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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

Trapani v. 10 Arial Way Associates

Cesare Trapani, an employee of P & W Electric, Inc., was injured at a construction site owned by 10 Arial Way Associates and managed by The Marcus Organization, Inc. Both property owner and manager sought defense and indemnification as additional insureds under an insurance policy issued by Assurance Company of America to P & W. A Judicial Hearing Officer initially found them to be additional insureds, a finding upheld by the Supreme Court which denied summary judgment to P & W and Assurance. On appeal, the order was reversed. The appellate court determined that the work contract did not expressly or specifically require additional insured coverage, and a certificate of insurance alone was insufficient. Consequently, the motions by P & W Electric, Inc. and Assurance Company of America were granted, the cross-motions by 10 Arial Way Associates and The Marcus Organization, Inc. were denied, and a judgment was entered declaring that the latter are not entitled to insurance coverage as additional insureds.

Additional InsuredInsurance PolicyContract InterpretationSummary JudgmentDeclaratory JudgmentConstruction Site InjuryThird-Party LiabilityCertificate of Insurance ValidityWork ContractAppellate Procedure
References
11
Case No. ADJ8550681
Regular
May 14, 2015

NANCY TOM vs. PARAMOUNT PICTURES

Applicant Nancy Tom sought reconsideration of a workers' compensation award, arguing her 9% permanent disability rating was too low. She contended for further medical evaluation regarding worsening symptoms and a claimed 40% grip loss in her right hand, plus additional impairment ratings for her thumb and knee. The Board denied reconsideration, adopting the WCJ's reasoning that Dr. Angerman's conclusory deposition testimony regarding increased impairment lacked substantial medical evidence and conflicted with AMA Guides to the Evaluation of Permanent Impairment. The Board found that Applicant failed to meet her burden of proof for a higher disability rating.

Workers' Compensation Appeals BoardParamount PicturesPermissibly Self-InsuredPetition for ReconsiderationFindings of Fact and AwardExecutive AssistantIndustrial InjuryPermanent DisabilityAgreed Medical EvaluatorOrthopedist
References
4
Case No. MISSING
Regular Panel Decision
Oct 08, 1986

Claim of Fischer v. Princess Ribbon Corp.

The Special Disability Fund appealed a Workers’ Compensation Board decision, which found the employer and its insurance carrier eligible for reimbursement under Workers’ Compensation Law § 15 (8) for death benefits paid to the claimant’s widow and minor child. The Fund argued that the employer lacked knowledge of the claimant's preexisting permanent physical impairment, a requirement for reimbursement, and also contested the necessity for an 'informed decision' by the employer. The court found substantial evidence supporting the Board’s conclusion that the employer's secretary/treasurer had knowledge and a good-faith belief in the impairment’s permanency. Additionally, the Fund contended that the Board failed to address the contribution of the preexisting impairment to the claimant's death and that the record lacked supporting evidence for such a finding. The court affirmed the Board's decision, stating that the Board had addressed the contribution issue and that substantial evidence in the record supported its conclusion.

Workers' CompensationSpecial Disability FundReimbursementPreexisting Permanent Physical ImpairmentEmployer KnowledgeWorkers' Compensation Law § 15 (8)Death BenefitsAppellate ReviewSubstantial EvidenceRetroactive Effect of Amendment
References
4
Case No. MISSING
Regular Panel Decision

Matter of Deck v. Dorr

This is a dissenting opinion concerning a Workers' Compensation Board's amended decision regarding a schedule loss of use (SLU) award. The claimant had already received a 100% SLU award for the loss of four fingers on their right hand and was granted an additional 100% SLU for their right thumb. The dissenting judge, Aarons, J., argues that there was a lack of substantial medical evidence to support the additional award for the thumb, as the claimant's surgeon did not explain how the thumb injury was separate and distinct from the injury to the other four fingers, which resulted from a single incident. The dissent highlights that the New York State Guidelines for Determining Permanent Impairment and Loss of Wage Earning Capacity specify that the loss of all fingers at proximal phalanges equates to 100% loss of use of the hand. Based on this, the dissenting judge would have reversed the portion of the amended decision granting the additional SLU for the thumb, although the final order stated the amended decision was affirmed.

schedule loss of useSLU awardright hand injurythumb amputationfinger amputationworkers' compensation boarddissenting opinionmedical evidencepermanent impairmentwage earning capacity
References
3
Case No. MISSING
Regular Panel Decision
Aug 19, 1981

Claim of Fortuna v. Pfizer, Inc.

This case involves an appeal from a Workers' Compensation Board decision concerning additional compensation for a claimant's left foot injury. The claimant received a schedule award until April 4, 1978, and subsequently additional compensation from April 4, 1978, to January 7, 1980, which was later continued. The appellant carrier sought review, claiming entitlement to a credit for alleged overpayments, arguing the claimant was employed while receiving compensation benefits. The Board found the claimant was entitled to additional compensation and the carrier was not entitled to any credit, a decision that was later amended. Appellants contended that the schedule award was not terminated within the meaning of Workers’ Compensation Law section 15 (subd 3, par [v]) due to the claimant's employment. The court affirmed the Board's decision, noting that 'disability' in a schedule award context refers to 'impairment of earning capacity,' not 'loss of earnings,' and found the Board's determination to be rational and reasonable.

Workers' CompensationSchedule AwardImpairment of Earning CapacityLoss of EarningsOverpaymentEmployment During DisabilityAppellate ReviewBoard DecisionCredit ClaimSection 15(3)(v) WCL
References
3
Case No. MISSING
Regular Panel Decision

Deshotel v. Berryhill

This case reviews an Administrative Law Judge's (ALJ) decision regarding a plaintiff's Social Security disability benefits claim. The ALJ had determined that the plaintiff suffered from severe impairments, including migraine headaches, anxiety, depression, hand numbness, and fibromyalgia, and had the residual functional capacity (RFC) to perform sedentary work. However, the Court found that the ALJ erred by assessing the impact of the plaintiff's depression and anxiety on her RFC without the benefit of medical opinion evidence, thus rendering the administrative record incomplete. Despite the Commissioner's argument that the impairments were minor, the Court emphasized that the ALJ's own finding of "severe" impairments necessitated further development of the record, including obtaining medical opinions. Consequently, the Court granted the plaintiff's motion for judgment on the pleadings, denied the Commissioner's cross-motion, reversed the Commissioner's decision, and remanded the case for additional administrative proceedings to gather the necessary medical opinion evidence concerning the plaintiff's mental limitations.

Social Security ActDisability BenefitsAdministrative Law JudgeResidual Functional CapacityMedical Opinion EvidenceMental ImpairmentsDepressionAnxietyRemandSubstantial Evidence
References
12
Case No. MISSING
Regular Panel Decision
Sep 29, 2014

Hairston v. Commissioner of Social Security

Denise M. Hairston, on behalf of her minor daughter S.N., sought judicial review of a final decision by the Commissioner of the Social Security Administration, which denied S.N.'s application for Supplemental Security Income (SSI) benefits. S.N. alleged disability due to various impairments, including migraine headaches, obesity, impulse control disorder NOS, and depressive disorder NOS, leading to functional limitations. The Administrative Law Judge (ALJ) found that S.N.'s impairments were severe but did not meet or medically equal a listed impairment, and functionally equaled only a "marked" limitation in the "caring for yourself" domain, thus denying benefits. The United States Magistrate Judge Frank Maas denied the Commissioner's motion for judgment on the pleadings, concluding that the ALJ's finding regarding S.N.'s health and physical well-being domain did not withstand scrutiny and required further fact-finding regarding the frequency and intensity of her migraines. The case was remanded to the Commissioner for further proceedings, including obtaining additional school and medical records, and ensuring the claimant's understanding and waiver of the right to counsel.

Social Security BenefitsSupplemental Security Income (SSI)Child DisabilityDepressive Disorder NOSMigraine DisorderObesityFunctional ImpairmentAdministrative Law Judge (ALJ)Judicial ReviewRemand Order
References
34
Case No. ADJ1390531
Regular
Aug 06, 2015

SARITA JANE BISSETT GARCIA vs. PEACE AND JOY CARE CENTER, ILLINOIS MIDWEST INSURANCE AGENCY

This case involves a workers' compensation appeal where the Court of Appeal remanded the matter to the Board for attorney's fees. Defense counsel informed the Board that a total of $\$11,000.00$ in attorney's fees was agreed upon, with an initial payment of $\$7,500.00$ and an additional $\$3,500.00$. The Workers' Compensation Appeals Board has issued an award for these agreed-upon appellate attorney's fees. This award is payable in addition to any compensation provided to the applicant.

Workers' Compensation Appeals BoardAttorney's FeesLabor Code § 5801Petition for Writ of ReviewCourt of AppealRemandAppellate Attorney's FeesPeace and Joy Care CenterVirginia Surety Inc.Marvin L. Mathis
References
1
Case No. ADJ6773331 ADJ7296677
Regular
Dec 11, 2015

REHAN NAZIR vs. CITY OF TORRANCE POLICE DEPARTMENT, CITY OF TORRANCE

This case involves a remand from the Court of Appeal to the Workers' Compensation Appeals Board (WCAB) for the award of attorney's fees. Applicant's counsel successfully responded to the defendant's Petition for Writ of Review, prompting the appellate court's order. The parties have stipulated to a reasonable fee of $10,000 for these appellate services. The WCAB has issued an award of this $10,000 in additional attorney's fees to the Law Offices of Lawrence R. Whiting, payable to the applicant's counsel in addition to any other compensation.

Workers' Compensation Appeals BoardRehan NazirCity of Torrance Police DepartmentADJ6773331ADJ7296677Long Beach District OfficeOpinion and AwardAdditional Attorney's FeesLabor Code § 5801Labor Code § 5811
References
1
Case No. ADJ10483516, ADJ6690853, ADJ886741 (POM 0300434)
Regular
May 02, 2018

CAROLINE JOHNSON vs. CAREMARK RX, INC.; TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Court of Appeal remanded this case to the Appeals Board to award additional attorney's fees to the applicant's attorney for services rendered in opposing the defendant's Petition for Writ of Review. The applicant's attorney sought $9,200.00 for 23 hours of work at $400.00 per hour. After reviewing the petition and considering factors like time, effort, skill, and complexity, the Appeals Board awarded the full requested amount of $9,200.00 in attorney's fees. This award is in addition to any other compensation due to the applicant.

Workers' Compensation Appeals BoardPetition for Writ of ReviewSupplemental attorney's feesLabor Code § 5801Court of Appealappellate attorney's feesapplicant's attorneyhourly ratereasonable feesremand
References
2
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