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

Case No. 534656
Regular Panel Decision
Feb 16, 2023

In the Matter of the Claim of Alberto Gomez

Claimant Alberto Gomez, who sustained work-related injuries in 2017, sought payment for medical treatment received in New Jersey from a New Jersey-licensed physician also licensed in New York. The employer's workers' compensation carrier objected to payment, arguing the physician lacked authorization from the Workers' Compensation Board. Both a Workers' Compensation Law Judge and a Board panel affirmed the carrier's position. However, the Appellate Division, Third Judicial Department, reversed these decisions. The court ruled that New York's physician authorization requirements do not apply to out-of-state physicians treating claimants in their home states, even if the physician holds a New York license. The Board's contrary interpretation was found to be irrational and unreasonable, leading to the reversal of the decisions and remittal of the matter to the Board for further proceedings.

Medical Provider AuthorizationInterstate Medical TreatmentRegulatory InterpretationJudicial Review of Administrative DecisionsClaimant ResidenceWorkers' Compensation Carrier LiabilityNew York Workers' Compensation BoardPhysician LicensingBoard Authorization
References
15
Case No. 2021 NY Slip Op 03276 [194 AD3d 607]
Regular Panel Decision
May 25, 2021

Alberto v. DiSano Demolition Co., Inc.

This case involves an appeal from a Supreme Court order concerning summary judgment motions related to Labor Law §§ 240(1), 241(6), and 200, as well as common-law negligence claims arising from a construction accident. The Appellate Division modified the lower court's order. It dismissed the Labor Law § 241(6) claim against all defendants, granted Niko's Construction's motion for summary judgment on the Labor Law § 241 (6) claim, and partially granted the Sota defendants' motion, while otherwise affirming. The court found issues of fact remaining regarding DiSano, Nick Sota, and Niko's Construction's roles as general contractors or in exercising supervisory control over the work, and Manuela Sota's liability under a dangerous condition theory. Claims against Anna Maria Oppedisano were dismissed entirely.

Labor LawSummary JudgmentAppellate DivisionConstruction SafetyGeneral Contractor LiabilitySupervisory ControlIndustrial CodeHomeowner ExemptionDangerous ConditionPersonal Injury
References
7
Case No. ADJ8059450
Regular
Aug 25, 2017

REYNA I. SANCHEZ vs. UNILEVER, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA, ALBERTO CULVER COMPANY, ACE AMERICAN INSURANCE

The WCAB granted reconsideration and rescinded the WCJ's decision to allow further proceedings. The employer's stipulation of employment for the entire cumulative trauma period was invalid as they only represented one insurer. Crucially, the date of injury must be determined under Labor Code § 5412 to establish liability under § 5500.5 for the correct employer(s). The applicant's election against Unilever was permissible under § 5500.5(c), and any future awards for jointly liable employers must be joint and several.

Workers Compensation Appeals BoardUnileverBroadspireAlberto CulverACE American InsuranceSecond Amended Findings and AwardPetition for ReconsiderationLabor Code Section 5412Date of InjuryCumulative Trauma
References
0
Case No. ADJ6954997
Regular
Oct 11, 2010

ALBERTO RODRIGUEZ vs. RUIZ FOOD PRODUCTS, ZURICH AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board denied a petition for reconsideration filed by Zurich American Insurance Company. Defendant disputed an administrative law judge's finding that Alberto Rodriguez sustained an industrial injury to his back and right lower extremity. The Board affirmed the judge's finding, crediting Rodriguez's testimony regarding the injury and his reporting of symptoms. Despite conflicting witness accounts on when and to whom the injury was reported, the Board found the weight of the evidence supported Rodriguez's claim and accorded deference to the judge's credibility determinations.

AOE/COEPetition for ReconsiderationFindings of Factindustrial injuryback injurylower extremity injuryapplicant's testimonydefendant's witnessesWCJ's determinationcredibility
References
3
Case No. ADJ8047287, ADJ8039307
Regular
Sep 12, 2022

CARLOS ALBERTO TOLEDO RODRIGUEZ vs. SILVER LAKE PETE'S AUTO, EMPLOYERS COMPENSATION INSURANCE COMPANY

This case before the Workers' Compensation Appeals Board concerns Applicant Carlos Alberto Toledo Rodriguez and Defendants Silver Lake Pete's Auto and Employers Compensation Insurance Company. The Board issued an Opinion and Order dismissing a Petition for Removal. This dismissal is due to the petitioner's withdrawal of their previously filed petition.

Petition for RemovalWithdrawn PetitionDismissal OrderWorkers' Compensation Appeals BoardAdjudication NumberLos Angeles District OfficeApplicantDefendantsCarrierAttorney
References
0
Case No. ADJ3859668
Regular
Sep 05, 2014

GUY CULVER vs. TERRY DAY, DEPT. OF SOCIAL SERVICES/IHSS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board dismissed Guy Culver's Petition for Reconsideration as untimely filed. The Board found the petition was filed more than 25 days after the original order, exceeding the statutory 20-day limit plus 5 days for mailing. Even if it had been timely, the Board would have denied it on the merits based on the administrative law judge's report. Therefore, the Petition for Reconsideration is dismissed.

Petition for ReconsiderationUntimely FilingWorkers' Compensation Appeals BoardAdministrative Law JudgeLabor Code Section 5903Code of Civil Procedure Section 1013DismissalApplicantDefendantState Compensation Insurance Fund
References
0
Case No. ADJ7899375
Regular
Apr 06, 2020

AMANDA CULVER vs. INITIATIVE FOODS, UNITED STATES FIRE INSURANCE COMPANY, CRUM AND FORSTER

This case involves Amanda Culver's claim for permanent total disability due to a 2010 industrial injury resulting in a fall down stairs. The defendant, Initiative Foods, contested the finding of 100% permanent disability, arguing the Administrative Law Judge (ALJ) improperly relied on an Independent Vocational Evaluator (IVE) and overlooked their own vocational expert. The Workers' Compensation Appeals Board affirmed the ALJ's decision, finding the IVE's report constituted substantial evidence supporting the applicant's permanent total disability. The Board found the defendant's arguments regarding the IVE's methodology and reliance on medical reports unconvincing.

Independent Vocational Evaluatorvocational rehabilitationpermanent total disabilityorthopedic injurypsychiatric injuryapportionmentAgreed Medical Examinerwork restrictionsvocational testingsubstantial evidence
References
3
Case No. ADJ7572145
Regular
Aug 09, 2012

ALBERTO CARMONA vs. MEDINA CONCRETE CONSTRUCTION, DELOS INSURANCE COMPANY, RISK ENTERPRISE MANAGEMENT LIMITED

The Workers' Compensation Appeals Board denied reconsideration of a decision that found no industrial injury occurred. The applicant, Alberto Carmona, alleged he fractured his arm in a trench but provided inconsistent accounts of the incident. The Workers' Compensation Judge found the applicant not credible based on contradictory testimony, including evidence that the injury may have occurred from a fall off a ladder inside a house. The Board adopted the Judge's report and reasoning, giving great weight to the credibility findings.

Workers' Compensation Appeals BoardReconsiderationWCJCredibilityIndustrial InjuryFractured HumerusConstruction SiteTrenchLadderMedical Reports
References
1
Case No. ADJ2886265 (SRO 0100345) ADJ578550 (SRO 0141469)
Regular
Jun 24, 2010

JOSE ALBERTO MARTINEZ vs. AMY'S KITCHEN and CIGA, adjusted by Intercare for Paula Insurance, now in liquidation

This case involves applicant Jose Alberto Martinez's petitions for reconsideration of prior WCAB decisions concerning industrial injuries to his back sustained in 1997 and cumulatively through 2002, against Amy's Kitchen and various insurers. The Appeals Board granted reconsideration to clarify apportionment of permanent disability, finding 56% permanent disability for the 1997 injury attributable to CIGA and 5% for the cumulative trauma injury against Majestic Insurance. The Board also corrected a clerical error regarding the duration of temporary disability indemnity.

CIGAPaula InsuranceIntercareliquidationproduction line workerindustrial injuryback injurynew and further disabilitypermanent disabilityapportionment
References
6
Case No. 2023 NY Slip Op 00900 [213 AD3d 1096]
Regular Panel Decision
Feb 16, 2023

Matter of Gomez v. Board of Mgrs. of Cipriani

Alberto Gomez, the claimant, sustained work-related injuries in 2017 and sought payment for medical treatment from a New Jersey-licensed physician who was also licensed in New York but not authorized by the Workers' Compensation Board. The employer and its carrier objected to the payment, and the Workers' Compensation Board affirmed the denial, ruling that the carrier was not liable. On appeal, the Appellate Division, Third Department, reversed the Board's decisions, holding that claimants injured in New York but residing in other states are entitled to treatment from qualified physicians in their home state, even without Board authorization. The court found the Board's interpretation of 12 NYCRR 323.1 to be irrational and unreasonable, remitting the matter for further proceedings.

Workers' CompensationMedical TreatmentOut-of-State PhysicianBoard AuthorizationStatutory InterpretationAppellate ReviewClaimant's RightsRegulatory InterpretationNew Jersey PhysicianNew York Licensing
References
11
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