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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

In Re Enron Corp.

Enterprise Products Operating L.P. filed a motion for resolution of dispute against Enron Gas Liquids, Inc. (EGLI) regarding lien claims for pre-petition services. Enterprise asserted a total lien claim of $888,059.09 under Texas law for various services including storage, trucking, fractionation, and product treatment of natural gas liquids. EGLI acknowledged a portion of the lien related to trucking and storage but disputed the claim for fractionation and product treatment services. The court examined whether Enterprise qualified as a 'mechanic, artisan, or materialman' under Article XVI, § 37 of the Texas Constitution. The court ultimately denied the fractionation and product treatment lien, finding that Enterprise's complex engineering and technical operations did not fit these traditional definitions. Additionally, the court denied Enterprise's request for post-petition attorneys' fees, citing the absence of a contractual agreement for such fees.

Bankruptcy LawLien EnforcementTexas Constitutional LawSecured ClaimsAttorneys' FeesCommercial DisputeNatural Gas LiquidsFractionation ServicesWarehouseman's LienDebtor-in-Possession
References
12
Case No. ADJ3135829 (AHM 0099139)
Regular
Jul 28, 2014

CAROLYN BERTRAND vs. COUNTY OF ORANGE, YORK

This case concerns a dispute over medical treatment disputes between an applicant and the County of Orange. The parties had previously stipulated to have the Agreed Medical Examiner (AME), Dr. Wilson, resolve future treatment disputes, potentially bypassing the statutory Utilization Review (UR) and Independent Medical Review (IMR) processes. The Workers' Compensation Appeals Board (WCAB) dismissed the employer's petition for reconsideration as the prior order was procedural, but granted removal. As a decision after removal, the WCAB clarified that while the stipulation to use the AME is valid and can supersede IMR, treatment requests must first go through UR, and only subsequent disputes are referred to the AME.

StipulationAgreed Medical ExaminerAMEUtilization ReviewURIndependent Medical ReviewIMRRemovalPetition for ReconsiderationLabor Code section 4610
References
3
Case No. MISSING
Regular Panel Decision

L&L Painting Co. v. Contract Dispute Resolution Board

L&L and Odyssey, contractors for lead-based paint removal on the Queensboro Bridge, disputed a contract drawing's interpretation with the Department of Transportation (DOT) concerning scaffolding clearance. Petitioners sought additional compensation after DOT rejected their proposed platform design, claiming a latent ambiguity in the contract. The Contract Dispute Resolution Board (CDRB) denied their claim, finding a patent ambiguity requiring pre-bid clarification. The Supreme Court upheld CDRB's decision, and this appellate court affirmed, concluding that the ambiguity was indeed patent, contrasting 'all roadways' in the note with the drawing's specific references. A dissenting opinion argued against this, stating an engineer would find no ambiguity.

Contract DisputePublic Works ContractQueensboro BridgeConstruction LawContract InterpretationAmbiguityPatent AmbiguityLatent AmbiguityCPLR Article 78Administrative Law
References
0
Case No. ADJ91 42464
Regular
Mar 18, 2016

MARIA ELENA GRIJALVA vs. CARE ADMINISTRATION AND MANAGEMENT PROFESSIONALS, CYPRESS INSURANCE COMPANY

The Appeals Board granted defendant's petition for removal, rescinding the WCJ's order for a PQME to comment on previously denied medical treatment. Discovery closed at the Mandatory Settlement Conference, and the UR/IMR denials rendered the treatment dispute non-justiciable at trial. Applicant must submit a new RFA for the disputed treatment, not seek PQME opinion. The case returns to the trial level for further proceedings.

Petition for RemovalQualified Medical Evaluator (PQME)Utilization Review (UR)Independent Medical Review (IMR)Mandatory Settlement Conference (MSC)Discovery ClosureRequest for Authorization (RFA)Treating PhysicianMedical Treatment DisputeAdministrative Law Judge (WCJ)
References
0
Case No. ADJ2373559 (OAK 0280633)
Regular
Dec 29, 2008

LYNN JONES vs. INTERNEWS NETWORK, STATE COMPENSATION INSURANCE FUND

The WCAB granted reconsideration, rescinded the prior award, and returned the case to the trial level to allow parties to complete the dispute resolution process regarding medical treatment denials. The Board found that after utilization review denied treatment, the parties failed to follow the required procedures under Labor Code sections 4610 and 4062 to resolve the dispute. Therefore, a new decision is to be made after the proper dispute resolution process is completed.

Workers' Compensation Appeals BoardUtilization ReviewMedical Treatment DisputeLabor Code Section 4610Labor Code Section 4062Qualified Medical ExaminerGym MembershipPhysical TherapyIndustrial InjuryTreating Physician
References
1
Case No. ADJ339088 (SDO 0304788)
Regular
Aug 30, 2016

Gregory Parrent vs. SBC-PACIFIC BELL TELEPHONE COMPANY

This case clarifies the utilization review (UR) and independent medical review (IMR) process for medical treatment recommendations within a Medical Provider Network (MPN). The Appeals Board affirmed that even when a physician is part of the defendant's MPN, their treatment recommendations are subject to UR by the employer if disputed. If UR denies or modifies the recommendation, the dispute must then proceed to IMR, not the Appeals Board. The applicant's contention that MPN physicians' recommendations are exempt from UR was rejected, emphasizing a uniform standard of care and review for all medical treatment.

Workers' Compensation Appeals BoardSBC-Pacific Bell Telephone CompanySedgwick Claims Management ServicesPetition for ReconsiderationMedical Provider Network (MPN)Independent Medical Review (IMR)Utilization Review (UR)Labor Code section 4600primary treating physicianRequest for Authorization (RFA)
References
5
Case No. ADJ9845532
Regular
Feb 03, 2017

DONNA PARKER ALVAREZ vs. MOTHER LODE UNION ELEMENTARY SCHOOL DISTRICT, SCHOOLS INSURANCE AUTHORITY

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration regarding an award of increased benefits. The Board upheld the administrative law judge's finding that the employer unreasonably delayed benefits for the applicant's left knee injury by failing to provide treatment after receiving a QME report identifying the injury and recommending treatment. The employer's contention of a medical and legal dispute was rejected as there was no evidence of a dispute and the employer had previously provided treatment for the left knee. Consequently, the $25\%$ penalty for unreasonable delay under Labor Code section 5814 was affirmed.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and AwardLabor Code section 5814unreasonable delaymedical disputelegal disputeQualified Medical Evaluator (QME)Declaration of Readiness to ProceedLabor Code section 4063
References
1
Case No. ADJ2148650
Regular
Sep 30, 2011

BRET ROSS vs. ALLERGAN, INC., AMERICAN HOME ASSURANCE

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior decision because the judge failed to make findings on all issues presented. The applicant sought reconsideration of a ruling requiring all medical treatment disputes to go through utilization review (UR), arguing this was unnecessary for chronic conditions. While UR is generally required per Labor Code §4610, the Board found the judge's decision was deficient by not addressing issues like liability for self-procured treatment or treatment outside the MPN. The case was returned to the trial level for a new decision that addresses all disputed issues.

Utilization ReviewPeroneal Nerve BlocksReflex Sympathetic DystrophySelf-Procured TreatmentLabor Code Section 4600Labor Code Section 4610Medical Treatment NecessityChief of SecurityPermanent DisabilityPrimary Treating Physician
References
7
Case No. 531151
Regular Panel Decision
Oct 07, 2021

Matter of Williams v. Orange & White Mkts.

Claimant Giulliana Williams, who sustained work-related left shoulder injuries in 2016 and 2018, sought payment for medical treatment from her orthopedist, Arnold Wilson. Insurance Company of Greater New York, the employer's carrier for the 2016 injury, disputed payment for treatment rendered between September 2018 and January 2019, arguing it was unrelated to the earlier injury. A Workers' Compensation Law Judge ruled the disputed treatment was causally related to the 2016 accident, obligating the 2016 carrier to pay. This decision was affirmed by the Workers' Compensation Board and subsequently by the Appellate Division, Third Department, which credited Dr. Wilson's testimony that the need for surgery initiated with the 2016 injury despite a compounding 2018 injury. The court found substantial evidence supported the Board's resolution of conflicting medical opinions.

Causal RelationshipMedical Bills DisputeShoulder InjuryOrthopedic SurgeryAppellate ReviewSubstantial EvidenceConflicting Medical OpinionsWorkers' Compensation Board DecisionInsurance Carrier LiabilityPrior Injury Aggravation
References
4
Case No. MISSING
Regular Panel Decision

In re the Arbitration between A.F.C.O. Metals, Inc. & Local Union 580 of International Ass'n of Bridge

This case concerns a dispute between Local Union 580 and AFCO Metals, Inc. regarding arbitration of pension fund contributions. Local 580 claimed AFCO underpaid contributions by assigning work to Carpenters Unions that should have been allocated to Local 580 members. AFCO sought to stay arbitration, arguing the dispute was jurisdictional and excluded from arbitration under their collective bargaining agreement. The Supreme Court initially dismissed AFCO's petition, but the Appellate Division reversed, finding the dispute jurisdictional. The Court of Appeals affirmed the Appellate Division's order, ruling that the underlying dispute is a jurisdictional matter, which the parties explicitly agreed to exclude from arbitration provisions in their collective bargaining agreement.

ArbitrationJurisdictional DisputeCollective Bargaining AgreementPension FundsUnion ContributionsWork AssignmentAppellate ReviewLabor LawContract InterpretationFund Delinquency
References
3
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