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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

Templeton v. Veterans Administration

The plaintiff, a probationary federal employee, filed a pro se complaint against the Veterans Administration’s Medical Center, alleging racial discrimination under Title VII and challenging his discharge on other grounds. The court found venue improper for the discrimination claim, noting it should be in California or Missouri based on statutory provisions. For the non-discrimination claim, the court determined the plaintiff failed to show procedural defects or arbitrary action in his dismissal, as the VA followed established regulations and provided rational bases for termination. Consequently, the non-discrimination claim was dismissed, and the discrimination claim was transferred to the Central District of California due to improper venue.

Racial DiscriminationTitle VIIFederal EmploymentVenueProbationary EmployeeWrongful DischargeDue ProcessProperty InterestLiberty InterestAdministrative Decision
References
18
Case No. ADJ869205 (SAC 0294976) ADJ302322 (SAC 0354178)
Regular
Oct 11, 2010

Patricia Rush vs. The Permanente Medical Group; Athens Administrators Concord

This case involves Patricia Rush claiming cumulative trauma injuries to her knees and back, among other body parts, against The Permanente Medical Group. The Workers' Compensation Appeals Board granted reconsideration because the Administrative Law Judge's findings of industrial causation for knee injuries lacked substantial medical evidence, with conflicting and uncertain Qualified Medical Evaluator opinions. The Board rescinded the prior findings and ordered further development of the medical record, suggesting an Agreed Medical Examiner or a court-appointed physician to resolve the causation issue for the knee injuries. The matter is returned to the trial level for a new final determination after the record is further developed on all issues, including injury causation.

Workers' Compensation Appeals BoardPermanente Medical GroupAthens Administratorscumulative trauma injurykneesbackshouldershandswristsindustrial causation
References
0
Case No. ADJ19616091
Regular
Aug 11, 2025

PAULA EASTON vs. THE PERMANENTE MEDICAL GROUP, INC., ATHENS ADMINISTRATORS

Paula Easton, the applicant, claims an industrial injury sustained while employed by The Permanente Medical Group, Inc. The workers' compensation administrative law judge (WCJ) initially found her request for a qualified medical evaluator (QME) panel invalid because it was filed simultaneously with the claim form, contrary to Labor Code section 4060. Easton petitioned for reconsideration, arguing that the statute does not prohibit simultaneous filing and request. The Appeals Board granted the petition for reconsideration, deferring a final decision on the merits for further review and consideration of the entire record.

Labor Code Section 4060Petition for ReconsiderationCompensability EvaluationQualified Medical Evaluator (QME)Simultaneous FilingDWC-1 Claim FormFinal OrderThreshold IssueContinuing JurisdictionRes Judicata
References
14
Case No. MISSING
Regular Panel Decision

Hason v. Department of Health

The petitioner, a physician, sought review of a determination by the Administrative Review Board for Professional Medical Conduct (ARB) which suspended his medical license. The ARB's decision was based on a prior California Board finding that the petitioner's ability to practice medicine was impaired by mental illness (bipolar affective disorder and narcissistic personality disorder). The court upheld the ARB's finding of professional misconduct, applying collateral estoppel to the California determination. However, the court found the penalty imposed by the ARB—a one-year suspension "and thereafter until such time as [petitioner] can demonstrate his fitness to practice medicine"—was not authorized by Public Health Law § 230-a. Consequently, the court modified the determination by annulling the penalty and remitted the matter to the ARB for the imposition of a statutorily appropriate penalty.

Medical License SuspensionProfessional MisconductPsychiatric ImpairmentMental IllnessBipolar Affective DisorderNarcissistic Personality DisorderCollateral EstoppelArticle 78 ProceedingAdministrative ReviewPenalty Annulment
References
26
Case No. MISSING
Regular Panel Decision

Mejias v. Social Security Administration

Plaintiff seeks judicial review of a determination by the Secretary of Health, Education, and Welfare denying him Supplemental Security Income (SSI) benefits. The plaintiff's application, based on a disability claim stemming from bronchial asthma, was initially denied by an Administrative Law Judge in July 1976 and subsequently affirmed by the Appeals Council in December 1976. The court found that despite the plaintiff's subjective complaints of disability and submissions from medical social workers and treating physicians asserting a deterioration in his condition, the administrative record contained substantial evidence that his asthma responded to treatment and his symptoms were minimal. The court affirmed the Secretary's decision to deny SSI benefits, but dismissed the complaint without prejudice, allowing the plaintiff to present additional, substantiated medical evidence to the Social Security Administration.

Supplemental Security IncomeSSI BenefitsDisability ClaimBronchial AsthmaAdministrative ReviewJudicial ReviewSubstantial EvidenceTreating Physician OpinionSubjective SymptomsMedical Evidence
References
15
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. Z docket
Regular Panel Decision
Oct 29, 2007

Matter of Administration for Children's Servs. v. Silvia S.

The Administration for Children's Services (ACS) filed a motion in Family Court, Queens County, seeking an order to compel the respondent, Silvia S., to produce her psychological, psychiatric, and medical records. ACS argued that these records were necessary to investigate allegations of child neglect involving Silvia S. and her child, Daniel C., following incidents related to her seizure disorder, homelessness, and postpartum depression. The court, presided over by Judge Edwina G. Richardson-Mendelson, denied the motion. The judge found that ACS had not demonstrated a meritorious cause of action for neglect and was improperly seeking pre-petition disclosure to determine if a cause of action existed. The court also emphasized the need for confidentiality under HIPAA and Mental Hygiene Law § 33.13, concluding that the interest of justice did not outweigh the respondent's need for privacy given the lack of a stated cause of action and no harm to the child.

Child NeglectMedical Records DisclosurePsychiatric RecordsPsychological RecordsPre-Petition DisclosureCPLR 3102(c)Family Court Act § 1038(d)HIPAAMental Hygiene Law § 33.13Confidentiality
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. ADJ736188 (GOL 0099658)
Regular
Sep 22, 2017

Deanna Power vs. St. John's Regional Medical Center, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case concerns Deanna Power's claim for continued medical treatment, specifically prescription medications Xyrem and Lunesta, for a previous industrial injury. The employer denied authorization for these medications through Utilization Review (UR), and the applicant's subsequent Independent Medical Review (IMR) application was deemed untimely. The trial judge initially ordered continued treatment and directed the Administrative Director to process the IMR appeal, finding it timely. However, the Appeals Board granted reconsideration, finding the trial judge lacked jurisdiction to order treatment when a timely UR decision was issued and the applicant's sole recourse was the IMR process. The matter was returned to the trial level for a determination solely on the timeliness of the IMR appeal, not the medical necessity of the medications.

WCABPetition for ReconsiderationFindings of Fact and AwardXyremLunestaIndependent Medical ReviewIMRUtilization ReviewURprescription medications
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
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