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

Case No. ADJ237189 (RIV 0058701)
Regular
May 22, 2009

DONALD K. SMITH vs. CITY OF SANTA ANA

This case concerns an applicant's attorney's petition for reconsideration regarding appellate costs and attorney's fees. The Workers' Compensation Appeals Board affirmed its prior decision, which had affirmed the finding of industrial injury to the heart and prostate but barred the skin cancer claim due to the statute of limitations. The Board ordered the applicant's attorney to reimburse the applicant $390 improperly solicited and received, while ordering the defendant to pay appellate costs of $382.79 upon confirmation of the reimbursement. The Board declined to increase the attorney's fee, finding it already exceeded typical ranges and that the attorney had not demonstrated entitlement to more.

Workers' Compensation Appeals BoardReconsiderationRemittiturStatute of LimitationsSkin CancerHeart InjuryProstate CancerPermanent DisabilityAttorney's FeeAppellate Costs
References
2
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. ADJ2185374 (LAO 0844306)
Regular
May 15, 2014

JOHN DEL PINTO vs. CITY OF LOS ANGELES

The Workers' Compensation Appeals Board affirmed an arbitrator's decision regarding reimbursement between two cities for medical treatment costs. The arbitrator awarded the City of Glendale 50% reimbursement from the City of Los Angeles for medical payments made. However, the arbitrator denied Glendale reimbursement for cost-containment expenses like bill review and utilization review. Glendale's petition for reconsideration, arguing for full apportionment recovery and reimbursement of cost-containment costs, was denied. The Appeals Board adopted the arbitrator's reasoning, affirming the original award.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardLien ClaimantReimbursementApportionmentAgreed Medical EvaluatorMedical Bill ReviewUtilization ReviewCost-Containment Expenses
References
0
Case No. MISSING
Regular Panel Decision

Poupard v. Mohonasen Central School District

The claimant, a librarian, sustained an employment-related injury. Following her injury, she received full salary for 27 weeks under a collective bargaining agreement, and then used 23 days of accumulated sick leave. The employer sought reimbursement for these advance payments. The referee and the Workers’ Compensation Board initially granted the full reimbursement. On appeal, the court modified the decision, holding that wages paid from accumulated sick leave, acquired through a collective bargaining agreement, are compulsory payments and thus not reimbursable under Workers’ Compensation Law § 25 (subd 4, par [a]). The matter was remitted for further proceedings consistent with this ruling, with costs awarded to the claimant.

Workers' CompensationReimbursementSick LeaveCollective Bargaining AgreementAdvance PaymentsOccupational DisabilityStatutory LimitationsAppellate ReviewEmployment InjuryReferee Decision
References
5
Case No. MISSING
Regular Panel Decision

Frances Schervier Home & Hospital Inc. v. Axelrod

This case concerns an appeal regarding Medicaid reimbursement rates for a residential health care facility. The Department of Health (DOH) disallowed certain costs from the petitioner's 1981 cost report, affecting 1983-1985 rates. Petitioner appealed, arguing it was a data error, not an alternative cost allocation method requiring prior approval. After DOH denied the appeal, the Supreme Court annulled DOH's determination, ruling in favor of the petitioner. The Appellate Division affirmed the Supreme Court's decision, finding DOH's interpretation of its regulations regarding data error corrections to be irrational.

Medicaid reimbursement ratescost reportDepartment of Healthresidential health care facilityCPLR article 78administrative lawdata errorcost allocationagency interpretationirrational interpretation
References
2
Case No. MISSING
Regular Panel Decision

New York City Board of Education v. Ambach

This CPLR article 78 proceeding challenged a determination by the Commissioner of Education. The Commissioner ordered the petitioner, the Committee on the Handicapped, District 28 (COH), to reimburse Marilyn P. for tuition and maintenance costs for her handicapped child. The COH had initially found the child not handicapped and failed to provide timely formal written notice of its determination to the mother, violating Education Law regulations. An independent hearing officer reversed the COH's finding but denied reimbursement. Upon appeal, the Commissioner affirmed the handicapped finding and ordered reimbursement due to the COH's procedural violations. The court upheld the Commissioner's finding that the child was handicapped and the entitlement to reimbursement, citing a rational basis for the decision and deference to the agency's interpretation. However, the court modified the determination, annulling the order for the petitioner to pay the full cost, and remitted the matter for apportionment of costs between the petitioner and the State of New York, as per Education Law sections 4405 and 4407.

CPLR Article 78Administrative ReviewEducation LawHandicapped Child PlacementTuition ReimbursementProcedural Due ProcessNotice RequirementsTimeliness ViolationsAgency DeferenceCost Apportionment
References
10
Case No. ADJ7427357; ADJ7427846 ADJ7427807; ADJ7427721 ADJ7427560; ADJ7429915 ADJ7429913; ADJ7429912 ADJ7427816; ADJ7427731 ADJ7427716; ADJ7427554 ADJ7429914; ADJ7427420
Regular
Apr 12, 2012

DELVIN WILLIAMS vs. SAN FRANCISCO 49ERS and ARGONAUT INSURANCE COMPANY and FIREMAN'S FUND INSURANCE COMPANY, MIAMI DOLPHINS, Permissibly Self-Insured, Administered by MULTI-LINE CLAIMS SERVICE, GREEN BAY PACKERS and HIGHLANDS INSURANCE GROUP, in Receivership

This case concerns a professional football player seeking reimbursement for medical-legal costs incurred in his workers' compensation claims against multiple teams. The Appeals Board granted the applicant's petition for removal, rescinding a prior order that denied these costs. The Board held that a statute of limitations defense does not bar reimbursement of reasonable medical-legal expenses if the applicant is determined to be an employee. However, subject matter jurisdiction issues with certain defendants require further adjudication, and the San Francisco 49ers, who do not dispute jurisdiction, are ordered to reimburse these costs pending further proceedings.

Petition for RemovalMedical-Legal CostsStatute of LimitationsSubject Matter JurisdictionAffirmative DefenseCumulative Trauma InjurySpecific InjuriesDeclaration of Readiness to ProceedMandatory Settlement ConferencePretrial Conference Statement
References
6
Case No. MISSING
Regular Panel Decision
Sep 17, 1980

Bass v. Westchester Concrete, Inc.

This case involves an appeal from a Workers’ Compensation Board decision, which was initially filed on March 14, 1980, and later amended on September 17, 1980. The employer's insurance carrier sought reimbursement from the Special Disability Fund under Workers’ Compensation Law § 15(8), claiming a known prior physical impairment of bilateral deafness in the claimant. The record established that the claimant's total disability stemmed from a severe psychoneurotic disorder, with a pre-existing psychiatric condition materially and substantially exacerbating the present disability due to a compensable accident. However, the appeal found no substantial evidence that the employer had prior knowledge of this psychiatric condition; only the bilateral deafness was known, which was deemed incidental to the current disability. Consequently, the Board's decision, which presumably denied reimbursement, was affirmed, with costs awarded to the Special Disability Fund.

Workers' CompensationSpecial Disability FundReimbursement ClaimPrior Physical ImpairmentBilateral DeafnessPsychoneurotic DisorderPre-existing ConditionEmployer KnowledgeTotal DisabilityCompensable Accident
References
0
Case No. MISSING
Regular Panel Decision

In re Butcher

This case addresses three handicapped petitions seeking tuition and maintenance costs at the Summit Residential Treatment Facility under sections 232 and 234 of the Family Court Act. Judge Rudolph Di Blasi found all petitioners qualified for benefits. The court affirmed that tuition costs are reimbursable without parental means testing, but maintenance costs are subject to parental ability to pay. Crucially, the court asserted its discretion to evaluate the reasonableness of charges by service providers, rejecting the City of New York's argument that it must pay inflated costs. The decision detailed inflated administrative costs at Summit and deemed certain staffing ratios an unnecessary luxury at public expense. The court subsequently ordered specific, adjusted amounts for tuition and maintenance for each petitioner, directing the City of New York as the initial payor and the State of New York for partial reimbursement.

Family Court ActHandicapped ChildrenTuition ReimbursementMaintenance CostsParental ContributionJudicial DiscretionReasonableness of ChargesPublic FundsSummit Residential Treatment CenterEducational Costs
References
9
Case No. ADJ1868495 (VNO 0452398) ADJ4538828 (VNO 0468076)
Regular
Dec 14, 2012

JORGE HERNANDEZ vs. CRESCENT TRUCK LINES, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, SEDGWICK CLAIMS MANAGEMENT SERVICES, RELIANCE NATIONAL INSURANCE COMPANY

This case concerns the California Insurance Guarantee Association (CIGA) seeking reimbursement from the State Compensation Insurance Fund (SCIF) for costs incurred administering workers' compensation claims. The WCJ initially awarded CIGA reimbursement for benefits paid but not for associated administration expenses. The Appeals Board granted CIGA's reconsideration petition, ruling that CIGA is entitled to reimbursement for both benefits and specific claim administration expenses, including medical-legal costs. The Board amended the findings and award to reflect this, returning the matter to the trial level for further proceedings.

CIGAReliance National Insurance CompanySedgwick Claims Management ServicesState Compensation Insurance Fund (SCIF)Petition for ReconsiderationJoint Findings and Award (F&A)reimbursementassociated expensesmedical treatmentloss adjustment expense
References
10
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