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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. ADJ3206000 (LAO 0877236)
Regular
Aug 10, 2012

JENNIFER HESTER vs. TECHNICOLOR, Permissibly Self-Insured

The applicant sought reconsideration of a decision limiting the defendant's payment for hip surgery to the Official Medical Fee Schedule, which the applicant's surgeon deemed insufficient. The Appeals Board granted reconsideration due to the complex fee dispute, noting that while extraordinary circumstances existed regarding the surgeon's qualifications, the reasonableness of his requested fee was unproven. To resolve this, the Board ordered the appointment of an agreed physician to investigate the surgeon's usual fee and its reasonableness compared to others with similar expertise.

ReconsiderationFindings of FactAgreed PhysicianMedical TreatmentFee ScheduleExtraordinary CircumstancesUsual FeeHip ArthroscopyOsteoplastyChondroplasty
References
1
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. MISSING
Regular Panel Decision

Choi v. State

The petitioner, a physician, initiated a CPLR article 78 proceeding to challenge a determination by the Commissioner of Education to suspend his medical license. The charges of professional misconduct stemmed from prior findings by the Department of Social Services (DSS) and the Department of Health (DOH) regarding unacceptable patient care, inappropriate treatment, excessive testing, and operating a clinical laboratory without a permit. The Regents Review Committee, utilizing an expedited procedure, found the petitioner guilty of two specifications based on the DSS determination and recommended a two-year license suspension, with a partial stay and probation. The court affirmed the Commissioner's determination and dismissed the petition, rejecting the petitioner's arguments against the application of collateral estoppel, the propriety of the expedited procedure, and the claim of ineffective assistance of counsel in the preceding administrative hearings. The court also upheld the penalty imposed, deeming it not excessive or an abuse of discretion.

Professional MisconductPhysician License SuspensionCPLR Article 78Collateral EstoppelExpedited ProcedureIneffective Assistance of CounselDepartment of Social ServicesDepartment of HealthAdministrative LawProfessional Regulation
References
4
Case No. ADJ2745839 (AHM 0136320)
Regular
Dec 15, 2008

Linda Kiehlmeier vs. CALIFORNIA EMERGENCY PHYSICIAN, TRAVELERS ORANGE

This case involves a physician's assistant claiming cumulative industrial injuries from 2000-2006. The WCAB granted reconsideration to clarify temporary disability indemnity, affirming the finding of injury but amending the benefit period and rates for temporary total disability. The applicant will receive benefits starting January 1, 2008, with adjusted weekly amounts for different periods, crediting the defendant for benefits already paid.

Petition for ReconsiderationCumulative Industrial InjuryPhysician's AssistantTemporary DisabilityMaximum RatePanel QMEAquatic TherapyTempurpedic MattressRetroactive BenefitsReport and Recommendation
References
0
Case No. MISSING
Regular Panel Decision

People v. Gans

This court opinion addresses whether a certified social worker can be qualified as an expert witness to provide testimony regarding a defendant's mental capacity to proceed and future competency. The defense sought to qualify Hillel Bodek, a certified social worker specializing in forensic clinical social work, as an expert witness for these purposes. The court meticulously reviewed the qualifications of clinical social workers, acknowledging their critical role in the diagnosis of mental disorders, including their involvement in the development of the DSM III. Despite statutory provisions in CPL article 730 outlining who may serve as psychiatric examiners, the court emphasized that other appropriately trained and experienced experts can also offer testimony on competence. Ultimately, the court ruled in the affirmative, concluding that certified social workers with demonstrated training and supervised clinical experience in diagnosis and capacity assessment are qualified to provide expert testimony on these crucial issues.

Expert Witness QualificationCertified Social WorkerMental Capacity AssessmentCompetency to ProceedForensic Mental HealthDiagnostic AssessmentPrognostic StatementsCriminal Procedure Law Article 730DSM IIINon-Medical Expert Testimony
References
13
Case No. ADJ916063 (VNO 0541860)
Regular
Mar 10, 2011

TERRY SCUDDER vs. VERIZON CALIFORNIA, INC.; Permissibly Self-Insured, Administered by SEDGWICK CMS

This case concerns an applicant who sustained industrial injuries and pre-designated a physician outside of the employer's established Medical Provider Network (MPN). The applicant's attorney subsequently referred him to physicians outside the MPN, whose reports were admitted by the WCJ. The Appeals Board overturned this, ruling that only the pre-designated physician, or referrals from that physician, could be outside the MPN and that referrals by an attorney were invalid. Consequently, the reports of these outside physicians were inadmissible, and the issues decided based on them were returned for further proceedings.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNPre-designationTreating PhysicianQualified Medical EvaluatorQMEPermanent and Stationary DateApportionmentSelf-Procured Medical Treatment
References
1
Case No. ADJ4332905 (SAL 0109881)
Regular
Jan 20, 2016

JESUS RODRIGUEZ vs. BUD OF CALIFORNIA

California Physicians Network (CPN) and its representative, Dennise Mejia, were sanctioned $2,500.00 jointly and severally for filing a frivolous and untimely petition for reconsideration that lacked proper verification and contained erroneous facts. The Board dismissed their reconsideration request because it did not challenge a final order and was procedurally deficient. CPN and Mejia failed to respond to the Board's notice of intent to impose sanctions. The defendant's claim for additional trial-level costs and attorney's fees was deferred to the workers' compensation administrative law judge for initial determination.

ADJ4332905SAL 0109881Opinion and Decision After RemovalSanctionCalifornia Physicians NetworkDennise MejiaLien ClaimantLabor Code section 5813(a)Appeals Board Rule 10561Frivolous
References
6
Case No. ADJ9145724
Regular
Jun 01, 2015

ARZAGA, JOSE vs. CROWN AUTOMOTIVE, INC., AMTRUST NORTH AMERICA

This case involves an applicant seeking to select a pain management specialist outside his employer's Medical Provider Network (MPN). The applicant argued the MPN failed to provide a qualifying specialist within the required 15-mile/30-minute access standard for a primary treating physician. The Board denied the employer's petition for reconsideration, affirming the applicant's right to choose an out-of-network physician and reimbursement for investigative costs. The majority reasoned that the MPN must meet the closer access standard for a primary treating physician, even if that physician is a specialist. A dissenting opinion argued that a specialist, when chosen as a primary treating physician, should fall under the 30-mile/60-minute access standard for specialists.

Medical Provider NetworkMPNprimary treating physicianpain management specialistaccess standardAdministrative Director's Rule 9767.5investigative costsLabor Code section 5703Lescallett v. Wal-MartMartinez v. New French Bakery
References
2
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