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

Case No. MISSING
Regular Panel Decision

Litwak v. Our Lady of Victory Hospital of Lackawanna

This medical malpractice action stemmed from the death of a plaintiff's decedent after hospital emergency room treatment. The plaintiff appealed an order granting summary judgment to defendant Dr. Kenneth H. Eckhert, Jr., who argued the claim was barred by workers' compensation. The appellate court analyzed whether the medical services were generally available and if the treatment occurred within the scope of employment for both the decedent (a Ford Motor Company employee) and Dr. Eckhert. The court determined that neither was acting within the scope of employment during the treatment, thus the Workers' Compensation Law's exclusive remedy did not apply. The order was reversed, the complaint and cross claims against Dr. Eckhert were reinstated, and summary judgment was granted to the plaintiff, dismissing the workers' compensation defense.

medical malpracticeworkers' compensationscope of employmentco-employeeemergency roomexclusive remedysummary judgmentappellate decisionNew York lawphysician
References
10
Case No. ADJ8487806
Regular
Aug 22, 2019

NICOLE CARTER vs. STATE OF CALIFORNIA - DEPARTMENT OF CORRECTIONS - INMATE CLAIMS

The Workers' Compensation Appeals Board affirmed a prior decision disallowing a lien claimant's claim for payment for medical treatment. The Board found that the treating physician's prior opinion, stating the applicant had reached maximum medical improvement and required no further treatment, constituted substantial evidence. Therefore, the lien claimant failed to meet its burden of proving the treatment was reasonably required to cure or relieve the applicant's industrial injury. The Board also noted a lack of evidence regarding the scope of a prior settlement and dismissed arguments about utilization review.

Workers' Compensation Appeals BoardLien ClaimantPetition for ReconsiderationFindings of Fact and OrderWorkers' Compensation Administrative Law JudgeMedical Provider NetworkUtilization ReviewCompromise and ReleaseLien AddendumPrimary Treating Physician
References
9
Case No. MISSING
Regular Panel Decision

Claim of Kigin v. State of New York Workers' Compensation Board

In 1996, claimant sustained work-related injuries, leading to workers' compensation benefits and a classification of permanent partial disability in 2006. Her treating physician, Andrea Coladner, requested a variance for additional acupuncture treatments beyond the scope of the Workers' Compensation Board's Medical Treatment Guidelines, which went into effect in 2010. The Special Fund for Reopened Cases denied the variance based on an independent medical examination by Peter Chiu, citing a lack of objective findings. A Workers' Compensation Law Judge and the Board affirmed this denial, prompting the claimant's appeal. The court affirmed the Board's decision, holding that the Board lawfully promulgated the Guidelines to predetermine medical necessity and that the variance procedure, which shifts the burden of proof to claimants for treatments outside the Guidelines, is permissible and consistent with due process.

Workers' CompensationMedical Treatment GuidelinesAcupunctureVariance RequestPermanent Partial DisabilityMedical NecessityBurden of ProofDue ProcessStatutory InterpretationAdministrative Law
References
19
Case No. MISSING
Regular Panel Decision
Jan 22, 2004

Mete v. New York State Office of Mental Retardation

This class action alleged age discrimination in employment against the New York State Office of Mental Retardation and Development Disabilities (OMRDD). Plaintiffs, former Chiefs of Developmental Center Treatment Services, claimed disparate treatment and disparate impact arising from a 1989 reduction in force (RIF) that eliminated their positions. All 46 Chiefs, who were over 40, were either demoted or retired, and statistical evidence showed a disproportionate impact on employees over 40. The Supreme Court granted defendants’ motion for summary judgment, dismissing all causes of action. The appellate court affirmed, finding that while plaintiffs established a prima facie case, OMRDD provided a legitimate, nondiscriminatory reason for the RIF (economic conditions and long-standing concerns about the position's utility), which plaintiffs failed to adequately prove was a pretext for discrimination.

Age DiscriminationClass ActionSummary JudgmentDisparate TreatmentDisparate ImpactReduction in ForceEmployment LawPretextPrima Facie CaseStatistical Evidence
References
11
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
Case No. ADJ1607469
Regular
Feb 01, 2010

CHRISTOPHER MELENDEZ vs. SALEM EQUIPMENT COMPANY, WAUSAU INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) rescinded a previous decision awarding penalties and attorney's fees. The Board found issues with the original WCJ's findings regarding the scope of injury, self-procured treatment costs, and penalty calculation for delayed medical treatment. The case is returned to the trial level for further proceedings and a new decision by the WCJ. The WCAB expressed no opinion on the merits of the issues raised in the petitions for reconsideration.

Workers' Compensation Appeals BoardReconsiderationIndustrial InjuryContracturesHydrocephalusHemiplegiaPneumoniaDecubitus UlcerationsNeurogenic BladderRenal Failure
References
0
Case No. LAO 0857845
Regular
Oct 12, 2007

NATIVIDAD URIAS vs. VISHAY TRANSDUCERS, LIBERTY MUTUAL INSURANCE COMPANY

This case involves a workers' compensation applicant seeking further medical treatment for admitted industrial injuries to her right shoulder and bilateral upper extremities. The Workers' Compensation Appeals Board granted reconsideration to clarify the scope of awarded medical treatment. The Board affirmed the need for a right carpal tunnel release surgery as recommended by the applicant's physician but reversed the award of arthroscopic shoulder surgery, finding it premature without a specific recommendation or request for authorization.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardExpedited HearingFurther Medical TreatmentArthroscopic Shoulder SurgeryCarpal Tunnel ReleasePrimary Treating PhysicianQualified Medical EvaluatorUtilization Review
References
0
Case No. ADJ4107442 (SAL 0119945)
Regular
Jul 14, 2010

LISA POITRAS vs. SPHERION STAFFING SERVICES, AIG/ CHARTIS

This case concerns a defendant's petition for reconsideration of a Workers' Compensation Appeals Board order. The defendant argued that the applicant's requested psychiatric treatment was for a separate injury, beyond the scope of an expedited hearing, and not a compensable consequence of her orthopedic injury. The Board denied reconsideration, adopting the judge's report which found the defendant misrepresented facts, misstated the law, and that the psychiatric treatment was sought to address depression and pain stemming from the accepted hip injury. The Board noted the defendant's petition mischaracterized the applicant's claim and the judge's findings.

WORKERS' COMPENSATION APPEALS BOARDSpherion Staffing ServicesAIG/ChartisSpecialty Risk ServicesADJ4107442Petition for ReconsiderationWCJLabor Code §3208.3(d)psychiatric injuryAOE/COE
References
1
Case No. ADJ11595561 ADJ11602485
Regular
Jun 27, 2019

CINTIA LEMUS vs. MOTEL 6/G6 HOSPITALITY, LIBERTY MUTUAL

In this case, the applicant sustained work-related injuries to her mid and low back. The defendant disputed the applicant's request for a chiropractic Qualified Medical Evaluator (QME) panel, arguing an orthopedic-spine specialist was more appropriate. The Medical Director initially agreed, citing the use of prescription medication outside a chiropractor's scope. However, the Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, finding that the Medical Director's rationale was insufficient. The Board affirmed the Workers' Compensation Judge's decision to overrule the Medical Director and allow a chiropractic QME, citing precedent that QMEs cannot provide treatment or opine on disputed treatment issues.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalFindings and OrderAdministrative Law Judge (WCJ)Qualified Medical Evaluator (QME)Medical DirectorQME Panel SpecialtyChiropracticOrthopedic-Spine
References
9
Case No. MISSING
Regular Panel Decision
Sep 13, 1979

Claim of Carley v. Triborough Bridge & Tunnel Authority

The Workers’ Compensation Board filed a decision on September 13, 1979, finding that the claimant's disability after January 21, 1977, was causally related to an industrial accident on January 1, 1977. The Board also determined that the claimant's subsequent treatment at the Veterans Administration Hospital was necessary and authorized. This determination was based on Dr. Russo's testimony. The court reviewed the appeal and found substantial evidence in the record to support the Board's decision. Consequently, the decision was affirmed, with costs awarded to the Workers’ Compensation Board.

Industrial AccidentCausally Related DisabilityMedical Treatment AuthorizationWorkers' Compensation AppealBoard DecisionVeterans Administration HospitalMedical TestimonySubstantial EvidenceAffirmed Decision
References
0
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