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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ4579042
Regular
Aug 02, 2010

MARY LOPEZ vs. GRANADA HILLS COMMUNITY HOSPITAL, SAFETY NATIONAL CASUALTY COMPANY

Here's a summary of the case in four sentences for a lawyer: The Workers' Compensation Appeals Board granted reconsideration to further study the medical evidence regarding applicant Mary Lopez's claims of psyche injury and fibromyalgia stemming from an admitted neck and back injury. Defendants contended the WCJ relied on insufficient medical evidence, specifically Dr. Levine's fibromyalgia diagnosis due to an inadequate medical history and a psychiatric report where the applicant withheld suicidal ideation from the evaluating physician. The Board found the existing medical record inadequate to establish fibromyalgia or psychiatric injury and rescinded the prior findings. The matter was returned to the trial level for further development of the medical record, potentially through Agreed Medical Examiners or an Independent Medical Examiner.

Workers Compensation Appeals BoardReconsiderationFibromyalgiaPsyche InjuryQualified Medical EvaluatorSubstantial Medical EvidenceMedical HistoryDue ProcessIndustrial InjuryNeck Injury
References
15
Case No. MISSING
Regular Panel Decision

Equal Employment Opportunity Commission v. Grief Bros.

This employment discrimination case, filed July 1, 2002, involves Michael Sabo (Plaintiff) who alleges constructive discharge based on sexual harassment and claims severe emotional pain and suffering. The Defendant moved for a mental examination of Sabo under Fed.R.Civ.P. 35 and to compel the production of his medical records. Sabo alleged severe humiliation, anxiety, depression, loss of self-esteem, sleeplessness, and weight gain, and admitted to a history of depression, past suicide attempts, and current psychiatric treatment with prescribed medications. The court granted the Defendant's motions, finding that Sabo had placed his mental condition in controversy due to the nature and severity of his claims and his medical history, justifying both the examination and the production of relevant medical records. The court also granted Defendant's request for costs associated with compelling the medical records, but denied the request for costs related to the Rule 35 motion itself, and denied Plaintiff's request for counsel or recording during the examination.

Employment DiscriminationSexual HarassmentConstructive DischargeEmotional DistressMental ExaminationRule 35Medical RecordsDepressionSuicide AttemptsCompensatory Damages
References
11
Case No. ADJ2270634 (VNO 0521616)
Regular
Aug 03, 2018

SHEVON THOMAS vs. POMONA VALLEY HOSPITAL MEDICAL CENTER, Administered by ADMINSURE, INC., SUBSEQUENT INJURIES BENEFITS TRUST FUND

This case concerns an applicant seeking benefits from the Subsequent Injuries Benefits Trust Fund (SIBTF) following a 2005 industrial injury that resulted in a 69% permanent disability and a substantial settlement. The applicant's claim for SIBTF benefits was denied because she failed to establish a prior "labor disabling" permanent disability that existed before the 2005 injury. The Appeals Board upheld the denial, finding that the applicant's evidence of prior symptoms, including a doctor's speculative impairment ratings, lacked substantial medical evidence and did not meet the strict requirements for establishing a pre-existing, labor-disabling condition. The Board emphasized that post-injury medical opinions, especially those based on hypotheticals and inadequate history, cannot retroactively establish a prior disability for SIBTF eligibility.

Subsequent Injuries Benefits Trust FundSIBTFlabor disablingpermanent partial disabilityLabor Code section 4751SB 899apportionmentpreexisting disabilityAMA Guides impairment ratingsretrospective prophylactic work restrictions
References
8
Case No. MISSING
Regular Panel Decision

Gartenbaum v. Beth Israel Medical Center

Plaintiff Ilona Gartenbaum, a white employee, filed a Title VII racial discrimination lawsuit against Beth Israel Medical Center and three supervisors, alleging she was denied promotions in favor of less qualified black employees. The court, sua sponte, questioned her counsel, Bart Nason's, pre-filing investigation under Rule 11, noting prior union grievance procedures and an arbitration, where race was not an issue, had not supported Gartenbaum's claims. While Mr. Nason's investigation was found to be inadequate, relying on the client's assertions and an unsupported affidavit from a union representative, the court acknowledged that Gartenbaum could make out a prima facie case for racial discrimination concerning at least two denied promotions. Consequently, the court denied Rule 11 sanctions at this juncture and allowed the Title VII claim to proceed to discovery. Additionally, the court ordered the consolidation of this action with a separate pro se retaliation lawsuit filed by Gartenbaum against the same defendants.

Title VIIRacial DiscriminationEmployment DiscriminationRule 11 SanctionsPre-Filing InvestigationPrima Facie CaseGrievance ProcedureArbitrationEEOC InvestigationNLRB
References
6
Case No. MISSING
Regular Panel Decision

Queens Blvd. Medical, P.C. v. Travelers Indemnity Co.

The plaintiff, Queens Blvd. Medical, P.C., sought $950 in first-party no-fault benefits for biofeedback medical services provided to its assignor for lower back and chronic pain syndrome. The central issue at trial was the medical necessity of these services under Insurance Law § 5102 (a) (1). The plaintiff established a prima facie case with expert testimony from a board-certified neurologist affirming the medical appropriateness of biofeedback. The defendant insurance company failed to present admissible evidence to disprove medical necessity, as its expert was deemed incompetent to testify on biofeedback for back pain. Consequently, the court granted the plaintiff's motion for a directed verdict, awarding judgment for $950 along with statutory costs, interest, and attorney's fees.

No-fault benefitsMedical necessityBiofeedback treatmentExpert testimonyDirected verdictInsurance lawChronic pain syndromeBack injuryCPT codesBurden of proof
References
9
Case No. MISSING
Regular Panel Decision

Claim of Cummins v. North Medical Family Physicians

A claimant sustained a work-related back injury and sought continued medical treatment, which was initially authorized. Disputes over authorization led the claimant to retain an attorney. A Workers’ Compensation Law Judge authorized continued medical treatment but denied counsel fees, stating no "money passing" occurred. The Workers' Compensation Board upheld this decision. The claimant appealed, arguing the Board unconstitutionally applied Workers’ Compensation Law § 24, misinterpreted the statute regarding fee payment from medical benefits, and abused its discretion. The appellate court affirmed the Board's decision, ruling that counsel fees must be paid from "compensation," defined as a money allowance, and medical benefits are not considered "compensation" for this purpose, thus finding no abuse of discretion.

Workers' CompensationCounsel FeesAttorney FeesMedical TreatmentStatutory InterpretationConstitutional LawLienCompensation DefinitionAppellate ReviewBoard Decision
References
3
Case No. MISSING
Regular Panel Decision

Rechenberger v. Nassau County Medical Center

Edward Rechenberger suffered hip fractures and underwent two operations at Nassau County Medical Center in May 1982. Following a re-injury and later diagnosis, he learned the surgical hardware was improperly implanted, leading to further operations. Mr. Rechenberger sought leave to serve a late notice of claim against the medical center. The Supreme Court initially denied the motion, but the Appellate Division reversed this decision, finding that the hospital had actual knowledge of the essential facts of the claim within the statutory 90-day period through its own medical records. The court concluded that the delay in serving the notice of claim was not substantially prejudicial to the hospital, and thus, granted the petitioners leave to serve the late notice of claim.

Medical MalpracticeLate Notice of ClaimNassau CountyHip FractureSurgical ErrorContinuous Treatment DoctrineActual NoticePrejudiceAppellate ReviewMunicipal Corporation
References
11
Case No. MISSING
Regular Panel Decision
Feb 10, 2017

Mitchell v. SUNY Upstate Medical University

Plaintiff Robbie Mitchell sued SUNY Upstate Medical Center for alleged Title VII violations, including race discrimination and retaliation, after experiencing a series of adverse employment actions. These actions included reassignment, disciplinary notices (NODs), a mandatory medical examination, a formal counseling memorandum, a verbal dispute, and eventual termination. The defendant moved for summary judgment, arguing the plaintiff failed to establish a prima facie case for most claims and that their actions were based on legitimate, non-discriminatory reasons. The court granted summary judgment in favor of SUNY Upstate Medical Center, concluding that the plaintiff failed to provide sufficient evidence of discrimination or that retaliation was the but-for cause of the challenged employment actions, and consequently, the case was closed.

Title VIICivil Rights ActEmployment DiscriminationRetaliationSummary JudgmentAdverse Employment ActionMcDonnell Douglas FrameworkWorkplace ConductDisciplinary ActionPaid Administrative Leave
References
49
Case No. ADJ3755232 (VNO0493072)
Regular
Aug 29, 2013

AKHMADMIR ABDULMIR vs. MED-PHARMEX, INC., EVEREST NATIONAL INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a prior award, finding that the applicant sustained industrial injury to his low back but not his kidneys or abdomen, and his occupation was a material handler/machine loader (group 460). The WCAB found that the opinions of the applicant's Qualified Medical Evaluator (QME) were not substantial evidence due to numerous discrepancies and an inadequate history. The WCAB also found the primary treating physician's (PTP) reports insufficient as they were stale, not based on an accurate history, and lacked review of all medical records. The case was returned to the WCJ for further proceedings on all other deferred issues.

Workers Compensation Appeals BoardPetition for ReconsiderationFindings Award and OrderPrimary Treating PhysicianTemporary DisabilityFurther Medical TreatmentApportionmentLabor Code section 4658(d)(2)Permanent DisabilityAttorney's Fees
References
0
Case No. ADJ8189240
Regular
Mar 04, 2013

MARY VAN RYN vs. BEJO SEEDS, INC., INSURANCE COMPANY OF THE WEST/EXPLORER INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a prior award, finding the medical evidence insufficient. The WCAB determined that the Panel Qualified Medical Evaluator's (PQME) opinion, which formed the basis of the award for industrial injury, lacked substantial evidence. Specifically, the PQME's supplemental report was based on inadequate history and examination, failing to consider crucial factors like job activities and non-work history. The case is returned to the trial level for further development of the record, including potential re-evaluation by the PQME with a job analysis or examination by a regular physician.

WCABReconsiderationFindings and AwardPQMESubstantial EvidenceIndustrial InjuryCumulative TraumaMedical OpinionLabor Code Section 5701EDD Lien
References
6
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