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

Case No. ADJ7197363
Regular
Feb 11, 2014

NARCISO NOVA vs. JC SALES, dba SHIMS BARGAIN, LIBERTY MUTUAL INSURANCE COMPANY

This case concerns a lien claimant, California Psychological Associates, seeking reconsideration for disallowed costs of psychological treatment for applicant Narciso Nova. The Workers' Compensation Appeals Board denied the petition, adopting the Administrative Law Judge's report. The judge found no evidence of an injury to the psyche or that the psychological treatment was medically necessary for the admitted cervical spine injury. Furthermore, the psychological reports were not incorporated into any primary treating physician reports, and treatment began nearly two years after the applicant reached maximum medical improvement.

WCABPetition for ReconsiderationPsychological treatmentMedical necessityPrimary treating physicianMaximum medical improvementLien claimantStipulations with Request for AwardPermanent disabilityReferral
References
0
Case No. MISSING
Regular Panel Decision

Valley Psychological, P.C. v. Liberty Mutual Insurance

Plaintiff, Valley Psychological, P.C., provided psychological services to a woman involved in a motor vehicle accident, with claims assigned to plaintiff and covered by defendant, Liberty Mutual Insurance. Defendant denied these claims more than 30 days after receipt, leading plaintiff to file a commercial claim. Defendant asserted a provider fraud defense, alleging improper supervision by plaintiff's principal psychologist. Both City Court and County Court dismissed the claim based on the fraud defense, ruling that the untimely denial did not preclude this defense. However, this Court reversed, holding that defendant's untimely denial did preclude the fraud defense, as it pertained to excessive treatment rather than a strict lack of coverage. The matter was remitted to the City Court of the City of Albany to determine the judgment amount in plaintiff's favor.

no-fault insuranceuntimely denialfraud defensemedical services providerpreclusion doctrinelack of coverageexcessive treatmentworkers' compensation schedulescommercial claimappellate review
References
8
Case No. ADJ1824746 (AHM 0146484) ADJ3300397 (AHM 0146486)
Regular
May 06, 2013

DIONISIO VASQUEZ vs. V CLAD LAMINATES, INC., PENNSYLVANIA MANUFACTURES ASSOC. INSURANCE CO., VIRGINIA SURETY

The Workers' Compensation Appeals Board affirmed the prior award for applicant Dionisio Vasquez's psychological injury, upholding the lien of Psychological Assessment Services for $22,772.71 plus penalties and interest. The Board also affirmed the lien of Royal Medical Group for treatment and reports dated December 8, 2007, and January 5, 2008, but excluded payment for a September 27, 2008 report. While the majority found substantial evidence supported the psychological treatment, a dissenting opinion argued that the number and intensity of therapy sessions, and the delay in treatment, lacked sufficient evidentiary support.

Workers Compensation Appeals BoardReconsiderationIndustrial InjuryPsycheHandsV Clad LaminatesPennsylvania ManufacturersVirginia SuretyPsychological Assessment ServicesRoyal Medical Group
References
0
Case No. ADJ9186468
Regular
Jan 13, 2017

LORENA GUERRA vs. FALLAS PADERES/NATIONAL STORES, INC. & HARTFORD INSURANCE COMPANY, GALLAGHER BASSETT SERVICES, INC.

This case involves a workers' compensation applicant seeking further medical treatment for a psychological injury exacerbated by her employment. The administrative law judge (WCJ) previously found that while the applicant sustained an industrial injury to her psyche and internal systems due to work stress and aggravation of Turner's Syndrome, she no longer required further treatment. The applicant appealed, arguing that the WCJ improperly apportioned treatment to her pre-existing condition. However, the Appeals Board denied the reconsideration petition, finding substantial medical evidence from a Qualified Medical Evaluator (QME) indicating that the applicant reached a stationary status regarding her industrial psychological injury in June 2013 and no longer required further treatment for that specific injury. The Board also noted that the medical opinions did not support an acceleration of the applicant's pre-existing Turner's Syndrome.

Workers' Compensation Appeals BoardFindings and AwardPsyche InjuryTurner's SyndromeMedical TreatmentQualified Medical EvaluatorApportionmentSubstantial EvidenceHysterectomyAcceleration
References
3
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. 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. ADJ1629506
Regular
Sep 18, 2014

MARIA MURILLO vs. HACIENDA HOTEL, US FIRE INSURANCE COMPANY, CRUM & FORSTER, ELENA KONSTAT, PHD

This case involves a lien claim by Dr. Elena Konstat for $35,443.85 for psychological treatment provided to applicant Maria Murillo. The WCAB denied reconsideration of the WCJ's order disallowing the lien. The WCJ found that the psychological treatment was not causally related to the applicant's industrial orthopedic injury, especially since a prior award found no psyche injury and the issue of medical-legal charges was not raised at trial.

Workers' Compensation Appeals BoardPetition for ReconsiderationMedical-legal chargesLien ClaimantFindings and OrderPermanent disabilityOrthopedic injuriesPsyche injurySuicidal tendenciesAdmissible evidence
References
3
Case No. ADJ9176746, ADJ10288149
Regular
Jan 05, 2018

ANA MARIA ROCHA vs. GREEN VALLEY CHRISTIAN CENTER, CHURCH MUTUAL INSURANCE COMPANY

This case involves Ana Maria Rocha's petition for reconsideration of a Workers' Compensation Appeals Board decision. The Board denied reconsideration, adopting the Administrative Law Judge's report. The applicant's primary contentions involved a separate psychological injury, her CRPS classification, apportionment of disability, and future medical treatment for her neck and back. The Judge found no separate psychological injury, that medical opinions on CRPS classification were for physicians, that apportionment was supported by substantial evidence regarding pre-existing conditions, and that further medical treatment was not warranted for her neck and back.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeniedAdministrative Law JudgePsychological InjuryPermanent DisabilityApportionmentCRPSWhole Person ImpairmentAMA Guides
References
3
Case No. ADJ1560752
Regular
Sep 09, 2025

EUGENE FLOWERS vs. RAY MAC PAINTING, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) affirmed the January 12, 2021 Findings and Award (F&A) in the case of Eugene Flowers, who sustained an industrial injury to his right shoulder and subsequently alleged a psyche injury. Defendant State Compensation Insurance Fund sought reconsideration, contesting the reasonableness of treatment provided by lien claimant Behavioral Medicine and Health Psychology, liability for statutory increase and interest, and the validity of the lien due to declaration requirements. The WCAB, adopting the WCJ's report, concluded that the applicant's psyche injury was a compensable consequence, the psychological treatment was medically necessary and reasonable, and the lien was not barred by the late filing of the declaration under Labor Code section 4903.8(d). Consequently, the F&A, which ordered payment for adjusted charges along with statutory interest and increase, was upheld.

ReconsiderationFindings and AwardBehavioral Medicine and Health Psychologyindustrial injurypsychemedically reasonablenecessarystatutory increaseinterestlien claimant
References
6
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