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

Case No. MISSING
Regular Panel Decision

Lutheran Medical Center v. Hereford Insurance

Maher Kiswani, a livery car driver, was injured in an automobile accident and received medical treatment from Lutheran Medical Center. Lutheran, as Kiswani's assignee, sought payment from Hereford Insurance Company, the no-fault carrier, which refused to pay. After an initial arbitration where the Workers' Compensation Board determined Kiswani was not injured in the course of employment (without Hereford's notice), a second arbitration awarded Lutheran no-fault benefits. The Supreme Court, Kings County, vacated this arbitration award, ruling that Hereford should have been notified of the Workers' Compensation Board hearing. The appellate court affirmed the Supreme Court's decision, holding that a party not afforded an opportunity to participate in a Board hearing is not bound by its determination.

Arbitration AwardNo-Fault InsuranceWorkers' Compensation BoardDue ProcessNotice RequirementsVacated Arbitration AwardAppellate ReviewLivery Car DriverAutomobile AccidentMedical Benefits
References
3
Case No. MISSING
Regular Panel Decision

Queens Blvd. Medical, P.C. v. Travelers Indemnity Co.

The plaintiff, Queens Blvd. Medical, P.C., sought $950 in first-party no-fault benefits for biofeedback medical services provided to its assignor for lower back and chronic pain syndrome. The central issue at trial was the medical necessity of these services under Insurance Law § 5102 (a) (1). The plaintiff established a prima facie case with expert testimony from a board-certified neurologist affirming the medical appropriateness of biofeedback. The defendant insurance company failed to present admissible evidence to disprove medical necessity, as its expert was deemed incompetent to testify on biofeedback for back pain. Consequently, the court granted the plaintiff's motion for a directed verdict, awarding judgment for $950 along with statutory costs, interest, and attorney's fees.

No-fault benefitsMedical necessityBiofeedback treatmentExpert testimonyDirected verdictInsurance lawChronic pain syndromeBack injuryCPT codesBurden of proof
References
9
Case No. ADJ8810795
Regular
Jul 21, 2014

MARIA AGUIRRE vs. LOMPOC VALLEY MEDICAL CENTER

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. This decision affirmed the award of attorney's fees to the applicant under Labor Code section 4651.3. The Board found that the defendant's continued pursuit of terminating temporary disability benefits, despite medical evidence indicating ongoing disability and a subsequent withdrawal attempt, triggered the attorney fee liability. This denial upholds the principle that applicant's attorney fees are awarded for successfully resisting a petition to terminate benefits, regardless of the defendant's intent.

WCABPetition for ReconsiderationLabor Code section 4651.3attorney's feesPetition to Terminatetemporary disabilitystrict liability statutemedical reportingdepositionPTP
References
1
Case No. ADJ4494642 (SBA 0026287)
Regular
Jun 18, 2009

MARY CONTRERAS vs. DAVID EARTHCRAFT, INC., ZENITH INSURANCE COMPANY

In this case, the applicant, Mary Contreras, sought attorney fees under Labor Code section 4607 after successfully challenging the denial of specific requested medications by the defendant. The Workers' Compensation Appeals Board (WCAB) reversed a prior award of attorney fees, holding that section 4607 only applies when an employee successfully resists an employer's attempt to terminate an entire award of medical treatment, not just specific treatment requests. The WCAB relied on the California Supreme Court's decision in *Smith v. Workers' Comp. Appeals Bd.*, which clarified this statutory interpretation. Therefore, the applicant was denied attorney fees as the defendant did not attempt to terminate the applicant's ongoing medical treatment award.

Utilization reviewAgreed medical evaluatorsAttorney feesSection 4607Termination of awardMedical treatmentMedication authorizationPermanent disabilityIndustrial injuryWCJ
References
1
Case No. MISSING
Regular Panel Decision

Flushing Hosp. and Medical Center v. Local 1199, Drug, Hospital and Health Care Employees Union RWSDU/AFL-CIO

Flushing Hospital and Medical Center (the Hospital) sought to vacate an arbitration award that reinstated Lenore Lasely, a nursing attendant, with back pay after her termination for independently changing an IV bag during an emergency, despite being unauthorized. Local 1199, the union, cross-moved to enforce the award. Arbitrator Janet Maleson Spencer determined Lasely was not fired for just cause, noting her actions were taken out of patient concern and under the reasonable belief of correctness. The court, acknowledging the limited scope of judicial review for arbitration awards, found no explicit public policy violation to justify vacating the award, distinguishing it from cases involving a clear propensity for dangerous conduct. Consequently, the court denied the Hospital's motion to vacate and granted the Union's motion to enforce the arbitration award.

Arbitration award reviewLabor disputeEmployee reinstatementUnjust terminationPublic policy exceptionCollective bargaining agreementNursing attendant dutiesIV bag procedureFederal Rule of Civil Procedure 56Judicial deference to arbitration
References
6
Case No. MISSING
Regular Panel Decision
Feb 10, 2017

Mitchell v. SUNY Upstate Medical University

Plaintiff Robbie Mitchell sued SUNY Upstate Medical Center for alleged Title VII violations, including race discrimination and retaliation, after experiencing a series of adverse employment actions. These actions included reassignment, disciplinary notices (NODs), a mandatory medical examination, a formal counseling memorandum, a verbal dispute, and eventual termination. The defendant moved for summary judgment, arguing the plaintiff failed to establish a prima facie case for most claims and that their actions were based on legitimate, non-discriminatory reasons. The court granted summary judgment in favor of SUNY Upstate Medical Center, concluding that the plaintiff failed to provide sufficient evidence of discrimination or that retaliation was the but-for cause of the challenged employment actions, and consequently, the case was closed.

Title VIICivil Rights ActEmployment DiscriminationRetaliationSummary JudgmentAdverse Employment ActionMcDonnell Douglas FrameworkWorkplace ConductDisciplinary ActionPaid Administrative Leave
References
49
Case No. MISSING
Regular Panel Decision
Mar 13, 2006

Taylor v. New York University Medical Center

The court reversed an order and granted judgment to defendants in a sexual orientation discrimination case. Plaintiff's employment was terminated, which he alleged was discriminatory. Defendants, New York University Medical Center (NYUMC) and Ferrara, successfully argued that the termination was due to legitimate budgetary concerns and departmental reorganization, not discrimination. The court found that the plaintiff failed to rebut the defendants' nondiscriminatory reason or prove that discrimination was the real motive, noting that Ferrara was not the decision-maker in the termination. The case was dismissed, with the court also noting improper admission of evidence that would have warranted a new trial.

Sexual Orientation DiscriminationEmployment TerminationBudgetary ConcernsDepartmental ReorganizationPretextMcDonnell Douglas FrameworkSummary JudgmentAppellate ReviewPunitive DamagesMental Anguish
References
14
Case No. MISSING
Regular Panel Decision

Rohlehr v. Brookdale University Hospital & Medical Center

Stanley Rohlehr sued Brookdale University Hospital and Medical Center alleging four claims: termination in violation of New York Labor Law § 740 and the Fair Labor Standards Act, breach of an employee handbook, and violation of public policy. Rohlehr was terminated after filing complaints with the National Labor Relations Board (NLRB) regarding union activities, followed by disciplinary notices for job performance issues. The NLRB dismissed his subsequent complaint, concluding termination was due to unsatisfactory performance. The Hospital moved for summary judgment. The court granted the Hospital's motion, dismissing all claims because the Labor Law § 740 claim did not involve public health or safety, the § 740 filing waived other contractual claims, the FLSA claim did not pertain to FLSA violations, and New York does not recognize a common law cause of action for abusive discharge.

WhistleblowerRetaliationWrongful TerminationSummary JudgmentLabor LawEmployee RightsEmployment ContractPublic PolicyNational Labor Relations BoardUnion Activities
References
23
Case No. ADJ4559849
Regular
Sep 30, 2009

PATSY VAN BUSKIRK vs. MOCEO E.V. COMPANY, CIGA

The Workers' Compensation Appeals Board affirmed a judge's decision denying attorney fees under Labor Code section 4607. The applicant's attorneys argued fees were owed because the defendant constructively terminated medical treatment without filing a formal petition to terminate the award. However, the Board found that the defendant only disputed specific treatment requests, not initiated proceedings to terminate the overall award of future medical care. Therefore, pursuant to *Smith v. Workers' Comp. Appeals Bd.*, attorney fees under section 4607 were not applicable.

Labor Code section 4607Petition for ReconsiderationPermanent DisabilityFurther Medical TreatmentQualified Medical ExaminerMedical Provider NetworkConstructively TerminatedSmith v. Workers' Comp. Appeals Bd.Termination ProceedingsAttorney Fees
References
3
Case No. MISSING
Regular Panel Decision
May 02, 1973

Reeves v. Golar

A probationary patrolman's employment with the New York City Housing Authority was terminated following suspicions of narcotic use, despite his claims of medication-related quinine traces and denial of unlawful drug use. His requests for medical test reports and a thorough medical examination were denied, leading to an informal hearing and subsequent termination. The court questioned the arbitrary and capricious nature of the dismissal, highlighting that the termination was based on unproven drug use rather than work performance. Citing due process concerns under the Fourteenth Amendment regarding the petitioner's liberty interest and reputation, the court found he deserved a proper hearing to refute the charges. Consequently, the Supreme Court's judgment to reinstate the petitioner was partially reversed, and the case was remanded to the Housing Authority for a further hearing and medical investigation.

Due processArticle 78probationary employmentterminationnarcotic suspicionurine testarbitrary and capriciousliberty interestFourteenth Amendmenthearing rights
References
10
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