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Case Law Database

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

Case No. 2016-03-0759
Regular Panel Decision
Feb 24, 2017

Lively, Jason v. Prudential Security, Inc.

Jason Allen Lively, a security officer, injured his shoulder while restraining a combative patient. Prudential Security, Inc. accepted the shoulder claim, and Mr. Lively was treated by Dr. Jon MacNaughton. Subsequently, Mr. Lively obtained independent medical evaluations from Dr. C.M. Salekin and Dr. William Kennedy, both of whom suggested he suffered from depression/anxiety related to the chronic pain from his work injury and recommended a psychological evaluation. However, Dr. MacNaughton, the authorized treating physician, never referred Mr. Lively for a psychological evaluation and his notes did not reflect psychological symptoms. The Court, interpreting Tennessee Code Annotated section 50-6-204(h), ruled that psychological services require a referral from an authorized treating physician. Consequently, Mr. Lively's request for a psychological evaluation was denied.

Workers' Compensation ClaimShoulder InjuryPsychological EvaluationMental InjuryAuthorized Treating PhysicianMedical BenefitsExpedited HearingStatutory InterpretationReferral RequirementChronic Pain
References
3
Case No. MISSING
Regular Panel Decision

Main Evaluations, Inc. v. State

The claimant, Main Medical Evaluations, entered into contracts with the New York State Office of Temporary and Disability Assistance (OTDA) to perform consultative medical evaluations. OTDA terminated these contracts, alleging the claimant failed to disclose professional disciplinary proceedings against its chief medical officer, Arvinder Sachdev, and submitted false information during the bidding process. Following the dismissal of its claim in the Court of Claims, the claimant appealed. The appellate court affirmed the lower court's judgment, concluding that OTDA had legitimate grounds for termination due to the claimant's misrepresentations and failure to report substantial contract-related issues concerning Sachdev's integral role. Additionally, the court rejected the claimant's equal protection argument, finding no evidence of selective enforcement based on impermissible considerations.

Contract TerminationProfessional MisconductFalse RepresentationEqual ProtectionGovernment ContractsAppellate ReviewBreach of ContractMedical LicensingAdministrative ProceedingsDue Diligence
References
5
Case No. MISSING
Regular Panel Decision

Davis v. Medical Evaluation Specialists, Inc.

Justice Wilson dissents from the majority's decision on a motion for rehearing, arguing that the majority improperly considered non-evidence and engaged in speculation. The dissent contends that Lennie Davis's controverting affidavit by Dr. Bergeron, which stated a 17% impairment rating compared to the defendants' 0%, was conclusory and insufficient to establish bad faith by Medical Evaluation Specialists, Inc., Dr. DeFrancesco, and Dr. Dozier. Justice Wilson believes that the affidavit failed to meet the objective 'no reasonable doctor' standard for controverting good faith, and therefore, the trial court's summary judgment in favor of the defendants should have been affirmed based on official immunity.

Summary JudgmentOfficial ImmunityGood FaithImpairment RatingMedical AffidavitConclusory StatementsTexas Workers' Compensation ActAppellate ReviewDissenting OpinionPermanent Disability
References
7
Case No. MISSING
Regular Panel Decision

Clear Water Psychological Services PC v. American Transit Insurance Co.

Plaintiff Clear Water Psychological Services PC sought no-fault benefits from defendant American Transit Insurance Company. The plaintiff moved for summary judgment, while the defendant cross-moved for a 90-day stay, arguing that the assignor, Oshane Crooks, was acting as an employee at the time of the November 10, 2014 automobile accident, falling under Workers’ Compensation Board jurisdiction. A key issue was the admissibility of an uncertified police accident report (MV-104AN) which suggested the assignor was driving a taxi. The court ruled the uncertified report inadmissible under CPLR 4518 (c) for authentication reasons, despite the officer's personal observations. However, acknowledging the unresolved factual question of the assignor’s employment status and the Workers’ Compensation Board's primary jurisdiction, the court granted the defendant’s motion, staying the action for 90 days for a Workers’ Compensation Law applicability determination.

No-fault benefitsSummary judgmentStay of actionWorkers' CompensationPolice accident reportAdmissibility of evidenceCPLR 4518Vehicle and Traffic LawPrimary jurisdictionEmployment status
References
12
Case No. MISSING
Regular Panel Decision

55th Management Corp. v. Goldman

This case addresses whether an out-of-court statement made to a court evaluator in an Article 81 guardianship proceeding is protected by absolute privilege, thereby defeating a defamation claim. The defendant, a tenant, made allegedly defamatory remarks about a landlord to a court evaluator during the evaluator's investigation for a guardianship proceeding. The court considered if the remarks were pertinent, if a statement to a court evaluator is considered part of a judicial proceeding, and if the speaker had standing. The court found the remarks pertinent, extended the absolute privilege to statements made to court evaluators given their role as court agents, and affirmed the defendant's standing as a potential witness. Consequently, the defendant's motion to dismiss the defamation complaint was granted.

DefamationAbsolute PrivilegeJudicial ProceedingsCourt EvaluatorGuardianshipMental Hygiene Law Article 81Tenant-Landlord DisputeMotion to DismissCPLR 3211 (a) (7)Scope of Privilege
References
44
Case No. 2015-455 K C
Regular Panel Decision
Dec 19, 2017

Metro Psychological Servs., P.C. v. Travelers Prop. & Cas. Ins. Co.

This case involves Metro Psychological Services, P.C., as an assignee, seeking first-party no-fault benefits from Travelers Property & Casualty Insurance Company. The defendant moved for summary judgment, arguing the assignor's injuries occurred during employment, which would make workers' compensation benefits applicable. The Civil Court denied the defendant's motion and granted the plaintiff's cross-motion for summary judgment. The Appellate Term reversed this order, concluding there was an unresolved issue as to whether the plaintiff's assignor was acting in the course of employment at the time of the accident. Consequently, the matter was remitted to the Civil Court to be held in abeyance, pending a determination by the Workers' Compensation Board regarding the parties' rights under the Workers' Compensation Law, underscoring the Board's primary jurisdiction in such matters.

No-Fault BenefitsWorkers' Compensation LawPrimary JurisdictionAbeyanceSummary JudgmentAppellate ReviewInsurance DisputeMedical ProviderAssigneeCourse of Employment
References
9
Case No. 2021 NY Slip Op 04626 [197 AD3d 518]
Regular Panel Decision
Aug 04, 2021

D. S. v. Positive Behavior Support Consulting & Psychological Resources, P.C.

This case involves an appeal by the Port Jefferson School District from an order denying its motion to dismiss a personal injury complaint. The infant plaintiff, a special education student, was allegedly injured by a therapist, Vito Silecchia, during a behavioral therapy session. The plaintiffs sued the School District, among others, alleging Silecchia was an employee or agent. The District contended Silecchia was an independent contractor retained through Positive Behavior Support Consulting and Psychological Resources, P.C. The Appellate Division affirmed the Supreme Court's denial of the dismissal motion, stating that the complaint adequately stated a cause of action and that documentary evidence did not conclusively establish an independent contractor relationship, given provisions in the agreement suggesting the District maintained some control over the services.

Personal InjuryRespondeat SuperiorIndependent ContractorMotion to DismissAppellate ReviewVicarious LiabilitySchool District LiabilitySpecial EducationTherapist NegligenceCPLR 3211 (a) (1)
References
25
Case No. 2016-08-1106
Regular Panel Decision
Feb 16, 2018

McDonough, James v. Phillips General and Mechanical

Mr. James McDonough, a steamfitter, suffered a head injury on January 8, 2015, while working for Phillips General and Mechanical (PGM), leading to psychiatric and neurological symptoms. PGM initially accepted the claim but later denied Mr. McDonough's requests for psychological counseling and neurological evaluations, based on opinions from doctors who conducted record reviews and surveillance, suggesting malingering. However, Mr. McDonough's treating psychiatrist, Dr. Jim Pang, who had extensive contact with him, concluded his conditions were work-related and assigned a 15% permanent impairment rating, also recommending further treatment. The Court, prioritizing the treating physician's presumed correctness, found Mr. McDonough likely to prevail and granted his requested benefits for psychological therapy and neurological evaluation.

Head InjuryPsychiatric InjuryNeurological InjuryPost-concussion SyndromeMaximum Medical ImprovementPermanent ImpairmentCausation DisputeTreating Physician PresumptionMedical Records ReviewSurveillance Evidence
References
5
Case No. MISSING
Regular Panel Decision

Sasser v. Kelley

Petitioner Andrew Sasser, convicted of capital murder, sought federal habeas corpus relief due to ineffective assistance of counsel during his sentencing phase. The Eighth Circuit Court of Appeals remanded the case, requiring a determination of whether Sasser was ineligible for the death penalty due to intellectual disability (an Atkins claim) and consideration of four claims of ineffective assistance of counsel. This Court focused on three ineffective assistance claims: failure to prepare for the sentencing phase, failure to obtain a timely psychological evaluation, and failure to meaningfully consult with a mental health professional. The Court found that trial counsel's failure to conduct a thorough investigation, timely obtain a psychological evaluation, and meaningfully consult with a qualified mental health professional constituted ineffective assistance. Consequently, postconviction counsel's failure to raise these claims was also deemed ineffective, excusing procedural default. The petition for habeas corpus relief was granted.

Ineffective assistance of counselHabeas corpusDeath penaltyIntellectual disabilityProcedural defaultAtkins claimSentencing phaseMitigation evidencePsychological evaluationMental health expert
References
26
Case No. ADJ10800397
Regular
May 20, 2019

MARILYN RAMIREZ GALVEZ vs. NIAGARA BOTTLING LLC, SAFETY NATIONAL INSURANCE CO.

The applicant sought a QME panel in psychology for a claimed psychiatric injury after orthopedic and internal medicine evaluations. The WCJ denied the request, finding no substantial medical evidence for a psychological QME. The Appeals Board granted removal, rescinded the WCJ's order, and found good cause for a psychological QME panel. This decision allows the applicant to pursue necessary medical-legal discovery regarding her disputed psychological injury claim.

Petition for RemovalFindings and OrderQualified Medical EvaluatorQME panelpsychologypsychiatric injurydiscoveryinternal medicineorthopedic QMEhypertension
References
1
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