CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

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. ADJ9070770
Regular
Jun 10, 2014

OSCAR GARCIA-PICEN vs. TIGHT QUARTERS, INC., CALIFORNIA INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) rescinded a prior ruling ordering viscosupplementation injections for an applicant's knee injury. The WCAB found the prior ruling, which deemed the defendant's utilization review (UR) denial defective due to a missing signature, to be based on an incorrect premise as the UR physician did sign the report. However, the WCAB noted the UR physician may not have been aware of the applicant's second surgery, potentially rendering the UR defective for other reasons. The case was returned to the trial level for further consideration, with a dissenting opinion arguing the UR was demonstrably defective for omitting key medical history and the treatment should have been affirmed.

Workers' Compensation Appeals BoardOscar Garcia-PicenTight QuartersInc.California Insurance CompanyADJ9070770Opinion and Decision After ReconsiderationViscosupplementation injectionsUtilization Review (UR) denialDefective UR
References
4
Case No. ADJ9460638
Regular

DAVID HAMALIAN vs. HANSEL FORD, SECURITY NATIONAL INSURANCE CO.

The Workers' Compensation Appeals Board granted the defendant's Petition for Reconsideration regarding a WCJ's order that rescinded a prior finding of no material defect in the defendant's Utilization Review (UR). This decision was based on a subsequent en banc ruling, *Dubon II*, which held that UR decisions are invalid only if untimely. Consequently, the Board rescinded the WCJ's Amended Findings & Order and remanded the case for further proceedings and a new decision consistent with *Dubon II*. The prior finding that the UR was not materially defective was rescinded, and the matter will be reheard to determine the UR's timeliness and applicant's need for surgery.

Utilization ReviewMaterial DefectDubon IDubon IIPetition for ReconsiderationFindings & OrderRescindedAdministrative Law JudgeAppeals BoardEn Banc Decision
References
3
Case No. ADJ2661083 (AHM 0097587) ADJ2316310 (AHM 0088976)
Regular
Oct 06, 2014

GENEEN RODRIGUEZ vs. STATEK CORPORATION, ACE USA

This case involves defendant Statek Corporation's petition for reconsideration of an award granting applicant Geneen Rodriguez a spinal cord stimulator. The Administrative Law Judge found the utilization review (UR) determination materially defective due to communication issues and the reviewer's specialty. The Appeals Board granted reconsideration, rescinded the award, and found the UR determination was not materially defective. The Board concluded that any alleged defects were not significant enough to bypass the Independent Medical Review (IMR) process.

Utilization ReviewSpinal Cord StimulatorMaterially DefectiveIndependent Medical ReviewLabor Code Section 4610Medical NecessityCompetency of ReviewerInternal MedicineTimely CommunicationDubon v. World Restoration
References
2
Case No. ADJ652088 (VNO 0535069) ADJ247491 (VNO 0535058) ADJ7902978
Regular
Nov 17, 2014

NORMA JOVEL vs. SISTERS OF THE HOLY NAMES dba RAMONA CONVENT SECONDARY SCHOOL, UNITED STATES FIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, affirming the finding that the defendant's utilization review (UR) decision denying knee surgery was defective due to missing documentation. However, the Board rescinded the administrative law judge's order to return the request to UR. Instead, the Board awarded the requested knee surgery and related treatment, finding substantial medical evidence in the record supported its medical necessity. This decision was based on subsequent case law that allows the Board to decide medical necessity when UR is defective.

Utilization ReviewPetition for ReconsiderationDefective URSubstantial Medical EvidenceAgreed Medical EvaluatorIndependent Medical ReviewMedical NecessityArthroscopic Knee SurgeryDubon IDubon II
References
8
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. ADJ8252446
Regular
Sep 09, 2014

DANIEL MARTIN vs. CITY OF RICHMOND

The WCAB dismissed the defendant's petition for reconsideration because it challenged an interim order, not a final decision. The Board granted removal on its own motion to address the administrative law judge's finding that the defendant's utilization review (UR) suffered a material procedural defect. The WCAB rescinded the judge's decision, finding the UR was not procedurally defective, and determined the medical treatment dispute should be resolved through Independent Medical Review (IMR).

Workers Compensation Appeals BoardUtilization ReviewMaterial Procedural DefectIndependent Medical ReviewPetition for ReconsiderationRemoval on Board MotionDecision After RemovalFindings and OrderRequest for AuthorizationTreating Physician
References
7
Case No. ADJ2972057 (LAO 0838464)
Regular
Jul 07, 2014

DONNA NEWTON vs. JACK-IN-THE-BOX, REPUBLIC INDEMNITY COMPANY OF CALIFORNIA

The Workers' Compensation Appeals Board granted reconsideration, finding the defendant's utilization review (UR) decision defective because it was signed by a nurse, not a physician, violating Labor Code section 4610(e). Although the Administrative Law Judge based his original award on a different UR defect, the Board has the power to consider other issues upon granting reconsideration. The Board issued a notice of intention to award aquatic therapy, providing the defendant an opportunity to object.

Workers' Compensation Appeals BoardUtilization ReviewDefective URAquatic TherapyDue ProcessAdministrative Law JudgeSubstantial EvidencePetition for ReconsiderationMedical TreatmentLicensed Physician
References
8
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
Showing 1-10 of 1,090 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational