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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

Matter of Lichten v. New York City Transit Authority

Claimant, a bus driver, filed for workers' compensation benefits due to an occupational disease stemming from repetitive stress injuries to his legs, including his hips, knees, and feet, caused by his employment. The Workers’ Compensation Law Judge established the case for bilateral hips but disallowed the claim for bilateral knees. This disallowance was upheld by the Workers’ Compensation Board. Claimant appealed this decision. Medical testimony presented conflicting opinions regarding the causal relationship of claimant's knee condition to his work activities. The Board's decision to discredit the treating orthopedist's opinion was found to be supported by substantial evidence and was within its authority concerning credibility determinations. The appellate court affirmed the Board's decision.

Workers' CompensationOccupational DiseaseRepetitive Stress InjuryBilateral KneesCausal RelationshipMedical EvidenceCredibility DeterminationAppellate ReviewAffirmed DecisionBus Driver
References
6
Case No. ADJ13571625
Regular
Apr 12, 2023

MARITZA CANALES vs. EAST WEST EYE INSTITUTE, INC., NOVA CASUALTY COMPANY, TRISTAR RISK MANAGEMENT

This case concerns a petition for reconsideration by Nova Casualty Company, the insurer for East West Eye Institute, Inc., challenging a finding of joint employment. The applicant, Maritza Canales, worked as a nanny/housekeeper, receiving simultaneous payments from East West/Premier Practice Management (PPM) and an individual, Naomi Kurata. The Workers' Compensation Appeals Board (WCAB) denied the petition, adopting the judge's report which found sufficient connection to East West/PPM to establish employment based on payroll and benefits provided. The judge also found Naomi Kurata credible, rejecting arguments of witness contradiction and mischaracterization of facts regarding overtime pay.

JOINT EMPLOYMENTALTER EGOEMPLOYMENT FOLLOWS PAYROLLCORPORATE ENTITIESRESIDENTIAL EMPLOYEEHOMEOWNER'S INSURANCEWITNESS CREDIBILITYCOMPENSATION JUDGEPETITION FOR RECONSIDERATIONWORKERS' COMPENSATION APPEALS BOARD
References
9
Case No. ADJ11001608
Regular
Nov 30, 2018

MICHAEL CARMONA vs. CORNERSTONE STAFFING SOLUTIONS, INC., ZURICH LOS ANGELES

This case involves a workers' compensation claim for an eye injury. The defendant sought reconsideration of the administrative law judge's finding of injury arising out of and in the course of employment (AOE/COE) to the applicant's right eye, arguing this issue was not properly before the court. The Board denied reconsideration, finding the defendant had already accepted liability for the right eye injury. The Board also affirmed the judge's discretion to defer the issue of injury to the left eye. However, one Commissioner dissented, arguing the defendant was denied due process by the judge amending the claim to include the right eye without notice or opportunity to be heard.

WCABFindings and OrderPetition for ReconsiderationInjury AOE/COERight EyeLeft EyePanel Qualified Medical EvaluatorQMEMandatory Settlement ConferencePre-Trial Conference Statement
References
0
Case No. Axelrod I, Axelrod II, Veit
Regular Panel Decision
Feb 19, 1985

Society of the New York Hospital v. Axelrod

This case concerns the Commissioner of Health of New York State's establishment of Medicaid, Blue Cross, workers' compensation, and no-fault insurance reimbursement rates for hospitals. In response to increased labor costs for hospitals affiliated with the League of Voluntary Hospitals, SHIF (Supplemental Hospital Index Factor) benefits were introduced to provide waivers based on actual increased labor costs. Eligibility for SHIF was determined by an "affordability" factor, utilizing a current ratio analysis where a ratio of current assets to liabilities less than 1:1 indicated eligibility. The Society of The New York Hospital and The New York Eye & Ear Infirmary were denied SHIF benefits due to their current ratios, while some other hospital groups with similar financial statuses received benefits. The Supreme Court initially found a rational basis for the rates but questioned the uniform application. The Appellate Division modified the decision, finding the application of eligibility tests to Hospital and Infirmary to be arbitrary, capricious, and discriminatory, thereby violating equal protection clauses. The court granted summary judgment to Hospital and Infirmary, declaring the denial of SHIF benefits arbitrary and capricious, and remanded for an assessment of due benefits.

Reimbursement RatesMedicaidWorkers' CompensationNo-Fault InsurancePublic Health LawSHIF BenefitsAffordability FactorCurrent Ratio TestArbitrary and CapriciousEqual Protection
References
5
Case No. MISSING
Regular Panel Decision
Nov 19, 1987

SOC'Y OF NY HOSP v. Axelrod

The Court of Appeals of New York reviewed a challenge by Society of the New York Hospital and New York Eye & Ear Infirmary against the Commissioner of Health, David Axelrod, concerning the denial of Supplemental Hospital Index Factor (SHIF) waivers. These waivers would allow hospitals to be reimbursed for actual, rather than projected, labor cost increases. The Commissioner denied the applications based on an "affordability" test, deeming the hospitals sufficiently affluent. The Court found this "affordability" test to be arbitrary and capricious, exceeding the statutory mandate under Public Health Law § 2807 (3), which focused on costs related to efficient service production. The decision modified the Appellate Division's order, remitting the case to the Commissioner for reconsideration without the "affordability" factor, rather than directing an immediate award of benefits.

Hospital reimbursementLabor cost waiversAdministrative discretionPublic Health LawArbitrary and capriciousStatutory interpretationRate-settingAgency overreachHealthcare financeJudicial review of administrative action
References
6
Case No. ADJ473373 (ANA 0406381)
Regular
Feb 10, 2012

FERNANDO GUTIERREZ vs. SOCAL FRAMING aka BMHC; ACE AMERICAN INSURANCE, administered by ESIS, INC.

This case concerns applicant's claim for extended temporary disability (TD) benefits beyond 104 weeks due to a left eye injury. The Appeals Board affirmed the WCJ's denial of the "amputation" exception, ruling that the surgical removal of an eye does not fit the statutory definition. However, the Board remanded the case for further development of the record on the "high-velocity eye injury" exception, as the velocity and force of the object that struck the applicant's eye were unclear. The applicant's Petition for Removal was dismissed as reconsideration was the appropriate remedy.

Workers' Compensation Appeals BoardFernando GutierrezSoCal FramingBMHCACE American InsuranceESISInc.ADJ473373ANA 0406381Opinion and Decision
References
1
Case No. MISSING
Regular Panel Decision

Claim of Petrie v. Crucible Steel Co.

An office worker, the claimant, suffered burns when his eye shade caught fire while lighting a cigar at his desk during work hours. The employer and carrier appealed an award, contending the accident resulted from a personal act unrelated to employment. The claimant testified that an eye shade was medically advised due to a prior eye enucleation and was necessary for working under artificial light, a condition of his employment. Smoking was also permitted by the employer. The board found that the injury arose out of employment, given the instrumentality (eye shade) was required by employment conditions and smoking was allowed. The award was unanimously affirmed.

Work-related injuryBurnsEye shade accidentSmoking during workArising out of employmentCourse of employmentPersonal act defense rejectedUnanimous affirmationWorkmen's CompensationOffice worker
References
1
Case No. MISSING
Regular Panel Decision

Ganci v. Berry

The petitioner sought habeas corpus relief under 28 U.S.C. § 2254, contending he was denied a fair trial due to prosecutors withholding exculpatory evidence. He had been convicted in Suffolk County, New York, for two bank robberies. Petitioner claimed F.B.I. reports containing witness descriptions inconsistent with his appearance were wrongfully withheld, and that local prosecutors failed to disclose witness statements describing the robber's eye color as brown, despite his blue eyes. The court found that state prosecutors were not obligated to furnish F.B.I. reports they had never seen or possessed. However, it ruled that the local prosecutors should have disclosed the witness statements regarding eye color, as they were inconsistent with the petitioner's blue eyes. Despite this, the court determined there was no reasonable probability that this evidence would have changed the jury's verdict, given other strong identification evidence and corroborating factors related to the second robbery. Therefore, the petition for habeas corpus was denied.

Habeas CorpusBrady ViolationExculpatory EvidenceProsecutorial MisconductBank RobberyWitness IdentificationMateriality of EvidenceDue ProcessState Remedies ExhaustionFBI Investigation
References
12
Case No. ADJ665716
Regular
Jun 15, 2009

JUDD GLOVER vs. ACCU CONSTRUCTION, FIRST COMP OMAHA

This case concerns an applicant who sustained a high-velocity eye injury on June 8, 2006, along with injuries to his head, brain, and psyche. The Workers' Compensation Appeals Board affirmed the finding of a high-velocity eye injury and ongoing temporary total disability. However, the Board remanded the case to the trial level for further development of the record to determine if the eye injury contributes to the applicant's continuing temporary disability, which is necessary for extended benefits under Labor Code section 4656(c)(3)(F). Issues of additional temporary disability indemnity and attorney's fees were deferred pending this determination.

High-velocity eye injuryLabor Code section 4656Temporary total disabilityReconsiderationFindings & AwardCompensable consequenceNexusAmputation exceptionCruz v. Mercedes-BenzFoster v. Workers' Comp. Appeals Bd.
References
17
Case No. ADJ12582828
Regular
Jan 03, 2023

TERRY KELLY vs. SAFEWAY

This case involves a workers' compensation claim where the defendant sought reconsideration of an award finding injury AOE/COE to multiple body parts. The primary dispute centers on the applicant's occupational group number, with the applicant claiming "butcher" (420) and the defendant arguing "meat cutter" (322), impacting permanent disability ratings. The Board granted reconsideration, finding insufficient evidence to determine the occupational group number and therefore deferring permanent disability for all affected body parts pending further development of the record. The finding of injury AOE/COE to the applicant's cervical spine, thoracic spine, lumbar spine, bilateral knees, bilateral elbows, and bilateral wrists was upheld.

Occupational Group NumberMeat CutterButcherCumulative TraumaPermanent DisabilityQualified Medical EvaluatorSubstantial EvidenceFurther DevelopmentBody PartsWPI Ratings
References
11
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