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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

Claim of Mallette v. Flattery's

A claimant, who had a preexisting lower back condition and had been recommended for artificial disc replacement surgery (ADRE), suffered further lower back injuries in a work accident in 2010. A Workers’ Compensation Law Judge initially apportioned liability for the ADRE equally between the preexisting condition and the work accident. However, the Workers’ Compensation Board modified this, finding the employer's carrier solely liable for the surgery. The carrier appealed, arguing a lack of causal relationship between the accident and the need for ADRE. The Appellate Division affirmed the Board's decision, concluding that substantial evidence supported the finding that the work accident aggravated the claimant's preexisting condition, making the need for ADRE causally related to the accident.

workers' compensationcausal relationshipaggravation of preexisting conditionartificial disc replacement surgerylower back injuryapportionmentmedical authorizationsubstantial evidenceBoard determinationAppellate Division decision
References
5
Case No. 2004 NY Slip Op 24217
Regular Panel Decision
Apr 06, 2004

Matter of Lahm v. Bloomberg

Richard K. Lahm, a former New York City police officer, sought accident disability retirement (ADR) due to stage III squamous cell carcinoma, which he claimed was environmentally induced by exposure to toxic debris at the World Trade Center site on September 11, 2001. His application for ADR was denied by the Board of Trustees of the Police Pension Fund, Article II, which instead granted him an ordinary disability retirement. Lahm petitioned the Supreme Court, New York County, under CPLR article 78, seeking to annul this determination. The court found that the Board of Trustees' denial of ADR, based on a tie vote and without medical evidence contradicting Lahm's experts who opined his cancer was aggravated by WTC exposure, lacked a rational basis. Consequently, the court annulled the Board's decision and granted Lahm's application for ADR, remanding the matter for recomputation of his retirement allowance.

Police Officer DisabilityAccident Disability RetirementOrdinary Disability RetirementWorld Trade Center ExposureCancer CausationLine-of-Duty InjuryCPLR Article 78Administrative Code § 13-252Board of Trustees Decision AnnulmentCausation Standard
References
7
Case No. ADJ6634260
Regular
Aug 02, 2010

MELCHOR ELIZARRARAS vs. MIKE BUBALO CONSTRUCTION COMPANY, SEABRIGHT INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior finding that the parties were not subject to an Alternative Dispute Resolution (ADR) process. The Board found the original decision was based on unclear issues and the record may support a valid ADR process applicable to the applicant's injury. The case is returned to the trial level for further proceedings and a new decision on whether the applicant's injury is covered by a valid ADR system under Labor Code §3201.5.

Labor Code §3201.5Alternative Dispute ResolutionADR systemcollective bargaining agreementSouthern California District Council of LaborersMike Bubalo Construction CompanySeabright Insurance Companyindustrial injurylow back injuryright shoulder injury
References
3
Case No. ADJ1403472
Regular
Dec 29, 2008

ALEKSANDER YAMNITSKIY vs. MORROW-MEADOWS CORP., ST. PAUL TRAVELERS

The Workers' Compensation Appeals Board denied the defendant's petition for removal, which sought dismissal of the applicant's claim based on a collective bargaining agreement's alternative dispute resolution (ADR) provisions. The Board found insufficient evidence regarding the operative eligibility letter for the ADR plan at the time of the applicant's injury. The case is returned to the trial level to determine if the defendant can provide the necessary documentation to establish the ADR plan's applicability and warrant dismissal.

ADRLabor Code Section 3201.5collective bargaining agreementpetition for removalworkers' compensationapplication for adjudicationeligibility letterAdministrative DirectorWCJdismissal
References
3
Case No. ADJ8098049
Regular
Oct 01, 2013

SEZETTE DUBAY, as conservator for CARI PILLO on behalf of JOHN PILLO (deceased) vs. CONTRA COSTA ELECTRIC, INC., insured by AMERICAN CASUALTY COMPANY OF REDDING, PENNSYLVANIA, Adjusted by SEDGWICK CMS, et al.

This case concerns whether a deceased employee's death benefit claim falls under an Alternative Dispute Resolution (ADR) carve-out agreement. The defendant argued that arbitration agreements bind non-signatories and should apply to death benefits, likening them to derivative wrongful death claims. However, the Appeals Board affirmed the WCJ's decision, finding Labor Code section 3201.5 clearly limits ADR to disputes "between employees and employers." The Board reasoned that a dependent's claim for death benefits is an independent statutory right, not a dispute between an employee and employer, thus outside the scope of the ADR carve-out.

ADR carve-outnon-signatorywrongful death claimdependentsemployee definitionLabor Code 3201.5collective bargaining agreementinter vivos benefitsarbitrationWCJ
References
11
Case No. MISSING
Regular Panel Decision

Jefferson v. Kelly

The petitioner, an unnamed uniformed New York City police officer, sought an Article 78 order to overturn the denial of his accident disability retirement (ADR) benefits and to receive retroactive benefits. He had previously been granted ordinary disability retirement (ODR) for major depressive disorder. His ADR application claimed his psychological conditions were caused by his assignment to the World Trade Center site after 9/11. The respondents, the Police Commissioner and the Police Pension Fund Board of Trustees, denied the ADR application, citing medical evidence that linked the petitioner's mental health issues to his mother's death and cardiac problems rather than his WTC service. The court found credible medical evidence to support the respondents' determination and noted that the petitioner did not qualify for the World Trade Center presumption. Consequently, the petition was denied, and the proceeding dismissed.

Accident Disability RetirementOrdinary Disability RetirementPolice Pension FundWorld Trade Center PresumptionCausationMajor Depressive DisorderGeneralized Anxiety DisorderPost-Traumatic Stress DisorderAgoraphobiaPsychological Disability
References
16
Case No. MISSING
Regular Panel Decision

Cartagena v. City of New York

Haydee Cartagena, a New York City police officer, suffered two line-of-duty injuries in 1987 and 1989, leading to extensive medical treatment and multiple surgeries. She applied four times for accidental disability retirement (ADR) benefits, but the Police Pension Fund's Medical Board repeatedly denied her claims, initially finding no disability, then later acknowledging a disability (Raynaud's Syndrome) but denying its service-related causation. Despite numerous treating physicians' opinions affirming her permanent disability and its work-related origin, the Trustees adopted the Medical Board's recommendation to grant ordinary disability retirement (ODR) but deny ADR. Cartagena challenged this decision via an Article 78 petition. The court found no credible evidence to support the lack of causation and concluded that her disability was the natural and proximate result of her line-of-duty injuries, thereby granting her petition and directing the Pension Fund to award her ADR.

Disability retirementAccidental disability retirementOrdinary disability retirementPolice Pension FundLine-of-duty injuryCarpal tunnel syndromeRaynaud's phenomenonMedical Board decisionJudicial reviewCausation of disability
References
6
Case No. MISSING
Regular Panel Decision

Dement v. Kelly

Petitioner William Dement, a former NYPD lieutenant and 9/11 first responder, challenged the denial of his World Trade Center (WTC) line-of-duty accident disability retirement (ADR) pension. Dement developed multiple conditions, including severe sleep apnea and gastroesophageal reflux disease (GERD), after his WTC exposure. The Medical Board repeatedly denied his WTC-ADR application, attributing his disability solely to sleep apnea unrelated to WTC exposure, despite evidence linking GERD and heavy metal poisoning (recognized WTC conditions) to his sleep apnea and overall disability. The Supreme Court upheld the denial. However, the appellate court reversed this decision, finding that the respondents failed to rebut the WTC presumption of causation. The court determined that Dement's disabling sleep apnea was attributable to WTC exposure and exacerbated by his WTC-related GERD, as supported by medical literature. The case was remanded for an award of a WTC-ADR pension, emphasizing the legislative intent to protect 9/11 workers.

WTC Disability RetirementFirst Responder HealthCausation StandardPresumptive EvidenceMedical Board ReviewSleep Apnea DisabilityGastroesophageal Reflux Disease (GERD)Heavy Metal ToxicityPolice Pension BenefitsArticle 78 Proceeding
References
12
Case No. MISSING
Regular Panel Decision

Lahm v. Bloomberg

The petitioner, a former New York City police officer named Lahm, sought an accident disability retirement (ADR) due to stage III squamous cell carcinoma, claiming it was environmentally induced by his prolonged exposure to toxic debris at the World Trade Center site on September 11, 2001. The Police Department and the Medical Board denied his request for a line-of-duty designation and ADR, asserting no causal relationship, and instead granted him an ordinary disability retirement. The Board of Trustees subsequently denied the ADR application via a tie vote. The court found that the Medical Board failed to consider whether the petitioner's pre-existing condition was aggravated by the WTC exposure. Concluding that the Board of Trustees' denial lacked a rational basis, and noting that the record contained only medical opinions supporting the aggravation claim, the court ruled as a matter of law that the petitioner's cancer was exacerbated by the service-connected September 11, 2001 injury. Consequently, the court granted the petitioner's application, annulled the Board of Trustees' determination, and remanded the matter for recomputation of his retirement allowance with an accident disability retirement.

WTC ExposureCancer AggravationAccident Disability RetirementOrdinary Disability RetirementPolice Pension FundLine-of-Duty InjuryCausation StandardMedical BoardTie Vote AnnulmentExacerbation of Pre-existing Condition
References
7
Case No. ADJ7188251 ADJ7188272
Regular
Jan 29, 2010

Raymond Mark vs. City of Los Angeles

The Workers' Compensation Appeals Board granted reconsideration of an Arbitrator's award of temporary partial disability for a sleep disorder. The defendant argued that the case fell under an ADR "carve-out" provision and that the chosen Qualified Medical Evaluator found the sleep disorder non-industrial. The Board rescinded the Arbitrator's decision because the record lacked a proper Minutes of Hearing and Summary of Evidence, which is crucial for meaningful review of ADR cases. The matter was returned to the Arbitrator for further proceedings and a new decision.

ADRCarve-out caseQualified Medical EvaluatorAgreed Medical EvaluatorSleep disorderTemporary partial disabilityArbitrator's DecisionReconsiderationMinutes of Hearing and Summary of EvidenceDue process
References
3
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