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Case Law Database

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

Case No. MISSING
Regular Panel Decision

Hartley v. City of New York

James Hartley, a commercial diver, was allegedly injured on October 3, 1989, while working for MVN Associates, Inc., a subcontractor for Healy Tibbitts Construction Co., Inc., who had a contract with the City of New York. Hartley claimed decompression sickness due to improper decompression procedures and sued under Labor Law sections and common-law negligence. The court determined that federal maritime law applied, preempting the state Labor Law claims, leading to their dismissal against Healy and the City. However, Healy's motion to dismiss Hartley's common-law negligence claims was denied due to unresolved factual issues regarding Healy's actions. The City's motion to dismiss all claims against it was granted, severing the action. Lastly, MVN's motion to dismiss Healy's third-party indemnification claim was denied, pending clarification of Healy's 'vessel' status under the LHWCA.

Decompression SicknessMaritime JurisdictionFederal PreemptionUnderwater ConstructionLongshore and Harbor Workers' Compensation ActVessel StatusCommon-Law NegligenceIndemnification ClaimDiver InjuryNavigable Waters
References
16
Case No. 2018-02-0051
Regular Panel Decision
Jun 05, 2018

Hoss, Timothy v. ASR Metals

Timothy Hoss, an employee, filed an expedited hearing request seeking medical benefits for a back injury sustained on October 29, 2014, while working for ASR Metals. The central issues were the causal relationship between his need for treatment and the injury, and the medical necessity of proposed spinal surgery and facet injections. After an initial denial of decompression surgery recommended by Dr. Morgan Lorio, Mr. Hoss was evaluated by neurosurgeon Dr. Jim Brasfield. Dr. Brasfield recommended an L2-L3 MIS decompressive hemilaminectomy and L5-S1 percutaneous facet injections, citing stenosis and radiculopathy. ASR Metals' utilization review physician, Dr. Kimberly Terry, denied these procedures, attributing findings to pre-existing degenerative disc disease. The Court, however, found that ASR Metals failed to overcome the presumption of correctness of the authorized panel physician, Dr. Brasfield, regarding both causation and medical necessity. Consequently, the Court granted Mr. Hoss's requested relief, ordering ASR Metals to schedule the recommended surgical procedures.

Workers' CompensationBack InjurySpinal SurgeryFacet InjectionsMedical NecessityCausationUtilization ReviewPresumption of CorrectnessExpedited HearingMedical Benefits
References
1
Case No. SAL 0107786
Regular
Oct 16, 2007

MOLLY KIRKPATRICK vs. DOMINICAN SANTA CRUZ HOSPITAL, PSI ADMINISTERED BY OCTAGON RISK SERVICES

This case concerns an injured worker who had cervical spine surgery involving diskectomy, vertebrectomy, decompression, and fusion. The defendant sought reconsideration of an award granting temporary disability benefits beyond the statutory 104-week limit, arguing the surgery was not an amputation. The Appeals Board rescinded the prior award and returned the matter for further proceedings, as the definition of "amputation" in precedent excludes internal body parts like those removed during spinal fusion.

Workers' Compensation Appeals BoardDominican Santa Cruz HospitalOctagon Risk ServicesMolly KirkpatrickIndustrial InjuryCervical Spine SurgeryTemporary Disability IndemnityLabor Code Section 4656(c)AmputationDiskectomy
References
1
Case No. ADJ3692050
Regular
Mar 11, 2011

STEVEN HAULENBECK vs. CITY OF ANAHEIM

This case concerns an applicant seeking reconsideration of a denial for lumbar spinal decompression therapy. The Appeals Board previously reversed a WCJ's award of this treatment, finding the applicant failed to follow proper utilization review (UR) and dispute resolution procedures. Although the applicant argued that the prior decision incorrectly applied a statute not applicable to pre-2005 injuries, the Board denied reconsideration. The Board determined that even under the applicable pre-2005 law, the applicant failed to timely object to the UR denial and initiate the required dispute resolution process. Therefore, the requested medical treatment was not authorized.

Workers' Compensation Appeals BoardPetition for ReconsiderationLumbar spinal decompression therapyIndustrial injuryKnee injuryPolice officerPermanent disabilityCompensable consequenceUtilization reviewLabor Code section 4062.2
References
3
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. MISSING
Regular Panel Decision
Mar 29, 1983

Claim of Morgante v. Southeastern Public Service Co.

The Workers' Compensation Board's decision, filed March 29, 1983, was affirmed on appeal. The Board had reversed an administrative law judge's disallowance, reinstating an award for total disability to the claimant. The claimant suffered a back injury in November 1979 while loading logs, which led to a myelogram and a decompressive laminectomy. Despite initial conflicting medical evidence and testimony regarding the causal link to employment and employer notice, the Board found the accident arose out of and in the course of employment. The appellate court upheld the Board's decision, stating that the resolution of conflicting facts and credibility issues are beyond its review, provided a sufficient evidentiary basis exists for the Board's factual determination.

Workers' Compensation AppealCausationCredibility AssessmentConflicting Medical EvidenceAccident Arising Out of EmploymentCourse of EmploymentLumbar InjuryMyelogramLaminectomyBoard Decision Review
References
3
Case No. 2023-06-7576
Regular Panel Decision
Feb 10, 2025

Allen, Heather v.

Ms. Heather Allen filed for an expedited hearing seeking authorization for a mid-neck decompressive spinal laminectomy and fusion recommended by her authorized treating physician, Dr. David Lanford. Her employer, Deliveries Via ISG, LLC, denied the surgery, arguing it stemmed from a preexisting condition rather than a work-related car accident. The Court considered expert medical opinions from Dr. Lanford, Dr. John Burleson, Dr. Kimberly Terry, and Dr. Luc Jasmin regarding causation. Relying on the rebuttable presumption of correctness for Dr. Lanford's opinion, the Court found that the employer failed to overcome this presumption and ordered ISG to authorize the surgery.

Workers' CompensationSpinal FusionNeck InjuryCar AccidentPreexisting ConditionCausationMedical NecessityExpedited HearingSurgical AuthorizationTreating Physician
References
3
Case No. ADJ6552734
Regular
Apr 02, 2015

Diane Garibay-Jimenez vs. Santa Barbara Medical Foundation Clinic, Zurich American Insurance

This case concerns a denied request for left ulnar nerve decompression surgery. The Administrative Law Judge (WCJ) upheld the denial, finding the applicant failed to provide necessary Agreed Medical Examiner (AME) reports to the Independent Medical Review (IMR), making a further review unreasonable. However, the Workers' Compensation Appeals Board (WCAB) granted reconsideration, rescinding the WCJ's order. The WCAB found the defendant failed to comply with Labor Code section 4610.5(l) by not providing all relevant medical records to IMR, thus invalidating the prior IMR determination. The matter was returned for a new IMR application, holding the defendant responsible for submitting complete records.

Workers' Compensation Appeals BoardDiane Garibay-JimenezSanta Barbara Medical Foundation ClinicZurich American InsuranceADJ6552734Opinion and Order Granting Petition for ReconsiderationExpedited Findings of Fact and OrderAdministrative Law JudgeIndependent Medical ReviewUtilization Review
References
0
Case No. 2018-06-2365
Regular Panel Decision
Mar 07, 2019

Bauknecht, Bauknecht, v Five Star Quality Care, Inc., d/b/a Morningside Assisted Living

Barbara Bauknecht, an employee of Five Star Quality Care, Inc., sustained a work injury to her low back on July 4, 2018, while assisting a patient. Her authorized treating physician, Dr. Edward Mackey, diagnosed sciatica and disc degeneration and recommended decompressive laminectomy and fusion surgery after non-operative treatments proved unsuccessful. The employer's carrier, Safety National Casualty Corp., initially denied the surgery. At an expedited hearing, the Court found Ms. Bauknecht met her burden to prove the medical necessity of the surgery, noting the presumption of necessity for treatment recommended by an authorized physician. Consequently, the Court granted the requested relief, ordering Five Star Quality Care to immediately authorize the recommended surgery.

Workers' Compensation ClaimsExpedited HearingMedical BenefitsBack SurgerySpinal FusionLaminectomySciaticaDisc DegenerationMedical NecessityAuthorized Treating Physician
References
1
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