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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

Long Island Neurological Assocs., P.C. v. Highmark Blue Shield & Reed Smith LLP

Plaintiff Long Island Neurological Associates, P.C. sued Highmark Blue Shield and Reed Smith LLP for under-reimbursement of surgical services under ERISA. The case involved a 4-year-old patient who received complex out-of-network surgery from Dr. Schneider due to the unavailability of in-network providers. Highmark significantly under-reimbursed the billed amount and denied multiple appeals, failing to provide requested documentation. The patient's parents assigned their rights to the Plaintiff, leading Defendants to move for dismissal, asserting an anti-assignment provision in their Administrative Service Agreement (ASA). The Court denied the motion, ruling that the ASA is not an ERISA plan document and thus its anti-assignment clause is not binding on plan participants, confirming Plaintiff's standing. The Rule 12(b)(6) motion was also denied as abandoned.

ERISAMotion to DismissAnti-assignment clauseAdministrative Service Agreement (ASA)Plan DocumentSubject Matter JurisdictionStandingUnder-reimbursementOut-of-network providerHealth Insurance
References
27
Case No. 2016-03-0413
Regular Panel Decision
Oct 05, 2017

Dodson, Deborah v. LHC Group

Deborah Dodson, an employee of LHC Group, injured her left ankle and right knee in May 2015. She underwent knee surgery and was placed at maximum medical improvement by Dr. Johnson. She later developed small fiber neuropathy, and despite a referral, faced difficulties obtaining a neurologic impairment evaluation. The Court granted Ms. Dodson's request for a neurologic impairment evaluation, either by Dr. Butler or another neurologist, referring Dr. Butler to the Penalty Program for failure to provide an impairment opinion. However, the Court denied her claim for additional temporary total disability benefits, finding she reached MMI on March 23, 2017, when Dr. Butler ceased active treatment.

Workers' CompensationNeurologic Impairment EvaluationTemporary Total Disability BenefitsMaximum Medical ImprovementSmall Fiber NeuropathyPain ManagementExpedited HearingMedical TreatmentImpairment RatingPenalty Program
References
3
Case No. MISSING
Regular Panel Decision

In re Anonymous

This case concerns an adoption proceeding in Nassau County for a neurologically handicapped child. The petitioners, an approved adoptive family, sought to finalize the adoption. Former foster parents, the intervenors, challenged this, claiming a statutory preference for adoption due to their long-term care of the child. The court found that the intervenors had previously declined to adopt the child and failed to take affirmative steps to gain statutory preference while the child was in their care. The decision emphasized that intervention rights apply to current foster parents in custody disputes, and ultimately, the court prioritized the child's best interests by granting the petitioners' adoption application.

AdoptionFoster CareChild WelfareNeurological HandicapBest Interests of ChildInterventionStatutory PreferenceSocial Services LawAgency Discretion
References
3
Case No. MISSING
Regular Panel Decision
May 20, 2007

Guzman v. 4030 Bronx Boulevard Associates L.L.C.

This appeal concerns the preclusion of expert testimony from a neuropsychologist, Dr. Elkhonon Goldberg, regarding the causation of infant plaintiff Tyrone Guzman's neurological deficits. The plaintiff has a history of multiple head traumas, and the lawsuit stems from alleged injuries sustained during a bathroom ceiling collapse. The trial court precluded Dr. Goldberg's testimony due to a lack of objective medical foundation to establish that the June 2001 incident was the proximate cause, subsequently dismissing the complaint. The appellate court agreed with the preclusion of testimony on causation but found an abuse of discretion in denying a continuance to allow plaintiffs to secure another medical expert. The matter was reversed and remanded for further proceedings.

Expert TestimonyNeuropsychologyTraumatic Brain InjuryCausationMotion in LimineContinuanceAppellate ProcedureEvidentiary StandardPersonal InjuryHead Trauma
References
22
Case No. 2018-05-1079
Regular Panel Decision
Apr 05, 2019

Kassmieh, Michael v. NEIS, Inc.

Michael Kassmieh, an auditor, sought workers' compensation benefits for facial pain, headaches, and tinnitus following a head injury in July 2017 while working for NElS, Inc. Despite NElS accepting the initial claim and providing authorized medical treatment, multiple physicians, including neurologists Dr. Strickland and Dr. Graham, found no objective neurological deficits or concluded that Mr. Kassmieh's subjective complaints were disproportionate to the minor injury. The Court denied Mr. Kassmieh's request for specific medical treatment and disability benefits, ruling he was unlikely to establish medical causation for his current complaints, as required by Tenn. Code Ann. § 50-6-102. NElS, however, was ordered to continue providing reasonable and necessary treatment for any conditions directly arising from the work injury.

Workers' CompensationHead InjuryFacial PainHeadachesTinnitusMedical CausationExpedited HearingNeurologyOphthalmologyENT Specialist
References
1
Case No. ADJ9379623
Regular
May 18, 2018

ETHERY AMARI vs. CHILDREN'S HOSPITAL OF LOS ANGELES

The Workers' Compensation Appeals Board granted the applicant's petition for removal, rescinding a prior order that denied her request for an additional neurology Qualified Medical Evaluator (QME). The applicant sustained admitted injuries including to her spine and shoulder, and also claimed headaches. Her treating physician recommended a neurology consult twice, and the applicant testified about worsening headaches post-injury. The Board found that these factors constituted good cause and demonstrated significant prejudice, warranting the appointment of a neurology QME panel.

Petition for RemovalPanel Qualified Medical EvaluatorNeurology QMEWCABFindings and OrderIndustrial InjuryCervical SpineLumbar SpineHeadachesPrimary Treating Physician
References
1
Case No. ADJ3218661 (OAK 0339889)
Regular
Feb 07, 2011

CHANCE ROLLINS vs. JOHN MARTIN STABLES, INC.; AMERICAN HOME ASSURANCE administered by AIG, CLAIMS SERVICES

The Appeals Board vacated its prior order granting reconsideration and dismissed the defendant's petition for reconsideration, finding the WCJ's ruling was not a final order. However, the Board granted removal, rescinded the WCJ's order, and denied the applicant's request for a neurology consultation under Labor Code §4601(a). The matter was returned to the trial level with instructions to issue an order for a new QME panel in neurology, as Dr. Jamasbi's request for a consultative neurological evaluation constituted good cause for a new panel under 8 Cal. Code Regs. §31.7. Attorney fees for the ex parte communication were upheld.

WCABPetition for ReconsiderationPetition for RemovalLabor Code 4601(a)Labor Code 4062.3QMEAgreed Medical EvaluatorNeurological ConsultMedical DirectorSpecialty Panel
References
0
Case No. MISSING
Regular Panel Decision

Burger v. Bladt

The infant plaintiff suffered personal injuries resulting in serious learning disabilities and neurological problems following a collision. The defendant moved to compel additional medical examinations by a psychologist, psychiatrist, and a teacher of the neurologically handicapped, as well as a parent intake evaluation by a psychiatric social worker, after the plaintiffs refused to submit to more than a single examination. The Supreme Court partially denied this motion, deeming it overly burdensome. On appeal, the order was modified to grant the defendant's request for an examination by Annella Stevens, a teacher of the neurologically handicapped, and an interview by a psychiatric social worker to obtain the child's developmental history, affirming the order as modified.

Personal InjuryMedical ExaminationDiscoveryAppellate ProcedureInfant PlaintiffNeurological ProblemsLearning DisabilitiesSupreme CourtPre-Trial DiscoveryCourt Order Modification
References
4
Case No. MISSING
Regular Panel Decision

Wilmerding v. O'Dwyer

The plaintiff, identified as a taxpayer, initiated an action seeking to prevent the City of New York and its Board of Transportation from issuing and selling budget notes. The purpose of these notes was to cover a significant deficit resulting from retroactive wage increases approved for subway employees. The central legal question involved the interpretation of the Local Finance Law, specifically whether the deficit qualified as an 'expenditure' with financing limitations or a 'claim which may be settled or compromised,' allowing for unlimited funding. The court affirmed the denial of the plaintiff's motion for an injunction and dismissed the complaint, concluding that the subway deficit constituted a mandatory claim subject to settlement or compromise under the Local Finance Law, thereby permitting the issuance of the budget notes.

Municipal FinanceBudget NotesSubway OperationsLocal Finance LawStatutory InterpretationWage IncreasesPublic EmployeesTaxpayer ActionInjunctionCity of New York
References
10
Case No. 2016-08-1106
Regular Panel Decision
Feb 16, 2018

McDonough, James v. Phillips General and Mechanical

Mr. James McDonough, a steamfitter, suffered a head injury on January 8, 2015, while working for Phillips General and Mechanical (PGM), leading to psychiatric and neurological symptoms. PGM initially accepted the claim but later denied Mr. McDonough's requests for psychological counseling and neurological evaluations, based on opinions from doctors who conducted record reviews and surveillance, suggesting malingering. However, Mr. McDonough's treating psychiatrist, Dr. Jim Pang, who had extensive contact with him, concluded his conditions were work-related and assigned a 15% permanent impairment rating, also recommending further treatment. The Court, prioritizing the treating physician's presumed correctness, found Mr. McDonough likely to prevail and granted his requested benefits for psychological therapy and neurological evaluation.

Head InjuryPsychiatric InjuryNeurological InjuryPost-concussion SyndromeMaximum Medical ImprovementPermanent ImpairmentCausation DisputeTreating Physician PresumptionMedical Records ReviewSurveillance Evidence
References
5
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