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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

O'HALLORAN v. Barnhart

The plaintiff, Kathleen O’Halloran, sought judicial review of a final determination by the Commissioner of Social Security denying her Disability Insurance Benefits. The District Court found that the Administrative Law Judge (ALJ) made several legal errors in assessing O’Halloran’s disability claim. These errors included failing to properly evaluate her mental impairments and functional limitations, not fully developing the record with "other source" evidence from treating therapists, nurses, and family, and misapplying standards regarding her residual functional capacity and ability to perform past work. The court also noted the ALJ's incorrect evaluation of the materiality of O'Halloran's alcohol abuse. Consequently, the court reversed the Commissioner's decision and remanded the case for further proceedings consistent with its order.

Social Security ActDisability Insurance BenefitsMental ImpairmentParanoid SchizophreniaAlcohol AbuseAdministrative Law JudgeResidual Functional CapacitySequential Evaluation ProcessMental Impairments EvaluationPast Relevant Work
References
12
Case No. ADJ10336191
Regular
Jan 18, 2023

JEFFERY BLUM vs. STATE OF CALIFORNIA, CALIFORNIA HIGHWAY PATROL, STATE COMPENSATION INSURANCE FUND, STATE CONTRACT SERVICES

This case involves an employer's petition for reconsideration of a workers' compensation award. The Appeals Board denied the petition, affirming the finding that the applicant sustained new and further permanent disability to his knees. The employer's arguments regarding apportionment for the lumbar spine and bias of the medical evaluator were rejected, as the lumbar spine issue was settled by prior stipulation and bias was not raised timely. The Board found the medical evaluator's opinions on knee impairment constituted substantial evidence, despite a functional capacity evaluation.

New and further disabilityPermanent disabilityApportionmentStipulations with Request for AwardQualified Medical Evaluator (QME)Lumbar spineBilateral knee impairmentSubstantial evidencePetition for ReconsiderationWorkers' Compensation Appeals Board (WCAB)
References
12
Case No. MISSING
Regular Panel Decision

Main Evaluations, Inc. v. State

The claimant, Main Medical Evaluations, entered into contracts with the New York State Office of Temporary and Disability Assistance (OTDA) to perform consultative medical evaluations. OTDA terminated these contracts, alleging the claimant failed to disclose professional disciplinary proceedings against its chief medical officer, Arvinder Sachdev, and submitted false information during the bidding process. Following the dismissal of its claim in the Court of Claims, the claimant appealed. The appellate court affirmed the lower court's judgment, concluding that OTDA had legitimate grounds for termination due to the claimant's misrepresentations and failure to report substantial contract-related issues concerning Sachdev's integral role. Additionally, the court rejected the claimant's equal protection argument, finding no evidence of selective enforcement based on impermissible considerations.

Contract TerminationProfessional MisconductFalse RepresentationEqual ProtectionGovernment ContractsAppellate ReviewBreach of ContractMedical LicensingAdministrative ProceedingsDue Diligence
References
5
Case No. ADJ10033983 ADJ11112700
Regular
Jul 08, 2019

PABLO PEREZ vs. TAYLOR FARMS, ZURICH NORTH AMERICA INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted applicant Pablo Perez's Petition for Removal, rescinding the prior finding that a Functional Capacity Evaluation (FCE) was not a reasonable and necessary medical-legal expense. The WCAB found that an FCE, recommended by Panel Qualified Medical Evaluator Dr. Ali Soozani to assess permanent impairment, provides crucial objective data not fully captured by subjective complaints or a standard physical examination. The Board reasoned that while a physical therapist conducts the FCE, this is permissible under Labor Code section 3209.5 for medical treatment and does not violate Labor Code section 4628 when viewed as a distinct diagnostic tool supporting the QME's overall evaluation. Consequently, the WCAB issued a new Finding of Fact and Order deeming the FCE reasonable and necessary.

Functional Capacity EvaluationMedical-Legal ExpensePanel Qualified Medical EvaluatorPermanent ImpairmentActivities of Daily LivingSubstantial EvidenceAlmaraz/GuzmanLabor Code Section 4628Diagnostic ToolMedical Opinion
References
4
Case No. 524528
Regular Panel Decision
May 17, 2018

Matter of Bloomingdale v. Reale Constr. Co. Inc.

Claimant, who suffered multiple work-related injuries in 1992 and 2011, appealed a Workers' Compensation Board decision classifying him with a 33% loss of wage-earning capacity and suspending awards due to a lack of labor market attachment. The Appellate Division, Third Department, affirmed the Board's determination regarding claimant's attachment to the labor market, finding it supported by substantial evidence of minimal job search efforts. However, the Court reversed the Board's assessment of a 33% loss of wage-earning capacity. It concluded that the medical evidence, extensive functional limitations, and limited vocational skills of the 55-year-old claimant did not support such a low impairment rating, necessitating a re-evaluation. The matter was remitted to the Workers' Compensation Board for further proceedings to correctly ascertain claimant's loss of wage-earning capacity.

Workers' Compensation LawPermanent Partial DisabilityLoss of Wage-Earning CapacityLabor Market AttachmentMedical ImpairmentVocational FactorsAppellate Division Third DepartmentRemittalBack InjuryNeck Injury
References
19
Case No. MISSING
Regular Panel Decision

Matejka v. Barnhart

Plaintiff, Ms. Matejka, alleging disability since March 31, 2000, applied for Disability Insurance Benefits, which was denied by an Administrative Law Judge (ALJ). The plaintiff sought review in District Court, arguing the ALJ's decision lacked sufficient inquiry into past relevant work, a reasoned finding on credibility, a proper residual functional capacity assessment, and a correct determination of the severity of her depression. The District Court found the ALJ's conclusions not supported by substantial evidence due to these deficiencies, particularly regarding the exertional requirements of past work, the evaluation of the plaintiff's credibility, the lack of a function-by-function RFC analysis, and the failure to adequately assess the severity of her depression, especially in light of uncontradicted medical opinions. Consequently, the Court reversed the Commissioner's decision and remanded the case for a new hearing consistent with its findings.

Disability Insurance BenefitsAdministrative Law JudgeResidual Functional CapacityCredibility AssessmentMedical EvidencePsychological AssessmentSpinal StenosisChronic Back PainDepressionRemand
References
24
Case No. ADJ2030253 (LAO 0885210)
Regular
Feb 07, 2014

GI KIM vs. COUNTY OF LOS ANGELES/PROBATION DEPARTMENT, Permissibly Self-Insured, Adjusted By ACCLAMATION INSURANCE MANAGEMENT SERVICES

The Workers' Compensation Appeals Board granted reconsideration and affirmed the WCJ's finding that a functional capacity evaluation was a reasonable and necessary medical-legal expense for proving new and further disability. The Board upheld the award of $997.89 for the evaluation, plus a 10% penalty and interest, as the defendant did not prevail in contesting the issue despite timely objection. However, the Board amended the decision to disallow reimbursement for the lien claimant's activation fee.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardLien ClaimantFunctional Capacity EvaluationMedical-Legal ExpenseContested ClaimNew and Further DisabilityPanel Qualified Medical EvaluatorJoint Letter
References
0
Case No. ADJ10278736
Regular
Nov 15, 2019

UFRACINA CERVANTES vs. STRATEGIC RESTAURANT COMPANY II, LLC, NEW HAMPSHIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration of a finding of $75\%$ permanent disability. The applicant argued for $100\%$ permanent disability based on vocational and medical expert opinions. The Board found the applicant failed to meet her burden of proof for total disability due to insufficient substantial medical evidence. A dissenting commissioner believed the record was undeveloped, particularly regarding a requested functional capacity evaluation and a psychiatric evaluation, and that further development was necessary for substantial justice.

WCABPetition for ReconsiderationFindings and AwardPermanent DisabilityVocational ExpertFunctional Capacity EvaluationQualified Medical EvaluatorResidual Functional CapacityPain Management SpecialistPsychologist
References
4
Case No. MISSING
Regular Panel Decision
Dec 30, 2015

Matter of Curcio v. Sherwood 370 Management LLC

The claimant, a building engineer, sustained a work-related back and neck injury, initially classified as a permanent total disability by a Workers' Compensation Law Judge (WCLJ) with awarded counsel fees. The Workers' Compensation Board (Board) modified this, finding a permanent partial disability with a 90% loss of wage-earning capacity and reduced counsel fees due to an improperly completed application. The appellate court affirmed the Board's decision, citing substantial medical evidence supporting a partial disability and a 90% loss of wage-earning capacity based on the claimant's age, education, work history, and functional abilities. The court also upheld the reduction of counsel fees due to the attorney's failure to accurately complete the required fee application form.

Permanent Partial DisabilityWage-Earning Capacity LossWorkers' Compensation BenefitsCounsel FeesMedical EvidenceVocational FactorsOC-400.1 ApplicationAdministrative AppealAppellate DivisionMedical Impairment Guidelines
References
12
Case No. MISSING
Regular Panel Decision

Johnson v. Barnhart

The plaintiff appealed the Commissioner of Social Security's denial of Supplemental Security Income (SSI) benefits, alleging disability due to various physical and mental ailments. The Administrative Law Judge (ALJ) initially denied the claim, a decision upheld by the Appeals Council. The District Court subsequently reversed the Commissioner's decision, identifying several errors in the ALJ's evaluation. Specifically, the court found fault with the ALJ's assessment of the plaintiff's claim under Listing of Impairments 12.05C, the determination of residual functional capacity, and the evaluation of the plaintiff's credibility. The case was remanded for a new hearing to address these deficiencies.

Social Security BenefitsSupplemental Security IncomeDisability ClaimAdministrative Law JudgeResidual Functional CapacityFibromyalgiaVocational Expert TestimonyCredibility AssessmentMedical-Vocational GuidelinesListing of Impairments 12.05C
References
27
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