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

Case No. 2023 NY Slip Op 02923 [217 AD3d 1045]
Regular Panel Decision
Jun 01, 2023

Matter of Updike v. Synthes

Claimant Lawrence Updike sustained work-related injuries to his back in 1996, which was later amended to include a consequential neck injury. In 2013, while working for Synthes, he sustained further neck and arm injuries. The employer and its workers' compensation carrier subsequently alleged a Workers' Compensation Law § 114-a violation, contending Updike intentionally failed to disclose his prior neck injury during evaluations for his 2019 symptoms. However, a Workers' Compensation Law Judge (WCLJ) and the Workers' Compensation Board found Updike to be credible, ruling that no such violation occurred. The Board concluded that while Updike's memory of the 1996 claim specifics might have been flawed, he did not intentionally withhold material information to obtain benefits. The Appellate Division affirmed the Board's decision, emphasizing that the Board is the sole arbiter of witness credibility and its decision will not be disturbed if supported by substantial evidence.

Workers' CompensationPermanent Partial DisabilityReduced Earnings AwardWorkers' Compensation Law § 114-aFraud AllegationCredibility DeterminationIndependent Medical ExaminationNeck InjuryBack InjuryAppellate Review
References
7
Case No. ADJ6669630
Regular
Jul 23, 2018

ROBERT SAXTON vs. SELECT A SERVICE RETAIL, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior decision regarding a lien claim by Western Imaging Services for copying services. The WCAB found that for most invoices, the defendant waived objections to reasonableness due to untimely and invalid objections. However, the WCAB noted potential issues with two specific invoices (82003-7 and 82003-8) and deferred the final determination of reimbursement for these and other contested invoices. The matter was returned to the administrative law judge for further proceedings on the validity of those specific invoices.

Workers' Compensation Appeals BoardLien ClaimantPetition for ReconsiderationFindings and AwardWorkers' Compensation Administrative Law JudgeReimbursementFee ScheduleObjectionsInvoicesReasonable and Necessary
References
5
Case No. MISSING
Regular Panel Decision

MARQUIS CONST. CO., INC. v. Johnson Masonry

This case addresses the admissibility of subcontractor invoices as business records under Texas law, specifically whether they are considered original records or mere summaries. The court re-evaluated its initial opinion, which had deemed the invoices inadmissible due to a perceived failure to prove their 'underlying source.' Citing precedents like *Grynberg v. Gwaltney* and *Roylex, Inc. v. Avco Community Developers, Inc.*, the court concluded that invoices, even if they compile prior information, can constitute business records themselves if a proper evidentiary predicate is established. The court found the subcontractor's owner's testimony sufficient to demonstrate personal knowledge of the information, affecting only the weight of the evidence, not its admissibility. Consequently, the appellate court held that the trial court did not abuse its discretion in admitting the invoices and affirmed the trial court's judgment in favor of the subcontractor on the theory of quantum meruit. Additionally, the contractor's claims for an overpayment credit were overruled due to insufficient evidence.

Admissibility of evidenceBusiness records exceptionInvoices as business recordsQuantum meruitMotion for rehearingTrial court judgmentAppellate reviewPersonal knowledge testimonyEvidentiary foundationCivil procedure
References
6
Case No. ADJ1952983
Regular
Mar 15, 2018

JUAN RIVERA vs. IMPORT EXPORT CACTUS, STATE COMPENSAITON INSURANCE FUND

In this workers' compensation case, the defendant sought reconsideration of a prior ruling that deemed them to have waived objections to a specific invoice from lien claimant Scandoc Imaging. The WCAB denied reconsideration, finding that the defendant's objection, if any, was untimely, having been filed approximately four years after the invoice was submitted. California regulations require objections to medical-legal billings within 60 days to avoid waiver. Therefore, the defendant waived their objections to the reasonableness of the services and charges for invoice #234447-3.

WCABPetition for ReconsiderationFindings and Orderslien claimantinvoice objectionwaiver of objectionreasonableness of servicesLabor Code section 4622Scandoc ImagingImport Export Cactus
References
2
Case No. ADJ7390533
Regular
Dec 10, 2018

HADA RAMOS vs. PREMIER BUILDING MAINTENANCE SERVICES, CYPRESS INSURANCE COMPANY C/O BERKSHIRE HATHAWAY HOMESTATE COMPANIES

The Workers' Compensation Appeals Board granted reconsideration to address discrepancies regarding submitted invoices for lien claimant Med-Legal Photocopy. Previously, a decision disallowed certain invoices due to perceived missing documentation, but the lien claimant asserted these were submitted. The Board found good cause to rescind its prior order and the WCJ's award due to potential technical filing issues with EAMS. The case is returned to the WCJ to develop the record concerning the disputed invoices and issue a new decision.

Med-Legal PhotocopyPetition for ReconsiderationOpinion and Decision After ReconsiderationAdministrative Law JudgeFindings and AwardLien ClaimantInvoicesBurden of ProofRecord DevelopmentElectronic Adjudication Management System (EAMS)
References
0
Case No. ADJ8127321
Regular
Aug 02, 2018

Miguel Anaya Cortez vs. Chem-Mex Industries Inc., Imperium Insurance Co., Cypress Insurance Company

The Workers' Compensation Appeals Board rescinded a prior decision and returned the matter for further proceedings. The Board found that the lien claimant failed to prove the reasonableness and necessity of its charges for copying services, but that the defendant waived objections due to failing to contest the invoices within the statutory 60-day period. The Board also noted issues with the lien claimant's service of process and the accuracy of certain invoices, requiring further clarification at the trial level. Finally, the Board found that despite defective service of subpoenas and invoices, the defendants had sufficient notice and opportunity to raise objections, thus suffering no prejudice.

Workers' Compensation Appeals BoardLien claimantReconsiderationFindings and OrderAdministrative Law JudgeDue processLabor CodeSan Diego ImagingChem-Mex IndustriesCypress Insurance Company
References
10
Case No. ADJ9120523
Regular
Jan 25, 2018

Guillermo Reyes Perez vs. Colorama Wholesale Nursery, Zenith Insurance Company

This Workers' Compensation Appeals Board case concerns disputed payments for copying services provided by lien claimant Citywide Scanning Services, Inc. The Board granted reconsideration to amend the original decision based on the WCJ's report. While most of the lien claimant's invoices were deemed satisfied due to failure to request a second review after receiving Explanations of Review (EORs), two invoices were specifically addressed. The Board found the defendant failed to provide valid EORs for services related to Colorama Wholesale Nursery and the California Secretary of State. Therefore, the lien claimant is entitled to full payment for these two invoices, less any amounts already paid by the defendant.

EORLabor Code section 4622WCAB Rule 9794(c)Petition for ReconsiderationLien claimantCopying servicesSecond reviewInvoicesDefendant's answerReport and Recommendation
References
0
Case No. ADJ9919185
Regular
Oct 09, 2019

DOMINGO JUAREZ vs. COOL ROOF SERVICE, STATE COMPENSATION INSURANCE FUND

This case concerns an interpreter's petition for sanctions against an insurance fund for delayed payment of an invoice. The Workers' Compensation Appeals Board granted reconsideration, finding the defendant's almost year-long delay in paying a $156.50 invoice and issuing irrelevant objections in its Explanation of Review constituted bad faith under Labor Code section 5813. The Board rescinded the previous order and returned the matter to the WCJ for further proceedings to determine appropriate sanctions for the defendant's actions.

Labor Code section 5813bad faithPetition for CostsPetition for Sanctionsinterpreter servicesExplanation of Review (EOR)60-day payment windowAdministrative Director Rule 9795.4unreasonable delaymeritless objection
References
0
Case No. ADJ9873183
Regular
Feb 24, 2020

WONDA BRAZILE TRAYLOR vs. COUNTY OF LOS ANGELES/PUBLIC HEALTH SERVICES; Permissibly SelfInsured, Administered by TRISTAR RISK MANAGEMENT

The WCAB affirmed the prior award finding the County of Los Angeles liable for copy services provided by lien claimant Med-Legal, LLC. The defendant failed to issue a timely and compliant Explanation of Review (EOR) for invoice 1313134, thereby waiving objections to its reasonableness. Consequently, the lien claimant is entitled to the reasonable value of the invoice, plus penalties and interest retroactive to receipt. The case is remanded to the WCJ to determine the exact reasonable value of the services.

WCABReconsiderationLien ClaimantCopy ServicesExplanation of ReviewMedical-Legal ExpensesLabor Code Section 4622PenaltiesInterestReasonable Value
References
2
Case No. ADJ9104022
Regular
Jan 07, 2019

WILLIAM GREEN vs. RPK DEVELOPMENT INC., CYPRESS INSURANCE, Administered by BERKSHIRE HATHAWAY HOMESTATE COMPANIES, INC., FARMERS INSURANCE

This case involves a lien claimant's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision regarding payment for medical-legal expenses. The claimant argues that the defendant's objection letters to certain invoices were procedurally deficient, thereby waiving all objections under *Otis v. City of Los Angeles*. The WCAB granted reconsideration, rescinded the prior findings, and returned the matter for further proceedings. This action is due to uncertainty regarding the procedural compliance of the defendant's objection letters and to allow further development of the record on specific disputed invoices.

Workers' Compensation Appeals BoardLien ClaimantPetition for ReconsiderationFindings and OrderLabor Code Section 4603.3Administrative Director Rule 9794Medical-Legal ExpenseContested ClaimExplanation of ReviewOtis v. City of Los Angeles
References
8
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