to depose the original PQME, Dr. Steiger, before ruling on whether his reports were admissible. The Board found that requiring this deposition without a ruling on Dr. Steiger's availability would be premature and cause irreparable harm. The case is returned to the trial level for a status conference before a new judge to address the PQME dispute and other issues.

Petition for RemovalVacating SubmissionPQME depositionMedical report admissibilityCross-examinationWCJ orderWorkers' Compensation Appeals BoardRecord developmentPrecedentIrreparable harm
References
3
Case No. MISSING
Regular Panel Decision

Johnson v. New York Hospital

Plaintiff, a registered nurse, filed an action under Section 504 of the Rehabilitation Act against The New York Hospital, its President Dr. David Skinner, and Assistant Director of Nursing Mr. Jody Sklar, alleging unlawful employment termination due to an alcoholism relapse. The plaintiff objected to a protective order preventing Dr. Skinner's deposition, while defendants sought to dismiss claims against individual defendants. The court granted dismissal against Mr. Sklar but denied it for Dr. Skinner, finding that individuals responsible for discriminatory decisions can be liable under the Act, especially those in positions to accept federal funds. Consequently, the protective order against deposing Dr. Skinner was set aside.

Rehabilitation Actemployment discriminationdisability rightsalcoholismindividual liabilitycorporate responsibilityprotective orderdiscoverymotion to dismiss
References
9
Case No. MISSING
Regular Panel Decision

Rafiy v. Nassau County Medical Center

Dr. M. Pierre Rafiy and Dr. Philip Rafiy (the Rafiys) initiated a civil action against Nassau County Medical Center, Nassau County, Dr. Bruce Meinhard, and Dr. Anthony Angelo. Their claims, brought under 42 U.S.C. § 1983 and the Sherman Act, included deprivation of hospital privileges without due process, racial discrimination, and retaliation for exercising free speech rights. The Defendants sought summary judgment, arguing the revoked assignments were not protected property interests and the Rafiys failed to exhaust state remedies. They also contended that the Rafiys' speech was not protected under the First Amendment and that evidence for discrimination was lacking. The court granted the Defendants' motion for summary judgment on all counts, concluding that no constitutional violations occurred and that the Rafiys' antitrust claim had been withdrawn.

Civil RightsDue ProcessFirst AmendmentEqual ProtectionRacial DiscriminationRetaliationHospital PrivilegesSummary JudgmentSherman ActAntitrust
References
29
Case No. MISSING
Regular Panel Decision
Feb 01, 1989

Murphy v. Blum

Donald Murphy, an NBA referee, underwent a physical examination by defendant Dr. Richard Blum and a stress test analyzed by Blum, which was found "abnormal." The results were communicated to the NBA and Murphy's personal physician. Following a a cardiac arrest that ended his career, Murphy sued Dr. Blum for medical malpractice. The Supreme Court, Nassau County, dismissed the complaint, ruling that no physician-patient relationship existed between Murphy and Dr. Blum because Blum was retained solely by the NBA for an examination, not for treatment. The Appellate Division affirmed the dismissal, upholding that a doctor engaged for examination purposes only assumes duties associated with those functions, not duties concerning treatment or expert opinions.

Medical MalpracticePhysician-Patient RelationshipDuty of CareComplaint DismissalCPLR 3211(a)(7)Appellate ReviewProfessional Sports InjuryPre-employment ExaminationNo Physician-Patient RelationshipAffirmation of Order
References
3
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
Case No. ADJ10192587
Regular
Dec 27, 2017

TIMOTHY WILCOX vs. CALIFORNIA DEPARTMENT OF FORESTRY AND FIRE PROTECTION, STATE COMPENSATION INSURANCE FUND

This case involved a workers' compensation claim where the applicant, Timothy Wilcox, sought benefits for an abdominal injury sustained while lifting. The defendant contested the 50-pound lifting restriction recommended by the applicant's Qualified Medical Examiner (PQME), Dr. Fearer. The Appeals Board upheld the WCJ's decision, finding Dr. Fearer's medical opinion to be substantial evidence, even though it changed significantly. The Board adopted Dr. Fearer's reasoning that the 50-pound restriction, supported by applicant's credible testimony and affecting his ability to perform his firefighter duties, justified an increased permanent disability rating.

workers' compensationPetition for ReconsiderationQualified Medical ExaminerPQMEwhole person impairmentWPIlifting restrictioninternal herniasmall bowel resectionAlmaraz/Guzman
References
5
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