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Case Law Database

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

Case No. 2023 NY Slip Op 23398 [81 Misc 3d 21]
Regular Panel Decision
Nov 30, 2023

Associated Plastic Surgeons & Consultants, P.C. v. Global Commodities, Inc.

Plaintiff, Associated Plastic Surgeons & Consultants, P.C., filed a commercial claims action against Global Commodities, Inc. for $5,000 for unpaid medical services provided to an alleged employee. Plaintiff claimed defendant agreed to pay privately. The District Court dismissed the action after excluding a document detailing telephone conversations, which plaintiff argued was admissible under the business records exception or relaxed commercial claims evidence rules. The Appellate Term affirmed the dismissal, ruling that plaintiff failed to prove the patient was injured during employment or that the document was admissible as a business record, thus failing to establish defendant's liability for the medical bill. The court emphasized that while commercial claims courts are not bound by strict evidence rules, judgments cannot rest solely on hearsay.

Commercial claimsMedical servicesUnpaid billsBusiness records exceptionHearsayEvidence rulesEmploymentWorkers' Compensation LawAppellate reviewSubstantial justice
References
10
Case No. ADJ3206000 (LAO 0877236)
Regular
Aug 10, 2012

JENNIFER HESTER vs. TECHNICOLOR, Permissibly Self-Insured

The applicant sought reconsideration of a decision limiting the defendant's payment for hip surgery to the Official Medical Fee Schedule, which the applicant's surgeon deemed insufficient. The Appeals Board granted reconsideration due to the complex fee dispute, noting that while extraordinary circumstances existed regarding the surgeon's qualifications, the reasonableness of his requested fee was unproven. To resolve this, the Board ordered the appointment of an agreed physician to investigate the surgeon's usual fee and its reasonableness compared to others with similar expertise.

ReconsiderationFindings of FactAgreed PhysicianMedical TreatmentFee ScheduleExtraordinary CircumstancesUsual FeeHip ArthroscopyOsteoplastyChondroplasty
References
1
Case No. CV-24-1300
Regular Panel Decision
Feb 19, 2026

In the Matter of the Claim of Kimberly Siddon

Kimberly Siddon appealed a Workers' Compensation Board decision denying the reopening of her claim for an increased schedule loss of use (SLU) of her left knee. Siddon, who had previously undergone two surgeries and received SLU findings of 12% and 20%, sought a 35% SLU based on an orthopedic surgeon's report detailing worsening range of motion. The Special Fund for Reopened Cases failed to properly contest the surgeon's medical opinion, despite multiple opportunities. The Board, however, rejected the surgeon's objective range-of-motion measurements as merely subjective, a finding inconsistent with its own impairment guidelines. The Appellate Division reversed the Board's decision, concluding that the Special Fund had waived its right to contest the evidence and that the Board's rationale for denial was unsupported given the uncontradicted and properly rendered medical opinion. The case was remitted to the Workers' Compensation Board for further proceedings consistent with the Court's decision.

Workers' CompensationSchedule Loss of UseLeft Knee InjuryClaim ReopeningMedical ExaminationSpecial Fund for Reopened CasesWaiverBoard DiscretionMedical EvidenceRange of Motion
References
7
Case No. MISSING
Regular Panel Decision
May 31, 1972

Talamo v. Murphy

This case concerns the termination of a probationary patrolman's services by the Police Commissioner following an on-duty injury and the subsequent discovery of an alleged pre-existing wrist condition. Despite medical opinions contradicting the Chief Surgeon's recommendation for dismissal and the patrolman's satisfactory performance, the Commissioner relied on the Chief Surgeon's report. The Supreme Court's judgment was affirmed, but a dissenting opinion argued for reversal and a remand for further proceedings, emphasizing the arbitrary nature of the dismissal and the unjust reflection on the petitioner's capacity. The dissent highlighted that the alleged condition only came to light due to an on-duty injury.

Probationary PatrolmanService TerminationWrist InjuryPre-existing ConditionMedical DisagreementPolice Commissioner DiscretionAppellate ReviewDissenting OpinionAnnulment of DeterminationPolice Department Doctors
References
1
Case No. ADJ532181 (SFO 0438716) ADJ250509 (SFO 0242560) ADJ6545137
Regular
Nov 14, 2014

MICHAEL THOMAS, vs. SAFEWAY STORES, INC. Permissibly Self-Insured,

This case involved an applicant seeking treatment from a highly specialized surgeon, Dr. Matsen, located in Seattle, for a complex shoulder revision. The original decision denied authorization for Dr. Matsen, deeming Seattle outside a reasonable geographic area, and excluded a crucial report from the applicant's treating physician, Dr. Osborn. The Appeals Board granted reconsideration, admitting Dr. Osborn's report, which strongly supported Dr. Matsen's expertise and the inadequacy of local Bay Area surgeons for this complex case. Based on the applicant's medical history and the availability of specialized treatment, the Board reversed the original decision, finding Dr. Matsen to be within a reasonable geographic area.

Workers' Compensation Appeals BoardReasonable geographic areaTreating surgeonAdministrative Director Rule 9780Labor Code section 4600Orthopedic surgeonTotal shoulder replacementRevision surgeryMedical historyPhysician competency
References
1
Case No. MISSING
Regular Panel Decision

Jockimo v. Abess

Plaintiff appealed a Supreme Court order which granted defendant's motion for summary judgment, dismissing her personal injury complaint. The case arose from an August 1998 car accident where plaintiff sustained injuries. She alleged serious injury to her back, neck, chest, and right shoulder under Insurance Law § 5102 (d). The defendant's motion for summary judgment was based on an orthopedic surgeon's report finding only temporary impairment. Plaintiff opposed with her own orthopedic surgeon's affirmation diagnosing impingement syndrome and fibromyalgia with a permanent partial disability. The appellate court affirmed the dismissal, ruling that plaintiff failed to present sufficient objective medical evidence quantifying the limitations to meet the serious injury threshold under the no-fault law.

Personal InjuryMotor Vehicle AccidentSerious Injury ThresholdSummary JudgmentAppellate ReviewNo-Fault LawPermanent Consequential LimitationObjective Medical FindingsImpingement SyndromeFibromyalgia
References
9
Case No. MISSING
Regular Panel Decision

Weldon v. DiNapoli

Petitioner, a State Police investigator, sought disability retirement benefits due to a left shoulder injury sustained in 2003 and 2008, claiming permanent incapacitation. The application was initially denied, and this denial was upheld after a hearing, concluding that the petitioner failed to establish permanent incapacity. The respondent affirmed this determination, leading to a CPLR article 78 proceeding. The court confirmed the determination, citing the lack of permanency findings in the petitioner's medical records and expert opinions from a neurologist and orthopedic surgeon who found no permanent disability. The orthopedic surgeon suggested the condition, diagnosed as chronic regional pain syndrome, was a temporary total disability that could improve with aggressive physical therapy. Consequently, the respondent's determination was supported by substantial evidence, and the petition was dismissed.

State PoliceDisability Retirement BenefitsPermanent IncapacityShoulder InjuryMedical RecordsNeurologist OpinionOrthopedic Surgeon OpinionChronic Regional Pain SyndromeTemporary Total DisabilityCPLR Article 78
References
5
Case No. MISSING
Regular Panel Decision
Apr 09, 1997

Claim of Krisher v. Graver Tank Manufacturing Co.

The claimant appealed a decision by the Workers' Compensation Board (WCB) that found no causally related disability during the period of April 10, 1995, to June 17, 1996. The claimant had sustained a back injury in 1990, followed by surgery in 1994, and later developed a left knee injury, leading to surgery in February 1995. A Workers' Compensation Law Judge initially awarded benefits for reduced earnings, but the WCB modified this, concluding there was no causally related disability. The appellate court affirmed the WCB's decision, citing testimony from orthopedic surgeon Roy Wert that the claimant could return to work without restrictions by April 1995. Another orthopedic surgeon, George Fuksa, opined that the knee injury was preexisting and not a result of the back surgery.

Workers' CompensationCausally Related DisabilityBack InjuryKnee InjuryMedical OpinionOrthopedic SurgeonReduced EarningsAppellate ReviewSubstantial EvidencePreexisting Injury
References
1
Case No. MISSING
Regular Panel Decision

Matter of Simpson v. New York City Transit Authority

Claimant, a retired bus driver, sought workers' compensation benefits for an occupational disease involving repetitive stress injuries to his knees. A Workers’ Compensation Law Judge initially disallowed the claim, crediting orthopedic surgeon Pierce Ferriter's opinion that the knee condition was not work-related. The Workers’ Compensation Board later reopened the record, leading to a new independent medical examination by orthopedic surgeon Carl Wilson, who also found no causal link; the WCLJ again disallowed the claim, which the Board affirmed. On appeal, the court reversed the Board's decision, finding that it was based on an inaccurate reading of MRI results and conflicting medical opinions regarding the extent of injury to the claimant's knees. The matter was remitted to the Workers’ Compensation Board for further proceedings consistent with the Court's decision.

Occupational DiseaseKnee InjuryRepetitive StressIndependent Medical ExaminationCausationMedical EvidenceMRI InterpretationAppellate ProcedureBoard ReversalRemand
References
2
Case No. MISSING
Regular Panel Decision

Marchell v. Littman

Plaintiff, injured at work, received workers' compensation benefits. After his initial surgeon deemed his injury resolved, the State Insurance Fund (SIF) sought to suspend benefits. Plaintiff then hired defendant, an attorney, who advised him to see another surgeon, who attributed 50% of the disability to the work injury. Defendant negotiated a settlement with SIF based on this 50% apportionment. Plaintiff became dissatisfied upon learning the Workers' Compensation Board typically wouldn't apportion in such cases. He sued defendant for legal malpractice, alleging the settlement was compelled by counsel's mistakes. The Supreme Court granted defendant's motion for summary judgment, finding plaintiff's damages speculative as he couldn't prove he would have won before the Board. The appellate court affirmed, concluding that there was no evidence SIF would have settled without apportionment, or that defendant could have achieved a better result through litigation, given conflicting medical opinions.

Legal malpracticeWorkers' compensationSettlement agreementApportionment doctrineSummary judgmentProximate causeDamagesAppellate procedureSupreme Court appealState Insurance Fund
References
15
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