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

Case No. ADJ7845438
Regular
Dec 08, 2011

TERESA ROJO vs. QUEST DIAGNOSTICS, TRAVERLERS

The defendant, Quest Diagnostics, filed a Petition for Removal seeking to rescind an order continuing the case for trial, arguing they lacked opportunity to rebut a newly received medical report. However, at the subsequent trial, both parties agreed to an Agreed Medical Evaluator and took the case off calendar. As the case is no longer proceeding to trial, the defendant's Petition for Removal has become moot. Consequently, the Appeals Board has dismissed the petition.

Petition for RemovalMandatory Settlement ConferenceAgreed Medical EvaluatorOff CalendarMootDismissedWorkers' Compensation Appeals BoardWCJRebuttal ReportMedical Report
References
0
Case No. ADJ7809684
Regular
Oct 09, 2014

SUSAN NELSON vs. QUEST DIAGNOSTICS, TRAVELERS

This case involves defendant Quest Diagnostics' petitions for removal and disqualification of the workers' compensation judge. The defendant sought to set the case for trial solely on its petitions to dismiss, arguing a mandatory settlement conference would incur additional costs. The Appeals Board denied both petitions, finding defendant's petition for removal contained false statements and applicant's answer was offensive, potentially warranting sanctions. The Board also rejected the disqualification request, agreeing with the judge that no bias was demonstrated.

Petition for RemovalPetition for DisqualificationWCJ Report and RecommendationWCAB Rule 10561(b)(5)(A)WCAB Rule 10561(b)(9)(A)Labor Code Section 5813SanctionsLack of ProsecutionPetition to DismissMandatory Settlement Conference
References
0
Case No. ADJ3603721 (ANA 0385798) ADJ3874014 (ANA 4689669) ADJ4689669 (ANA 0388899)
Regular
Nov 07, 2014

CAROL HILL vs. UNILAB CORPORATION/QUEST DIAGNOSTICS, TRAVELERS INSURANCE COMPANY

This case involves an applicant seeking reconsideration of a WCJ's decision regarding unreasonable delays in benefit payments. The Board granted reconsideration and affirmed the finding of unreasonable delay for temporary disability indemnity, awarding a 25% penalty. However, the Board deferred the issue of permanent disability indemnity advance penalties for further analysis due to record ambiguity. The Board also found no unreasonable delay in medical treatment benefits and reversed an award of attorney's fees under LC 5814.5, but allowed fees from the temporary disability penalty recovery.

Workers' Compensation Appeals BoardUnreasonable DelayTemporary Disability IndemnityPermanent Disability Indemnity AdvancesLabor Code Section 5814 PenaltyMedical Treatment BenefitsAttorney's FeesPetition for ReconsiderationAdministrative Law JudgeJoint Findings and Award
References
1
Case No. MISSING
Regular Panel Decision

Elmont Open MRI & Diagnostic Radiology, P.C. v. New York Central Mutual Fire Insurance

Plaintiff Elmont Open MRI & Diagnostic Radiology, PC. sued defendant New York Central Mutual Fire Insurance Company (NYCMFIC) for overdue first-party no-fault benefits following a brain MRI performed on Abdelghani Kinane. NYCMFIC moved for summary judgment, asserting the action was premature because Elmont allegedly failed to respond to verification requests, thereby tolling NYCMFIC's time to pay or deny the claim. Elmont countered with an affidavit from its billing supervisor, Brijkumar Yamraj, and a certificate of mailing, proving the requested MRI films and information were sent to NYCMFIC on November 12, 2008. The court found Elmont's proof of mailing sufficient to establish a response, thus denying NYCMFIC's motion and subsequently granting summary judgment to Elmont upon searching the record.

No-fault insuranceVerification requestsSummary judgmentProof of mailingMedical benefitsInsurance claims processTolling of time limitMotor vehicle accidentRadiology fee scheduleBusiness records
References
24
Case No. ADJ4634338 (MON 02262377) ADJ614711 (MON 0288710)
Regular
Dec 07, 2009

NINA GOODRICH vs. UNILAB/QUEST DIAGNOSTICS, SEDGWICK CLAIMS MANAGEMENT SERVICES, AMERICAN CASUALTY CO. OF READING, PA, CNA CLAIMSPLUS, VALLEY HEALTH SYSTEMS, TRISTAR RISK MANAGEMENT, ZURICH INSURANCE CO.

Zurich's petition for reconsideration of the June 24, 2009 Opinion and Order Granting Reconsideration and Decision After Reconsideration is denied for the reasons stated in prior opinions.

Workers' Compensation Appeals BoardNina GoodrichUnilab/Quest DiagnosticsSedgwick Claims Management ServicesAmerican Casualty Co.Valley Health SystemsTristar Risk ManagementZurich Insurance Co.Labor Code section 5500.5Arbitration Finding of Facts
References
6
Case No. ADJ4634338 (MON 0262377)
Regular
Jun 24, 2009

NINA GOODRICH vs. UNILAB/QUEST DIAGNOSTICS, SEDGWICK CLAIMS MANAGEMENT SERVICES, AMERICAN CASUALTY CO. OF READING, PA, CNA CLAIMSPLUS, VALLEY HEALTH SYSTEMS, TRISTAR RISK MANAGEMENT, ZURICH INSURANCE CO.

This case concerns a dispute over contribution claims following a cumulative injury to the applicant. The Workers' Compensation Appeals Board granted reconsideration, rescinded an arbitration finding, and remanded the matter for further proceedings. The Board found that Sedgwick, which paid over $180,000 in benefits, was not required to file a petition for contribution under section 5500.5 because it was not a signatory to the Compromise and Release (C&R). Furthermore, the Board held that even if Sedgwick had been required to file, the co-defendant CNA would be estopped from asserting the statute of limitations due to stipulations in the C&R reserving contribution rights. The Board concluded Sedgwick's claim for reimbursement was not time-barred.

Workers' Compensation Appeals BoardNina GoodrichUnilabQuest DiagnosticsSedgwick Claims Management ServicesAmerican Casualty Co.CNA ClaimsplusValley Health SystemsTristar Risk ManagementZurich Insurance Co.
References
2
Case No. 0132572 and STK 0132571
Regular
Dec 16, 2008

BERNARD McGRATH vs. D & J TILE, INC., STATE COMPENSATION INSURANCE FUND, MULLIKIN MEDICAL CENTER, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION For FREMONT INSURANCE, In Liquidation, Administered By CAMBRIDGE INTEGRATED SERVICES, UNILAB CORPORATION/QUEST DIAGNOSTICS, HARTFORD UNDERWRITERS INSURANCE COMPANY, Administered By SPECIALTY RISK SERVICES, INC.

The Workers' Compensation Appeals Board granted reconsideration and rescinded the Workers' Compensation Judge's (WCJ) decisions due to disputed findings on the applicant's neck, wrist, shoulder, back, and upper extremity injuries. Both the applicant and co-defendant Hartford sought reconsideration, alleging errors in the WCJ's reliance on specific medical opinions and the exclusion of certain injuries. The Board found the medical record required further development concerning causation and apportionment of these injuries before a new decision could be issued.

Workers' Compensation Appeals BoardPetition for ReconsiderationIndustrial InjuryNeck InjuryCervical SpinePhlebotomistTile SetterPermanent DisabilityApportionmentAgreed Medical Evaluator
References
5
Case No. ADJ264698 (GOL 0101840)
Regular
Dec 14, 2011

JEFFREY GEER vs. QUEST DIAGNOSTICS, TRAVELERS INSURANCE

This case involves an applicant who sustained a back injury. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, affirming that the applicant sustained an industrial injury and that the statute of limitations was tolled due to the employer's failure to provide a claim form. However, the WCAB reversed the finding of unreasonable delay or refusal of benefits, concluding the defendant had a non-frivolous legal doubt regarding liability. The WCAB also removed the presumption of compensability, as the defendant denied the claim within 90 days of the claim form filing.

Workers' Compensation Appeals BoardReconsiderationStatute of LimitationsLabor Code section 5402(b)Presumption of CompensabilityFirst AidLabor Code section 5401(a)TollingEstoppelGenuine Doubt
References
5
Case No. 2019 NY Slip Op 05740 [174 AD3d 1196]
Regular Panel Decision
Jul 18, 2019

Matter of Presida v. Health Quest Sys., Inc.

Claimant Oprah Presida sustained a work-related injury to her right knee, which was later amended to include a causally-related lower back injury, and a total knee replacement was authorized. The employer and its workers' compensation carrier sought review from the Workers' Compensation Board of a Workers' Compensation Law Judge's decision. The Board denied this application, finding it defective for not complying with 12 NYCRR 300.13 (b)(1), which requires applications to be completely filled out on Form RB-89 without merely referring to attached documents. The carrier appealed this denial, arguing it was arbitrary and capricious. The Appellate Division affirmed the Board's decision, concluding that the Board did not abuse its discretion in denying the application due to the carrier's failure to provide complete responses on the prescribed form.

Appellate ReviewApplication for Board ReviewProcedural ComplianceForm RB-89Administrative LawDenial of ApplicationArbitrary and Capricious StandardJudiciary Law § 431Work-Related InjuryKnee Injury
References
5
Case No. ADJ7904460
Regular
Mar 20, 2017

REYNALDO BAUTISTA vs. QUEST DIAGNOSTIC, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board granted the defendant's Petition for Reconsideration. The Board found that the Workers' Compensation Administrative Law Judge's (WCJ) February 6, 2017 Order Rescinding was issued beyond the permitted time limit. Therefore, the Board is affirming the rescission order and returning the case to the trial level for further proceedings.

Petition for ReconsiderationOrder RescindingAppeals Board Rule 10859further development of the recordtrial levelDecision After ReconsiderationWorkers' Compensation Appeals BoardWCJ
References
0
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