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

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. MISSING
Regular Panel Decision

Claim of Steuber v. Home Properties, Inc.

Claimant applied for workers' compensation benefits after a March 2010 work fall, establishing injuries to his back, left knee, and left hip. After thoracic spine surgery in 2011, the employer and its workers' compensation carrier objected to coverage, arguing it was not causally connected to the initial claim. The Workers’ Compensation Board agreed, a decision which the appellate court affirmed. The court credited an independent medical examiner's opinion that the thoracic condition and subsequent falls were unrelated to the compensable accident, despite the claimant's orthopedic surgeon's testimony suggesting otherwise.

Workers' Compensation BenefitsCausal RelationThoracic Spine InjuryDegenerative ConditionIndependent Medical ExaminationSubsequent FallsBoard DecisionAppellate ReviewCredibility AssessmentSubstantial Evidence
References
3
Case No. MISSING
Regular Panel Decision
Jun 02, 2008

Claim of Laezzo v. New York State Thruway Authority

The claimant suffered a work-related slip and fall in 2002, leading to injuries including his head, neck, back, and knees. His morbid obesity contributed to his back and knee issues, prompting him to seek authorization for gastric bypass surgery. The Workers’ Compensation Law Judge approved the surgery, a decision affirmed by the Workers’ Compensation Board, which found the surgery causally related to the compensable injuries. The employer and its carrier appealed, challenging the causal link. The court affirmed the Board's decision, noting substantial evidence that the claimant's weight gain was a result of the sedentary lifestyle imposed by his injuries, and that the surgery would aid in his recovery.

Workers' CompensationConsequential InjuryGastric Bypass SurgeryMorbid ObesityMedical Treatment AuthorizationCausationKnee InjuryBack InjurySedentary LifestyleBoard Decision Appeal
References
2
Case No. ADJ11053430; ADJ14397522
Regular
Jun 23, 2025

MICHAEL FISHEL vs. RICK'S LUBE AND COMPLETE AUTO, OAK RIVER INSURANCE COMPANY

Applicant Michael Fishel, an auto mechanic, sustained an injury to his back and other body parts on August 18, 2017, while employed by Rick's Lube and Complete Auto, insured by Oak River Insurance Company. The case involved extensive litigation concerning the necessity of lumbar spine surgery and the waiver of the Utilization Review/Independent Medical Review process, leading to the appointment of Dr. Laura Hatch. The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration, rescinding and substituting a prior Findings and Award. The Board's decision clarified Dr. Hatch's appointment date and the scope of her evaluation, ultimately upholding the award for the applicant's lumbar spine surgery based on Dr. Hatch's medical opinions.

AOE/COEUR/IMRRegular PhysicianStipulationPetition for ReconsiderationFindings and AwardLabor Code Section 5701Lumbar Spine SurgeryQualified Medical EvaluatorPrimary Treating Physician
References
23
Case No. 2021 NY Slip Op 03090
Regular Panel Decision
May 13, 2021

Matter of Ozoria v. Advantage Mgt. Assn.

Crucita Ozoria, a home health aide, was injured in September 2017 and filed a workers' compensation claim, which was established for back and neck injuries. After initial treatments, her physician referred her for surgery. An independent medical examination by Sidhwani concluded she no longer needed causally-related treatment, leading to a suspension of benefits by the WCLJ. A neurosurgeon, Ratzker, requested authorization for cervical spine surgery, which the carrier denied based on reports from Cash and Storrs. The WCLJ upheld the denial and found no further causally-related disability after November 7, 2018. The Workers' Compensation Board affirmed this decision. On appeal, the Appellate Division, Third Department, found that claimant was denied due process by not having the opportunity to cross-examine the carrier's consultants regarding the surgery denial, as this issue was not properly before the WCLJ at the initial hearing. The court modified the Board's decision by reversing the denial of the C-4 authorization request for surgery and remitted the matter for further proceedings to allow claimant to present evidence or cross-examine the consultants on this specific issue.

Workers' CompensationHome Health AideCervical SpineLumbar Disc HerniationMedical AuthorizationDue ProcessIndependent Medical ExaminationCausally-Related DisabilityCross-ExaminationProcedural Error
References
5
Case No. MISSING
Regular Panel Decision

Claim of Casiano v. CCIP/Union Settlement Home Care

In March 2001, claimant sustained a work-related back injury. Neurosurgeon Richard J. Radna recommended and performed decompression surgery despite the workers' compensation carrier denying preauthorization for the procedure. Both a Workers’ Compensation Law Judge and the Workers’ Compensation Board subsequently ruled that the surgery was not medically necessary, thereby absolving the carrier of liability for its cost. Claimant and Radna appealed this determination to the appellate court. Radna's appeal was dismissed due to lack of standing, and the Board's decision was affirmed, as it was within its purview to resolve the conflicting medical evidence presented by Radna and the carrier's neurosurgeon regarding the necessity of the surgery.

Workers' Compensation LawMedical NecessitySurgical ProcedurePreauthorization DenialNeurological InjuryConflicting Medical OpinionsAppellate ReviewStanding IssueCarrier LiabilityBack Injury
References
3
Case No. LAO 0811779, LAO 0811780
Regular
Mar 06, 2008

ELENA BLANKEVOORT vs. HUNTINGTON MEMORIAL HOSPITAL, S&B SURGERY CENTER

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a trial judge's order disallowing a lien claim from S&B Surgery Center. The WCAB found that while S&B Surgery Center did have a required "surgical clinic" license, it failed to prove compliance with fictitious business name filing requirements. However, the WCAB returned the case to the trial level for further proceedings, allowing S&B Surgery Center an opportunity to correct this procedural defect to recover on its lien.

Fictitious business nameLien claimantSurgical clinic licenseBusiness and Professions Code section 17910Medical BoardDepartment of Health ServicesBurden of proofReconsiderationWorkers' Compensation Appeals BoardOutpatient setting
References
12
Case No. ADJ9312637
Regular
Nov 21, 2014

ARNOLD KRAFT vs. BRISTOL RESTORATION, BENCHMARK INSURANCE COMPANY

This case concerns a workers' compensation applicant seeking cervical spine surgery. The defendant employer and insurer sought reconsideration of an award granting the surgery, primarily arguing the decision lacked substantial medical evidence and presenting a new AME report. However, the defendant conceded the administrative law judge's finding that their utilization review denial was untimely. The Appeals Board denied reconsideration, finding the defendant waived their procedural arguments by not challenging the timeliness. While acknowledging the new AME report was newly discovered evidence, the Board found it did not impact the decision as it did not mention the proposed surgery.

Workers' Compensation Appeals BoardUtilization ReviewRequest For AuthorizationCervical Spine SurgeryLabor Code § 4610(g)Invalid DenialNewly Discovered EvidenceAgreed Medical ExaminerMaximum Medical ImprovementPetition For Reconsideration
References
11
Case No. ADJ2965812 (SAC 0308365)
Regular
Apr 23, 2012

CHRISTINE KRAUSE vs. STATE OF CALIFORNIA, SECRETARY FOR RESOURCES AGENCY, Legally Uninsured, Adjusted By STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded an order compelling the defendant to provide cervical spine surgery, deferring the issue pending a final report from a Spinal Surgery Second Opinion Physician (SSSOP). The SSSOP's report was delayed beyond the statutory 45-day timeframe, but the WCAB found neither party was at fault for this delay, and obtaining the SSSOP's opinion was crucial for a proper decision. The WCAB dismissed the defendant's petition for removal. A dissenting commissioner argued the defendant should be liable for the surgery due to the delayed process, citing precedent that placed the burden on the employer to ensure timely adherence to statutory procedures.

Workers' Compensation Appeals BoardPetition for ReconsiderationSpinal Surgery Second Opinion PhysicianUtilization ReviewLabor Code Section 4062(b)Industrial InjuryCervical Spine SurgeryTreating PhysicianIndustrial InjuryDeclaration of Readiness to Proceed
References
4
Case No. MISSING
Regular Panel Decision

Prentice v. Levy

Plaintiff sustained a work-related cervical spine injury in 1998 and underwent surgery by defendant Dr. Walter J. Levy in 1999. After the first surgery failed and a second surgery in 2002 to remove loosened hardware, plaintiff settled a medical malpractice action against Levy for $400,000. The self-insured employer, Tops, Inc., and its administrator, MAC Risk Management, as "the carrier," asserted a workers' compensation lien against the settlement. The Supreme Court provisionally set the lien at $22,442.91 and appointed a referee to determine the final lien and offset amounts, with the carrier bearing the costs. The appellate court affirmed the order, ruling that the interim lien was "without prejudice" and the referee's hearing scope was sufficient to conduct a comprehensive evidentiary hearing, thus causing no prejudice to the carrier.

Workers' Compensation LienMedical MalpracticeSettlement LienInterim LienWorkers' Compensation LawAppellate ReviewReferee AppointmentLien EstablishmentOffset PaymentsEvidentiary Hearing
References
2
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