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

Case No. ADJ2270634 (VNO 0521616)
Regular
Aug 03, 2018

SHEVON THOMAS vs. POMONA VALLEY HOSPITAL MEDICAL CENTER, Administered by ADMINSURE, INC., SUBSEQUENT INJURIES BENEFITS TRUST FUND

This case concerns an applicant seeking benefits from the Subsequent Injuries Benefits Trust Fund (SIBTF) following a 2005 industrial injury that resulted in a 69% permanent disability and a substantial settlement. The applicant's claim for SIBTF benefits was denied because she failed to establish a prior "labor disabling" permanent disability that existed before the 2005 injury. The Appeals Board upheld the denial, finding that the applicant's evidence of prior symptoms, including a doctor's speculative impairment ratings, lacked substantial medical evidence and did not meet the strict requirements for establishing a pre-existing, labor-disabling condition. The Board emphasized that post-injury medical opinions, especially those based on hypotheticals and inadequate history, cannot retroactively establish a prior disability for SIBTF eligibility.

Subsequent Injuries Benefits Trust FundSIBTFlabor disablingpermanent partial disabilityLabor Code section 4751SB 899apportionmentpreexisting disabilityAMA Guides impairment ratingsretrospective prophylactic work restrictions
References
8
Case No. MISSING
Regular Panel Decision

Fraser v. Brunswick Hospital Medical Center, Inc.

In this medical malpractice action, the defendant The Brunswick Hospital Medical Center, Inc. appealed an order that granted the plaintiff’s motion to strike its workers’ compensation coverage defense. Concurrently, the plaintiff cross-appealed the dismissal of the complaint against defendant S. Fong. The appellate court affirmed the decision to strike the workers’ compensation defense for The Brunswick Hospital Medical Center, Inc., citing its participation and lack of appeal in the prior Workers’ Compensation Board hearing. However, the dismissal of the complaint against S. Fong was reversed, as S. Fong was not present at the Board hearing, thus preclusion did not apply, and a triable issue of fact existed regarding whether the injury was employment-related. The court also rejected S. Fong's argument regarding the absence of a doctor-patient relationship.

Medical MalpracticeWorkers' CompensationAffirmative DefenseSpecial EmployeeCoemployeePreclusive EffectTriable Issue of FactDoctor-Patient RelationshipAppellate ReviewHospital Liability
References
7
Case No. ADJ7436407, ADJ1895040 (FRE 0238028)
Regular
Feb 04, 2015

Colleen Newby vs. Fresno Community Medical Center, St. Agnes Medical Center, State Compensation Insurance Fund

The Workers' Compensation Appeals Board denied Colleen Newby's Petition for Removal, upholding the denial of her petition to quash a Qualified Medical Evaluator (QME) request. The Board found that the prior employer, Fresno Community Medical Center, was authorized to file an application for adjudication of claim for Newby's subsequent employment with St. Agnes Medical Center. Crucially, the Board determined that a claim form is not a prerequisite for St. Agnes to request a QME panel in this specific scenario, where a second injury is claimed by a prior employer. Newby's due process claim was rejected as she had an opportunity to present her arguments on removal.

Petition for RemovalPetition to QuashQME RequestQualified Medical EvaluatorClaim FormDue ProcessAgreed Medical EvaluatorApplication for AdjudicationTemporary DisabilityPermanent Disability
References
1
Case No. MISSING
Regular Panel Decision
Sep 15, 1997

Mushatt v. Cayuga Medical Center

Plaintiff appealed a judgment favoring defendants Cayuga Medical Center and the estate of her obstetrician, Frank Flacco, in a medical malpractice case. Plaintiff alleged that negligent care during her son Quandale's birth on August 15, 1990, led to his severe spastic cerebral palsy, mental retardation, and seizure disorder, attributing it to oxygen deprivation caused by a delayed Cesarean section. Defendants argued the oxygen deprivation occurred prior to delivery due to an acute event and chronic condition, and their care met standards. The jury sided with defendants. On appeal, plaintiff challenged the verdict's weight, the application of CPLR 4519 (Dead Man's Statute), the admission of testimony regarding her drug and alcohol use, and a missing witness charge. The Supreme Court Appellate Division affirmed the judgment, finding no errors warranting reversal.

Medical MalpracticeBirth InjuryCerebral PalsyOxygen DeprivationCesarean SectionExpert WitnessDead Man's StatuteCPLR 4519Appellate ReviewNegligence
References
4
Case No. STK 0204368
Regular
Jun 20, 2008

JUDITH KNOX vs. DOCTOR'S MEDICAL CENTER, SPECIALTY RISK SERVICES

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a prior finding that the applicant did not sustain a cumulative trauma injury. The Board found the Agreed Medical Evaluator's (AME) opinion lacked substantial evidence due to an incomplete medical history regarding the applicant's actual job duties and work schedule. The case is returned to the trial level for further development of the record, including a supplemental report from the AME.

Workers' Compensation Appeals BoardCumulative TraumaAgreed Medical EvaluatorSubstantial EvidenceMedical OpinionCausationReturn to Trial LevelFurther Development of RecordRescinded OrderSupplemental Report
References
6
Case No. MISSING
Regular Panel Decision

NYSA-ILA Medical & Clinical Services Fund Ex Rel. Capo v. Catucci

The NYSA-ILA Medical & Clinical Services Fund, an employee medical services fund, sued Sabato Catucci and his three sons for allegedly withholding payments from Saleo Trucking Corporation to the fund. This action followed a prior judgment against the corporation for delinquent contributions. The plaintiff sought to hold the defendants personally liable under alter ego, breach of ERISA fiduciary duty, and embezzlement theories. The court granted summary judgment to the plaintiff on the breach of ERISA fiduciary duty claim against Sabato Catucci, finding him to be a fiduciary who misused plan assets. However, claims against his sons were dismissed due to lack of sufficient control over the corporation. The alter ego claim against Sabato Catucci will proceed to trial, and the embezzlement claim was dismissed for not supporting a private civil cause of action.

ERISA Fiduciary DutyAlter Ego LiabilityCorporate Veil PiercingDelinquent ContributionsSummary JudgmentEmployee Benefit PlanMultiemployer FundSelf-DealingCorporate ControlLabor Law
References
32
Case No. MISSING
Regular Panel Decision

Equal Employment Opportunity Commission v. Grief Bros.

This employment discrimination case, filed July 1, 2002, involves Michael Sabo (Plaintiff) who alleges constructive discharge based on sexual harassment and claims severe emotional pain and suffering. The Defendant moved for a mental examination of Sabo under Fed.R.Civ.P. 35 and to compel the production of his medical records. Sabo alleged severe humiliation, anxiety, depression, loss of self-esteem, sleeplessness, and weight gain, and admitted to a history of depression, past suicide attempts, and current psychiatric treatment with prescribed medications. The court granted the Defendant's motions, finding that Sabo had placed his mental condition in controversy due to the nature and severity of his claims and his medical history, justifying both the examination and the production of relevant medical records. The court also granted Defendant's request for costs associated with compelling the medical records, but denied the request for costs related to the Rule 35 motion itself, and denied Plaintiff's request for counsel or recording during the examination.

Employment DiscriminationSexual HarassmentConstructive DischargeEmotional DistressMental ExaminationRule 35Medical RecordsDepressionSuicide AttemptsCompensatory Damages
References
11
Case No. ADJ9818602
Regular
May 04, 2016

MIGUEL RAMIREZ vs. LABOR FINDERS STAFFING; ACE AMERICAN INSURANCE COMPANY; administered by ESIS

Applicant Miguel Ramirez sought reconsideration of a prior award finding temporary disability only from December 12, 2014, to January 12, 2015, stemming from a right leg injury. He argued the WCJ improperly relied on the treating physician's report releasing him from care and excluding his own medical evidence. The Board denied reconsideration, affirming the prior finding. The Board found Ramirez waived objections to the initial medical report by not raising them at trial and that subsequent medical opinions lacked substantial evidence due to incomplete histories, particularly neglecting his prior release from care and subsequent employment.

Petition for ReconsiderationFindings and Awardtemporary disabilityprimary treating physicianadmissible evidencesubstantial evidencestricken exhibitsreturn to full dutymedical treatmentWCJ
References
6
Case No. ADJ8424952
Regular
Sep 10, 2014

ALFONSO CRUZ vs. SIERRA CIRCUITS, INC.; THE HARTFORD

This case involves an applicant's petition for removal regarding deposition questions about medical history and insurance coverage. The Workers' Compensation Appeals Board (WCAB) granted the petition in part, allowing questions about medical insurance and personal doctors, as these are discoverable under CCP § 2017.010. However, the WCAB found questions about past medical treatment paid by others and prior hospitalizations to be overbroad, as they could infringe on the physician-patient privilege regarding unrelated conditions. The Board ordered the applicant to answer specific questions but requires defendants to reframe broader questions concerning medical history to avoid privileged information.

Petition for RemovalFifth AmendmentFirst Amendmentphysician-patient privilegeconfidential communicationindustrial injurymedical historydeposition questionsCode of Civil Procedure section 2017.010Evidence Code sections 990
References
3
Case No. ADJ7844540
Regular
Nov 04, 2011

LOURDES MALDONADO vs. JEWISH FAMILY AND CHILDREN'S SERVICES, SPARTA INSURANCE

This case concerns an applicant who sustained an industrial injury to her right knee and foot. The defendant sought reconsideration of a previous award of temporary disability and medical care. The defendant argued the applicant failed to utilize the QME process, that the medical opinion evidence was unsubstantial regarding the necessity of surgery, and that the treating physician's report was flawed due to an incorrect medical history. The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior award, returning the matter to the trial level for further development of the record. This decision was based on the WCJ's recommendation to allow for further development of evidence, particularly regarding previously undisclosed medical records concerning prior ankle injuries.

Petition for ReconsiderationFindings and AwardIndustrial InjuryRight KneeRight FootTemporary DisabilityMedical TreatmentQME ProcessLabor Code Section 4062Treating Physician
References
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