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

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 Consequently, the Board rescinded the WCJ's decision and remanded the case for a new IMR by a different reviewer.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. 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. 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. 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

State Division of Human Rights v. Bakery & Confectionery Workers' International Union of America

This case involves a review of a determination finding discrimination. The court affirmed the discrimination finding, stating it was based on substantial evidence. However, the Commissioner's calculation of damages was found to be erroneous. The original damage award for eight complainants was based on an hourly wage rate applicable to only one. The court modified the awards for complainants whose actual wages were less than the hourly wage rate used by the Commissioner, accepting their actual hourly wage rate and hours lost. Awards where actual wages exceeded the determined rate were not disturbed due to the absence of a cross-appeal.

DiscriminationDamagesWage RateErroneous ComputationJudicial ReviewModificationComplainantsHourly WageSubstantial EvidencePanel Decision
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. 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
Case No. 824-01
Regular Panel Decision

Hi Pockets, Inc. v. Music Conservatory of Westchester, Inc.

Hi Pockets, Inc. (HPI) sued The Music Conservatory of Westchester, Laura Calzolari, and several White Plains municipal entities and officials, alleging illegal issuance of a building permit for the Conservatory's new site. HPI brought fifteen causes of action, including Section 1983 claims for civil and constitutional rights violations, and numerous state law claims related to zoning ordinances, lease agreements, and parking rights. The Conservatory defendants moved for summary judgment, and the White Plains defendants moved for judgment on the pleadings. The court granted both motions, dismissing the case in its entirety, finding that HPI's state law claims were barred by res judicata and collateral estoppel, and its federal Section 1983 claims failed to state a claim upon which relief could be granted due to absolute immunity for municipal officials and the availability of adequate state post-deprivation remedies.

Summary JudgmentJudgment on the PleadingsCollateral EstoppelRes JudicataAbsolute ImmunityZoning OrdinanceBuilding PermitParking RightsCovenant of Quiet EnjoymentSection 1983
References
31
Case No. ADJ1413052 (STK 0170134) ADJ4567871 (STK 0173675)
Regular
May 03, 2016

EPIFANIO MEDINA vs. SECOND NATURE, MID-CENTURY INSURANCE

The Workers' Compensation Appeals Board (WCAB) denied an applicant's petition for reconsideration, affirming the WCJ's decision that an appeal of an Independent Medical Review (IMR) determination was untimely. While the WCAB agreed the untimeliness finding lacked evidentiary support, the applicant failed to prove any of the five statutory grounds for appeal of an IMR determination by clear and convincing evidence. Therefore, the applicant could not overturn the IMR's denial of authorization for eight medications. Commissioner Sweeney dissented, arguing the applicant presented sufficient evidence of plainly erroneous findings of fact in the IMR determination.

WORKERS' COMPENSATION APPEALS BOARDEPIFANIO MEDINASECOND NATUREMID-CENTURY INSURANCEADJ1413052ADJ4567871Petition for ReconsiderationIndependent Medical Review (IMR)Labor Code section 4610.6(h)WCJ
References
8
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