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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
Jun 02, 2008

Claim of Laezzo v. New York State Thruway Authority

The claimant suffered a work-related slip and fall in 2002, leading to injuries including his head, neck, back, and knees. His morbid obesity contributed to his back and knee issues, prompting him to seek authorization for gastric bypass surgery. The Workers’ Compensation Law Judge approved the surgery, a decision affirmed by the Workers’ Compensation Board, which found the surgery causally related to the compensable injuries. The employer and its carrier appealed, challenging the causal link. The court affirmed the Board's decision, noting substantial evidence that the claimant's weight gain was a result of the sedentary lifestyle imposed by his injuries, and that the surgery would aid in his recovery.

Workers' CompensationConsequential InjuryGastric Bypass SurgeryMorbid ObesityMedical Treatment AuthorizationCausationKnee InjuryBack InjurySedentary LifestyleBoard Decision Appeal
References
2
Case No. MISSING
Regular Panel Decision

Claim of Casiano v. CCIP/Union Settlement Home Care

In March 2001, claimant sustained a work-related back injury. Neurosurgeon Richard J. Radna recommended and performed decompression surgery despite the workers' compensation carrier denying preauthorization for the procedure. Both a Workers’ Compensation Law Judge and the Workers’ Compensation Board subsequently ruled that the surgery was not medically necessary, thereby absolving the carrier of liability for its cost. Claimant and Radna appealed this determination to the appellate court. Radna's appeal was dismissed due to lack of standing, and the Board's decision was affirmed, as it was within its purview to resolve the conflicting medical evidence presented by Radna and the carrier's neurosurgeon regarding the necessity of the surgery.

Workers' Compensation LawMedical NecessitySurgical ProcedurePreauthorization DenialNeurological InjuryConflicting Medical OpinionsAppellate ReviewStanding IssueCarrier LiabilityBack Injury
References
3
Case No. LAO 0811779, LAO 0811780
Regular
Mar 06, 2008

ELENA BLANKEVOORT vs. HUNTINGTON MEMORIAL HOSPITAL, S&B SURGERY CENTER

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a trial judge's order disallowing a lien claim from S&B Surgery Center. The WCAB found that while S&B Surgery Center did have a required "surgical clinic" license, it failed to prove compliance with fictitious business name filing requirements. However, the WCAB returned the case to the trial level for further proceedings, allowing S&B Surgery Center an opportunity to correct this procedural defect to recover on its lien.

Fictitious business nameLien claimantSurgical clinic licenseBusiness and Professions Code section 17910Medical BoardDepartment of Health ServicesBurden of proofReconsiderationWorkers' Compensation Appeals BoardOutpatient setting
References
12
Case No. MISSING
Regular Panel Decision

Suarez v. Abe

Plaintiff, with a history of right knee injuries and surgeries since age 15, sustained another injury in a workplace mishap in March 1993, leading to disability payments. After a subsequent diagnosis of a new lateral meniscus tear in April 1998, his treating physician requested authorization for arthroscopic surgery. Eleven days after the Workers' Compensation Board directed the carrier to authorize the surgery, plaintiff was involved in a motor vehicle accident, claiming it caused a 'serious injury' to his already compromised knee. The Supreme Court initially denied the defendants' motion for summary judgment, but the appellate court reversed, finding the plaintiff failed to provide objective medical evidence that the motor vehicle accident aggravated his preexisting knee condition to the statutory 'serious injury' threshold.

Summary JudgmentSerious Injury ThresholdPreexisting InjuryAggravation of InjuryMotor Vehicle AccidentObjective Medical ProofNo-Fault InsuranceAppellate ProcedureKnee PathologyMedical Affidavit
References
9
Case No. ADJ306310
Regular
Mar 23, 2009

MATTHEW T. MORAN vs. ABHE & SVOBODA, INC., ZURICH NORTH AMERICA, BRANDVOLD & ASSOCIATES

The Appeals Board granted reconsideration and rescinded the WCJ's March 23, 2009 decision, which awarded further medical treatment including arthroscopic surgery. The Board found the medical record, particularly regarding the conflict between the treating physician's and QME's opinions on the need for surgery and the causation of the left shoulder tear, was not adequately developed. The matter was returned for further proceedings, specifically to obtain an Agreed Medical Evaluator or have the WCJ appoint an expert to resolve the conflicting medical opinions.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardAdministrative Law JudgeQualified Medical EvaluatorIndustrial InjuryLeft ShoulderArthroscopic SurgeryMR ArthrogramRotator Cuff Tear
References
17
Case No. LAO 0857845
Regular
Oct 12, 2007

NATIVIDAD URIAS vs. VISHAY TRANSDUCERS, LIBERTY MUTUAL INSURANCE COMPANY

This case involves a workers' compensation applicant seeking further medical treatment for admitted industrial injuries to her right shoulder and bilateral upper extremities. The Workers' Compensation Appeals Board granted reconsideration to clarify the scope of awarded medical treatment. The Board affirmed the need for a right carpal tunnel release surgery as recommended by the applicant's physician but reversed the award of arthroscopic shoulder surgery, finding it premature without a specific recommendation or request for authorization.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardExpedited HearingFurther Medical TreatmentArthroscopic Shoulder SurgeryCarpal Tunnel ReleasePrimary Treating PhysicianQualified Medical EvaluatorUtilization Review
References
0
Case No. ADJ8171086
Regular
Oct 07, 2015

Patricia Smith vs. Scholle Packaging, Liberty Mutual Insurance Company

This case concerns Patricia Smith's petition for removal of a WCJ order denying her requested arthroscopic knee surgery. The WCJ found the defendant's utilization review (UR) denial of the surgery request was timely, divesting the WCJ of jurisdiction. The Appeals Board denied the petition for removal, finding the UR determination was timely under Labor Code section 4610(g)(1) and applicable regulations. Therefore, Smith's sole remedy is to pursue an Independent Medical Review (IMR) of the UR decision.

Workers' Compensation Appeals BoardPetition for RemovalUtilization Review (UR)Primary Treating Physician (PTP)Request for Authorization (RFA)Arthroscopic SurgeryIndustrial Knee InjuryExpedited HearingJurisdictionLabor Code Section 4610
References
1
Case No. MISSING
Regular Panel Decision
Apr 25, 1979

Woodward v. Black Clawson/Dilts Div.

The Workers' Compensation Board found the claimant's cardiac disability and surgery were causally related to an accidental injury on January 12, 1972, based on the testimony of Dr. A. Black. The court affirmed this decision, finding substantial evidence in the record to support the board's determination. Costs were awarded to the Workers’ Compensation Board against the employer and its insurance carrier.

cardiac disabilitycardiac surgeryaccidental injurycausal relationshipmedical testimonyWorkers' Compensation Boardappeal affirmedemployer liabilityinsurance carrier liabilitysubstantial evidence
References
0
Case No. MISSING
Regular Panel Decision

Fernandez v. North Shore Orthopedic Surgery & Sports Medicine, P.C.

Frank Fernandez, an x-ray technician, sued his former employer, North Shore Orthopedic Surgery & Sports Medicine, P.C., for retaliation under Title VII after filing a national origin discrimination complaint. A jury found in favor of Fernandez, awarding back pay, front pay, and punitive damages. North Shore subsequently moved for judgment as a matter of law, a new trial, and to modify the damage awards. The court denied North Shore's motions for judgment and a new trial, affirmed the jury's back pay award, but vacated and reduced the front pay award from $160,000 to $50,000, and the punitive damages award from $100,000 to $50,000.

RetaliationTitle VIIEmployment DiscriminationBack PayFront PayPunitive DamagesMitigation of DamagesFederal Rules of Civil ProcedureJudicial DiscretionEquitable Relief
References
27
Case No. MISSING
Regular Panel Decision

Meyers v. Epstein

This case concerns a motion in limine filed by the plaintiffs, Samara Meyers and her parents, in a 'ghost surgery' case. The plaintiffs allege that a different surgeon, Dr. Ira Richmond Abbott, performed brain surgery on Samara than the one they consented to, Dr. Fred Epstein. Following the surgery, Samara experienced severe complications including left side paralysis and cognitive impairments. The plaintiffs sought to recover damages for these complications, arguing that they were proximately caused by the unauthorized surgery. However, the court denied their motion, ruling that under New York law, a plaintiff cannot recover for injuries that would have foreseeably resulted from the surgery even if performed by the consented doctor, especially without evidence of negligent performance. The court limited potential recovery to nominal damages and mental anguish for the unauthorized act itself, not the inherent risks or consequences of the surgery.

Ghost surgeryBatteryMedical malpracticeInformed consentCausationDamagesMotion in limineBrain surgery complicationsProximate causeIntentional torts
References
18
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