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

Case No. ADJ 3006646 (GOL 0101478) ADJ 4273750 (GOL 0101479)
Regular
Dec 23, 2010

YOLANDA ROMO RODRIGUEZ vs. COUNTY OF SANTA BARBARA

Applicant Yolanda Romo-Rodriguez sought penalties under Labor Code § 132a, alleging the County of Santa Barbara discriminated against her by denying a 9/80 work schedule after her industrial injury. The WCJ denied the petition, finding no evidence applicant was singled out due to her injury, as others in her training class also worked 40-hour weeks. The employer demonstrated a business necessity for the 40-hour schedule due to call center performance demands. The Appeals Board denied reconsideration, upholding the WCJ's findings.

Labor Code section 132aDiscrimination9/80 work scheduleBusiness necessityReconsiderationPenaltiesFinding of FactIndustrial injuryLauher standardEligibility worker
References
2
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. 2016-334 S C
Regular Panel Decision
Apr 27, 2017

2 & 9 Acupuncture, P.C. v. 21st Century Advantage Ins. Co.

This case concerns an appeal by 2 & 9 Acupuncture, P.C. from an amended order that granted summary judgment to 21st Century Advantage Insurance Company, dismissing a complaint to recover assigned first-party no-fault benefits. The defendant argued it had paid the plaintiff in accordance with the workers' compensation fee schedule. The Appellate Term, Second Department, reversed the lower court's decision, finding that the defendant failed to prima facie demonstrate proper denial of payment for services billed under CPT codes 97026 and 97016. Consequently, the defendant's motion for summary judgment regarding these specific CPT codes was denied.

No-Fault BenefitsSummary JudgmentCPT CodesWorkers' CompensationAppellate ReviewInsurance LawMedical BillingAcupunctureSuffolk CountyPayment Dispute
References
3
Case No. MISSING
Regular Panel Decision
Sep 23, 1988

Claim of Edmondson v. State Insurance Fund

The claimant, a payroll clerk, sustained a left hip injury after tripping at work in 1981, leading to multiple surgeries including a hip fusion and removal of the femoral head and neck, resulting in an 80% schedule loss of use of her left leg. The employer sought to apportion the disability due to a preexisting condition of avascular necrosis and a prior hip injury. However, the Workers' Compensation Board determined the 80% schedule loss was solely related to the compensable accident, a finding affirmed on appeal based on medical testimony that the orthopedic surgeon opined the preexisting condition was nondisabling and not progressive at the time of the accident.

Workers' CompensationHip InjurySchedule Loss of UseAvascular NecrosisApportionmentPreexisting ConditionMedical TestimonyOrthopedic SurgeryCausationState Insurance Fund
References
3
Case No. MISSING
Regular Panel Decision

Claim of Staebler v. Chloral Group, Inc.

The claimant, a salesman, sustained a left shoulder injury at work. The Workers’ Compensation Board initially awarded him $16,380 for a 15% schedule loss of use and directed reimbursement to the employer for $9,378.25 in wages. The claimant appealed the reimbursement, arguing he lost no work time. The Board subsequently rescinded the reimbursement award and reopened the case. Upon further proceedings, the Board again found the employer entitled to reimbursement under Workers’ Compensation Law § 25 (4). The claimant appealed this decision. The court reversed the Board's decision and remitted the matter for further proceedings, finding that the Administrative Law Judge failed to conduct a fair inquiry into whether the claimant lost time from work, preventing him from testifying adequately on the issue. The employer offered no contradictory evidence to the claimant’s statement that he lost no time from work. The claimant died after filing the appeal, with his executor continuing the case.

Workers' CompensationShoulder InjurySchedule Loss of UseReimbursement of WagesAdministrative Law JudgeProcedural ErrorDue Process ViolationRemittalEvidentiary DevelopmentDeceased Claimant
References
0
Case No. 2018 NY Slip Op 06537 [165 AD3d 667]
Regular Panel Decision
Oct 03, 2018

Matter of Heritage Mech. Servs., Inc. v. Suffolk County Dept. of Pub. Works

This case involves an appeal by Heritage Mechanical Services, Inc. (petitioner) from a judgment denying its petition to annul a determination by the Suffolk County Department of Public Works (DPW). The dispute stemmed from a general construction contract awarded to Posillico/Skanska, JV for a waste water treatment plant upgrade. Heritage was listed as a subcontractor for HVAC work, but a disagreement arose over the agreed-upon amount, with Heritage claiming a higher price for alternates not included in the initial bid figure. DPW approved Posillico's request to perform the HVAC work itself, citing Heritage's refusal as a 'legitimate construction need' under General Municipal Law § 101 (5). The Appellate Division, Second Department, affirmed the Supreme Court's judgment, finding DPW's determination was not arbitrary and capricious, affected by an error of law, or an abuse of discretion, and thus dismissed the proceeding.

Public Works ContractSubcontractor DisputeGeneral Municipal LawCPLR Article 78Administrative ReviewArbitrary and CapriciousProject Labor AgreementHVAC SubcontractBid DisputeContractual Interpretation
References
1
Case No. MISSING
Regular Panel Decision

Claim of Grugan v. The Record

Claimant sustained a work-related injury to her left hand in 2007, leading to a dispute over whether she should receive a permanent partial disability classification or a schedule loss of use award. The Workers’ Compensation Board ultimately issued a 15% schedule loss of use award, which the claimant appealed. The Appellate Division affirmed the Board's decision, finding that substantial evidence supported the determination. The court noted that claimant had reached maximum medical improvement and her condition was stable, factors supporting a schedule loss of use award. Conflicting medical opinions from the treating orthopedist and an independent medical examiner were resolved by the Board within its discretion.

Schedule Loss of UsePermanent Partial DisabilityWorkers' Compensation BoardMedical EvidenceIndependent Medical ExaminationTreating PhysicianAppellate ReviewBoard DiscretionMaximum Medical ImprovementConflicting Medical Opinions
References
3
Case No. MISSING
Regular Panel Decision

Matter of Terranova v. Lehr Construction Co.

In 2009, Claimant sustained a right knee injury at work, leading to workers' compensation benefits and a 10% schedule loss of use award. Concurrently, Claimant settled a third-party action for $173,500. A dispute arose concerning the carrier's credit and the apportionment of litigation expenses from the third-party settlement, specifically whether Burns v Varriale or Matter of Kelly v State Ins. Fund applied to a schedule loss of use award. The Workers’ Compensation Board ruled that Matter of Kelly controlled, denying Claimant ongoing payments for litigation expenses. The appellate court affirmed, clarifying that for schedule loss of use awards, future benefits are ascertainable, making Matter of Kelly applicable.

Schedule Loss of UseThird-Party SettlementWorkers’ Compensation BenefitsLitigation ExpensesCarrier CreditApportionment of Counsel FeesFuture BenefitsIndependent Medical ExaminationOrthopedist ReportCourt of Appeals Precedent
References
5
Case No. MISSING
Regular Panel Decision

Matter of Picone v. Putnam Hosp.

In 2002, claimant sustained a non-work-related left knee injury, followed by surgery. In 2011, claimant suffered a work-related left knee injury. A Workers' Compensation Law Judge determined a 35% schedule loss of use of the left leg, apportioning 50% to the prior non-work-related injury, resulting in a 17.5% award. The Workers' Compensation Board affirmed this decision. Claimant appealed the apportionment, arguing it should not apply to a schedule loss of use award. The Appellate Division affirmed the Board's decision, citing medical evidence from two orthopedic surgeons supporting the apportionment of the schedule loss of use award between the work-related and prior non-work-related injuries.

Schedule loss of useApportionmentKnee injuryWorkers' compensation appealMedical opinionPrior injuryNon-work-related injuryWork-related injuryAppellate DivisionWorkers' Compensation Board
References
3
Case No. 533901
Regular Panel Decision
Apr 14, 2022

In the Matter of the Claim of Vincent Gambardella

In this workers' compensation appeal, claimant Vincent Gambardella challenged a decision by the Workers' Compensation Board. Gambardella, a bus maintainer, sustained multiple work-related injuries in 2018. A WCLJ initially established permanent partial disability and schedule loss of use (SLU) awards, finding a 35% SLU of his left arm, 15.80% SLU of his right third finger, and a nonschedule permanent impairment of his lower back. Due to his voluntary retirement in April 2020, he was deemed ineligible for a nonschedule award but was granted an SLU award by the WCLJ. The Board reversed, asserting that SLU awards were only for claimants who returned to pre-injury wages. The Appellate Division disagreed, holding that an SLU award is appropriate when no initial award is made based on a nonschedule permanent partial disability classification, regardless of whether the claimant returned to work or voluntarily retired. The court found that voluntary retirement, like returning to work at preinjury wages, precludes a nonschedule award, thus making the claimant eligible for an SLU award for his permanent impairments. The case was remitted to the Workers' Compensation Board for further proceedings consistent with this decision.

Schedule Loss of UsePermanent Partial DisabilityVoluntary RetirementWage-Earning CapacityWorkers' Compensation LawAppellate ReviewRemittalDuplicative CompensationLabor Market AttachmentImpairment Rating
References
13
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