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

Case No. 2020 NY Slip Op 07121 [188 AD3d 1292]
Regular Panel Decision
Nov 25, 2020

Villada v. 452 Fifth Owners, LLC

The plaintiff, Carlos Villada, was allegedly injured while working on a roof demolition project at property owned by 452 Fifth Owners, LLC. He was injured when a wheeled dumpster he was pulling up a plywood ramp tipped over. Villada commenced an action against 452 Fifth Owners, LLC, alleging common-law negligence and a violation of Labor Law § 200. The Supreme Court denied 452 Fifth's motion for summary judgment dismissing these causes of action. On appeal, the Appellate Division, Second Department, reversed the Supreme Court's order, granting 452 Fifth's motion for summary judgment. The court found that 452 Fifth established, prima facie, that it did not create or have actual or constructive notice of the dangerous condition and did not have the authority to supervise or control the work. The cross-appeal by CBRE, Inc. was dismissed.

Personal InjuryRoof DemolitionSummary JudgmentCommon-Law NegligencePremises LiabilityWorkplace SafetyAppellate ReversalLabor Law ComplianceDangerous ConditionSupervision and Control
References
10
Case No. ADJ9376675
Regular
Oct 20, 2015

JESSICA FIELD vs. INGLEWOOD POLICE DEPARTMENT, ADMINSURE

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant challenged the permanent disability rating, arguing the DRE method, rather than the ROM method, was improperly applied by the QME. The Board adopted the WCJ's report, which found the QME's reliance on the DRE method, specifically Category IV, was supported by substantial medical evidence and properly applied under the AMA Guides, Fifth Edition. The defendant's contention that the rating was invalid under *Blackledge* was also rejected, as the QME report met legal and regulatory requirements.

Workers' Compensation Appeals BoardPetition for ReconsiderationDENIEDINGLEWOOD POLICE DEPARTMENTADMINSUREPermanent DisabilityAMA Guides Fifth EditionDRE MethodLumbar Spine Category IVwhole person impairment
References
2
Case No. ADJ10187704, ADJ10924724
Regular
May 17, 2018

STEVEN CASE vs. GOLDEN GATE BRIDGE HIGHWAY AND TRANSPORTATION DISTRICT

The Workers' Compensation Appeals Board granted reconsideration to increase applicant's permanent disability rating for bilateral shoulder injury from 9% to 38%. The Board found the Agreed Medical Evaluator's (AME) alternative rating, based on strength loss, was substantial medical evidence and properly considered within the AMA Guides. The WCJ erred in applying an overly restrictive interpretation of "complex or extraordinary" cases for deviating from strict AMA Guides ratings. The AME's use of strength loss data from the AMA Guides, even for an age outside the specified range, was permissible under the *Almaraz-Guzman* line of cases when justified by clinical judgment.

Workers' Compensation Appeals BoardJoint Findings and AwardPetition for ReconsiderationAgreed Medical Evaluator (AME)permanent disability ratingbilateral shouldersorthopedic AMEAMA GuidesAlmaraz-Guzmanstrength loss index
References
20
Case No. ADJ3849676 (AHM 0147658) ADJ1948081 (AHM 0147721)
Regular
Feb 14, 2011

ROBERT LEON vs. RF DEVELOPMENT & BUSCH CORPORATION, LINCOLN GENERAL INSURANCE

In this workers' compensation case, the defendant sought reconsideration of a $37\%$ permanent disability award, arguing the physician's impairment rating improperly deviated from the AMA Guides. The Appeals Board granted reconsideration, finding the physician's justification for not strictly applying the Guides was insufficient and not based on substantial medical evidence. Specifically, the physician's reliance on subjective complaints and analogies to amputation were not adequately supported. The Board rescinded the award and remanded the case for a new rating strictly following the AMA Guides.

Workers' Compensation Appeals BoardRF Development & Busch CorporationLincoln General InsuranceAmerican Claims ManagementRobert LeonADJ3849676ADJ1948081ReconsiderationFindings and AwardIndustrial Injuries
References
2
Case No. ADJ9890148
Regular
Feb 02, 2017

Timothy Bedford vs. CITY OF LOS ANGELES

This Workers' Compensation Appeals Board case denies reconsideration of a permanent disability rating. The Board affirmed the use of Figure 15-19 of the AMA Guides, finding it permissible to use any chapter or method within the Guides that most accurately reflects impairment. The Agreed Medical Evaluator's opinion was deemed substantial, as he explained how Figure 15-19 was used to derive a more accurate rating based on the applicant's specific spinal condition. The decision also distinguished the current case from prior panel decisions regarding the application of the AMA Guides and work limitations.

AMA Guidespermanent disability ratingrebuttable presumptionwhole person impairmentAlmaraz/Guzman IIclinical judgmentagreed medical evaluator (AME)Figure 15-19functional losssurgical-grade disc herniations
References
7
Case No. ADJ6788177
Regular
May 13, 2015

GREGORY GREENE vs. CENTRAL PARKING SYSTEMS, SEDGWICK CMS

In this workers' compensation case, the Appeals Board denied the defendant's petition for reconsideration. The defendant challenged a $75\%$ permanent disability award, arguing the primary treating physician's rating improperly combined various lower extremity impairments, violating the AMA Guides. The Board found the WCJ's reliance on the physician's opinion was supported by substantial evidence, emphasizing the need for accurate, not mechanical, application of the Guides. A dissenting opinion argued the rating was not substantial evidence as it failed to follow proper *Almaraz-Guzman* procedures for deviating from strict AMA Guides application and advocated for remand.

Workers' Compensation Appeals BoardAmended Findings and AwardPetition for Reconsiderationindustrial injurypermanent disabilitylife pensionLabor Code section 4658 (d) increasesubstantial medical evidenceLabor Code section 4660 (b)(1)AMA Guides
References
4
Case No. ADJ285115 (STK 0203659)
Regular
May 17, 2010

ARTEMIO GONZALEZ vs. RANGEL DRYWALL, INC., STATE COMPENSATION INSURANCE FUND

The applicant sustained an admitted industrial injury to his left lower extremity, specifically a fractured ankle requiring surgery. The defendant sought reconsideration of the WCJ's award of 30% permanent disability, arguing the panel QME's reports lacked specific measurements and explanations required by the AMA Guides. The Appeals Board affirmed the WCJ's decision, finding the QME's deposition testimony, which provided detailed explanations and measurements, constituted substantial evidence. The Board clarified that while AMA Guides sections must be followed, physicians can use their clinical judgment and specific tables within the Guides as long as the basis is explained.

Workers' Compensation Appeals BoardArtemio GonzalezRangel DrywallState Compensation Insurance FundPermanent DisabilityMedical TreatmentConstruction WorkerQualified Medical ExaminerAMA GuidesPermanent Impairment
References
2
Case No. MISSING
Regular Panel Decision
Feb 22, 1989

Berrios v. 1115 Fifth Avenue Corp.

Ricardo Berrios, an employee of Opal Window Cleaning Company, suffered injuries from a four-story fall while cleaning a window. He initiated a lawsuit against the building owner, 1115 Fifth Avenue Corporation, and its managing agent, Douglas-Elliman, Gibbons & Ives, who subsequently impleaded Opal Window Cleaning Company and the apartment residents, the Heironimuses. A jury determined that Berrios was 100% responsible for his injuries due to his failure to wear a provided safety belt, which was found to be in good condition. On appeal, the core issue was whether the owner and agent were liable under Labor Law § 202 for Berrios's failure to use safety devices. The appellate court affirmed the trial court's judgment, clarifying that while Labor Law § 202 mandates owners to provide safe means, it does not extend responsibility to ensure the worker's utilization of such safety equipment.

Window Cleaning AccidentLabor Law 202Safety BeltPersonal InjuryAppellate AffirmationOwner LiabilityAgent LiabilityEmployer LiabilityThird-Party LiabilityComparative Negligence
References
3
Case No. 2018 NY Slip Op 03852 [161 AD3d 1183]
Regular Panel Decision
May 30, 2018

Munzon v. Victor at Fifth, LLC

Juan P. Munzon, a laborer, was injured during demolition work when he fell from a wooden beam after detaching his safety harness to help a coworker move a heavy metal beam. The metal beam struck the wooden beam, causing Munzon to fall from the fourth to the third floor. Munzon sued Victor at Fifth, LLC, and a general contractor/construction manager, alleging violations of Labor Law §§ 240 (1) and 241 (6). The Supreme Court, Queens County, granted summary judgment to Munzon on the Labor Law § 240 (1) claim and denied the defendants' motion to dismiss. A jury subsequently awarded Munzon damages. The Appellate Division, Second Department, affirmed the judgment, concluding that Munzon established a prima facie case under Labor Law § 240 (1) due to inadequate safety equipment, and found that the jury's awards for past and future pain and suffering and future medical expenses were reasonable and did not materially deviate from reasonable compensation.

Personal InjuryLabor Law ViolationElevated Work SiteSummary JudgmentLiabilityDamages AwardPain and SufferingMedical ExpensesAppellate ReviewConstruction Accident
References
27
Case No. ADJ1078163 (BAK 0145426), ADJ3341185 (SJO 0254688)
Significant
Feb 03, 2009

Mario Almaraz, Joyce Guzman vs. Environmental Recovery Services (a.k.a. ENVIROSERVE), State Compensation Insurance Fund, Milpitas Unified School District, Permissibly Self-Insured, Keenan & Associates, Adjusting Agent

The Appeals Board held that the AMA Guides portion of the 2005 Schedule for Rating Permanent Disabilities is rebuttable by showing that an impairment rating based on the AMA Guides would be inequitable, disproportionate, and not a fair and accurate measure of the employee’s permanent disability.

AMA Guidesrebuttable presumptionpermanent disability rating2005 Scheduleimpairment determinationmedical opinionevidentiary standardequitable awardvocational specialistsactivities of daily living
References
61
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