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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

Sass v. AMR Electro Conduits, Inc.

Claimant, a tractor-trailer truck driver, was rendered a quadriplegic after an accident on November 20, 1981. His employer, AMR Electro Conduits, Inc., and its insurance carrier, the State Insurance Fund, were notified. The Fund began paying benefits but subsequently filed a notice of controversy, almost eight months past the deadline, alleging newly discovered evidence that the claimant was not an employee of AMR or that the injury did not arise in the course of employment. The Workers’ Compensation Board refused to excuse the late filing, citing Workers’ Compensation Law § 25 (2) (b), which imposes a pleading bar for untimely controversies. The appellate court affirmed the Board's decision, determining that the Fund's evidence was belatedly obtained rather than newly discovered and its failure to investigate earlier was not a valid excuse for the late filing.

Workers' CompensationLate FilingNotice of ControversyNewly Discovered EvidencePleading BarQuadriplegiaEmployer LiabilityInsurance CarrierAppellate ReviewAbuse of Discretion
References
5
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. ADJ6484208
Regular
Aug 21, 2018

ERIK LOPEZ vs. SERFIN CONSTRUCTION, INC., STATE COMPENSATION INSURANCE FUND

The WCAB granted reconsideration and rescinded the prior order, finding that lien claimant South Bay Neurological Diagnostic Center was not entitled to reimbursement for a sleep study. The Board determined the sleep study and associated reports were not valid medical-legal expenses because they were not requested by a medical-legal evaluator and were not incidental to the production of a medical-legal report capable of proving or disproving a disputed medical fact. Therefore, the lien claim was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderAdministrative Law Judgeindustrial injurysleep disorderlien claimantmedical-legal expenseAgreed Medical Evaluator (AME)Report and Recommendation
References
1
Case No. ADJ1371205 (VNO 0557310)
Regular
Mar 10, 2011

VICTOR LOPEZ vs. GREYSTONE MANAGEMENT, ZENITH INSURANCE COMPANY

This case concerns a lien claimant, Unicare Diagnostic Center, seeking payment for sleep studies related to an applicant's claimed industrial injuries. The applicant settled their primary claim via Compromise and Release, but Unicare's lien remained unresolved. The trial judge ruled against the lien claimant, finding the insomnia claim non-industrial and the sleep studies medically unnecessary. The Appeals Board affirmed this decision after reconsideration, adopting the trial judge's reasoning.

Compromise and ReleaseLien ClaimantUnicare Diagnostic CenterIndustrial InjuryChestEarNoseHandsWristsHeadaches
References
0
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. MISSING
Regular Panel Decision

Casale v. Washington Mills Electro Mineral Corp.

A laborer, employed by Monteleone and Marchetti (M&M), sustained a back injury while removing metal alloy residue from a furnace owned by Washington Mills Electro Mineral Corp. The plaintiff initiated legal action against Washington Mills, citing violations of Labor Law § 200 (1) and § 241 (6), alongside a negligence claim. Washington Mills subsequently involved M&M and Falls Steel Erectors, Inc. (Falls Steel) as third-party defendants. The Supreme Court partially granted summary judgment to M&M and Falls Steel, dismissing aspects of the Labor Law § 200 (1) claim and negligence cause of action. The appellate court, disagreeing with the plaintiff's arguments, modified the order, concluding that the section 200 (1) claim and the negligence cause of action should have been dismissed entirely due to the absence of Washington Mills' supervisory control over the work methods. Furthermore, the court ruled that removing metal residue did not constitute 'demolition work' under Labor Law § 241 (6). Consequently, the order was modified to grant full summary judgment, dismissing the complaint, third-party complaint, and cross claims in their entirety.

Labor LawNegligenceSummary JudgmentPremises LiabilityIndustrial AccidentThird-Party ClaimStatutory InterpretationConstruction Site SafetyOwner LiabilityEmployer Liability
References
6
Case No. MON 0114910
Regular
Oct 02, 2007

TEDDIE GRIFFIN vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES - IHSS, Legally Uninsured, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board dismissed a petition for reconsideration filed by lien claimants California Psychiatric Center and Neuro-Electro Diagnostic. The dismissal was based on the petition's failure to meet the verification requirement of Labor Code section 5902. The lien claimants sought reconsideration of a prior ruling that barred their claims due to latches, statute of limitations, and prejudice to the defendant.

Lien claimantsPetition for ReconsiderationWorkers' Compensation Appeals BoardAdministrative Law JudgeLabor Code section 4903.5statute of limitationslatchesprejudiceverificationLabor Code section 5902
References
2
Case No. ADJ1934243 (FRE 0221043)
Regular
Apr 25, 2011

MARIA RAYOS vs. WALGREENS, ZURICH INSURANCE COMPANY

This case concerns a dispute over a second Qualified Medical Examiner (QME) for an applicant with a work-related knee, back, and hip injury. The defendant sought removal, arguing that allowing a second QME without striking the first QME's reports violated due process and would taint the new evaluation. The Appeals Board granted removal, amended the prior order, and clarified that a new QME is allowed. However, the admissibility of the first QME's reports is deferred to the trial judge, and those reports, unlike diagnostic study results, are not to be provided to the new evaluator.

Petition for RemovalQualified Medical Evaluator (QME)Admissibility of ReportsDue ProcessWorkers' Compensation Appeals Board (WCAB)Administrative Law Judge (WCJ)Industrial InjuryMedical EvaluationsDiscoveryMandatory Settlement Conference (MSC)
References
0
Case No. ADJ4424610
Regular
Oct 14, 2014

Bruce Sanders vs. Federal Express, Sedgwick

Here's a summary of the case in four sentences for a lawyer: The Workers' Compensation Appeals Board denied reconsideration of an order dismissing lien claims filed by Beverly Neurological Medical Group and Neuro-Electro Diagnostic. These liens, for services rendered between 1989 and 1990, were filed over twenty years later in 2013, long after the applicant's case was resolved in 1993. The Board adopted the WCJ's reasoning that the lien claimants waived any objection to the timeliness issue by failing to object when the case was noticed for submission. The Board found Labor Code Section 4903.5, as revised in 2013, applicable, barring the untimely filed liens.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code Section 4903.5Lien claimantsTimelinessDismissal of liensWaiverJurisdictionWCJ reportContinuous trauma injury
References
2
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