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

Case No. No. M2018-01696-COA-R3-CV; No. 15-4-IV
Regular Panel Decision
Dec 07, 2020

American Board of Craniofacial Pain v. American Board Of Orofacial Pain

This case involves an appeal concerning a failed merger between two professional dental associations, American Board of Craniofacial Pain (ABCP) and American Board of Orofacial Pain (ABOP). ABCP sued ABOP, alleging a breach of an agreement to merge formed through email exchanges and seeking specific performance and damages. The Chancery Court for Davidson County granted summary judgment to ABOP, finding no meeting of the minds and thus no enforceable contract. The Court of Appeals of Tennessee affirmed this decision, concluding that the parties’ objective manifestations showed a lack of mutual assent because an essential term (disposition of intellectual property) was not agreed upon and they intended to reduce the agreement to a formal Memorandum of Understanding, which was never finalized. The court also agreed that specific performance was not an available remedy due to the incompleteness of the purported contract.

Contract DisputeMerger NegotiationsCorporate MergerDental ProfessionMutual AssentSpecific Performance DenialSummary Judgment AffirmationTennessee Court of AppealsContract FormationLack of Agreement
References
26
Case No. 2024 NY Slip Op 00599 [224 AD3d 428]
Regular Panel Decision
Feb 06, 2024

Matter of New Millennium Pain & Spine Medicine, P.C. v. Garrison Prop. & Cas. Ins. Co.

This case involves two appeals by New Millennium Pain & Spine Medicine, P.C. against Garrison Property & Casualty Insurance Company and GEICO Casualty Company. New Millennium sought to vacate master arbitration awards that denied its claims for no-fault benefits for medical services. The Supreme Court denied these applications. The Appellate Division, First Department, affirmed the Supreme Court's decisions, stating that an arbitrator's award will not be set aside unless it is irrational. The court also addressed the argument regarding a 20% wage offset in no-fault benefits, finding it unavailing under Insurance Law § 5102 (b). Ultimately, New Millennium was not entitled to attorneys' fees as it was not the prevailing party.

No-fault benefitsarbitration awardvacaturinsurance lawwage offsetappellate reviewmedical servicesno-fault policy exhaustionattorneys' feesCPLR Article 75
References
8
Case No. 04-06-00237-CV
Regular Panel Decision
May 30, 2007

Braulio Lara v. Weeks Marine, Inc.

Braulio Lara, a deckhand for Weeks Marine, Inc., appealed a judgment rendered in his favor based on claims under the Jones Act and for maintenance and cure, specifically challenging the jury's failure to award damages for past physical pain and suffering after he sustained a fractured left shoulder in a fall. Lara reported immediate pain, and medical evidence from Dr. Fitter and Dr. Donovan confirmed a painful shoulder fracture, with Dr. Donovan also diagnosing ruptured discs in the neck and back. Despite these objective injuries and awarded medical expenses, the jury awarded zero for past physical pain. The appellate court reviewed the factual sufficiency of the evidence, finding the jury's failure to award damages for past physical pain and suffering to be against the great weight and preponderance of the evidence, especially given the undisputed objective evidence of a significant injury. Consequently, the judgment of the trial court was reversed, and the cause was remanded for a new trial.

Jones ActMaintenance and CureMaritime LawPersonal InjuryNegligenceShoulder FracturePain and Suffering DamagesFactual SufficiencyJury VerdictMedical Expenses
References
10
Case No. ADJ1088522 (RIV 0015524)
Regular
Jan 03, 2013

SAMANTHA VAN DUINHOVEN vs. SPA HOTEL & CASINO, CALIFORNIA CASUALTY, Administered by GAB ROBINS NORTH AMERICA

This case involved an applicant who claimed industrial injury to her neck, back, left shoulder, psyche, and associated chronic pain syndrome, resulting in a finding of permanent total disability. The defendant sought reconsideration, arguing the medical evidence did not support injury to the low back or a diagnosis of chronic pain syndrome. The Appeals Board reversed the findings on the low back and chronic pain syndrome, finding no substantial evidence to support them. Consequently, the applicant's permanent disability award was amended to 70%, based on ratings for her neck, left shoulder, and psyche.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPermanent Total DisabilityChronic Pain SyndromeAgreed Medical EvaluatorQualified Medical EvaluatorMedical Record ReviewIndustrial InjuryPermanent Disability Indemnity
References
0
Case No. MISSING
Regular Panel Decision

Baker v. Orange Heating & Cooling

Claimant, who suffered a work-related injury in 1994, began experiencing right arm and shoulder pain four years later, which treating physicians diagnosed as reflex sympathy dystrophy (RSD) causally related to the 1994 incident. However, a Workers’ Compensation Law Judge and subsequently the Workers’ Compensation Board found that the right arm and shoulder pain was not causally related to the earlier accident. On appeal, the Board's determination was supported by expert testimony from Michael Weintraub, a clinical professor of neurology, who attributed the pain to the claimant’s severe diabetes rather than RSD. The appellate court affirmed the Board’s decision, emphasizing that the Board is the arbiter of credibility determinations, especially concerning causation. Thus, the court upheld the denial of workers’ compensation benefits.

Workers' CompensationCausationReflex Sympathy DystrophyDiabetesMedical Expert TestimonyBoard DecisionAppellate AffirmationInjury ClaimCredibilityMedical Evidence
References
2
Case No. 2020-06-0903
Regular Panel Decision
Aug 10, 2021

Gupton, Matthew v. Jackson-Hon Gallatin, LLC d/b/a Gallatin Honda

Mr. Gupton, an auto detailer, sought medical and temporary disability benefits for bilateral shoulder pain. He attributed his injury to increased workload as the sole detailer at Gallatin Honda, claiming a specific incident on May 18, 2020, although previous pain was acknowledged. Honda contested, citing untimely reporting and pre-existing conditions. The Court found Mr. Gupton provided timely notice and that his cumulative overuse injury became disabling during his employment with Honda. Medical evidence, particularly Dr. Grutter's testimony, supported the work-related causation for his injuries. Consequently, the court ordered Honda to provide medical treatment for Mr. Gupton's left shoulder but denied benefits for his right shoulder due to a non-work-related reinjury and temporary disability benefits.

Cumulative InjuryShoulder PainMedical BenefitsTemporary DisabilityNotice RequirementCausation DisputeExpedited OrderPre-existing InjuryEmployer DefensesAuto Industry
References
3
Case No. MISSING
Regular Panel Decision

Matter of White v. Bethany House

Claimant, a certified nurse assistant, sustained a work-related left shoulder injury in August 2010, leading to an established workers' compensation claim, surgeries, and temporary partial disability. Subsequently, she developed right shoulder pain and sought to amend her claim, contending a consequential injury arising from her initial left shoulder injury. Both a Workers' Compensation Law Judge and the Workers' Compensation Board affirmed this causal connection, prompting an appeal by the employer and its carrier. The carrier argued insufficient medical evidence to establish the causal nexus; however, the appellate court found substantial evidence, particularly the report from pain management specialist Mary Trusilo, supported the Board's determination. The court also deemed the carrier's orthopedist's conflicting testimony speculative, ultimately affirming the Board's decisions.

Workers' CompensationConsequential InjuryShoulder InjuryCausal RelationshipMedical EvidenceAppellate ReviewDisabilityNurse AssistantPain Management
References
7
Case No. MISSING
Regular Panel Decision
May 05, 2000

Pain Resource Center v. Travelers Insurance

This case addresses a dispute regarding the payment of first-party no-fault benefits to a health provider, Pain Resource Center, as the assignee of John Hiotis, who was injured in an auto accident. The defendant, Travelers Ins. Co., challenged the validity of the assignment and the necessity of the medical services provided. The court affirmed the validity of the assignment under New York's Insurance Law and related regulations. However, based on conflicting expert testimonies, the court limited the compensable medical services to six hours and awarded the plaintiff $566.10, along with statutory interest and attorney's fees.

No-Fault InsuranceFirst-Party BenefitsAssignment ValidityMedical ServicesPeer ReviewInsurance LawHealth Provider ClaimAutomobile AccidentDamagesStatutory Interpretation
References
5
Case No. MISSING
Regular Panel Decision

Universal Acupuncture Pain Services, P.C. v. Lumbermens Mutual Casualty Co.

The New York court addresses a motion for reargument by Universal Acupuncture Pain Services, P.C. against Lumbermens Mutual Casualty Company concerning no-fault insurance claims. The central legal question is whether an expert witness's peer review report, created after a timely denial of a no-fault claim, can be admitted at trial, specifically under the Cirucci precedent regarding the specificity of denial grounds. The court grants the motion for reargument but upholds its initial ruling, which granted partial summary judgment on one of five claims. It clarifies that the expert's testimony must be strictly limited to the "concurrent or excessive care" ground initially stated by the insurer, excluding any new grounds like "medical necessity" not specified in the original denial. The court emphasizes that the issue of whether different treatment modalities constitute concurrent care for the same condition requires a trial for factual determination.

No-Fault InsurancePeer ReviewExpert Witness TestimonySummary Judgment MotionInsurance Law InterpretationSpecificity of DenialConcurrent Medical CareAcupuncture TreatmentChiropractic TreatmentPhysical Therapy
References
7
Case No. 07-CV-2634; 07-CV-4841
Regular Panel Decision
Apr 05, 2010

Price v. Reilly

Plaintiff Anthony Price, a pro se inmate, alleged deliberate indifference to his serious medical needs at Nassau County Correctional Center, violating his Eighth Amendment rights under 42 U.S.C. § 1983. Price claimed incorrect medication dosage for renal disease, failure to be tested for a kidney transplant, and inadequate treatment for shoulder pain against Sheriff Edward Reilly, Kim Edwards, Perry Intal, Mary Sullivan, Dr. Benjamin Okonta, and Nassau University Medical Center. The court granted defendants' motion for summary judgment regarding the medication dosage and all claims against Sheriff Reilly. However, the motion was denied concerning the kidney transplant request and shoulder pain claims, as genuine issues of material fact remained. The court also addressed the exhaustion of administrative remedies, finding defendants failed to establish plaintiff's non-exhaustion for the kidney transplant claim.

Eighth AmendmentDeliberate IndifferenceMedical NeedsPrisoner RightsSummary JudgmentKidney DiseaseRenal FailureDialysisShoulder PainInmate Grievance
References
70
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