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Case Law Database

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

Case No. ADJ1939880 (LAO 0865897) ADJ1112153 (LAO 0868868)
Regular
Mar 06, 2014

ANTONIO GARCIA VASQUEZ vs. BAGUETTE WORLD, STATE COMPENSATION INSURANCE FUND

In this workers' compensation case, the applicant sought home health care following industrial injuries. The defendant denied authorization via Utilization Review (UR), and the applicant subsequently filed for Independent Medical Review (IMR). The Appeals Board granted the applicant's petition for removal, rescinding the prior order that sent the matter off calendar for IMR. The Board clarified that challenges to the timeliness and procedural validity of UR denials fall under the WCAB's jurisdiction, not IMR. The case is returned to the trial level for an expedited hearing on the validity of the UR decision, with IMR only to proceed if the UR is deemed timely and valid.

Petition for RemovalUtilization ReviewIndependent Medical ReviewWCABWCJOff Calendar OrderHome Health CareDubon v. World RestorationInc.Procedural Defects
References
1
Case No. MISSING
Regular Panel Decision
Sep 03, 1982

Cerrato v. Thurcon Construction Corp.

This case concerns a construction worker (plaintiff) who sustained serious injuries and sued 211 Thompson Corp. (owner) and Thurcon Construction Corp. (general contractor). Defendant 211 Thompson Corp. raised an affirmative defense of lack of personal jurisdiction due to improper service of process. After the Statute of Limitations had expired, plaintiff moved to strike this defense, while 211 cross-moved to dismiss the action as time-barred. Special Term referred the issue of service validity to a referee, but the plaintiff argued for a jury trial on this factual issue. The Appellate Division, Supreme Court, New York County, modified Special Term's order, directing a jury trial on the validity of the service, while otherwise affirming the original determination. The dissenting opinion argued that the right to a jury trial should not be conditioned on the stage of proceedings or the impact of dismissal on the Statute of Limitations, and furthermore, considered the question of authority to accept service as one of law, not fact.

Jury TrialService of ProcessPersonal JurisdictionStatute of LimitationsAffirmative DefenseAppellate ReviewCPLRProcedural LawConstruction AccidentsNew York Courts
References
3
Case No. ADJ4274323 (ANA 0387677), ADJ1601669 (ANA 0388466)
En Banc
Feb 27, 2014

JOSE DUBON vs. WORLD RESTORATION, INC.; STATE COMPENSATION INSURANCE FUND

The WCAB holds that it has jurisdiction over disputes regarding the procedural validity and timeliness of utilization review (UR) decisions, while Independent Medical Review (IMR) is solely for resolving medical necessity. A UR decision with material procedural defects is invalid, and in such cases, the WCAB, not IMR, will determine the medical necessity of the treatment.

Utilization ReviewIndependent Medical ReviewEn Banc DecisionWCAB JurisdictionProcedural DefectsMedical NecessityLabor Code Section 4610Substantial Medical EvidenceMaterial Procedural DefectsInvalid UR Decision
References
17
Case No. SDO 0251396
Regular
May 19, 2008

KENN FINKELSTEIN vs. BUILDERS STAFF CORPORATION, CENTRE INSURANCE COMPANY

The applicant sought reconsideration of a prior Workers' Compensation Appeals Board decision that denied certain medications (Nexium, Lisinopril) and epidural steroid injections, while awarding Lipitor. The Board denied reconsideration, holding that the applicant failed to follow the proper statutory procedure for disputing the employer's utilization review denials. Although there was some question about the validity of the utilization review denial for the injections, the applicant's procedural failure was the decisive factor.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and Award/OrderAdministrative Law Judge (WCJ)Further Medical TreatmentPrescriptive MedicationLipitorNexiumLisinoprilEpidural Steroid Injections
References
5
Case No. ADJ10070672 ADJ10070673 ADJ10070674
Regular
Sep 12, 2018

JOAO GOMEZ vs. JP ELECTRIC SERVICES, INC, NEW YORK MARINE \& GENERAL INSURANCE COMPANY, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a finding of contempt and award of fees against applicant's law firm, Gordon & Gordon. The WCAB found the original order procedurally defective, lacking proper notice and findings for contempt and sufficient documentation for the fee award. While rescinding the sanctions, the WCAB strongly admonished Gordon & Gordon for its repeated failures to appear, stating that proper procedures could have led to valid sanctions. The matter was returned to the trial level for further proceedings.

Petition for ReconsiderationContempt of CourtFee AwardProcedural DefectSubstantive DefectFailure to AppearShow Cause HearingLabor Code Section 5813SanctionsDue Process
References
8
Case No. ADJ3700908 (SRO 0101979) ADJ3874442 (SRO 0098853)
Regular
Jul 18, 2014

Randall Otten vs. Cardinal Newman High School, California Insurance Guarantee Association for Superior National Insurance Company, in liquidation

This case concerns the validity of a Utilization Review (UR) determination regarding the applicant's need for a radiofrequency rhizotomy injection for his low back injury. The Appeals Board reversed the lower judge's decision, finding the UR determination valid. They held that the omission of certain medical reports was not a material procedural defect because they would not have changed the UR physician's conclusion. Furthermore, the Board found the applicant failed to present substantial medical evidence to support the necessity of the treatment or prove the UR was invalid. The issue of medical necessity is now subject to Independent Medical Review (IMR).

Workers' Compensation Appeals BoardUtilization ReviewIndependent Medical ReviewReconsiderationFindings and AwardMaterial Procedural DefectDubonEvidence-Based GuidelinesAgreed Medical EvaluatorTreating Physician
References
6
Case No. ADJ8606940
Regular
Apr 18, 2013

ANGELICA PEREZ vs. PERMANENTE MEDICAL GROUP, INC.

The Workers' Compensation Appeals Board denied defendant's petition for removal or reconsideration regarding the applicant's entitlement to multiple Panel Qualified Medical Examiners (PQMEs). The defendant contested the procedural validity of the applicant's PQME requests, while the applicant asserted proper procedure was followed due to the defendant's lack of response to an Agreed Medical Examiner offer. The Board found that the February 4, 2013 notation was not a final order, as PQME requests remained pending with the Medical Unit. Therefore, the petition was denied without prejudice to the Medical Unit's future determination on the propriety of the PQME requests.

Panel Qualified Medical ExaminersPQMEPetition for RemovalPetition for ReconsiderationIndustrial InjuryCumulative InjuryAgreed Medical ExaminerAMEMedical UnitAdministrative Law Judge
References
0
Case No. 73 Civ. 1540
Regular Panel Decision
Jan 21, 1980

Kirkland v. NY STATE DEPT. OF CORRECTIONAL SERVICES

This case, on remand from the Second Circuit, addresses the constitutionality of a new examination (No. 36-435) for correctional sergeants and a proposed 250-point score adjustment for minority applicants. Plaintiffs and defendants sought approval of the exam and summary judgment against intervenors who opposed the score adjustment and the job performance evaluation component. The U.S. District Court, Southern District of New York, granted both requests, finding the revised examination procedure compliant with EEOC Guidelines and federal anti-discrimination laws, and the job performance rating sufficiently objective under state law, concluding that the score adjustment was not an impermissible quota but rather served to balance the examination's validated procedure.

Employment DiscriminationCorrectional ServicesCivil Service ExamsAffirmative ActionSummary JudgmentEEOC GuidelinesTest ValidityMinority PreferenceJudicial ReviewFederal Court
References
6
Case No. MISSING
Regular Panel Decision
Oct 02, 1991

Save Audubon Coalition v. City of New York

This case involves petitioners challenging the City of New York's approvals for the Audubon Research Park project in Manhattan, alleging violations of the State Environmental Quality Review Act (SEQRA), City Environmental Quality Review Act (CEQR), and Uniform Land Use Review Procedure (ULURP). Petitioners specifically contested amendments to the Zoning Resolution permitting biological research in C6 zones and the site-specific approvals for the Audubon Research Building, claiming environmental impact statements (EIS) were flawed regarding public health and safety and that public notice was inadequate. The court determined that respondents had adequately addressed environmental concerns, provided reasoned elaborations, and fulfilled public notice requirements, despite minor procedural omissions. Consequently, the lower court's judgment was affirmed, validating the Board of Estimate's rationally based and non-arbitrary decisions.

Environmental ReviewZoning AmendmentsLand Use PlanningSEQRACEQRULURPPublic HearingsManhattan DevelopmentUrban RenewalBiomedical Research Facilities
References
8
Case No. MISSING
Regular Panel Decision

Ciago v. Ameriquest Mortgage Co.

Plaintiff Angela Ciago sued Ameriquest Mortgage Company for alleged violations of the Fair Labor Standards Act (FLSA) and New York state law, seeking unpaid overtime wages and alleging retaliation. Ameriquest moved to dismiss the action and compel arbitration, citing an arbitration agreement signed by Ciago as a condition of her employment. Ciago challenged the agreement's validity, arguing it was unconscionable due to procedural and substantive flaws, implicitly waived her right to a jury trial, contained restrictive notice and fee-splitting provisions, and limited discovery. The court, applying the Federal Arbitration Act and New York contract law, found that the parties had a valid agreement to arbitrate that encompassed Ciago's claims. It rejected Ciago's arguments, holding that FLSA claims are arbitrable and that the enforceability of specific provisions within the agreement, as well as potential arbitration costs, were matters for the arbitrator to decide. Therefore, the court granted Ameriquest's motion to dismiss the action and compel arbitration.

Arbitration AgreementFair Labor Standards ActFederal Arbitration ActOvertime WagesRetaliation ClaimUnconscionabilityProcedural UnconscionabilitySubstantive UnconscionabilityJury Trial WaiverForum Selection Clause
References
34
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