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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

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

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. 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

Lutheran Medical Center v. Hereford Insurance

Maher Kiswani, a livery car driver, was injured in an automobile accident and received medical treatment from Lutheran Medical Center. Lutheran, as Kiswani's assignee, sought payment from Hereford Insurance Company, the no-fault carrier, which refused to pay. After an initial arbitration where the Workers' Compensation Board determined Kiswani was not injured in the course of employment (without Hereford's notice), a second arbitration awarded Lutheran no-fault benefits. The Supreme Court, Kings County, vacated this arbitration award, ruling that Hereford should have been notified of the Workers' Compensation Board hearing. The appellate court affirmed the Supreme Court's decision, holding that a party not afforded an opportunity to participate in a Board hearing is not bound by its determination.

Arbitration AwardNo-Fault InsuranceWorkers' Compensation BoardDue ProcessNotice RequirementsVacated Arbitration AwardAppellate ReviewLivery Car DriverAutomobile AccidentMedical Benefits
References
3
Case No. MISSING
Regular Panel Decision

Perez v. Brookdale University Hospital & Medical Center

Eulalia Perez was admitted to Brookdale University Hospital on November 16, 2010, and treated for various medical conditions before being discharged on December 7. She died two days later. Her family, Ivan and Irma Perez, sued Brookdale and other defendants, alleging a violation of the Emergency Medical Treatment and Active Labor Act (EMTALA) and state-law claims of wrongful death and negligence. The court granted Brookdale's motion for summary judgment on the EMTALA claim, determining that the hospital fulfilled its EMTALA duties once Mrs. Perez was stabilized, and any subsequent issues were outside the statute's scope. Consequently, the court declined to exercise supplemental jurisdiction over the state-law claims, leading to the dismissal of all claims against all parties.

EMTALAEmergency Medical Treatment and Active Labor ActMedical MalpracticeNegligenceWrongful DeathSummary JudgmentSupplemental JurisdictionPatient DumpingHospital DischargeFederal Question Jurisdiction
References
8
Case No. ADJ1936437 (RIV 0070095) ADJ211616 (RIV 0073390)
Regular
Jun 20, 2011

ROSE MARIE RODRIGUEZ vs. HI-DESERT MEMORIAL, ALPHA FUND

In this case, the Workers' Compensation Appeals Board (WCAB) denied reconsideration of a supplemental award. The WCAB affirmed the finding that lien claimants were entitled to reimbursement for psychiatric treatment provided to the applicant. This treatment was deemed a compensable consequence of the applicant's industrial left thumb injury, with medical experts opining the psychiatric condition was predominantly caused by the orthopedic disability. The WCAB found that the industrial physical injury was the predominant cause of the applicant's psychiatric condition, making the treatment necessary.

Workers' Compensation Appeals BoardRose Marie RodriguezHi-Desert MemorialAlpha Fundlicensed vocational nurseorthopedic injurypsyche injurycompensable consequenceLabor Code section 3208.3(b)(1)psychiatric treatment
References
6
Case No. ADJ1635668 (OXN 0148383)
Regular
May 08, 2014

MARTHA MORALES vs. RICK BORQUEZ, D.D.S., STATE FARM INSURANCE

This case involves a lien claimant seeking payment for psychiatric treatment and medication provided to the applicant. The initial WCJ disallowed the lien, finding the psychiatric treatment was not for a compensable consequence of the industrial injury and that the lien claimant failed to meet its burden of proof. The Appeals Board rescinded this decision, holding that the applicant's psychiatric condition was a compensable consequence of the industrial injury, as evidenced by the Compromise and Release, a QME's report, and the employer's prior payments for such treatment. The matter was returned to the trial level for further proceedings to determine the amount due to the lien claimant.

Workers Compensation Appeals BoardLien ClaimantOrchid Multispecialty Medical GroupPsychiatric TreatmentCompensable ConsequenceUtilization ReviewQualified Medical EvaluatorBurden of ProofPreponderance of the EvidenceCompromise and Release
References
5
Case No. ADJ3247515 (GRO 0033799), ADJ3413251 (GRO 0033800), ADJ3766423 (GRO 0033798)
Regular
Sep 15, 2011

NEYFFI NORIEGA vs. C & D ZODIAC, TRAVELERS INSURANCE

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for removal as reconsideration was a more appropriate remedy. The WCAB granted reconsideration and rescinded the WCJ's award of psychiatric medical treatment. The Board found no industrial psychiatric injury in one case, and contrary expert medical opinions regarding the need for further treatment in the other two cases. The matter was returned to the trial level for further proceedings and a new decision consistent with the WCAB's opinion.

Workers' Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationJoint Findings and AwardQualified Medical Evaluator (QME)Psychiatric Medical TreatmentIndustrial InjuryLabor Code Section 4062.2Judicial NoticeMedical Evidence
References
1
Case No. ADJ3827044 (VNO 0434416)
Regular
Oct 11, 2010

ERIKA GUEDEL vs. KAISER PERMANENTE, Permissibly Self-Insured

This case involves an applicant seeking reconsideration of a workers' compensation award that found industrial injury to her wrists and cervical spine, causing 13% permanent disability. The original award failed to address medical treatment for the applicant's wrists, and denied her claim for psychiatric injury. The Appeals Board granted reconsideration to amend the decision, adding an award for future medical treatment for all injured body parts, but otherwise affirmed the original findings, including the denial of the psychiatric injury claim.

Workers' Compensation Appeals BoardKaiser PermanenteFindings and AwardWCJindustrial injurywristscervical spinepermanent disabilityapportionmentmedical treatment
References
1
Case No. MISSING
Regular Panel Decision

Claim of Evevsky v. Liberty Mutual Group

This case involves an appeal from a Workers’ Compensation Board decision regarding a claimant's unauthorized medical treatment. The claimant, who sustained neck and shoulder injuries in 1993, had her case reopened in 2001 after the employer's carrier objected to her request for authorized massage therapy. Both the Workers’ Compensation Law Judge and the Board determined that the treatment was not authorized under Workers’ Compensation Law § 13-b, as the massage therapist was not Board-authorized nor supervised by an authorized physician. The appellate court reviewed the Board's decision, affirming that there was no legal basis to overturn the finding. The court also considered and dismissed the claimant's constitutional arguments as being without merit.

Workers' CompensationMedical TreatmentMassage TherapyAuthorizationBoard DecisionAppellate ReviewStatutory InterpretationPhysician SupervisionConstitutionalityPermanent Partial Disability
References
3
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