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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

Claim of Prescott v. Town of Lake Luzerne

A claimant fell off a dump truck at work in February 2008, landing on his right buttock and injuring his hip. The injury led to surgery in May 2008 to remove heterotopic bone and subsequent two-stage hip replacement revision surgeries in November 2008 and February 2009 due to an infection. The Workers’ Compensation Board found the initial surgery and subsequent revisions causally related to the work fall and supported compensation awards. The employer appealed, arguing that an independent medical examination (IME) was improperly precluded and that the initial surgery lacked proper authorization. The Appellate Division affirmed the preclusion of the IME due to untimeliness and upheld the causal relationship findings for the injury and subsequent surgeries. However, the court reversed the Board's determination that the May 2008 surgery was properly authorized, remitting that specific issue for further proceedings, while affirming all other appealed decisions.

Causal RelationshipIndependent Medical Examination (IME)Evidence PreclusionSurgery AuthorizationHip InjuryHeterotopic OssificationMedical Opinion ConflictDue ProcessRemittiturEmployer Liability
References
8
Case No. MISSING
Regular Panel Decision
May 20, 1996

Roman v. 1185 Avenue of the Americas Associates

This case involves an appeal from an order granting the plaintiff, Victor Roman, leave to amend his bill of particulars to include additional injuries. Roman filed an action in 1989 for injuries sustained in a 1987 job site accident, initially alleging traumatic degenerative arthritis and torn muscles in his left hip. After undergoing hip replacement surgeries in 1992 and 1994, a stipulation was made in 1994 with defendant A.J. Contracting Co., allowing for further discovery if the hip surgeries were later alleged to be causally related. In 1996, Roman moved to amend his bill of particulars to include these surgeries, supported by proof of workers' compensation coverage due to the causal connection. The court granted this motion, and the appellate court affirmed, citing the policy of freely allowing amendments in the absence of prejudice, which the defendants failed to demonstrate.

Personal injurySlip and fallConstruction accidentHip replacementBill of particularsLeave to amendStipulationCausal connectionWorkers' compensationPrejudice
References
1
Case No. 525196
Regular Panel Decision
Apr 26, 2018

Matter of Derouchie v. Massena W. Wc Smelter

Claimant Gerry J. Derouchie sustained injuries on February 18, 2015, including to his right knee and left hip, after stepping into a pothole on his employer's premises. He filed for workers' compensation benefits, and his case was established for multiple injuries. Having prior injuries and surgeries, claimant sought authorization for total right knee and left hip replacement surgeries, which the employer and carrier denied. A Workers' Compensation Law Judge (WCLJ) granted the authorization, and the Workers' Compensation Board affirmed, finding a causal relationship between the February 2015 accident and the need for surgeries. The Appellate Division, Third Department, affirmed the Board's decision, citing substantial evidence and deference to the Board's assessment of medical witness credibility.

Workers' Compensation BenefitsCausal RelationshipKnee Replacement SurgeryHip Replacement SurgeryPreexisting ConditionsAggravation of InjuryMedical AuthorizationSubstantial EvidenceCredibility AssessmentAppellate Review
References
10
Case No. MISSING
Regular Panel Decision

Claim of Stilwell v. Marriott

The case involves an appeal from a Workers' Compensation Board decision regarding a claimant's work-related hip injury. The claimant sought authorization for hip replacement revision surgery due to recurring dislocations. The employer and its workers' compensation carrier opposed the request, arguing a lack of causal relationship and failing to provide conflicting medical evidence as required by Workers’ Compensation Law § 13-a (5). The Workers’ Compensation Law Judge and subsequently the Board authorized the surgery, finding the employer failed to comply with the statute. The employer's appeal, which also raised a due process argument, was ultimately affirmed.

Hip InjuryRevision Surgery AuthorizationCausal Relationship DisputeWorkers' Compensation Law § 13-a (5)Medical Evidence RequirementEmployer Non-complianceDue Process AppealWorkers' Compensation Board DecisionAppellate Division AffirmationTreating Physician Recommendation
References
3
Case No. MISSING
Regular Panel Decision

Claim of Fitzgerald v. Berkshire Farm Center & Services for Youth

Decedent sustained a work-related injury in 1994, received workers’ compensation benefits, and underwent left hip replacement surgery in 2005. Complications from the surgery led to his death in 2007. His widow filed a claim for death benefits, which the employer's carrier attempted to shift to the Special Fund for Reopened Cases. The Workers’ Compensation Board ruled that the Special Fund's payments to the decedent from 2005 to 2007 meant the time requirements for shifting liability under Workers’ Compensation Law § 25-a (1) were not met for the death claim. The Appellate Division reversed, holding that the Special Fund had assumed liability for the stale claim in 2005, and its subsequent payments did not re-establish the carrier's liability for the death claim.

Workers' CompensationSpecial Fund for Reopened CasesDeath BenefitsLiability ShiftStatutory InterpretationWorkers’ Compensation Law § 25-aAppellate ReviewStale ClaimsHip InjurySurgery Complications
References
10
Case No. MISSING
Regular Panel Decision
Mar 14, 1994

Claim of Miller v. Congel-Palenscar, Inc.

In 1972, the claimant suffered a non-work-related hip dislocation requiring replacement. Subsequent work accidents in 1980 and 1989 caused further hip injuries and prosthesis loosening, leading to additional surgeries and workers' compensation claims. A Workers' Compensation Law Judge initially apportioned the claimant's permanent partial disability among the 1989 work accident (40%), 1980 work accident (10%), and the non-work-related sledding accident (50%). However, the Workers' Compensation Board rescinded this apportionment, attributing 100% of the disability to the 1989 accident and awarding a higher benefit rate. The employer and its carrier appealed the Board's decision, arguing that the 100% apportionment lacked substantial medical evidence. The appellate court agreed, finding that the Board's apportionment was contrary to the testimony of both testifying physicians. Consequently, the court modified the decision by reversing the finding on apportionment and remitted the matter to the Board for further proceedings to determine the correct apportionment percentages, while affirming the application of the maximum partial rate.

Workers’ CompensationHip InjuryDisability ApportionmentMedical EvidencePreexisting ConditionWork-Related AccidentRemittalAppellate ReviewMaximum Partial RateBoard Decision Reversal
References
5
Case No. MISSING
Regular Panel Decision

Nayal v. HIP Network Services IPA, Inc.

Dr. Christine Nayal initiated a class action against HIP Network Services IPA, Inc., alleging breach of contract, unjust enrichment, and a violation of New York General Business Law § 349. As a practicing psychologist, Nayal claimed that HIP, a health maintenance organization, failed to provide timely and adequate reimbursement, including interest, for services rendered under their agreement. HIP responded by filing a motion to compel arbitration, citing a clause in their contract, or, alternatively, seeking dismissal of the claims. The Court, presided over by Judge Victor Marrero, evaluated the enforceability of the arbitration provision. Finding no procedural or substantive unconscionability under New York law, the Court granted HIP's motion to compel arbitration for all claims, subsequently dismissing the entire action without prejudice.

Arbitration AgreementUnconscionabilityClass Action WaiverFederal Arbitration ActNew York General Business LawContract DisputeBreach of ContractUnjust EnrichmentMotion to Compel ArbitrationDismissal Without Prejudice
References
34
Case No. FRE 191206
Regular
Nov 20, 2007

MARY SEPEDA vs. SEPEDA BROTHERS DAIRY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of FREMONT INDEMNITY, in liquidation, REPUBLIC INDEMNITY

This case involves an applicant seeking reconsideration of a workers' compensation award concerning a low back injury sustained through July 13, 1995. The applicant, supported by her treating physician, argued for additional disc replacement surgery at the L4-5 level beyond the previously awarded L5-S1 spinal fusion. The Workers' Compensation Appeals Board granted reconsideration and amended the award to include the L4-5 disc replacement surgery, finding it reasonably required to cure or relieve the applicant's injury based on the treating physician's opinion.

CIGAFremont IndemnityRepublic Indemnitylow back injurypermanent disabilityfurther medical treatmentspinal surgeryL5-S1 fusionL4-5 disc replacementtreating physician
References
2
Case No. ADJ9179881
Regular
Dec 19, 2014

CURTIS MAUCH vs. CITY OF LODI, YORK RISK SERVICES GROUP, INC.

Here's a summary of the case for a lawyer in four sentences: The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration, upholding the prior decision that required liability for necessary medical treatment. This liability is specifically limited to treatment enabling knee replacement surgery, not for subsequent conditions. The Board adopted the WCJ's reasoning, citing *Braewood Convalescent Hospital v. Workers' Comp. Appeals Bd.* to support the decision. The case involved an applicant needing knee replacement surgery, and the defendant argued that a separate cardiac defibrillator issue was unrelated to the industrial injury.

Petition for ReconsiderationWorkers' Compensation Appeals BoardCity of LodiYork Risk Services GroupAdministrative Law JudgeKnee replacement surgeryCardiac defibrillatorBraewood Convalescent HospitalLabor Code Section 5903Myers
References
8
Case No. MISSING
Regular Panel Decision

Claim of Stewart v. P & C Food Markets, Inc.

A claimant, who worked as a cashier, developed persistent leg and hip pain diagnosed as a slipped femoral epiphysis requiring surgery in August 1990. Following surgery, he allegedly developed chronic low back pain and filed for workers' compensation benefits. While surgeons opined that neither the slipped hip nor back pain were work-related, chiropractors testified otherwise. The Workers’ Compensation Board ruled in the claimant's favor, finding a causal relationship for both conditions. The employer and its insurer appealed, raising an issue about the chiropractors' qualifications which was deemed not properly preserved. The Appellate Division affirmed the Board's decision, finding substantial evidence for the causal relationship.

Workers' CompensationCausal RelationshipSlipped Femoral EpiphysisBack PainChiropractor TestimonyMedical Expert QualificationSubstantial EvidenceAppellate ReviewEmployer AppealInsurance Carrier
References
4
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