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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

Abreo v. URS Greiner Woodward Clyde

A plaintiff sustained personal injuries while working on a scaffold during a renovation project, alleging violations of Labor Law §§ 200, 240 (1), and 241 (6). Defendants Colgate Scaffolding and URS Greiner Woodward Clyde (now URS Corporation-New York), the alleged general contractor and scaffolding provider, respectively, moved for summary judgment to dismiss the complaint. The Supreme Court denied their motions in part. On appeal, the denial of summary judgment for URS concerning Labor Law § 240 (1) and § 241 (6) claims was affirmed, as triable issues of fact existed and the cited Industrial Code provisions were deemed specific. Colgate's appeal from one order was dismissed as they were not aggrieved, and their motion for summary judgment was also found to lack a prima facie case. The plaintiff was awarded costs.

Personal InjuryLabor LawScaffolding AccidentSummary JudgmentAppellate DecisionConstruction AccidentElevation-Related RiskIndustrial Code ViolationsNegligenceWorkers' Safety
References
14
Case No. 2022 NY Slip Op 00941 [202 AD3d 505]
Regular Panel Decision
Feb 10, 2022

Locke v. URS Architecture & Eng'g-N.Y., P.C.

Plaintiff Michael Locke sustained injuries after slipping on soapy water in a designated restroom at a construction site managed by URS. Locke had repeatedly notified URS of an overflowing sink causing water to pool, but URS attributed responsibility to prime general contractor Tri-Rail. The Supreme Court granted summary judgment to plaintiffs on common-law negligence and Labor Law claims against URS, while denying URS's motion to dismiss and for contractual indemnification against Tri-Rail, and denying Crescent's motion to dismiss. The Appellate Division modified the Supreme Court's order, dismissing the common-law negligence and Labor Law § 200 claims against Crescent and granting URS conditional contractual indemnification against Tri-Rail, pending liability apportionment. The court found URS liable under Labor Law §§ 241(6) and 200 due to its control over the injury-producing activity and notice of the dangerous condition.

Workers' CompensationConstruction Site AccidentSlip and FallPremises LiabilityLabor Law §200Labor Law §241(6)Industrial Code ViolationSummary JudgmentContractual IndemnificationCommon-Law Negligence
References
9
Case No. ADJ12194461
Regular
Dec 10, 2020

Antonio Lemus vs. STEVE P. RADOS, INC., STARR INDEMNITY & LIABILITY COMPANY

This case concerns applicant Antonio Lemus's entitlement to home health care following an admitted industrial head injury. Defendant sought reconsideration of a WCJ's award enforcing a Utilization Review (UR) determination that modified but approved home health aide services. The defendant argued the WCJ lacked jurisdiction to enforce the UR determination due to a second, later UR denial of the same request, which they claimed was timely. The Appeals Board affirmed the WCJ's decision, finding jurisdiction to enforce the initial UR approval and deeming the subsequent denial an improper "self-granted appeal." The Board concluded the applicant was entitled to the treatment approved by the first UR determination.

Workers' Compensation Appeals BoardUtilization ReviewRequest for AuthorizationIndependent Medical ReviewFindings Orders and AwardPetition for ReconsiderationNurse Case ManagerTraumatic Brain InjuryHome Health AideMedical Treatment
References
2
Case No. ADJ16034617; ADJ13224263; ADJ9403331
Regular
Aug 12, 2025

DARREL LINK vs. NORTHROP GRUMMAN SYSTEMS CORPORATION, AIU INSURANCE COMPANY

Defendant sought reconsideration of a WCJ's finding that its Utilization Review (UR) process certified a Request for Authorization (RFA) and that the court lacked jurisdiction to alter this determination, while also ordering defendant to authorize treatment. The Appeals Board granted reconsideration to admit trial exhibits and amend findings of fact regarding the UR determination. The Board affirmed the WCJ's decision, concluding that the November 16, 2023 UR decision was timely and valid, and that the WCJ appropriately exercised authority to order compliance with the UR determination.

Utilization ReviewRequest for AuthorizationMedical NecessityFindings of FactPetition for ReconsiderationJurisdictionDue ProcessLabor Code Section 4610Aircraft MechanicTraumatic Brain Injury
References
10
Case No. ADJ8454101
Regular
Dec 18, 2014

Joshua Desmarias vs. California Highway Patrol

The Appeals Board rescinded the original WCJ's decision, finding the applicant's appeal of the UR denial for spinal surgery is denied. The Board clarified that a procedural defect in a UR report, such as an illegible signature, does not invalidate the UR determination unless the UR itself was untimely. Since the parties stipulated the UR was timely, the Board lacked jurisdiction to determine the medical necessity of the surgery. Therefore, the IMR decision upholding the UR denial stands, and the applicant's request for surgery is denied.

Workers' Compensation Appeals BoardCalifornia Highway Patrollegally uninsuredState Compensation Insurance FundFindings of Fact and Orderindustrial injuryutilization reviewUR denialspinal surgeryorthopedic surgeon
References
3
Case No. ADJ9893989
Regular
Oct 10, 2017

DAMIAN SANCHEZ vs. MICHAEL SIMMS dba SIMMS PAINTING AND DECORATING, TRUMBULL INSURANCE COMPANY

This case concerns the timeliness of a utilization review (UR) determination regarding a request for home health care. The defendant argued its UR denial was timely because it requested additional information, thereby extending the review period under Labor Code section 4610(g)(1). The WCJ initially found the UR determination untimely for prospective and concurrent review, but timely for retrospective review, citing a narrow interpretation of who can request further information. The Appeals Board granted reconsideration, rescinded the WCJ's decision, and found the UR denial timely. The Board held that the defendant's attorney, acting as an agent for the claims administrator, could validly request additional information, extending the UR deadline to 14 days.

Utilization ReviewRequest For AuthorizationIndependent Medical ReviewProspective ReviewConcurrent ReviewRetrospective ReviewTimelinessLabor Code Section 4610Administrative Director Rule 9792.9.1Findings Of Fact And Order
References
6
Case No. ADJ15513907
Regular
Apr 12, 2023

MARICELA LEON vs. ADVANCE BUILDING MAINTENANCE INC., SECURITY NATIONAL INSURANCE COMPANY, AMTRUST CONCORD

The applicant sought reconsideration of a WCJ's finding that the Appeals Board lacked jurisdiction over medical treatment reasonableness due to a timely utilization review (UR) determination. The applicant argued the UR decision was untimely because it was not served on counsel within two days. The Appeals Board granted reconsideration, finding that a UR decision, even if timely made, is invalid if not timely communicated. Therefore, the matter was returned for a new decision, requiring the WCJ to determine if the UR decision was timely communicated and to adjudicate medical necessity if it was not.

Workers' Compensation Appeals BoardUtilization ReviewTimelinessMedical TreatmentPetition for ReconsiderationFindings of FactLabor CodeDubon IIBodamIndependent Medical Review
References
5
Case No. ADJ2333954 (GRO 0032434)
Regular
Jan 25, 2015

FRANK OLIVEIRA vs. KING VENTURES, STATE COMPENSATION INSURANCE FUND

The Appeals Board vacated the original award, finding the record insufficient to determine if the applicant's ongoing medication use qualified for prior authorization without new utilization review (UR), as per *Patterson*. The Board also corrected the WCJ's UR timeliness calculation, finding the determination likely timely under the proper Administrative Director Rule. However, the case is remanded to develop the record on whether UR was required and if the UR decision was communicated timely, before addressing penalties. The issue of penalties and attorney fees is deferred pending these further proceedings.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardLabor Code section 5814Labor Code section 5814.5Utilization Review (UR)Patterson v. The Oaks FarmRequest For Authorization (RFA)Administrative Director (AD) Rule 9792.9.1Bodam v. San Bernardino County Dept. of Social Services
References
7
Case No. ADJ3700908 (SRO 0101979) ADJ3874442 (SRO 0098853)
Regular
Jul 18, 2014

Randall Otten vs. Cardinal Newman High School, California Insurance Guarantee Association for Superior National Insurance Company, in liquidation

This case concerns the validity of a Utilization Review (UR) determination regarding the applicant's need for a radiofrequency rhizotomy injection for his low back injury. The Appeals Board reversed the lower judge's decision, finding the UR determination valid. They held that the omission of certain medical reports was not a material procedural defect because they would not have changed the UR physician's conclusion. Furthermore, the Board found the applicant failed to present substantial medical evidence to support the necessity of the treatment or prove the UR was invalid. The issue of medical necessity is now subject to Independent Medical Review (IMR).

Workers' Compensation Appeals BoardUtilization ReviewIndependent Medical ReviewReconsiderationFindings and AwardMaterial Procedural DefectDubonEvidence-Based GuidelinesAgreed Medical EvaluatorTreating Physician
References
6
Case No. MISSING
Regular Panel Decision

Hobbs v. Lavine

Petitioner's home relief assistance was discontinued by the New York City Department of Social Services based on a finding that she was fully employed. This determination was affirmed by the respondent after a hearing. The court found that the respondent's determination was not supported by substantial evidence, as the city agency's evidence consisted only of two vague case-record entries. Consequently, the application was granted, and the determination was annulled, with petitioner's assistance directed to be reinstated retroactively.

Home ReliefPublic AssistanceSocial ServicesEmployment StatusSubstantial EvidenceArticle 78 CPLRAdministrative ReviewRetroactive BenefitsDiscontinuation of Benefits
References
2
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