CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

Case Law Database

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

Case No. 2018 NY Slip Op 01591 [159 AD3d 787]
Regular Panel Decision
Mar 14, 2018

Bidnick v. Grand Lodge of Free & Accepted Masons of the State of N.Y.

Neal Bidnick, a long-standing member of the Grand Lodge of Free & Accepted Masons, was expelled following Masonic trials, despite initial reversals by the Masonic Commission of Appeals. This action arose after the Grand Lodge reinstated a guilty finding at its annual meeting, leading to Bidnick's expulsion. Bidnick sued the Grand Lodge and individual defendants for breach of contract, alleging wrongful expulsion, and defamation, claiming false statements of misappropriation. The Supreme Court's order partially dismissed the complaint. The Appellate Division modified this order, granting the dismissal of the defamation claim against the Grand Lodge, denying dismissal of the defamation claim against individual defendants in their individual capacities, and denying the dismissal of the breach of contract claim. The court's decision addressed the application of Benevolent Orders Law and the _Martin_ rule concerning the liability of unincorporated associations and their members.

Breach of ContractDefamationExpulsionUnincorporated AssociationBenevolent Orders LawMasonic LodgeIndividual LiabilityRepresentative CapacityCPLR 3211 (a) (7) MotionAppellate Review
References
11
Case No. ADJ7660641
Regular
Jan 12, 2012

BREANNA CLIFTON vs. SEARS HOLDING CORPORATION (KMART CORPORATION), administered by SEDGWICK CMS, INC.

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of an award finding industrial injury to claimant's knee, foot, and ankle, temporary disability, and reimbursement for self-procured medical treatment. Defendant contested the award of temporary disability and self-procured treatment based on claimant's treatment outside the employer's Medical Provider Network (MPN), citing *Valdez*. The WCAB found the original decision lacked sufficient explanation regarding the MPN establishment and notice, and the employer's liability for self-procured treatment. Therefore, the WCAB amended the award to defer issues of temporary disability, self-procured treatment, and attorney's fees for further proceedings at the trial level.

MPNValdezKnightself-procured treatmentprimary treating physicianindustrial injurytemporary disabilityreconsiderationmedical provider networkWCJ
References
5
Case No. ADJ10168011
Regular
Sep 25, 2017

BELINDA GO vs. SUTTER SOLANO MEDICAL CENTER

This case involved an applicant who self-procured cervical spine surgery after her employer denied authorization, which was upheld by an Independent Medical Review. Despite the denial, the Workers' Compensation Appeals Board (WCAB) denied the employer's petition for reconsideration. The WCAB affirmed that injured workers are entitled to temporary and permanent disability for reasonable, self-procured medical treatment, even if initially unauthorized. The Board found the self-procured surgery was reasonable due to its positive outcome, and the Permanent Qualified Medical Evaluator's findings supported the disability award. The WCAB clarified that utilization review and independent medical review processes do not preclude temporary disability indemnity for self-procured treatment deemed reasonable.

Workers' Compensation Appeals BoardPetition for ReconsiderationUtilization Review (UR)Independent Medical Review (IMR)Self-Procured SurgeryTemporary Disability IndemnityPermanent DisabilityPanel Qualified Medical Evaluator (PQME)Medical Treatment DisputesLabor Code Section 4600
References
14
Case No. MISSING
Regular Panel Decision
Aug 21, 1998

Santos v. Floral Park Lodge of Free & Accepted Masons

In a personal injury action, third-party defendants appealed from orders denying their motion to dismiss a third-party claim for breach of an agreement to procure insurance. The Supreme Court, Queens County, had initially denied the dismissal. The appellate court dismissed the appeal from the initial order, as it was superseded by a subsequent order made upon reargument. The appellate court affirmed the order made upon reargument, holding that the Omnibus Workers’ Compensation Act of 1996 does not bar a third-party action against an employer for breach of an agreement to procure liability insurance.

Personal InjuryThird-Party ActionWorkers' Compensation LawBreach of Agreement to Procure InsuranceEmployer LiabilityAppealSupreme CourtQueens CountyMotion to DismissStatutory Interpretation
References
5
Case No. ADJ2060741 (RJV 0068035)
Regular
Apr 13, 2009

GAIL ARITA vs. STATE OF CALIFORNIA, CDCR-CALIFORNIA REHABILITATION CENTER, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration to address petitions from both the applicant and defendant concerning the WCJ's decision. The applicant disputed the finding that she failed to prove entitlement to self-procured medical care. The defendant argued the claim was time-barred, but agreed with the applicant on the self-procured treatment issue. The Board affirmed the WCJ's original decision as amended, finding the applicant's self-procured treatment contention moot due to deferral.

Workers' Compensation Appeals BoardReconsiderationSelf-procured medical careBurden of proofAOE/COEStatute of limitationTemporary disabilityWCJ decisionAdministrative law judgeDefendant petition
References
0
Case No. ADJ7957976
Regular
Nov 18, 2013

CHARLES TREJO vs. NORTHRUP GRUMMAN CORPORATION, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA

The Workers' Compensation Appeals Board (WCAB) granted reconsideration, rescinding a prior award. The WCJ improperly relied solely on applicant's self-procured physician's report for findings on cervical and lumbar spine injury and permanent disability. Amended Labor Code section 4605 requires any self-procured medical opinions to be addressed by a Qualified Medical Evaluator (QME) or authorized treating physician, which did not occur. The case is returned for further medical development, specifically requiring the QME to address the self-procured physician's opinions.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardMedical Provider Network (MPN)Self-Procured Medical TreatmentLabor Code Section 4605Qualified Medical Evaluator (QME)Panel Qualified Medical Examiner (PQME)Permanent Disability RatingWhole Person Impairment
References
3
Case No. 2018 NY Slip Op 08737
Regular Panel Decision
Dec 20, 2018

NYAHSA Servs., Inc., Self-Insurance Trust v. Recco Home Care Servs., Inc.

This case concerns an appeal from an order of the Supreme Court in Albany County. Plaintiff NYAHSA Services, Inc., Self-Insurance Trust, a self-insured trust providing workers' compensation coverage, sued defendant Recco Home Care Services, Inc. for unpaid adjustments after the defendant terminated its membership. Following an amendment to the complaint adding individual trustees as plaintiffs, the defendant asserted counterclaims for fraud, breach of fiduciary duty, and negligence against these trustees, which the Supreme Court dismissed as time-barred. The defendant also sought to amend its answer to include a counterclaim under General Business Law, which was denied. The Appellate Division, Third Department, found that the Supreme Court erred in dismissing the counterclaims for fraud and breach of fiduciary duty and in denying the cross-motion to amend for the General Business Law claim. Consequently, the Appellate Division modified the Supreme Court's order, reversing parts of the dismissal and denial, and affirmed the order as modified.

Workers' Compensation CoverageSelf-Insurance TrustFraud AllegationsBreach of Fiduciary DutyGeneral Business LawStatute of LimitationsAmended PleadingsCounterclaimsAppellate ReviewMotion to Dismiss
References
2
Case No. ADJ9203286
Regular
Mar 23, 2018

Hugo Bucio vs. County of Merced

The Workers' Compensation Appeals Board granted reconsideration, reversing a prior decision that denied temporary total disability indemnity. The applicant, a deputy sheriff, underwent self-procured surgery for an admitted industrial back injury after the employer denied authorization. The Board held that an injured worker is entitled to temporary disability indemnity regardless of whether the treatment was employer-authorized or self-procured. The decision clarified that the utilization review process governs medical treatment disputes, not temporary disability indemnity claims arising from self-procured treatment.

BucioCounty of MercedDeputy Sheriff/Coronerbilateral sacroiliac joint fusiontemporary total disability indemnityself-procured medical treatmentutilization review (UR)denial of authorizationphysician depositionpermanent and stationary status
References
4
Case No. ADJ1047594 (VNO 0549852)
Regular
Dec 22, 2016

Diane De Los Reyes vs. Mediscan, Zurich American Insurance Company

In this case, the applicant, Diane De Los Reyes, sought reimbursement for self-procured medical treatment related to her work-induced Reactive Airway Disease and Anxiety Disorder. The Appeals Board found that some of the applicant's self-procured treatment was likely industrial and reversed the WCJ's finding that all such treatment was non-industrial. The Board therefore rescinded the original order and returned the matter to the WCJ for further proceedings to determine the extent of reimbursable self-procured medical treatment and associated penalties. The applicant's entitlement to reimbursement for medical mileage and penalties thereon was affirmed.

Workers' Compensation Appeals BoardReconsiderationAgreed Medical EvaluatorReactive Airway DiseaseAnxiety DisorderSelf-procured Medical TreatmentReimbursementPenaltiesMedical MileageLabor Code § 4600(a)
References
9
Case No. ADJ6774605
Regular
Sep 02, 2016

Tammy Tran vs. PROFESSIONAL SERVICE INDUSTRY, ZURICH LOS ANGELES

The Workers' Compensation Appeals Board granted reconsideration of the Administrative Law Judge's (ALJ) decision, which limited reimbursement for self-procured medical treatment. The Board found that the ALJ erred by only allowing reimbursement for treatment from the claim date until the denial date. Citing *McCoy v. Industrial Accident Commission*, the Board determined that the employer is liable for all reasonably necessary self-procured medical expenses incurred after the employer denied the claim, as this denial effectively refused to provide treatment. Consequently, the Board rescinded the ALJ's award and remanded the case for further proceedings to determine the reasonableness of all self-procured medical expenses.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardSelf-Procured Medical TreatmentLabor Code Section 4600McCoy v. Industrial Accident CommissionDenial of ClaimReimbursementIndustrial InjuryReasonably Necessary Treatment
References
5
Showing 1-10 of 1,389 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational