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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

Renteria v. Santino's Café

Claimant, a chef, suffered a work-related back injury. Five months later, while in Florida, his pain worsened, leading to an emergency room visit where a report noted he 'twisted his back again.' His employer and its carrier argued this constituted a new, unrelated injury and that the claimant had voluntarily withdrawn from the labor market. However, a Workers' Compensation Law Judge and the Workers' Compensation Board determined there was no new accident and that the claimant remained attached to the workforce. The appellate court affirmed the Board's decision, finding substantial evidence to support the claimant's job search efforts within medical restrictions and that the worsened pain was an exacerbation of an existing injury.

Back InjuryVoluntary Withdrawal from Labor MarketJob SearchExacerbation of InjuryMedical Report DiscrepancyWitness CredibilitySubstantial EvidenceAppellate ReviewClaimant TestimonyEmployer Liability
References
4
Case No. 2021 NY Slip Op 00598 [191 AD3d 1051]
Regular Panel Decision
Feb 04, 2021

Matter of Grimaldi v. Suffolk County Dept. of Health C/O Suffolk County Risk Mgt.

The claimant, William Grimaldi, sustained work-related injuries in 2007 and 2008. The Workers' Compensation Board initially established his average weekly wage for awards based on the lower 2008 wage. The Appellate Division, Third Department, found that the Board erred in applying the 2008 average weekly wage for the ongoing permanent partial disability awards related to the 2007 injury. The court held that the awards for the 2007 injury should be based on the higher wage earned at the time of that injury. Therefore, the Board's decision was modified and remitted for further proceedings, while the appeal from the denial of reconsideration was dismissed as academic.

Workers' CompensationAverage Weekly WagePermanent Partial DisabilityApportionmentRemittalJudicial ReviewWage Earning CapacityAppellate ReviewInjury ClaimsBoard Decision
References
6
Case No. ADJ1510738
Regular
Oct 10, 2008

XXZZX SJO2 vs. SUBSEQUENT INJURIES BENEFITS TRUST FUND

The Workers' Compensation Appeals Board (WCAB) dismissed the Subsequent Injuries Benefits Trust Fund's (SIF) petition for reconsideration as untimely. The petition was filed on August 11, 2008, which was beyond the 25-day jurisdictional deadline for reconsideration after service by mail on July 14, 2008. The WCAB emphasized that filing is determined by the date of receipt, not mailing, and the petition was received by the San Jose district office three days after the deadline.

Subsequent Injuries Benefits Trust FundPetition for ReconsiderationTimelinessJurisdictionalFiling DateReceipt DateOfficial Address RecordProof of ServiceDismissedWCAB
References
8
Case No. ADJ6659926 ADJ6659223
Regular
Jan 06, 2012

MICHELLE JIMENEZ vs. DENCO SALES COMPANY, ACE PROPERTY AND CASUALTY COMPANY, ARGONAUT INSURANCE COMPANY

This case concerns applicant Michelle Jimenez's claim for additional temporary disability benefits for lumbar spine injuries sustained from a specific injury in July 2007 and a cumulative trauma injury ending in July 2008. The Appeals Board found that while the 2007 injury's temporary disability indemnity limit under Labor Code section 4656(c)(1) expired in August 2009, the applicant is entitled to remaining temporary disability under section 4656(c)(2) for the 2008 cumulative trauma injury. Because the applicant had only received 69 weeks of temporary disability for the cumulative trauma injury and is entitled to 104 weeks within five years of the injury date, she is awarded an additional 35 weeks of temporary disability indemnity prior to July 17, 2013.

Labor Code section 4656temporary disability indemnityaggregate disability paymentscompensable weeksperiod of two yearsperiod of five yearsdate of commencementdate of injurycumulative trauma injuryspecific injury
References
4
Case No. MISSING
Regular Panel Decision
Dec 03, 2004

Claim of Scally v. Ravena Coeymans Selkirk Central School District

In this case, a claimant appealed a Workers’ Compensation Board decision regarding apportionment of her workers' compensation award. The claimant, who suffered a work-related left knee injury in 2002, had a pre-existing non-work-related injury to the same knee from 1986. While a WCLJ initially denied apportionment, the Board reversed, directing a 50/50 apportionment based on the premise that the prior injury would have resulted in a schedule loss of use award had it been work-related. The appellate court upheld the Board's determination, deferring to its interpretation that a non-work-related injury leading to a schedule loss of use constitutes a "disability in a compensation sense" for apportionment purposes. This decision was supported by medical expert testimony indicating a schedule loss of use from the prior surgery.

Workers' CompensationApportionmentKnee InjuryNon-work-related InjurySchedule Loss of UsePreexisting ConditionMedical Expert TestimonyBoard InterpretationJudicial ReviewAppellate Decision
References
13
Case No. ADJ6987253 ADJ5768983
Regular
Nov 22, 2019

MICHAEL PARKER vs. TRI-CITY MEDICAL CENTER, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

This case involves petitions for reconsideration by Tri-City Medical Center and Travelers Property Casualty Company of America regarding an award for a January 7, 2008 injury. Tri-City sought to implead Travelers for contribution, arguing the 2004 injury contributed to the award. The Board denied reconsideration, finding contribution issues between separate injury dates are not subject to mandatory arbitration under LC 5500.5. The Board also upheld the WCJ's use of mandated commutation tables for attorney fees and found Travelers was not prejudiced by the decision concerning only the 2008 injury.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings Award and OrderPermanent Total DisabilityJoint and Several LiabilityReimbursementCommutationAttorney's FeesLife Expectancy DataMRSA Infection
References
1
Case No. ADJ4702564 (RDG 0094598) ADJ6944237
Regular
Apr 17, 2018

CLAUDETTE GILBERT vs. DEPARTMENT OF SOCIAL SERVICES, INHOME SUPPORTIVE SERVICES, YORK RISK SERVICES, ADVENTIST HEALTH OF CALIFORNIA, LIBERTY MUTUAL INSURANCE COMPANY

This case concerns a dispute over reimbursement for medical expenses following two lumbar spine injuries sustained by the applicant. The Department of Social Services (IHSS) sought reimbursement from Liberty Mutual Insurance Company for treatment costs after the applicant's 2008 injury, arguing the 1999 injury contributed to the need for care. However, the Appeals Board found Dr. Sommer's medical opinions lacked substantiality due to inconsistent apportionment and a failure to adequately explain the causal link between the 1999 injury and the 2008 treatment needs. Consequently, IHSS failed to meet its burden of proof, and their claims for reimbursement and shared medical expenses were denied.

Workers' Compensation Appeals BoardReconsiderationIn-Home Supportive Services (IHSS)Legally UninsuredYORK RISK SERVICESADVENTIST HEALTH OF CALIFORNIALIBERTY MUTUAL INSURANCE COMPANYlumbar spine injuryapportionmentmedical opinions
References
0
Case No. ADJ6736069 ADJ6736155
Regular
Dec 01, 2020

YVETTE WHITMER vs. HI SHEAR CORPORATION, ZURICH NORTH AMERICA, GOLDEN STATE FOODS, LIBERTY MUTUAL, SANTA BARBARA APPLIED RESEARCH

This case concerns applicant Yvette Whitmer's claim for workers' compensation benefits for back injuries allegedly sustained on May 1 and June 13, 2008. The Workers' Compensation Appeals Board (WCAB) denied reconsideration of its prior decision, which reversed an administrative law judge's finding of compensability. The WCAB found applicant's claims barred by Labor Code section 3600(a)(10) because they were post-termination claims where the employer lacked prior notice of the injury. The applicant contended she provided notice of an injury on June 13, 2008, by reporting a motor vehicle accident, but the WCAB credited employer testimony that she was not late and did not report an injury until after her termination.

Workers' Compensation Appeals BoardReconsideration DeniedLabor Code Section 3600(a)(10)Post-Termination ClaimsCompensable Industrial InjuryNotice of InjuryPre-Termination NoticeMotor Vehicle AccidentAdministrative Law JudgeFindings of Fact
References
1
Case No. MISSING
Regular Panel Decision

Claim of Hilbrandt v. Village of Red Hook

The claimant, a volunteer emergency medical technician, was injured on August 26, 2005. Her initial workers’ compensation claim was established for left ankle/leg and consequential right shoulder injuries. In April 2008, she sought to amend her claim to include a consequential right hip injury. The Workers’ Compensation Law Judge (WCLJ) dismissed the right hip claim as time-barred under Workers’ Compensation Law § 28, a decision upheld by the Workers’ Compensation Board. On appeal, the court affirmed the Board's decision, finding that while Volunteer Firefighters’ Benefit Law § 41 should have been applied, the claim for the right hip injury was time-barred under either statute as it was a direct injury from the 2005 accident and not claimed until April 2008.

Volunteer Firefighters' BenefitsStatute of LimitationsTime-barred ClaimConsequential InjuryDirect InjuryRight Hip InjuryEmergency Medical TechnicianDutchess CountyMedical EvidenceAppellate Review
References
6
Case No. MISSING
Regular Panel Decision

Claim of Prescott v. Town of Lake Luzerne

A claimant fell off a dump truck at work in February 2008, landing on his right buttock and injuring his hip. The injury led to surgery in May 2008 to remove heterotopic bone and subsequent two-stage hip replacement revision surgeries in November 2008 and February 2009 due to an infection. The Workers’ Compensation Board found the initial surgery and subsequent revisions causally related to the work fall and supported compensation awards. The employer appealed, arguing that an independent medical examination (IME) was improperly precluded and that the initial surgery lacked proper authorization. The Appellate Division affirmed the preclusion of the IME due to untimeliness and upheld the causal relationship findings for the injury and subsequent surgeries. However, the court reversed the Board's determination that the May 2008 surgery was properly authorized, remitting that specific issue for further proceedings, while affirming all other appealed decisions.

Causal RelationshipIndependent Medical Examination (IME)Evidence PreclusionSurgery AuthorizationHip InjuryHeterotopic OssificationMedical Opinion ConflictDue ProcessRemittiturEmployer Liability
References
8
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