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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

Zuckerman v. Volume Services America, Inc.

Plaintiff Gail Zuckerman initiated a disability discrimination lawsuit under New York State law against her former employer, Volume Services America (VSA), and her union, Local 37. The defendants removed the case to federal court, arguing preemption by Section 301 of the Labor Relations Act and seeking dismissal based on the statute of limitations. The court denied VSA's summary judgment motion, ruling that Zuckerman's claims against the employer did not necessitate interpreting the collective bargaining agreement and thus were not preempted. Conversely, the court granted Local 37's motion, finding that the claims against the union amounted to a breach of the duty of fair representation, which is preempted by federal law and time-barred by a six-month limitation period. Consequently, the case against VSA was remanded to the Supreme Court of the State of New York, County of Queens, as federal jurisdiction no longer applied to that portion of the dispute.

Disability DiscriminationLabor Relations ActSection 301 PreemptionCollective Bargaining AgreementStatute of LimitationsSummary JudgmentDuty of Fair RepresentationRetaliatory DischargeHostile Work EnvironmentConstructive Discharge
References
23
Case No. MISSING
Regular Panel Decision

People v. Baghai-Kermani

This case concerns an appeal from two Supreme Court orders regarding a defendant's conviction for criminal sale of prescription for a controlled substance. The trial court initially granted the defendant's CPL 440.10 motion to set aside his conviction due to Rosario material violations, but denied his motion on jurisdictional grounds. On appeal, the higher court modified the Rosario order, reinstating most of the convictions, arguing that the Rosario violation for two counts did not necessarily taint the entire indictment. The court affirmed the denial of the jurisdictional motion, holding that the Attorney-General had broad jurisdiction under Executive Law § 63 (3) to prosecute the defendant for offenses connected with Medicaid, despite the defendant no longer being a Medicaid provider.

Criminal Sale of Controlled SubstanceCPL 440.10Rosario MaterialBrady v MarylandJurisdictionExecutive Law § 63 (3)Medicaid FraudAppellate ReviewBench TrialSelf-representation
References
6
Case No. ADJ2296444 (LAO 0786271)
Regular
Feb 10, 2015

CAROLYN HOLMAN vs. LOS ANGELES UNIFIED SCHOOL DISTRICT, P S-I, A B SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board affirmed a WCJ's decision denying liens for Dr. Burstein and The Prescription Center. The Board found no evidence Dr. Burstein treated the applicant for industrial injuries, nor that his services or charges were reasonable and necessary. Consequently, The Prescription Center's lien for filling prescriptions from Dr. Burstein was also denied as not related to the industrial injury. Both lien claimants failed to meet their burden of proof regarding the reasonableness and necessity of their claims.

Workers' Compensation Appeals BoardLien claimantPetition for ReconsiderationFindings and OrdersWCJStipulations with Request for AwardIndustrial injuryReasonableness of chargesNecessity of servicesBurden of proof
References
2
Case No. ADJ2263476 (VNO 0318779)
Regular
Apr 20, 2016

DARLENE FERRONA vs. WARNER BROTHERS, TIME WARNER ENTERTAINMENT CO; ZURICH LOS ANGELES

This case concerns Darlene Ferrona's entitlement to 24/7 home health care following a psyche and fibromyalgia injury. The defendant, Warner Brothers, sought reconsideration of an order granting these services, arguing that utilization review only authorized limited care and that new prescriptions were required per Labor Code section 4600(h). The Appeals Board denied reconsideration, affirming that the applicant's prior authorization of 24/7 home health care by treating physicians and subsequent stipulation established ongoing need. The Board clarified that while a prescription date is crucial for liability, a new prescription is not always necessary to continue approved, ongoing home health care if the applicant's condition has not changed, citing the precedent of *Patterson v. The Oaks Farm*.

Workers' Compensation Appeals BoardDarlene FerronaWarner BrothersZurich Los Angelesindustrial injurypsychefibromyalgiahome health careutilization reviewsubstantial medical evidence
References
5
Case No. ADJ3685938 (WCK 0066506)
Regular
Dec 02, 2014

EMMETT BOONE vs. DREYER'S GRAND ICE CREAM, FIREMAN'S FUND INSURANCE COMPANY

In this workers' compensation case, the Appeals Board affirmed a prior award finding defendant's utilization review (UR) denials for prescription refills invalid. The Board agreed with the WCJ that the UR denials were untimely because the defendant failed to communicate the decisions to the treating physician within the statutory 24-hour timeframe. Consequently, the Board found the UR invalid, allowing the WCAB to determine medical necessity based on substantial evidence. This decision upholds the applicant's right to ongoing prescription refills.

Workers' Compensation Appeals BoardUtilization ReviewReconsiderationFindings and AwardPrescription RefillsMedical TreatmentDefective DenialTimeliness RequirementsLabor Code § 4610Dubon v. World Restoration
References
8
Case No. ADJ7763946
Regular
May 06, 2013

CLIFFORD MULFORD vs. EL TORO RV, INC.; THE HARTFORD, Administered By AMERICAN ALL-RISK LOSS ADMINISTRATION

The applicant sustained a catastrophic brain injury after falling from a ladder while employed. The Workers' Compensation Appeals Board denied reconsideration and dismissed removal, upholding the WCJ's finding that the employer was not liable for home health care from October 23, 2012, onward. This decision was based on the retroactive application of Labor Code section 4600(h), which requires a physician's prescription for home health care. The Board found that the applicant's physician's reports did not contain a sufficient prescription to trigger employer liability under the new statute.

Workers Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalFindings & Orderindustrial injurycatastrophic brain injuryhome health careLabor Code § 4600(h)physician's prescriptionprospective application
References
4
Case No. WCB Case No. G076 8920
Regular Panel Decision
Nov 16, 2023

FAZEKAS, WILLIAM J. v. TIME WARNER CABLE, INC.

The case involves Adan E. Cifuentes, who sustained an injury while working for Amazon.com. A Workers' Compensation Law Judge (WCLJ) found the claimant had a permanent medical impairment and directed the carrier to pay for a medical cannabis prescription. The carrier appealed, arguing the WCLJ lacked jurisdiction and that medical cannabis is not covered under the Workers' Compensation Law. The Board Panel affirmed the WCLJ's decision, finding that the WCLJ had jurisdiction and that the medical cannabis prescription was properly awarded as necessary medical treatment for the claimant's work-related injury.

Workers' Compensation BoardMedical CannabisPermanent Medical ImpairmentJurisdictionMedical TreatmentAppellate ReviewWork-Related InjuryPrescription ReimbursementWCLJ DecisionBoard Panel Review
References
6
Case No. ADJ7995806
Regular
Jun 12, 2013

ROQUE NERI-HERNANDEZ vs. WORKFORCE STAFFING, TOWER GROUP COMPANIES

The Workers' Compensation Appeals Board (WCAB) granted reconsideration on its own motion regarding a prior decision that awarded applicant Roque Neri-Hernandez payment for self-procured home health care. The WCAB found that while the applicant met the burden of proof for reasonable and necessary home health care services based on a physician's prescription, further factual development was required. Issues to be clarified include the exact date the prescription was received by the defendant and the specific duration and nature of care required from the date of injury. The case was returned to the WCJ for further proceedings and a new decision.

Workers' Compensation Appeals BoardReconsiderationOpinion and OrderFindings and AwardAdministrative Law JudgePetition for ReconsiderationDecision After ReconsiderationLabor CodeSelf-procured medical careHome health care
References
13
Case No. ADJ10884813
Regular
Feb 18, 2025

ALICIA RODRIGUEZ vs. DYNAMIC EDGE CONSULTING, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

Alicia Rodriguez, applicant, suffered a brain injury during employment with Dynamic Edge Consulting, insured by Travelers Property Casualty Company of America. The initial WCJ decision found the defendant liable for 24-hour home health care due to a failure in timely utilization review of Dr. Roger Bertoldi's prescription, which incorporated Sue Coleman's evaluation. Defendant petitioned for reconsideration, arguing the prescription was non-compliant and their duty was investigative, not to submit to UR. The Appeals Board granted the petition, deferring a final decision for further review and encouraging mediation.

Workers Compensation Appeals BoardDynamic Edge ConsultingTravelers Property Casualty Company of AmericaPetition for ReconsiderationFindings and AwardAOE/COEBrain Injury24-Hour Home Health CareUtilization ReviewDr. Roger Bertoldi
References
27
Case No. ADJ3128963 (AHM 0129527)
Regular
Aug 29, 2014

OMAR ROSAS vs. LAURENCE-HOVENIER, INC., CALIFORNIA CONTRACTORS' NETWORK administered by AMERICAN CLAIMS MANAGEMENT

This case involves a lien claim for home health care services provided to Omar Rosas. The lien claimant, Tayde Perez, contended that the services were reasonably required and that recent case law supported developing the record on the employer's receipt of a prescription. The Workers' Compensation Appeals Board denied the petition for reconsideration, adopting the WCJ's report. The WCJ found no substantial medical evidence supporting the necessity of the home health care services, and that even if the services were deemed necessary, Labor Code §4600(h) barred recovery as there was no evidence the employer received a prescription prior to 2013.

Petition for ReconsiderationLien ClaimantHome Health Care ServicesReasonably RequiredMedical EvidenceLabor Code §4600(h)Physician's PrescriptionNeri HernandezBurden of ProofCompromise and Release
References
1
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