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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

Romano v. Franklin General Hospital

A claimant, injured in an auto accident in her employer's parking lot, received treatment from an employer-affiliated orthopedist for cervical myositis. A C-4 medical report was filed, and the employer billed its carrier for physical therapy. The carrier controverted the claim, citing a failure to timely file under Workers' Compensation Law § 28. The Workers' Compensation Board found that the employer had timely notice and that the medical services provided constituted an advance payment of compensation, thus waiving the § 28 requirement. The appellate court affirmed the Board's decision, concluding that the medical care was indeed an advance payment, and the employer was aware the injury was work-related, thereby supporting the waiver of the timely filing requirement.

Workers' Compensation Law § 28Advance Payment of CompensationWaiver of FilingTimely NoticeMedical Services as CompensationC-4 Medical ReportWork-Related InjuryAppellate ReviewEmployer LiabilityCarrier Controversion
References
7
Case No. 532415
Regular Panel Decision
Nov 18, 2021

In the Matter of the Claim of Giovani Garcia

Claimant, a laborer, was bitten by a snake while working for an uninsured employer. A Workers' Compensation Law Judge (WCLJ) established the claim for a work-related injury to claimant's left hand and left wrist, authorized medical treatment, and assessed a penalty against the employer for being uninsured. The employer appealed the WCLJ's decision to the Workers' Compensation Board, but the Board denied the application for review due to the employer's failure to provide a complete response to a required question on the application form (RB-89). Specifically, the employer's response did not provide the date on which an objection or exception was interposed. The Appellate Division affirmed the Board's decision, stating that the Board has the discretion to deny review when a party, represented by counsel, fails to comply with its regulations regarding application requirements.

Workers' CompensationUninsured EmployerAdministrative ReviewBoard RegulationsForm RB-89Objection DateAppellate DivisionCompliancePenalty AssessmentWork-Related Injury
References
14
Case No. MISSING
Regular Panel Decision

Claim of Martin v. New York Telephone

This case concerns an appeal from a Workers' Compensation Board decision regarding the liability for benefits. The claimant sustained a left knee injury in 1987 and a reinjury in 1995. A 1998 Section 32 settlement agreement released the employer from future claims for a lump sum, but required it to cover medical treatment. In 2004, the claimant developed a consequential right knee injury. The Workers' Compensation Board ultimately shifted liability for benefits to the Special Fund for Reopened Cases under Workers' Compensation Law § 25-a, citing the passage of statutory timeframes. The Special Fund appealed, challenging its statutory liability and the employer's ongoing responsibility for medical expenses per the settlement. The appellate court affirmed the Board's decision, upholding the applicability of Section 25-a and noting the employer's statutory obligation for medical treatment.

Workers' Compensation Law § 25-aSpecial Fund for Reopened CasesSection 32 Settlement AgreementConsequential InjuryMedical Treatment LiabilityStatutory LiabilitySchedule Loss of UseAppellate ReviewTimelinessBoard Review
References
4
Case No. MISSING
Regular Panel Decision

Claim of Buzea v. Alphonse Hotel Corp.

The claimant was terminated by his employer on June 20, 1997, shortly after sustaining a work-related head injury and seeking medical attention. He filed a workers' compensation claim and a discrimination complaint under Workers’ Compensation Law § 120, alleging he was fired for seeking medical treatment for his injury. Although a Workers’ Compensation Law Judge initially denied the discrimination complaint, misinterpreting the requirement for filing a claim, the Workers’ Compensation Board reversed, finding the employer discriminated. The appellate court affirmed the Board's determination, concluding that substantial evidence supported the finding that the employer violated Workers’ Compensation Law § 120, as the prospect of a claim motivated the retaliatory discharge.

Workers' CompensationRetaliatory DischargeEmployment DiscriminationWorkplace InjuryMedical TreatmentIntent to File ClaimAppellate ReviewStatutory InterpretationCredibility AssessmentNew York Law
References
5
Case No. ADJ6801375
Regular
Jul 13, 2010

MICHAEL DAVID HERNANDEZ vs. VINCE'S ITALIAN TO GO, PREFERRED EMPLOYERS

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a prior award. The WCAB found that the applicant was not entitled to medical treatment outside the employer's Medical Provider Network (MPN) for a meniscus transplant or graft. The applicant failed to follow the required procedures for obtaining a second and third opinion within the MPN before seeking treatment from an out-of-network physician. Therefore, the WCAB concluded there was no showing that treatment outside the MPN was justified under the relevant rules.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNFurther Medical TreatmentSports Medicine DoctorMedical Meniscus TransplantGraft ProcedureDr. Patrick O'MearaDr. John DeSantisSubspecialist
References
2
Case No. ADJ2593762 (SAC 0363364)
Regular
Jul 13, 2012

RICHARD HODGE vs. DEPENDABLE HIGHWAY EXPRESS, ZURICH NORTH AMERICA INSURANCE

The Workers' Compensation Appeals Board denied reconsideration, upholding the WCJ's decision to provide psychiatric treatment. Even if the need for psychiatric treatment stems from a potentially non-compensable psychiatric injury, the employer remains liable if the treatment is reasonably required to cure or relieve the effects of a compensable industrial injury. In this case, the applicant's psychiatric treatment was deemed necessary to address cognitive impairment caused by a compensable traumatic brain injury. Therefore, the employer is liable for this treatment under established case law, regardless of the nuances of the six-month employment rule.

Labor Code section 3208.3(d)sudden and extraordinary exceptionsix-month employment rulemedical treatmentLabor Code section 4600reasonably requiredcure or relievenon-compensable injurypsychiatric treatmenttraumatic brain injury
References
6
Case No. ADJ551158 (MON 0363400)
Regular
Jul 09, 2010

HELEN B. JAKES, HELEN JAKES ELAM vs. STATE OF CALIFORNIA; DEPARTMENT OF CORRECTIONS, CIM, Legally Uninsured

This case involves the State of California and the Department of Corrections seeking reconsideration of a Workers' Compensation Appeals Board decision. The Board found the employer failed to properly notify the employee of its Medical Provider Network (MPN), making them liable for self-procured medical treatment. However, the Board reversed this, finding that subsequent notices from the employer did sufficiently inform the employee about the MPN. Therefore, the employee is now required to seek treatment within the employer's MPN, and the employer is not liable for self-procured treatment after the date of the subsequent notice.

Medical Provider NetworkMPNSelf-Procured Medical TreatmentNotice RequirementsLabor Code Section 4616.3Administrative Director's Rule 9767.12(a)Due ProcessJoint Findings and AwardPetition for ReconsiderationReturn to Work Coordinator
References
3
Case No. ADJ7942487
Regular
Sep 14, 2012

PEDRO SANCHEZ MARTINEZ vs. STEVENS TRANSPORTATION, INC., TRAVELERS INSURANCE CO.

This case involves an applicant truck driver who sustained industrial injuries and sought self-procured medical treatment outside his employer's Medical Provider Network (MPN). The applicant claimed the employer failed to meet MPN notice requirements, making them liable for his treatment costs. However, the Board affirmed the trial judge's decision, finding the employer provided adequate MPN information via a bilingual letter and signed acknowledgment, despite the applicant's claims of not recalling the notice. Therefore, the employer was not found liable for the applicant's self-procured treatment.

Workers' Compensation Appeals BoardPetition for ReconsiderationIndustrial InjuryMedical Provider Network (MPN)Self-Procured TreatmentPosting and Notice RequirementsLabor Code § 4605Labor Code § 4600(a)Consulting PhysicianAttending Physicians
References
2
Case No. MISSING
Regular Panel Decision

Claim of Dudas v. Town of Lancaster

The claimant, a laborer, allegedly injured his right ankle on February 28, 2007, after slipping on ice at the employer's Town Hall. Despite ongoing symptoms, the claimant delayed seeking medical treatment and reporting the injury to the employer until June 27, 2007. The employer's workers' compensation carrier initially authorized medical care but later controverted the claim due to conflicting reports regarding the cause of injury. A Workers' Compensation Law Judge disallowed the claim for failure to provide timely notice, a decision affirmed by the Workers' Compensation Board. The appellate court affirmed the Board's decision, concluding that the employer did not waive the defense of timely notice and that the Board did not abuse its discretion in disallowing the claim given the claimant's delay in reporting and treatment.

Workers' CompensationTimely NoticeAnkle InjurySlip and FallEmployer PrejudiceMedical Treatment DelayClaim DisallowanceBoard DiscretionAppellate ReviewWork-Related Injury
References
6
Case No. MISSING
Regular Panel Decision

State v. Public Employment Relations Board

The State University of New York at Albany (SUNYA) initiated a CPLR article 78 proceeding to challenge a Public Employment Relations Board (PERB) determination. PERB had previously found that SUNYA engaged in improper employer practices by directing employees to take leave without pay or use accrued leave for a day off after Thanksgiving in 1977 and 1978, violating Civil Service Law § 209-a (1) (d). SUNYA argued against PERB's refusal to defer to arbitration awards and its interpretation of contractual rights. The court affirmed PERB's findings, concluding that PERB's actions were neither arbitrary nor capricious, and upheld the remedy requiring compensation for affected employees. Consequently, the petition was dismissed, and PERB's determination was confirmed.

CPLR Article 78Improper Employer PracticePublic Employment Relations BoardState University of New York at AlbanyCivil Service LawCollective Bargaining AgreementRes JudicataCollateral EstoppelAdministrative ReviewMandatory Subject of Negotiation
References
11
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