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Case Law Database

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

Case No. 533089
Regular Panel Decision
Oct 07, 2021

Matter of Barden v. General Physicians PC

Claimant, a patient services representative, sought to amend her workers' compensation claim to include left shoulder aggravation after a work-related injury to her right shoulder. The Workers' Compensation Board disallowed this request, finding that claimant failed to provide sufficient credible medical evidence to establish a causal relationship between her employment and the left shoulder condition. The Appellate Division, Third Department, affirmed the Board's decision. The court noted that the claimant's treating physician opined the left shoulder pathology was largely preexisting and unrelated to the work injury, and other medical opinions either lacked sufficient weight or were based on inaccurate information, providing no basis to disturb the Board's finding.

Workers' CompensationShoulder InjuryCausationMedical EvidencePreexisting ConditionAppellate ReviewBoard DecisionClaim AmendmentPatient Services Representative
References
10
Case No. MISSING
Regular Panel Decision
Apr 07, 1988

De Coste v. Champlain Valley Physicians Hospital

Decedent, Darwin A. De Coste, experienced chest pain and elevated blood pressure, leading him to Champlain Valley Physicians Hospital where he was seen by Dr. William Amsterlaw. Amsterlaw diagnosed reflux esophagitis despite an abnormal electrocardiogram, discharging De Coste, who subsequently suffered a fatal cardiopulmonary arrest 12 hours later. The administrator of De Coste's estate filed a wrongful death action, alleging medical malpractice and that the misdiagnosis was the proximate cause of death. A jury awarded pecuniary damages and funeral expenses, which the defendants appealed. The appellate court affirmed the verdict, finding rational support for the jury's malpractice finding and rejecting the defendants' argument to reduce the award by Social Security benefits due to the effective date of CPLR 4545 (c).

Medical MalpracticeWrongful DeathProximate CauseCollateral Source RuleCPLR 4545Jury VerdictEmergency Room CareMisdiagnosisArteriosclerosisMyocardial Infarction
References
3
Case No. ADJ7763946
Regular
May 06, 2013

CLIFFORD MULFORD vs. EL TORO RV, INC.; THE HARTFORD, Administered By AMERICAN ALL-RISK LOSS ADMINISTRATION

The applicant sustained a catastrophic brain injury after falling from a ladder while employed. The Workers' Compensation Appeals Board denied reconsideration and dismissed removal, upholding the WCJ's finding that the employer was not liable for home health care from October 23, 2012, onward. This decision was based on the retroactive application of Labor Code section 4600(h), which requires a physician's prescription for home health care. The Board found that the applicant's physician's reports did not contain a sufficient prescription to trigger employer liability under the new statute.

Workers Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalFindings & Orderindustrial injurycatastrophic brain injuryhome health careLabor Code § 4600(h)physician's prescriptionprospective application
References
4
Case No. ADJ2263476 (VNO 0318779)
Regular
Apr 20, 2016

DARLENE FERRONA vs. WARNER BROTHERS, TIME WARNER ENTERTAINMENT CO; ZURICH LOS ANGELES

This case concerns Darlene Ferrona's entitlement to 24/7 home health care following a psyche and fibromyalgia injury. The defendant, Warner Brothers, sought reconsideration of an order granting these services, arguing that utilization review only authorized limited care and that new prescriptions were required per Labor Code section 4600(h). The Appeals Board denied reconsideration, affirming that the applicant's prior authorization of 24/7 home health care by treating physicians and subsequent stipulation established ongoing need. The Board clarified that while a prescription date is crucial for liability, a new prescription is not always necessary to continue approved, ongoing home health care if the applicant's condition has not changed, citing the precedent of *Patterson v. The Oaks Farm*.

Workers' Compensation Appeals BoardDarlene FerronaWarner BrothersZurich Los Angelesindustrial injurypsychefibromyalgiahome health careutilization reviewsubstantial medical evidence
References
5
Case No. MISSING
Regular Panel Decision

Tesillo v. Emergency Physician Associates, Inc.

Manuel Tesillo sued Emergency Physician Associates, Inc. (EPA) for medical malpractice, alleging vicarious liability for the negligence of Dr. William C. Shepherd, an emergency physician at Schuyler Hospital. EPA moved for summary judgment, arguing Dr. Shepherd was an independent contractor. The court found material issues of fact regarding the extent of EPA's control over Dr. Shepherd and its managerial obligations to the Emergency Department, which could establish an employer-employee relationship despite contractual terms. Consequently, the court denied EPA's motion for summary judgment, indicating that the determination of Dr. Shepherd's employment status requires further discovery and possibly a trial.

Medical MalpracticeVicarious LiabilityRespondeat SuperiorIndependent ContractorAgency by EstoppelSummary JudgmentPhysician NegligenceEmergency DepartmentControl TestMaterial Issues of Fact
References
18
Case No. ADJ3685938 (WCK 0066506)
Regular
Dec 02, 2014

EMMETT BOONE vs. DREYER'S GRAND ICE CREAM, FIREMAN'S FUND INSURANCE COMPANY

In this workers' compensation case, the Appeals Board affirmed a prior award finding defendant's utilization review (UR) denials for prescription refills invalid. The Board agreed with the WCJ that the UR denials were untimely because the defendant failed to communicate the decisions to the treating physician within the statutory 24-hour timeframe. Consequently, the Board found the UR invalid, allowing the WCAB to determine medical necessity based on substantial evidence. This decision upholds the applicant's right to ongoing prescription refills.

Workers' Compensation Appeals BoardUtilization ReviewReconsiderationFindings and AwardPrescription RefillsMedical TreatmentDefective DenialTimeliness RequirementsLabor Code § 4610Dubon v. World Restoration
References
8
Case No. ADJ7995806
Regular
Jun 12, 2013

ROQUE NERI-HERNANDEZ vs. WORKFORCE STAFFING, TOWER GROUP COMPANIES

The Workers' Compensation Appeals Board (WCAB) granted reconsideration on its own motion regarding a prior decision that awarded applicant Roque Neri-Hernandez payment for self-procured home health care. The WCAB found that while the applicant met the burden of proof for reasonable and necessary home health care services based on a physician's prescription, further factual development was required. Issues to be clarified include the exact date the prescription was received by the defendant and the specific duration and nature of care required from the date of injury. The case was returned to the WCJ for further proceedings and a new decision.

Workers' Compensation Appeals BoardReconsiderationOpinion and OrderFindings and AwardAdministrative Law JudgePetition for ReconsiderationDecision After ReconsiderationLabor CodeSelf-procured medical careHome health care
References
13
Case No. MISSING
Regular Panel Decision

Claim of Dixon v. State University College

Claimant sustained a work-related back injury in July 1995. The treating physician prescribed home whirlpool and hydrotherapy after a February 1996 examination, which the employer's workers' compensation carrier denied for an in-home whirlpool, instead authorizing treatment at a YMCA. Claimant purchased a whirlpool tub and sought reimbursement under Workers' Compensation Law § 13 (a). The Workers' Compensation Board denied the request. On appeal, the court affirmed the Board's decision, finding no merit to the claimant's arguments regarding untimely denial or the sufficiency of the physician's prescription due to a lack of documented medical necessity for home treatment over a facility.

Workers' Compensation BenefitsMedical NecessityHome HydrotherapyWhirlpool ReimbursementCarrier AuthorizationTimeliness of RequestAppellate ReviewTreating Physician RecommendationBack InjuryPhysical Therapy
References
2
Case No. MISSING
Regular Panel Decision

Roginsky v. County of Suffolk, NY

Plaintiff Dr. Martin Roginsky filed an employment discrimination lawsuit against the County of Suffolk, alleging age discrimination in violation of the Age Discrimination in Employment Act (ADEA) and New York State Executive Law. Roginsky, a physician, was constructively discharged from his Staff Physician role at the Suffolk County Jail. He claims the termination was due to his age, citing remarks made by Dr. Gerazi, the Medical Director of the Jail, and that the County used a prescription-writing issue as a pretext. The County moved to dismiss the complaint, asserting it was not Roginsky's employer and that age was not the 'but for' cause of his discharge. The Court denied the County's motion to dismiss, finding that Roginsky had plausibly alleged an employment relationship with the County and satisfied the 'but for' causation standard for his ADEA claim. Consequently, the Court also decided to exercise supplemental jurisdiction over the state law claim.

Age DiscriminationEmployment DiscriminationADEAMotion to DismissConstructive DischargeEmployer-Employee RelationshipBut-For CausationPleading StandardsFederal Civil ProcedureNew York Law
References
24
Case No. MISSING
Regular Panel Decision

Renzi v. Case Manangement Concepts

In this workers' compensation case, the claimant sustained a compensable injury in 1998, with the claim becoming the Special Fund for Reopened Cases' liability in 2006. In 2008, a licensed massage therapist submitted requests for payment for services allegedly prescribed by the claimant's treating physician. The Special Fund objected, arguing massage therapists are not authorized providers under the Workers’ Compensation Law. A Workers' Compensation Law Judge (WCLJ) initially found massage therapy compensable if performed by a licensed therapist under a physician's supervision, holding payments in abeyance pending prescription submission. The Workers' Compensation Board affirmed this in an amended decision. This Court reversed the Board's decision, concluding that there was insufficient evidence to support the Board’s determination that the Special Fund is liable, as the massage therapist was not an authorized provider nor did they fall under any statutory exceptions like being a registered nurse, person trained in diagnostic techniques, physical therapist, or occupational therapist.

Workers' Compensation LawMassage TherapyAuthorized Medical ProvidersSpecial Fund for Reopened CasesCompensability of TreatmentStatutory ExceptionsAppellate ReviewProvider AuthorizationMedical Treatment GuidelinesSupervision of Care
References
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