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

Case No. ADJ8115084
Regular
Jun 02, 2014

MARY HAYWORTH vs. KCI HOLDINGS USA, INC., FIDELITY AND GUARANTY INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, rescinding a prior finding that the applicant failed to establish a plainly erroneous fact in an Independent Medical Review (IMR) determination. The Board found the IMR decision was based on a plainly erroneous mistake of fact because it evaluated a request for dorsal medial branch block injections as though it were a request for facet injections, which are different procedures. Consequently, the medical treatment dispute is remanded to the Administrative Director for review by a different independent review organization or reviewer.

Workers' Compensation Appeals BoardIndependent Medical ReviewLabor Code Section 4610.5Plainly Erroneous Finding of FactMedical Treatment DisputeUtilization ReviewAdministrative DirectorDorsal Medial Branch BlockFacet InjectionsMTUS Guidelines
References
2
Case No. ADJ2068970 (STK 0167616)
Regular
Jul 21, 2016

Norman McAtee vs. Briggs & Pearson Construction, State Compensation Insurance Fund

The applicant seeks reconsideration of a WCJ's decision that dismissed his appeal of an Independent Medical Review (IMR) determination regarding pain medication. The IMR found the medication medically unnecessary, but the applicant argues this was based on a plainly erroneous finding of fact regarding the applicable treatment guidelines. The Appeals Board granted reconsideration, finding the IMR determination was indeed based on a plainly erroneous interpretation of the medical treatment guidelines. Consequently, the Board rescinded the WCJ's decision and remanded the case for a new IMR by a different reviewer.

Workers' Compensation Appeals BoardIndependent Medical ReviewPlainly Erroneous Finding of FactLabor Code Section 4610.6Medical Treatment GuidelineOpioid TherapyPermanent DisabilityVocational RehabilitationAdministrative Law JudgeReconsideration
References
1
Case No. ADJ803377 (RIV 0075685) ADJ6675892
Regular
Oct 05, 2017

SANDRA ARMENTA vs. SAN BERNARDINO SHERIFF'S DEPARTMENT

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to address a plainly erroneous finding of fact in an Independent Medical Review (IMR) determination. The IMR incorrectly stated there was no documentation of constipation, despite medical reports confirming this issue, which was a basis for denying Amitiza. The WCAB also noted a case numbering error in the original findings of fact. Consequently, the WCAB rescinded the findings and returned the matter to the trial level for correction and further proceedings regarding the IMR determination's validity.

WCABReconsiderationIndependent Medical Review Determination (IMR)Findings of Fact (FOF)San Bernardino Sheriff's DepartmentApplicantPlainly Erroneous FactDocumentationPain ReliefFunctional Benefit
References
2
Case No. MISSING
Regular Panel Decision
Nov 28, 1984

Claim of De Bitetto v. City of White Plains

The claimant, a firefighter for the City of White Plains, suffered a compensable back injury in 1971, leading to permanent partial disability benefits. His case was reopened, and in 1983, the Workers' Compensation Board awarded him over $15,000 in back compensation. Subsequently, the claimant sought review to rescind these awards, aiming to recover Social Security deductions, but the Board denied his request. The claimant appealed this denial. The court dismissed the appeal, ruling that the claimant lacked standing as he was not an aggrieved party, and the Board's discretionary decision was not arbitrary or capricious.

Disability BenefitsPermanent Partial DisabilityTotal Disability ClaimSocial Security OffsetsAppeal from Board DecisionReconsideration RequestJudicial DiscretionStanding to AppealAggrieved PartyFirefighter Injury
References
3
Case No. MISSING
Regular Panel Decision
Jul 21, 2006

Diaz v. White Plains Coat & Apron Co.

Manuel Diaz, a laundry worker, was injured after falling from a laundry bin while employed in a building owned by White Plains Coat & Apron Co., Inc. He initiated an action for personal injuries against the defendant, predicated on premises liability. At the close of the plaintiff's case, the defendant moved to dismiss the complaint for failure to establish a prima facie case and sought to amend its answer to include a Workers' Compensation defense, arguing surprise due to a shift in the plaintiff's theory of liability to negligent supervision. The Supreme Court denied the defendant's motion. On appeal, the interlocutory judgment was reversed, and the defendant's motion to dismiss the complaint for failure to establish a prima facie case was granted, leading to the dismissal of the complaint.

Premises LiabilityNegligent SupervisionWorkers' Compensation ExclusivityPrima Facie CaseMotion to DismissAppellate ReviewJury VerdictInterlocutory JudgmentNew York LawPersonal Injury Damages
References
3
Case No. MISSING
Regular Panel Decision

Lewis v. White Plains Housing Authority

The petitioner challenged the White Plains Housing Authority's June 28, 1993 determination to terminate his employment as a maintenance worker through a CPLR article 78 proceeding. The court confirmed the determination, dismissing the proceeding on the merits with costs. The decision was based on a finding that substantial evidence supported all three charges against the petitioner, referencing precedents such as Matter of Lahey v Kelly and Matter of County of Suffolk v Newman.

CPLR Article 78Judicial ReviewEmployment TerminationMaintenance WorkerWhite Plains Housing AuthoritySubstantial EvidenceAdministrative DeterminationPublic EmploymentDismissal on MeritsCourt Costs
References
2
Case No. ADJ7274592, ADJ9009485
Regular
Aug 01, 2019

Scott Ussery vs. CITY OF MODESTO POLICE DEPARTMENT, YORK RISK SERVICES GROUP

The applicant appealed a denial of medications, arguing the Independent Medical Review (IMR) determination was improper because the defendant failed to provide complete medical records. The Appeals Board granted reconsideration, finding the WCJ erred in deeming the issue solely a medical question. The Board determined the IMR decision was based on plainly erroneous findings of fact and lacked necessary documentation. Consequently, the case is remanded to the Administrative Director for a new IMR by a different reviewer.

Independent Medical ReviewUtilization ReviewLabor Code Section 4610.6Petition for ReconsiderationFindings and OrderWCJAdministrative DirectorGabapentinAmitriptylineIndustrial Injuries
References
0
Case No. ADJ4 227596 (POM 0281890) MF ADJ3 720208 (POM 0281889)
Regular
Apr 06, 2016

MARISSA GONZALEZ-ORNELAS vs. COUNTY OF RIVERSIDE

The applicant sought reconsideration of a denied authorization for Synvisc knee injections. The original Independent Medical Review (IMR) denied the request, finding no documentation of the applicant's osteoarthritis failing to respond to conservative treatment. The Appeals Board found this IMR determination was based on a plainly erroneous finding of fact, as medical records in the file directly contradicted this assertion. Therefore, the Board granted the applicant's appeal, rescinded the WCJ's decision, and remanded the case for a new IMR.

Workers' Compensation Appeals BoardIndependent Medical ReviewSynvisc injectionsOsteoarthritisLabor Code section 4610.6(h)Plainly erroneous finding of factOrdinary knowledgeExcess of powersUtilization reviewTreating physician
References
1
Case No. ADJ156419
Regular
Feb 20, 2019

JOCELYN BOWEN vs. COUNTY OF SAN BERNARDINO

The Workers' Compensation Appeals Board reversed a prior Independent Medical Review (IMR) decision that denied the applicant's Norco prescription. The Board found the IMR reviewer failed to consider all submitted medical records and prior IMR determinations, leading to plainly erroneous findings of fact. Specifically, the IMR reviewer incorrectly stated there was no documentation of functional improvement with Norco, despite such documentation being present. The case is remanded for a new IMR review by a different reviewer or organization.

Workers' Compensation Appeals BoardIndependent Medical ReviewUtilization ReviewPlainly Erroneous FindingsAdministrative DirectorLabor CodeMedical Treatment Utilization ScheduleNorcoPain ManagementOrthopedic Surgery
References
11
Case No. ADJ2068970 (STK 0167616)
Regular
Aug 20, 2015

Norman McAtee vs. Briggs & Pearson Construction, State Compensation Insurance Fund

The Workers' Compensation Appeals Board granted the applicant's petition for reconsideration, finding that the Administrative Director's prior Independent Medical Review (IMR) determination was based on plainly erroneous findings of fact. The Board concluded that the IMR wrongly stated there was no documentation of improved function or reduced pain with the applicant's Duragesic patches, citing medical reports and applicant testimony to the contrary. Therefore, the IMR decision was rescinded, the applicant's appeal was granted, and the treatment dispute was remanded for a new IMR.

WCABPetition for ReconsiderationIndependent Medical ReviewLabor Code Section 4610.6(h)Plainly Erroneous Findings of FactAdministrative DirectorDuragesicOpioid AnalgesicsPermanent DisabilityMedical Treatment
References
0
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