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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

Claim of Faello v. Federal Express

Claimant appealed a Workers’ Compensation Board decision that deemed his application for review untimely. The claimant initially sought compensation for a work-related injury, claiming assault by a security officer. However, a Workers’ Compensation Law Judge found the incident non-compensable as it was not an assault. Claimant subsequently applied for Board review but failed to serve the self-insured employer, instead serving only its claims manager. The Board panel denied the application, citing a violation of 12 NYCRR 300.13 (a), which mandates service on all parties in interest. The appellate court affirmed the Board’s denial, concluding that service upon the employer’s representative was insufficient for the self-insured employer, who clearly held a manifest interest in the proceedings.

Timely FilingApplication for ReviewService RequirementsParties in InterestSelf-Insured EmployerAppellate ReviewBoard Panel DecisionCompensable Injury DenialAssault ClaimProcedural Due Process
References
1
Case No. ADJ3953416
Regular
Mar 07, 2013

CLENNON MOORE vs. COUNTY OF LOS ANGELES, TRISTAR

The Workers' Compensation Appeals Board denied the applicant's petition for removal, finding no significant prejudice or irreparable harm from the WCJ's order vacating a trial date. The Board also denied the defendant's petition to remove the applicant's non-attorney representative, Danny Boyd, from appearing, despite Boyd's history of abusive conduct. However, the Board issued a stern warning to Boyd that future misconduct will result in proceedings to remove his privilege to represent parties. The Board noted Boyd's potential violation of paralegal regulations and advised him to ensure compliance.

WCABPetition for RemovalHearing RepresentativeLabor Code Section 4907Cease and Desist OrderAbusive ConductNon-attorney RepresentativeSB 899Labor Code Section 5814Medical Mileage
References
3
Case No. ADJ3923265 (MON 0243587)
Regular
Jun 24, 2011

, Deirdre vs. RALPHS GROCERY STORE; Permissibly Self-Insured and Administered by SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves an applicant seeking reconsideration of a workers' compensation award. The applicant's petition focused on a discrepancy in the stipulated dates for permanent disability payments, which the original award failed to fully reflect. The defendant's petition argued for a lack of evidence regarding psychiatric disability apportionment and claimed the applicant was attempting a double recovery for prior injuries. The Appeals Board denied the defendant's petition and granted the applicant's, amending the award to accurately reflect the parties' stipulations on the commencement of permanent disability benefits.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and AwardPermanent DisabilityCumulative InjuryApportionmentPsychiatric DisabilityLife PensionStipulationsOverpayment
References
1
Case No. MISSING
Regular Panel Decision

In re the Liquidation of the Union Indemnity Insurance

The Superintendent of Insurance, as liquidator of Union Indemnity Insurance Company of New York, sought an order to compel Frank B. Hall and Co. of Connecticut, Inc. (Hall) to turn over funds held at First American Bank of New York. These funds originated from a workers' compensation insurance program between Union and the Public Employer Risk Management Association (PERMA), where Hall acted as Union's agent for premium collection and claims administration. Hall and PERMA opposed the application, arguing the program was self-insurance and Union was not entitled to the funds, with PERMA seeking a constructive trust. The court found that the segregated funds, representing unutilized premiums for claims, constituted general assets of Union and were not protected. It further determined that the PERMA-Union agreement was not a self-insurance plan, as Union bore the primary risk and the plan lacked Workers' Compensation Board approval. Consequently, the court granted the liquidator's application, directing Hall to remit the funds.

Insurance LiquidationAgency AgreementPremium FundsGeneral AssetsSelf-InsuranceConstructive TrustInsurance LawSuperintendent of InsuranceThird-Party AdministratorClaims Administration
References
2
Case No. ADJ460346 (STK 0189196) ADJ3032103 (STK 0191252)
Regular
Jun 15, 2009

THERESA MICHELLE DELGADO vs. MERCED CITY SCHOOL DISTRICT, Permissibly Self-Insured, Adjusted By CLAIMS MANAGEMENT, INC.

This case involves Applicant Theresa Delgado's petition for reconsideration of the Appeals Board's decision to allow further development of the record. The Board had previously rescinded a prior award, deeming the existing psychiatric QME reports stale due to the passage of time and Applicant's return to work. Applicant argued this violated procedural rules regarding exhibit readiness at the Mandatory Settlement Conference. The Board denied the petition, reiterating that its March 23, 2009 decision was an interim procedural order and that updated medical reports are necessary for a determination of current disability, as stale medical evidence does not constitute substantial evidence.

Workers Compensation Appeals BoardPetition for ReconsiderationOpinion and OrderFindings and AwardIndustrial InjuryPsyche InjuryPermanent DisabilityFurther Medical TreatmentMandatory Settlement ConferenceQualified Medical Examiner
References
7
Case No. MISSING
Regular Panel Decision
Sep 20, 1991

Krajas v. Chevy Pontiac Canada Group

This case involves an appeal from a Workers’ Compensation Board decision regarding a self-insured employer's responsibility for a claim. The Board exercised its continuing jurisdiction, despite the case being previously closed. A letter from the claimant’s attorney, submitted after the closing date, was deemed a valid application for compensation, alerting the employer to ongoing proceedings. The Board concluded that this application prevented the employer from being relieved of responsibility under Workers’ Compensation Law §25-a. The application was also found to be filed within the stipulated time limits. The court affirmed the Board's decision.

Workers' CompensationContinuing JurisdictionReduced Earnings AwardApplication for CompensationSelf-Insured EmployerStatutory Time LimitsBoard DecisionAppealReopened CasesClaimant Rights
References
3
Case No. ADJ9203286
Regular
Mar 23, 2018

Hugo Bucio vs. County of Merced

The Workers' Compensation Appeals Board granted reconsideration, reversing a prior decision that denied temporary total disability indemnity. The applicant, a deputy sheriff, underwent self-procured surgery for an admitted industrial back injury after the employer denied authorization. The Board held that an injured worker is entitled to temporary disability indemnity regardless of whether the treatment was employer-authorized or self-procured. The decision clarified that the utilization review process governs medical treatment disputes, not temporary disability indemnity claims arising from self-procured treatment.

BucioCounty of MercedDeputy Sheriff/Coronerbilateral sacroiliac joint fusiontemporary total disability indemnityself-procured medical treatmentutilization review (UR)denial of authorizationphysician depositionpermanent and stationary status
References
4
Case No. MISSING
Regular Panel Decision

People v. Young

An attorney representing an indigent defendant in Monroe County filed an application seeking reimbursement for legal services at a rate of $200 per hour, mirroring the rate charged by the Special Prosecutor, rather than the statutory rates under County Law § 722-b. The attorney argued that the significant disparity in hourly compensation violated the defendant's right to equal protection and that his qualifications justified the requested rate. The New York State Association of Criminal Defense Lawyers supported the application as amicus curiae, while Monroe County opposed it, arguing the request was untimely and lacked extraordinary circumstances. Presiding Judge Donald J. Mark, J., acknowledged the court's authority to grant compensation in excess of statutory limits under extraordinary circumstances but ultimately denied the application. The denial was based on the court's reasoning that an analogous argument was previously rejected, that linking assigned counsel rates to prosecutor rates would render County Law § 722-b ineffective, and that extraordinary circumstances could not be demonstrated prior to the conclusion of the criminal action. The court, however, reserved the right to reconsider an increased hourly fee upon the case's termination if such circumstances are then proven.

Assigned CounselLegal Aid CompensationCounty Law Section 722-bHourly Rate DisputeSpecial Prosecutor FeesIndigent RightsJudicial DiscretionExtraordinary CircumstancesMonroe County LawEqual Protection Challenge
References
16
Case No. ADJ14895207; ADJ162421; ADJ14895259; ADJ14894712
Regular
Feb 13, 2023

DENISE ARMTROUT vs. PLEASANTON UNIFIED SCHOOL DISTRICT, KEENAN ASSOCIATES

This case involves an applicant seeking reconsideration of a Workers' Compensation Appeals Board decision denying her petition. The applicant, Denise Armtrout, sought authorization for lymphatic massage therapy for lymphedema. Independent medical review initially denied the treatment, citing a lack of evidence for its necessity and the applicant's ability to perform self-treatment. The Board adopted the WCJ's report and denied reconsideration, upholding the prior decision to deny the petition.

Workers' Compensation Appeals BoardPetition for ReconsiderationDenying PetitionIndependent Medical Review (IMR)Lymphatic MassageLymphedemaChild Nutrition SpecialistAgreed Medical Evaluator (AME)Utilization Review (UR)Plainly Erroneous Finding of Fact
References
1
Case No. ADJ9829793
Regular
Feb 28, 2020

JOHN SILVA vs. ARS INVESTMENT HOLDINGS, LIBERTY MUTUAL INSURANCE COMPANY

This case involves multiple petitions for reconsideration following an administrative law judge's decision on applicant John Silva's workers' compensation claim. The applicant's petition was dismissed as untimely filed. The defendant's petition was denied on its merits. The lien claimant, representing the applicant's former attorneys, had its petition granted to defer the issue of attorney's fees and related liens. The original decision was otherwise affirmed.

WCABPetition for ReconsiderationPetition for ReconsiderationUntimely FilingTollingLabor CodeShipleyDue ProcessLien ClaimantAttorney's Fees
References
5
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