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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

Palmer v. State University of New York Upstate Medical University

The claimant, an orthopedic hand surgeon, developed cervical radiculopathy and degenerative disc disease due to the physical strain of performing hand surgery and filed for workers' compensation benefits. His claim was controverted by the State University of New York Upstate Medical University and its carrier, as well as the Research Foundation of New York and its carrier. The Workers' Compensation Board determined that the claimant was a dual employee of both the University and the Foundation and that his condition constituted a causally related occupational disease. The University and its carrier appealed this decision. The appellate court affirmed the Board's findings, concluding there was substantial evidence to support both the dual employment status and the existence of a recognizable link between the claimant's condition and the distinctive features of his occupation.

Occupational DiseaseCervical RadiculopathyDegenerative Disc DiseaseDual EmploymentWorkers' Compensation BenefitsHand Surgery StrainMedical OpinionAppellate ReviewCausationEmployer Liability
References
8
Case No. ADJ261234 (GOL 0093065) ADJ1281382 (GOL 0093064)
Regular
May 02, 2016

RITA ROBINSON vs. SANSUM SANTA BARBARA MEDICAL FOUNDATION CLINIC, DYNAMIC CLAIMS, Arrowpoint, GOLETA UNION SCHOOL DISTRICT

This case concerns an employer's (Sansum Santa Barbara Medical Foundation Clinic/Arrowood) petition for reconsideration of a prior award. The Appeals Board affirmed the award, which mandated right hip surgery and the provision of a Nurse Case Manager (NCM), finding Arrowood responsible for both. Arrowood's arguments regarding due process and utilization review were rejected, and the Board found that prior orders compelled NCM provision, which Arrowood had unilaterally ceased without sufficient medical evidence. The Board also admonished Arrowood's counsel for unprofessional conduct and misrepresentation of facts.

WCABReconsiderationNurse Case ManagerUtilization ReviewAgreed Medical ExaminerPrimary Treating PhysicianMedical Provider NetworkJoint and Several LiabilityMandatory Settlement ConferenceDeclaration of Readiness to Proceed
References
5
Case No. 96-CV-3879, 96-CV-6310
Regular Panel Decision

Schuloff v. Queens College Foundation, Inc.

Plaintiff Anita Schuloff filed two separate lawsuits against Queens College Foundation, Inc. and Brooklyn College Foundation, Inc., which were consolidated due to identical legal issues. Schuloff alleged violations of 26 U.S.C. § 6104 for the defendants' failure to promptly provide federal tax returns for public inspection, along with claims under 42 U.S.C. § 1983 and New York Freedom of Information Law. The defendants moved to dismiss the complaints under Federal Rules of Civil Procedure 12(b)(1) and 12(b)(6). The Court granted the motions to dismiss under Rule 12(b)(6), ruling that 26 U.S.C. § 6104 does not create a private cause of action, thus precluding the related § 1983 claims. Consequently, the Court declined supplemental jurisdiction over the state law claims, dismissing both complaints in their entirety.

Private Cause of ActionTax-Exempt Organizations26 U.S.C. § 610442 U.S.C. § 1983Rule 12(b)(6)Motion to DismissFederal JurisdictionStatutory InterpretationLegislative HistorySupplemental Jurisdiction
References
28
Case No. ADJ8750277
Regular
Jun 26, 2013

RUTH SHAW vs. PALO ALTO MEDICAL FOUNDATION, SUTTER HEALTH

This case concerns a dispute over venue for a workers' compensation claim. The defendant objected to the initial venue in Anaheim, arguing it was improper as the applicant resided in Santa Cruz County and the injury occurred there. The Appeals Board found that both Felton (applicant's residence) and Santa Cruz (injury location) are within Santa Cruz County, which lacks a local Appeals Board office. Therefore, venue was properly changed to the Salinas district office, which is the nearest to the applicant's residence.

Workers' Compensation Appeals BoardPetition for RemovalChange of VenueLabor Code section 5501.5(c)Venue VerificationApplicant's ResidenceLocation of InjuryNearest Appeals Board OfficeSalinasSanta Cruz County
References
0
Case No. ADJ8300605
Regular
Sep 12, 2013

LATOYA ARRINGTON, LATOYA ARRINGTON-ARTIS vs. SUPPORT MEDICAL FOUNDATION, SUTTER HEALTH SACRAMENTO, SUTTER MEDICAL FOUNDATION

This case involves a petition for reconsideration and removal that was dismissed and denied, respectively, by the Workers' Compensation Appeals Board (WCAB). The WCAB found that the petition for reconsideration was improperly taken from interlocutory orders and that removal was not warranted as the defendant failed to show irreparable harm or prejudice. The underlying dispute involves the WCJ's decision to order further development of the medical record after trial, despite the applicant's failure to object to the defendant's declaration of readiness. The WCAB adopted the WCJ's report, which found no irreparable harm or significant prejudice to the defendant from the order to develop the record.

Petition for ReconsiderationRemovalFinal OrderInterlocutory OrderSubstantive RightIrreparable HarmSignificant PrejudiceAOE-COECumulative TraumaDeclaration of Readiness
References
10
Case No. MISSING
Regular Panel Decision

Queens Blvd. Medical, P.C. v. Travelers Indemnity Co.

The plaintiff, Queens Blvd. Medical, P.C., sought $950 in first-party no-fault benefits for biofeedback medical services provided to its assignor for lower back and chronic pain syndrome. The central issue at trial was the medical necessity of these services under Insurance Law § 5102 (a) (1). The plaintiff established a prima facie case with expert testimony from a board-certified neurologist affirming the medical appropriateness of biofeedback. The defendant insurance company failed to present admissible evidence to disprove medical necessity, as its expert was deemed incompetent to testify on biofeedback for back pain. Consequently, the court granted the plaintiff's motion for a directed verdict, awarding judgment for $950 along with statutory costs, interest, and attorney's fees.

No-fault benefitsMedical necessityBiofeedback treatmentExpert testimonyDirected verdictInsurance lawChronic pain syndromeBack injuryCPT codesBurden of proof
References
9
Case No. ADJ3052057 (SAC 0360534)
Regular
Aug 26, 2010

MARY MORRISON vs. SUTTER MEDICAL FOUNDATION, SUTTER HEALTH SACRAMENTO

This case involves a nurse, Mary Morrison, who sustained a 100% permanent total disability industrial injury to her spine and other areas. The defendant, Sutter Medical Foundation, sought reconsideration, arguing against the 100% award without apportionment. The applicant, Ms. Morrison, contended the award should commence retroactively from a specific earlier date. The Workers' Compensation Appeals Board denied the defendant's petition and granted the applicant's, amending the original award to commence permanent total disability benefits on July 26, 2008.

Workers' Compensation Appeals BoardIndustrial injuryPermanent total disabilityApportionmentLabor Code section 4664Temporary disabilityPermanent and stationaryAgreed medical evaluatorPetition for ReconsiderationFindings and Award
References
1
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. ADJ132127 (VNO 0524197) ADJ2705905 (VNO 0524198)
Regular
May 24, 2016

MIRELLA FLORES DE LOPEZ vs. FACEY MEDICAL FOUNDATION, CRUM & FORSTER INSURANCE

The Workers' Compensation Appeals Board (WCAB) granted reconsideration for Mirella Flores de Lopez's case against Facet Medical Foundation and Crum & Forster Insurance. This decision was made to allow the Board more time to thoroughly review the factual and legal issues presented. The WCAB requires all future correspondence related to the petition to be filed directly with their office, not district offices or e-filed. Settlements cannot be processed by a WCJ while a case is under reconsideration by the Board.

WORKERS' COMPENSATION APPEALS BOARDMIRELLA FLORES DE LOPEZFACEY MEDICAL FOUNDATIONCRUM & FORSTER INSURANCEPetition for ReconsiderationOpinion and OrderStatutory Time ConstraintsFactual IssuesLegal IssuesJust and Reasoned Decision
References
0
Case No. SJO 0235623
Regular
Feb 25, 2008

SILVIA IBARRA vs. PALO ALTO MEDICAL FOUNDATION, and CIGA by CAMBRIDGE INTEGRATED SERVICES, administering for FREMONT, in liquidation, and STATE COMPENSATION INSURANCE FUND

This case involves an applicant seeking reconsideration of a workers' compensation award, primarily concerning vocational rehabilitation benefits. The applicant argued the employer's duty to provide notice was triggered earlier than found by the WCJ, based on a doctor's report indicating work limitations. The Appeals Board granted reconsideration, finding the applicant entitled to vocational rehabilitation benefits retroactive to the date of the doctor's initial request, and denied the defendant SCIF's petition.

Workers Compensation Appeals Boardcumulative traumabilateral upper extremitiesneck injurypatient services representativepermanent disabilityvocational rehabilitation maintenance allowance (VRMA)Qualified Injured Worker (QIW)vocational rehabilitation temporary disabilityState Compensation Insurance Fund (SCIF)
References
12
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