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Case Law Database

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. VNO 0483316
Regular
Aug 14, 2007

SILVIA MACIAS vs. JOSEPH AND NITA REBECK, STATE FARM INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration of a prior award concerning applicant Silvia Macias's lumbar spine injury. The primary issue on reconsideration was the applicant's attorney's fees, which the original judge failed to award despite representing the applicant during a portion of the proceedings. The Board affirmed the permanent disability award but deferred the attorney fees issue, remanding the case to the trial level for further proceedings and a new decision specifically addressing attorney fees.

Workers' Compensation Appeals BoardSilvia MaciasJoseph and Nita RebeckState Farm Insurance CompanyFindings and AwardPetition for ReconsiderationAttorney FeesIndustrial InjuryLumbar SpinePermanent Disability
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. ADJ3070416 (LAO 0707238) ADJ3611048 (LAO 0707239)
Regular
Mar 09, 2009

ALBERTO MACIAS vs. GUSTAFSON MANUFACTURING CORP., REVCON MOTOR COACH MFG., UNINSURED EMPLOYERS BENEFITS TRUST FUND, PACIFIC EMPLOYER INSURANCE CO. (ESIS)

The Workers' Compensation Appeals Board granted removal and rescinded a WCJ's order that declared an arbitrator's finding regarding employment dates unenforceable. The Board found a clear clerical error in the arbitrator's finding, which stated employment was from "August, 1985 through May 8, 1985," an impossibility. The Board held that a WCJ has authority to correct such a clerical error nunc pro tunc. The case was returned to the WCJ to correct this error and address the defendant's appeal from the Vocational Rehabilitation Unit's decision.

Workers' Compensation Appeals BoardGustafson Manufacturing Corp.Revcon Motor Coach Mfg.Uninsured Employers Benefits Trust FundPacific Employer Insurance Co. (ESIS)Alberto MaciasArbitrator's DecisionCumulative TraumaVocational Rehabilitation BenefitsCompromise and Release
References
4
Case No. ADJ1699994 (LAO 0748438)
Regular
Aug 24, 2011

JOSE L. MACIAS vs. J. B. HUNT TRANSPORT, INC., CHARTIS CLAIMS, INC.

Here's a summary of the case for a lawyer in four sentences: The Workers' Compensation Appeals Board denied a Petition for Removal filed by J.B. Hunt Transport, Inc. (Chartis) against Jose L. Macias. The employer sought removal, arguing the Administrative Law Judge (WCJ) violated their due process by setting the case for trial before completing discovery. The Board adopted the WCJ's report, finding removal to be an extraordinary remedy not warranted here as no substantial prejudice or irreparable harm was shown. The WCJ noted the employer's delay in pursuing discovery and failure to object to the applicant's readiness to proceed, deferring discovery rulings to the trial judge.

Workers' Compensation Appeals BoardPetition for RemovalDue ProcessDiscoveryHome Health CareStipulations with Request for AwardPermanently Totally DisabledMandatory Settlement ConferenceDeclaration of Readiness to ProceedLabor Code §5310
References
0
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. ADJ11229680
Regular
Oct 13, 2025

BEATRIZ MACIAS vs. COUNTY OF LOS ANGELES SHERIFF'S DEPARTMENT, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

Applicant Beatriz Macias (deceased) sought reconsideration of a Findings of Fact and Award (F&A) that found her 100% permanently disabled but applied credits for earnings, temporary disability, and Labor Code section 4850 benefits. The defendant argued the credit was appropriate to prevent double recovery. The Appeals Board granted reconsideration, determining that the WCJ improperly allowed credits for temporary disability indemnity, salary, or section 4850 benefits, as permanent disability compensates for physical loss and lost earning capacity, distinct from temporary disability. Consequently, the F&A was amended to permit credit solely for permanent disability paid and reasonable attorney fees, with the remainder of the F&A affirmed.

Workers' Compensation Appeals BoardDeputy SheriffMetastatic Breast CancerUlnar Nerve InjuryPermanent Total DisabilityPetition for ReconsiderationLabor Code Section 4850Temporary Total DisabilityPermanent Disability IndemnityCredit for Benefits Paid
References
7
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