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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 23398 [81 Misc 3d 21]
Regular Panel Decision
Nov 30, 2023

Associated Plastic Surgeons & Consultants, P.C. v. Global Commodities, Inc.

Plaintiff, Associated Plastic Surgeons & Consultants, P.C., filed a commercial claims action against Global Commodities, Inc. for $5,000 for unpaid medical services provided to an alleged employee. Plaintiff claimed defendant agreed to pay privately. The District Court dismissed the action after excluding a document detailing telephone conversations, which plaintiff argued was admissible under the business records exception or relaxed commercial claims evidence rules. The Appellate Term affirmed the dismissal, ruling that plaintiff failed to prove the patient was injured during employment or that the document was admissible as a business record, thus failing to establish defendant's liability for the medical bill. The court emphasized that while commercial claims courts are not bound by strict evidence rules, judgments cannot rest solely on hearsay.

Commercial claimsMedical servicesUnpaid billsBusiness records exceptionHearsayEvidence rulesEmploymentWorkers' Compensation LawAppellate reviewSubstantial justice
References
10
Case No. 2017-07-0242
Regular Panel Decision
Aug 25, 2017

Steinzor, Justin v. Kroger Limited Partnership

Justin Steinzor, a Kroger employee, filed a request for an expedited hearing seeking medical and temporary disability benefits for an alleged work-related hand injury after working in a cold dairy department. He reported symptoms including discomfort, rash, and color changes in his hands, which he attributed to cold exposure. Medical evaluations by FNP Tidwell, FNP Sturdivant, and vascular surgeon Dr. Alexander Alperovich followed. While FNP Sturdivant noted Raynaud’s syndrome triggered by cold, Dr. Alperovich diagnosed vasculitis and concluded Mr. Steinzor's condition was not more than 50% caused by work. Based on Dr. Alperovich's expert medical opinion, Kroger denied the claim. The Court found Mr. Steinzor credible regarding the incident but ruled he failed to provide sufficient medical evidence to establish that his injury primarily arose out of his employment. Consequently, his request for benefits was denied. Kroger was referred to the Penalty Unit for failing to provide a panel of physicians.

Workers' CompensationExpedited HearingMedical CausationRaynaud's SyndromeVasculitisHand InjuryCold ExposureDenial of BenefitsPanel of PhysiciansEmployer Liability
References
2
Case No. 2015-07-0053
Regular Panel Decision
Sep 22, 2015

Boyd, Michael v. Revel Logging, LLC.

The employee, Michael Boyd, alleged a work-related back injury and a vascular leg injury from a fall. He received authorized treatment for his back but sought independent treatment for the vascular condition. The trial court deemed both injuries compensable, ordering continuing care for the vascular issue and payment for related medical expenses, while denying a request for a second panel of physicians for the back injury. On appeal by the employer, Revel Logging, LLC, the Appeals Board affirmed the denial of additional back injury benefits. However, it reversed the trial court's determination that the vascular injury was compensable and that the employer was liable for associated medical bills, remanding the case for further proceedings.

Workers' CompensationBack InjuryVascular InjuryCausationMedical TreatmentEmployee ClaimEmployer LiabilityAppealRemandPhysician Opinion
References
0
Case No. ADJ3206000 (LAO 0877236)
Regular
Aug 10, 2012

JENNIFER HESTER vs. TECHNICOLOR, Permissibly Self-Insured

The applicant sought reconsideration of a decision limiting the defendant's payment for hip surgery to the Official Medical Fee Schedule, which the applicant's surgeon deemed insufficient. The Appeals Board granted reconsideration due to the complex fee dispute, noting that while extraordinary circumstances existed regarding the surgeon's qualifications, the reasonableness of his requested fee was unproven. To resolve this, the Board ordered the appointment of an agreed physician to investigate the surgeon's usual fee and its reasonableness compared to others with similar expertise.

ReconsiderationFindings of FactAgreed PhysicianMedical TreatmentFee ScheduleExtraordinary CircumstancesUsual FeeHip ArthroscopyOsteoplastyChondroplasty
References
1
Case No. MISSING
Regular Panel Decision

Claim of Zygler v. Tenzer Coat Co.

An employer and carrier appealed a disability award granted to a claimant who suffered a cerebral vascular episode after an oral quarrel with his foreman over work distribution. The Workers' Compensation Board had previously determined this constituted an accident, reversing a Referee's finding of no accident. The court, however, found that an argument without physical violence, even if it leads to a vascular incident, does not constitute an accident within the meaning of the Workmen’s Compensation Law, especially when such arguments are common in piece work environments. Citing relevant precedents involving similar emotional strain without physical exertion leading to heart attacks or vascular incidents, the court concluded that a finding of accident could not be sustained. Consequently, the award was reversed, and the claim was dismissed, with costs awarded to the appellants against the Workmen’s Compensation Board.

Workers' CompensationAccident DefinitionCerebral Vascular EpisodeEmotional StrainOral QuarrelDisability AwardEmployer LiabilityCarrier LiabilityPiece WorkPre-existing Condition
References
3
Case No. 2015-08-0106
Regular Panel Decision
Sep 24, 2015

McIntosh, Sarah Kaye v. Randstad

Sarah Kaye Mcintosh, an employee, filed a claim alleging wrist injuries from her work at Randstad. Randstad, the employer, filed a motion to terminate benefits, arguing the claim was not compensable. The Court previously ordered Randstad to provide a panel of orthopedic surgeons and pay temporary disability benefits. Although Ms. Mcintosh selected Dr. Cannon, an orthopedic surgeon, she was instead seen by Dr. Alday, an occupational medicine physician, who opined her injury was not work-related. The Court found Dr. Alday was not an authorized treating physician as Dr. Cannon declined to treat Ms. Mcintosh directly. Therefore, Dr. Alday's opinion on causation did not carry a presumption of correctness. The Court denied Randstad's motion, ordered the continuation of temporary partial disability benefits, and mandated Randstad to provide a new panel of orthopedic surgeons to Ms. Mcintosh.

Workers' CompensationExpedited HearingBenefit TerminationOrthopedic SurgeonOccupational MedicineCausationMedical PresumptionPanel of PhysiciansTemporary Disability BenefitsCarpal Tunnel Syndrome
References
1
Case No. CV-24-1300
Regular Panel Decision
Feb 19, 2026

In the Matter of the Claim of Kimberly Siddon

Kimberly Siddon appealed a Workers' Compensation Board decision denying the reopening of her claim for an increased schedule loss of use (SLU) of her left knee. Siddon, who had previously undergone two surgeries and received SLU findings of 12% and 20%, sought a 35% SLU based on an orthopedic surgeon's report detailing worsening range of motion. The Special Fund for Reopened Cases failed to properly contest the surgeon's medical opinion, despite multiple opportunities. The Board, however, rejected the surgeon's objective range-of-motion measurements as merely subjective, a finding inconsistent with its own impairment guidelines. The Appellate Division reversed the Board's decision, concluding that the Special Fund had waived its right to contest the evidence and that the Board's rationale for denial was unsupported given the uncontradicted and properly rendered medical opinion. The case was remitted to the Workers' Compensation Board for further proceedings consistent with the Court's decision.

Workers' CompensationSchedule Loss of UseLeft Knee InjuryClaim ReopeningMedical ExaminationSpecial Fund for Reopened CasesWaiverBoard DiscretionMedical EvidenceRange of Motion
References
7
Case No. SJO 238655 SJO 238656 SJO 238657
Regular
Apr 02, 2008

JAMES BEENE vs. ANDERSON CHEVROLET/AUTONATION, INC., ACE-USA, UNIVERSAL UNDERWRITERS GROUP

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior award because the Agreed Medical Examiner's opinion was based on an incorrect legal theory regarding industrial causation. The Board found that the AME's opinion that the applicant's vascular condition was not industrially caused or aggravated was not substantial evidence, requiring further development of the record. Therefore, the case was returned to the trial level for the AME to provide a supplemental opinion on whether the vascular condition was industrially caused or a consequence of the admitted injury.

workers compensationindustrial injuryvascular systemagreed medical evaluatorAMEreconsiderationtemporary disability indemnityTDIlien claimsubrogation
References
15
Case No. MISSING
Regular Panel Decision
May 31, 1972

Talamo v. Murphy

This case concerns the termination of a probationary patrolman's services by the Police Commissioner following an on-duty injury and the subsequent discovery of an alleged pre-existing wrist condition. Despite medical opinions contradicting the Chief Surgeon's recommendation for dismissal and the patrolman's satisfactory performance, the Commissioner relied on the Chief Surgeon's report. The Supreme Court's judgment was affirmed, but a dissenting opinion argued for reversal and a remand for further proceedings, emphasizing the arbitrary nature of the dismissal and the unjust reflection on the petitioner's capacity. The dissent highlighted that the alleged condition only came to light due to an on-duty injury.

Probationary PatrolmanService TerminationWrist InjuryPre-existing ConditionMedical DisagreementPolice Commissioner DiscretionAppellate ReviewDissenting OpinionAnnulment of DeterminationPolice Department Doctors
References
1
Case No. ADJ532181 (SFO 0438716) ADJ250509 (SFO 0242560) ADJ6545137
Regular
Nov 14, 2014

MICHAEL THOMAS, vs. SAFEWAY STORES, INC. Permissibly Self-Insured,

This case involved an applicant seeking treatment from a highly specialized surgeon, Dr. Matsen, located in Seattle, for a complex shoulder revision. The original decision denied authorization for Dr. Matsen, deeming Seattle outside a reasonable geographic area, and excluded a crucial report from the applicant's treating physician, Dr. Osborn. The Appeals Board granted reconsideration, admitting Dr. Osborn's report, which strongly supported Dr. Matsen's expertise and the inadequacy of local Bay Area surgeons for this complex case. Based on the applicant's medical history and the availability of specialized treatment, the Board reversed the original decision, finding Dr. Matsen to be within a reasonable geographic area.

Workers' Compensation Appeals BoardReasonable geographic areaTreating surgeonAdministrative Director Rule 9780Labor Code section 4600Orthopedic surgeonTotal shoulder replacementRevision surgeryMedical historyPhysician competency
References
1
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