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

Case No. ADJ4378069 (AHM 0085676) ADJ2997222 (AHM 0085721)
Regular
Jun 09, 2010

LARRY LAZAR vs. HOME DEPOT, Permissibly Self-Insured

The Workers' Compensation Appeals Board denied the applicant's petition for removal and dismissed his petition for disqualification of the judge. The applicant argued that his treating physician's reports constituted substantial evidence and questioned the need for a court-appointed regular physician. The Board found that the judge correctly followed procedures for supplementing the medical record and that the existing reports lacked substantial evidence. Therefore, the Board upheld the judge's appointment of a regular physician.

Workers Compensation Appeals BoardPetition for RemovalPetition for DisqualificationRegular PhysicianLabor Code Section 5701Findings and OrderIndustrial InjuryPermanent DisabilitySubstantial EvidenceTreating Physician
References
1
Case No. ADJ9749961
Regular
Oct 11, 2017

ROMEL MAAIA vs. REDNECK TRAILER SUPPLY, INC., NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURG, PA.

In this workers' compensation case, the Appeals Board granted reconsideration to address the applicant's entitlement to treat outside the defendant's Medical Provider Network (MPN). The defendant contested that the applicant's chosen physician, Dr. Shaw, qualified as a "regular physician" under Labor Code section 4600(d). Specifically, the defendant argued the applicant failed to prove the predesignation notice was submitted to the employer before the injury, and that Dr. Shaw was indeed the applicant's regular physician who retained his records. The Board found the record insufficient to definitively rule on these issues and remanded the case to the WCJ for further development of the evidence.

Predesignation of Personal PhysicianMedical Provider NetworkRegular PhysicianLabor Code section 4600Workers' Compensation Appeals BoardFindings of FactOpinion and Decision After ReconsiderationDevelop the RecordDue ProcessNimish Shah M.D.
References
1
Case No. 533089
Regular Panel Decision
Oct 07, 2021

Matter of Barden v. General Physicians PC

Claimant, a patient services representative, sought to amend her workers' compensation claim to include left shoulder aggravation after a work-related injury to her right shoulder. The Workers' Compensation Board disallowed this request, finding that claimant failed to provide sufficient credible medical evidence to establish a causal relationship between her employment and the left shoulder condition. The Appellate Division, Third Department, affirmed the Board's decision. The court noted that the claimant's treating physician opined the left shoulder pathology was largely preexisting and unrelated to the work injury, and other medical opinions either lacked sufficient weight or were based on inaccurate information, providing no basis to disturb the Board's finding.

Workers' CompensationShoulder InjuryCausationMedical EvidencePreexisting ConditionAppellate ReviewBoard DecisionClaim AmendmentPatient Services Representative
References
10
Case No. MISSING
Regular Panel Decision
Apr 07, 1988

De Coste v. Champlain Valley Physicians Hospital

Decedent, Darwin A. De Coste, experienced chest pain and elevated blood pressure, leading him to Champlain Valley Physicians Hospital where he was seen by Dr. William Amsterlaw. Amsterlaw diagnosed reflux esophagitis despite an abnormal electrocardiogram, discharging De Coste, who subsequently suffered a fatal cardiopulmonary arrest 12 hours later. The administrator of De Coste's estate filed a wrongful death action, alleging medical malpractice and that the misdiagnosis was the proximate cause of death. A jury awarded pecuniary damages and funeral expenses, which the defendants appealed. The appellate court affirmed the verdict, finding rational support for the jury's malpractice finding and rejecting the defendants' argument to reduce the award by Social Security benefits due to the effective date of CPLR 4545 (c).

Medical MalpracticeWrongful DeathProximate CauseCollateral Source RuleCPLR 4545Jury VerdictEmergency Room CareMisdiagnosisArteriosclerosisMyocardial Infarction
References
3
Case No. MISSING
Regular Panel Decision

Tesillo v. Emergency Physician Associates, Inc.

Manuel Tesillo sued Emergency Physician Associates, Inc. (EPA) for medical malpractice, alleging vicarious liability for the negligence of Dr. William C. Shepherd, an emergency physician at Schuyler Hospital. EPA moved for summary judgment, arguing Dr. Shepherd was an independent contractor. The court found material issues of fact regarding the extent of EPA's control over Dr. Shepherd and its managerial obligations to the Emergency Department, which could establish an employer-employee relationship despite contractual terms. Consequently, the court denied EPA's motion for summary judgment, indicating that the determination of Dr. Shepherd's employment status requires further discovery and possibly a trial.

Medical MalpracticeVicarious LiabilityRespondeat SuperiorIndependent ContractorAgency by EstoppelSummary JudgmentPhysician NegligenceEmergency DepartmentControl TestMaterial Issues of Fact
References
18
Case No. ADJ7507238
Regular
Dec 27, 2011

GERARDO SANCHEZ vs. MARVIN ENGINEERING COMPANY, TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) affirmed an Administrative Law Judge's (ALJ) order appointing a regular physician to examine the applicant. The defendant argued this order was improper and would cause prejudice. The WCAB found the defendant's petition for reconsideration and removal was without merit, upholding the ALJ's decision to appoint a physician to address deficiencies in existing medical reports. The WCAB determined that the defendant failed to demonstrate irreparable harm or substantial prejudice to warrant removal.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalOrder Appointing Regular PhysicianLabor Code Section 5701Medical Legal ExamPermanent DisabilityApportionmentAlmaraz/GuzmanQualified Medical Evaluator
References
10
Case No. ADJ13010543
Regular
Oct 26, 2020

THONG TO vs. BENCHMARK ELECTRONICS, INC., TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA, TRAVELERS SACRAMENTO

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a Workers' Compensation Judge's (WCJ) order appointing a regular physician. The WCAB found that the WCJ's order to develop the record by appointing a physician was premature and not supported by a clear dispute. The Board clarified that if a dispute arises requiring medical evaluation, parties can utilize the Qualified Medical Evaluator (QME) process. Alternatively, if treatment is disputed, the applicant can seek intervention through a Declaration of Readiness to Proceed.

WCABPetition for ReconsiderationFindings and OrderStipulated AwardInadequate AwardMaximum Medical ImprovementLabor Code Section 5701Develop the RecordRegular Treating PhysicianAOE/COE
References
8
Case No. ADJ2167155 (VNO 0443514)
Regular
Oct 17, 2013

Thomas David Williams vs. MAKENZIE ELECTRICAL INC., STATE COMPENSATION INSURANCE FUND

The Appeals Board remanded the case for further development of the record concerning the applicant's claimed injury to psyche/PTSD. The prior findings were not based on substantial evidence due to an inadequate medical history and stale opinions from the evaluating physician, Dr. Glaser. The Board ordered a new evaluation by an Agreed Medical Evaluator or a regular physician to address the complex psychological issues, including PTSD, substance abuse, and potential organic brain injury. After this evaluation, the matter will return to the judge for a new decision incorporating all relevant findings.

Workers' Compensation Appeals BoardReconsiderationPsyche/PTSDSubstantial EvidenceAgreed Medical EvaluatorLabor Code section 5701Findings and AwardWCJPermanent DisabilityApportionment
References
0
Case No. MISSING
Regular Panel Decision

Bernhard v. Hartsdale Fire District

The petitioner initiated a CPLR article 78 proceeding to challenge a determination by the Board of Fire Commissioners of the Hartsdale Fire District, which denied him benefits under General Municipal Law § 207-a. The court confirmed the determination and dismissed the proceeding, holding that eligibility for a disability pension under Retirement and Social Security Law § 363-c does not automatically grant supplemental wage benefits. The court emphasized that entitlement to General Municipal Law § 207-a benefits requires both a line-of-duty injury and physical inability to perform regular duties. Despite a workers’ compensation finding of injury, the petitioner continued performing regular duties until retirement. The Board's decision, supported by medical evidence from the respondent's physician, found the petitioner not disabled, a finding upheld by the court.

Disability BenefitsFirefighter BenefitsGeneral Municipal LawRetirement and Social Security LawCPLR Article 78Judicial ReviewMunicipal EmployerPhysical Inability to WorkMedical EvidenceWorkers' Compensation Board
References
10
Case No. MISSING
Regular Panel Decision

Choi v. State

The petitioner, a physician, initiated a CPLR article 78 proceeding to challenge a determination by the Commissioner of Education to suspend his medical license. The charges of professional misconduct stemmed from prior findings by the Department of Social Services (DSS) and the Department of Health (DOH) regarding unacceptable patient care, inappropriate treatment, excessive testing, and operating a clinical laboratory without a permit. The Regents Review Committee, utilizing an expedited procedure, found the petitioner guilty of two specifications based on the DSS determination and recommended a two-year license suspension, with a partial stay and probation. The court affirmed the Commissioner's determination and dismissed the petition, rejecting the petitioner's arguments against the application of collateral estoppel, the propriety of the expedited procedure, and the claim of ineffective assistance of counsel in the preceding administrative hearings. The court also upheld the penalty imposed, deeming it not excessive or an abuse of discretion.

Professional MisconductPhysician License SuspensionCPLR Article 78Collateral EstoppelExpedited ProcedureIneffective Assistance of CounselDepartment of Social ServicesDepartment of HealthAdministrative LawProfessional Regulation
References
4
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