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

Case No. ADJ916063 (VNO 0541860)
Regular
Mar 10, 2011

TERRY SCUDDER vs. VERIZON CALIFORNIA, INC.; Permissibly Self-Insured, Administered by SEDGWICK CMS

This case concerns an applicant who sustained industrial injuries and pre-designated a physician outside of the employer's established Medical Provider Network (MPN). The applicant's attorney subsequently referred him to physicians outside the MPN, whose reports were admitted by the WCJ. The Appeals Board overturned this, ruling that only the pre-designated physician, or referrals from that physician, could be outside the MPN and that referrals by an attorney were invalid. Consequently, the reports of these outside physicians were inadmissible, and the issues decided based on them were returned for further proceedings.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNPre-designationTreating PhysicianQualified Medical EvaluatorQMEPermanent and Stationary DateApportionmentSelf-Procured Medical Treatment
References
1
Case No. ADJ7692623
Regular
Sep 07, 2012

ANTHONY FAGONE vs. CITY OF FRESNO

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The Board upheld the finding that the applicant sustained industrial injuries and that the defendant lost control of medical treatment due to failing to process the applicant's pre-designated physician form. The defendant's argument that the applicant could not pre-designate a chiropractor was rejected, as the employer's inaction estopped them from benefiting from their processing failure. Therefore, the applicant is entitled to treatment by his chosen chiropractor during the period of the employer's processing error.

Workers' Compensation Appeals BoardIndustrial InjuryNeck InjuryChest Wall InjuryMedical Provider Network (MPN)Pre-designation of Treating PhysicianChiropractorLabor CodeEstoppelFindings and Award
References
1
Case No. ADJ3487625 (VNO 0525644)
Regular
Oct 16, 2017

TERESA SALAZAR vs. SENIOR SYSTEMS TECHNOLOGY, INC., THE HARTFORD

This case concerns a worker's claim for sanctions and penalties against her employer and their insurer. The applicant contended that the defendant's failure to provide written pre-authorization to her chosen physician constituted a denial of medical treatment, warranting penalties. However, the Workers' Compensation Appeals Board found no evidence of bad faith or unreasonable delay. Crucially, there was no statutory or case law requirement for the defendant to issue such a pre-authorization letter to the designated primary treating physician. Therefore, the Board affirmed the decision denying the applicant's claim for sanctions and penalties.

Petition for ReconsiderationFindings of FactWCJLabor Code section 5813Labor Code section 5814sanctionspenaltiespre-authorizationmedical treatmentprimary treating physician (PTP)
References
2
Case No. ADJ10975151
Regular
Jan 06, 2020

RUSSELL CAMARA vs. TESLA, INC., AMERICAN ZURICH INSURANCE COMPANY

In this workers' compensation case, the Applicant sustained an admitted industrial injury to the lumbar spine. The Applicant's primary treating physician (PTP) designated a secondary physician to evaluate permanent and stationary status and impairment, whose report the PTP adopted. The defense challenged the validity of this secondary physician's report, arguing only the Panel Qualified Medical Examiner's (PQME) report was properly obtained. The Workers' Compensation Appeals Board denied the Petition for Reconsideration, affirming that the PTP, or a physician designated by the PTP, is authorized to render opinions on medical issues, provided proper notice and procedural requirements are met. The Board found the designation and subsequent report were compliant with Labor Code and Administrative Director Regulations.

Workers' Compensation Appeals BoardPetition for ReconsiderationPrimary Treating PhysicianQualified Medical ExaminerLabor Code Section 4061.5Permanent and Stationary ReportMedical-Legal EvaluationSecondary PhysicianAdministrative Director Rule 9785Designation of Physician
References
0
Case No. MISSING
Regular Panel Decision

Martegani v. Cirrus Design Corp.

Micaela Martegani, individually and as natural guardian of her minor child, commenced a wrongful death action against Cirrus Design Corporation and East End Aviation following her husband's death in a 2006 plane crash. The parties reached a settlement, and Martegani sought court approval, including attorney's fees and the establishment of a trust for the minor child's share. The court approved the settlement in principle, but significantly reduced the requested attorney's fees by 30% due to the absence of contemporaneous time records. Additionally, the court denied the recovery of "case expenses" and a $5,000 reserve due to insufficient documentation. The final order authorized Martegani to settle the claims, with specific allocations for attorney's fees, the minor child's trust, and Martegani's personal compensation.

Infant SettlementWrongful DeathPlane CrashAttorney FeesContingency FeeCourt ApprovalMinor Child TrustSettlement AllocationCase ExpensesDocumentation Requirements
References
17
Case No. MISSING
Regular Panel Decision
Aug 15, 2012

Rozenfeld v. Department of Design & Construction

Plaintiff Paul Rozenfeld sued his former employer, the New York City Department of Design and Construction (DDC), and several DDC employees, alleging discrimination and retaliation based on race, color, and age under federal and state laws, including Title VII, ADEA, § 1983, SHRL, and CHRL. Defendants moved for summary judgment, and Plaintiff cross-moved. The court found that Plaintiff knowingly and voluntarily waived most of his claims through a settlement agreement. Even if the waiver were invalid, Plaintiff failed to demonstrate adverse employment action or circumstances inferring discrimination. The court denied Plaintiff's motion for summary judgment and granted Defendants' motion, dismissing all of Plaintiff's claims.

Employment DiscriminationAge DiscriminationRace DiscriminationHostile Work EnvironmentRetaliationSummary JudgmentWaiver AgreementADEATitle VIISection 1983
References
70
Case No. MISSING
Regular Panel Decision

Claim of Joyner v. Event Design Associates, Inc.

Claimant was retained by Event Design Associates, Inc. (EDA) to transport furniture and event props for a party. While en route to a hotel during this assignment, claimant was involved in an automobile accident and sustained serious injuries. Subsequently, claimant applied for workers' compensation benefits, asserting an employer-employee relationship with EDA. The Workers' Compensation Board ruled in favor of the claimant, finding that an employment relationship existed. EDA appealed this decision. The Appellate Division affirmed the Board's ruling, concluding there was substantial evidence to support the finding of an employer-employee relationship, based on factors such as EDA's control over the work, method of payment, and right to terminate.

Workers' CompensationEmployer-Employee RelationshipIndependent ContractorSubstantial EvidenceControl TestAppellate ReviewAutomobile AccidentNew YorkWorkers' Compensation BoardTemporary Employment
References
4
Case No. MISSING
Regular Panel Decision

Nichols v. BDS Landscape Design

Deborah Nichols, injured in a slip and fall in 2005, sought to enforce an oral settlement for a negligence claim against BDS Landscape Design, William Dobson, III, and National Grange Mutual Insurance. Despite reaching an agreement contingent on a workers' compensation lien waiver, National Grange later disputed the settlement and claimed the action was time-barred after Nichols received the necessary consent. Nichols initiated a special proceeding to compel payment, which the Supreme Court granted. On appeal, the higher court reversed the lower court's order, converting the special proceeding into an action, and held that Nichols failed to establish the existence and terms of the settlement agreement as a matter of law.

Personal InjurySlip and FallNegligenceSettlement AgreementBreach of ContractStatute of LimitationsSpecial ProceedingConversion of ActionWorkers' Compensation LienInsurance Dispute
References
9
Case No. MISSING
Regular Panel Decision

Johnson v. General Design and Development, Inc.

Jerry Johnson was severely injured in November 1991 when a drill bound, causing him to fall from a stepladder at a construction site. He and his spouse sued the general contractor, General Design and Development, Inc., alleging violations of Labor Law §§ 200, 240 (1), and 241 (6), among other claims. General subsequently initiated a third-party action against subcontractors Omni Plumbing Company and Thomas P. Pleat Construction, Inc., seeking contribution and indemnification. Plaintiffs were granted partial summary judgment on liability under Labor Law § 240 (1) by the Supreme Court. The defendants appealed, contending the injuries were not elevation-related. The appellate court affirmed the Supreme Court's order, ruling that the stepladder was inadequate and the accident constituted an elevation-related risk under Labor Law § 240 (1), thus establishing a prima facie violation.

Construction AccidentLabor LawFall from HeightScaffolding LawSummary JudgmentAppellate ReviewPersonal InjuryContractor LiabilitySubcontractor LiabilityIndemnification
References
11
Case No. 533089
Regular Panel Decision
Oct 07, 2021

Matter of Barden v. General Physicians PC

Claimant, a patient services representative, sought to amend her workers' compensation claim to include left shoulder aggravation after a work-related injury to her right shoulder. The Workers' Compensation Board disallowed this request, finding that claimant failed to provide sufficient credible medical evidence to establish a causal relationship between her employment and the left shoulder condition. The Appellate Division, Third Department, affirmed the Board's decision. The court noted that the claimant's treating physician opined the left shoulder pathology was largely preexisting and unrelated to the work injury, and other medical opinions either lacked sufficient weight or were based on inaccurate information, providing no basis to disturb the Board's finding.

Workers' CompensationShoulder InjuryCausationMedical EvidencePreexisting ConditionAppellate ReviewBoard DecisionClaim AmendmentPatient Services Representative
References
10
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