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Case Law Database

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

Case No. 2016-03-0400

Regular Panel Decision

Jul 18, 2016

Dunn, Jason v. United States Infrastructure

Jason Dunn, a utility worker for United States Infrastructure (USI), injured his right shoulder in October 2014. After multiple surgeries and physical therapy for his right shoulder, he began experiencing left shoulder problems in February 2015, which his authorized physician, Dr. Eric A. Morgan, diagnosed as an over-compensation injury related to the original right shoulder injury. Dr. Morgan recommended left shoulder surgery, which utilization review approved but Liberty Mutual denied. An independent medical evaluation by Dr. Edward Kahn concluded the left shoulder injury was age-related and not caused by the work incident. The Court weighed the conflicting medical opinions, giving greater weight to Dr. Morgan's opinion due to his greater contact with Mr. Dunn, and found that Mr. Dunn is likely to prevail on the merits, granting his request for left shoulder surgery.

Shoulder InjuryOvercompensation InjuryMedical BenefitsCausationConflicting Medical OpinionsExpedited HearingPreponderance of EvidenceDirect and Natural Consequences RuleMedical Treatment AuthorizationUtilization Review

References

Case No. 2017-06-1090

Regular Panel Decision

Dec 04, 2017

Henderson, Debbie v. South Central Communications

Ms. Henderson filed a Request for Expedited Hearing seeking knee and shoulder surgery and temporary total disability benefits following a work fall on July 19, 2016. Dr. Ronald Derr, the authorized treating physician, opined that her injuries to her right shoulder, left knee, left hand, and right foot stemmed from the fall, aggravating pre-existing conditions in her knee and causing soft tissue impingement in her shoulder that was previously asymptomatic. The Court found that Ms. Henderson is likely to prevail on causation, determining that her need for surgery arises primarily out of her employment. Consequently, the Court granted her requests for additional medical benefits, including the proposed shoulder and knee surgeries, and awarded her $3,516.54 in past temporary total disability benefits. A status conference is scheduled for February 5, 2018.

Medical BenefitsKnee InjuryShoulder InjuryTemporary Total DisabilityExpedited HearingCausationPre-existing Condition AggravationWork AccidentSurgeryEmployer Liability

References

Case No. 2021-03-0377

Regular Panel Decision

Jul 07, 2021

Hamon, Brandon v. Dickens Turf And Landscape Supply

Brandon Hamon, an employee, sought attorney's fees at an expedited hearing after his employer, Dickens Turf and Landscape Supply, allegedly caused an undue delay in approving treatment for a left-shoulder injury. Hamon had previously sustained a right-shoulder injury at work, leading to surgery. The left-shoulder injury, initially questioned for its work-relatedness, was later deemed by Dr. Hovis to be primarily related to the original right-shoulder injury, prompting approval for surgery. Hamon argued this delay warranted attorney's fees of $1,725.00. However, Judge Brian K. Addington denied the request at this interlocutory stage, determining that the circumstances were not "highly unusual" as required by precedent for such an award. The Court noted that the issue of attorney's fees could be revisited at the case's conclusion.

Attorney's FeesInterlocutory StageShoulder InjuryRotator Cuff TearMedical Treatment DelayExpedited HearingEmployer's ExaminationCausationPanel of PhysiciansDenial of Benefits

References

Case No. 525358

Regular Panel Decision

Jun 07, 2018

Matter of Busat v. Ramapo Manor Nursing Ctr.

Claimant, a food service worker, suffered work-related injuries to his back, neck, and right shoulder in 1997, receiving workers' compensation benefits. In 2014, claimant resumed treatment for his right shoulder and was found to have a 50% temporary disability. During a vacation, he underwent an unrelated cardiac procedure, which prevented him from receiving medical clearance for planned shoulder surgery due to ongoing heart medication. The Workers' Compensation Board initially ruled that claimant's departure from employment was unrelated to his disability and that he failed to remain attached to the labor market. The Appellate Division, Third Department, found the Board's reasoning contradicted by consistent medical evidence indicating claimant's inability to obtain shoulder surgery clearance due to his cardiac condition. Consequently, the court reversed the Board's decisions and remitted the matter for further proceedings.

Workers' CompensationDisability BenefitsLabor Market AttachmentMedical ClearanceCardiac ConditionShoulder InjuryBoard ReconsiderationAppellate ReviewMedical EvidenceCausation

References

Case No. 2015-07-0229

Regular Panel Decision

Feb 18, 2016

Thomas, William v. MTD Products, Inc.

William Thomas, a 71-year-old employee of MTD Products, Inc., filed for an expedited hearing seeking medical benefits for a right shoulder injury. He alleged the injury occurred in December 2014 while operating a press at work. MTD initially denied the claim, arguing inconsistent histories and a subsequent, unrelated chest abscess. The court found Mr. Thomas's testimony credible regarding his work-related shoulder injury and relied on Dr. Nord's opinion, the panel-selected physician, who stated the shoulder condition was work-related. MTD's utilization review denying surgery was deemed non-compliant with rules regarding providing the report and appeal form to the employee. The court ultimately ruled that Mr. Thomas is likely to prevail on the merits and is entitled to medical benefits, including the recommended surgery by Dr. Nord, for his right shoulder injury.

Workers' CompensationExpedited HearingMedical BenefitsRight Shoulder InjuryRotator Cuff TearSurgical RecommendationMedical CausationUtilization ReviewEmployee CredibilityEmployer Liability

References

Case No. SFO 0425862 SFO 0425863

Regular

May 14, 2008

William Bishop vs. IGC POLYCOLD SYSTEMS, ROYAL & SUN ALLIANCE

This case involves a workers' compensation applicant claiming injury to his right shoulder and seeking a new vocational rehabilitation plan. The Appeals Board affirmed the WCJ's denial of a new vocational plan and the finding of no industrial injury to the right shoulder. However, they reversed the WCJ to award benefits resulting from right shoulder surgery, deeming it a consequence of the compensable left shoulder injury.

Workers' Compensation Appeals BoardReconsiderationVocational Rehabilitation PlanIndustrial InjuryRight ShoulderLeft ShoulderTemporary DisabilityQualified Medical EvaluationCausationNon-Industrial

References

Case No. 2015-07-0460

Regular Panel Decision

Nov 10, 2016

Dyer, Teresa v. Support Solutions of the Mid-South

This case involves Teresa Dyer, an employee, seeking approval for a right-shoulder surgical procedure after sustaining an injury on January 12, 2015. Her authorized treating physician, Dr. Kelly Pucek, recommended the surgery, but Liberty Mutual, the insurance carrier for employer Support Solutions of the Mid-South, denied it based on a Utilization Review (UR) report by Dr. Glenn Smith. The central issue was whether Ms. Dyer was entitled to the surgery considering the divergent medical opinions. The Workers' Compensation Judge, Allen Phillips, found that Liberty Mutual failed to rebut the presumption of medical necessity attached to Dr. Pucek's recommendation by a preponderance of the evidence. Consequently, the court ordered Liberty Mutual to continue paying for Ms. Dyer's medical treatment, including the approved right shoulder surgery.

Workers' CompensationMedical BenefitsRight Shoulder InjurySurgical ProcedureUtilization ReviewMedical NecessityAuthorized Treating PhysicianConflicting Medical OpinionsBurden of ProofPreponderance of Evidence

References

Case No. LAO 0857845

Regular

Oct 12, 2007

NATIVIDAD URIAS vs. VISHAY TRANSDUCERS, LIBERTY MUTUAL INSURANCE COMPANY

This case involves a workers' compensation applicant seeking further medical treatment for admitted industrial injuries to her right shoulder and bilateral upper extremities. The Workers' Compensation Appeals Board granted reconsideration to clarify the scope of awarded medical treatment. The Board affirmed the need for a right carpal tunnel release surgery as recommended by the applicant's physician but reversed the award of arthroscopic shoulder surgery, finding it premature without a specific recommendation or request for authorization.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardExpedited HearingFurther Medical TreatmentArthroscopic Shoulder SurgeryCarpal Tunnel ReleasePrimary Treating PhysicianQualified Medical EvaluatorUtilization Review

References

Case No. 2019-06-1960

Regular Panel Decision

Nov 20, 2020

Grimes, Kimberly v. YRC, Inc.

Ms. Kimberly Grimes sought additional medical benefits, specifically shoulder-replacement surgery, for a right-shoulder injury sustained while working at YRC, Inc. in August 2018. YRC opposed, arguing the need for surgery stemmed from pre-existing 'end-stage' arthritis rather than the work injury. Two physicians, Dr. Blake Garside and Dr. Ronald Glenn, both concluded that Ms. Grimes's need for a shoulder replacement was due to her pre-existing arthritis and not the work accident. Consequently, the Court denied Ms. Grimes's claim for additional medical benefits, finding she failed to meet the burden of proof that the surgery was a reasonable and necessary treatment for her workplace injury.

expedited hearingworkers' compensationmedical benefitsshoulder injuryarthritiscausationpre-existing conditionmedical necessityexpert testimonyrotator cuff tear

References

Case No. 2017-06-0219

Regular Panel Decision

Apr 27, 2017

Vercek, Eugene v. Yellow Road Corp.

Eugene Vercek, an employee, sought medical benefits for a right-shoulder injury sustained on April 16, 2016, while working for Yellow Road Corp. The employer denied authorization for recommended shoulder replacement surgery, arguing the injury was due to a pre-existing condition and not primarily work-related. The court held an expedited hearing to determine entitlement to additional medical benefits. The judge reviewed the deposition testimony of Dr. R. Edward Glenn, the treating physician, who opined that the work injury exacerbated a previously asymptomatic pre-existing arthritic condition and that the recommended surgery was medically necessary. The court concluded that Mr. Vercek demonstrated a likelihood to prevail on the merits, finding a compensable aggravation of a pre-existing condition arising primarily out of employment, and thus granted the request for medical benefits, including shoulder surgery.

Medical BenefitsShoulder InjuryAggravation of Pre-existing ConditionExpedited HearingCausationMedical NecessityOrthopedic SurgeryRight ShoulderExacerbationDeposition Testimony

References

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Updated Daily

Case Law Database

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

Case No. 2016-03-0400

Regular Panel Decision

Jul 18, 2016

Dunn, Jason v. United States Infrastructure

References

Case No. 2017-06-1090

Regular Panel Decision

Dec 04, 2017

Henderson, Debbie v. South Central Communications

Medical BenefitsKnee InjuryShoulder InjuryTemporary Total DisabilityExpedited HearingCausationPre-existing Condition AggravationWork AccidentSurgeryEmployer Liability

References

Case No. 2021-03-0377

Regular Panel Decision

Jul 07, 2021

Hamon, Brandon v. Dickens Turf And Landscape Supply

Attorney's FeesInterlocutory StageShoulder InjuryRotator Cuff TearMedical Treatment DelayExpedited HearingEmployer's ExaminationCausationPanel of PhysiciansDenial of Benefits

References

Case No. 525358

Regular Panel Decision

Jun 07, 2018

Matter of Busat v. Ramapo Manor Nursing Ctr.

Workers' CompensationDisability BenefitsLabor Market AttachmentMedical ClearanceCardiac ConditionShoulder InjuryBoard ReconsiderationAppellate ReviewMedical EvidenceCausation

References

Case No. 2015-07-0229

Regular Panel Decision

Feb 18, 2016

Thomas, William v. MTD Products, Inc.

Workers' CompensationExpedited HearingMedical BenefitsRight Shoulder InjuryRotator Cuff TearSurgical RecommendationMedical CausationUtilization ReviewEmployee CredibilityEmployer Liability

References

Case No. SFO 0425862 SFO 0425863

Regular

May 14, 2008

William Bishop vs. IGC POLYCOLD SYSTEMS, ROYAL & SUN ALLIANCE

Workers' Compensation Appeals BoardReconsiderationVocational Rehabilitation PlanIndustrial InjuryRight ShoulderLeft ShoulderTemporary DisabilityQualified Medical EvaluationCausationNon-Industrial

References

Case No. 2015-07-0460

Regular Panel Decision

Nov 10, 2016

Dyer, Teresa v. Support Solutions of the Mid-South

References

Case No. LAO 0857845

Regular

Oct 12, 2007

NATIVIDAD URIAS vs. VISHAY TRANSDUCERS, LIBERTY MUTUAL INSURANCE COMPANY

References

Case No. 2019-06-1960

Regular Panel Decision

Nov 20, 2020

Grimes, Kimberly v. YRC, Inc.

expedited hearingworkers' compensationmedical benefitsshoulder injuryarthritiscausationpre-existing conditionmedical necessityexpert testimonyrotator cuff tear

References

Case No. 2017-06-0219

Regular Panel Decision

Apr 27, 2017

Vercek, Eugene v. Yellow Road Corp.

Medical BenefitsShoulder InjuryAggravation of Pre-existing ConditionExpedited HearingCausationMedical NecessityOrthopedic SurgeryRight ShoulderExacerbationDeposition Testimony

References

Showing 1-10 of 8,382 results

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