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

Case No. MISSING
Regular Panel Decision

Claim of Eber v. Jawanio, Inc.

The claimant, who had prior work-related injuries in 2001 and 2002, filed a new workers' compensation claim in 2006 for alleged right arm, hand, and wrist injuries from a slip and fall, claiming it aggravated her existing complex regional pain syndrome (CRPS). The Workers' Compensation Board had previously denied amending the 2002 claim to include CRPS due to insufficient medical evidence. For the 2006 claim, a Workers’ Compensation Law Judge initially established it based on neurologist Walter Nieves' opinion, who diagnosed CRPS. However, the Board rescinded this decision, finding Nieves' opinion insufficient as it was based on subjective complaints rather than objective signs of CRPS. The Appellate Division affirmed the Board's determination, concluding that substantial evidence supported the rejection of Nieves' opinion and the denial of benefits.

Workers' Compensation BenefitsComplex Regional Pain Syndrome (CRPS)Causal RelationMedical Expert TestimonySubjective SymptomsObjective Medical EvidenceWorkers' Compensation Board DecisionAppellate ReviewSubstantial Evidence StandardInjury Aggravation
References
4
Case No. ADJ8731635
Regular
Apr 02, 2019

Daissy Contreras vs. CRESTWOOD BEHAVIORAL HEALTH, UNION FIRE INSURANCE COMPANY

The Appeals Board granted reconsideration and rescinded the prior award, finding the medical record inadequate to determine applicant's claim of Complex Regional Pain Syndrome (CRPS). While some physicians noted symptoms consistent with CRPS, the Agreed Medical Examiner (AME) found no objective evidence. The Board ordered the matter returned to the trial level for further development of the medical record by appointing a pain management specialist. This new evaluation will aim to diagnose the applicant's right upper extremity condition and determine its industrial causation.

Complex Regional Pain SyndromeCRPSskin injuryrashcumulative traumaAgreed Medical ExaminerAMEskin conditionright upper extremitypain management specialist
References
4
Case No. ADJ9176746, ADJ10288149
Regular
Jan 05, 2018

ANA MARIA ROCHA vs. GREEN VALLEY CHRISTIAN CENTER, CHURCH MUTUAL INSURANCE COMPANY

This case involves Ana Maria Rocha's petition for reconsideration of a Workers' Compensation Appeals Board decision. The Board denied reconsideration, adopting the Administrative Law Judge's report. The applicant's primary contentions involved a separate psychological injury, her CRPS classification, apportionment of disability, and future medical treatment for her neck and back. The Judge found no separate psychological injury, that medical opinions on CRPS classification were for physicians, that apportionment was supported by substantial evidence regarding pre-existing conditions, and that further medical treatment was not warranted for her neck and back.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeniedAdministrative Law JudgePsychological InjuryPermanent DisabilityApportionmentCRPSWhole Person ImpairmentAMA Guides
References
3
Case No. ADJ7376647 (1-ARB-130005)
Regular
Apr 25, 2016

Christopher Santi vs. Contra Costa Electric, Zurich Insurance Co.

The applicant seeks reconsideration of an arbitrator's decision concerning a July 2009 industrial injury. The applicant argues the arbitrator erred by not considering his Chronic Regional Pain Syndrome (CRPS) diagnosis, which treating and defense physicians link to $100\%$ permanent total disability. The applicant also challenges the apportionment of psychiatric disability, contending the QME's report lacks substantial evidence. The Appeals Board granted reconsideration, rescinded the original award, and returned the case for further proceedings to allow the arbitrator to review critical evidence, specifically the deposition of the applicant's treating physician, and to address the CRPS findings.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardChronic Regional Pain SyndromeApportionmentQualified Medical ExaminerDepositionsMedical EvidencePermanent DisabilityTrial Level
References
1
Case No. 2020 NY Slip Op 00657
Regular Panel Decision
Jan 30, 2020

Matter of Dibenedetto v. Rochester City Sch. Dist.

Claimant Claire Dibenedetto, who suffered a work-related left shoulder injury in 2012, sought to amend her workers' compensation claim to include consequential Complex Regional Pain Syndrome (CRPS) in her left and right upper extremities. A Workers' Compensation Law Judge initially approved the amendment and related medical treatments, but the Workers' Compensation Board subsequently modified this decision, ruling that CRPS was not established and adjusting the disability rate. The Board also resolved disputed medical bills and denied further injections against the claimant. Upon appeal, the Appellate Division reversed the Board's decisions and remitted the matter for further proceedings. The court found that the Board's determination might have been based on an incomplete review of the record, specifically failing to consider a crucial medical report from a physician at the Cleveland Clinic.

Complex Regional Pain Syndrome (CRPS)Consequential InjuryMedical Evidence ReviewDisability DeterminationAppellate RemittalIndependent Medical Examination (IME)Pain Management TreatmentClaim AmendmentBoard DiscretionCredibility Assessment
References
7
Case No. 2018 NY Slip Op 04413 [162 AD3d 1286]
Regular Panel Decision
Jun 14, 2018

Matter of Tobin v. Finger Lakes DDSO

Kristi M. Tobin, a support aide, sustained injuries in April 2012 after being assaulted by a client, leading to a workers' compensation claim established for various injuries including reflex sympathetic dystrophy (RSD)/complex regional pain syndrome (CRPS) of her right face. A Workers' Compensation Law Judge initially awarded schedule loss of use for vision loss and facial disfigurement. The Workers' Compensation Board reversed this decision, classifying claimant's RSD/CRPS and ptosis as a nonschedule permanent partial disability under Workers' Compensation Law § 15 (3) (w), rescinding the prior awards, and remitting the case for further record development regarding loss of wage-earning capacity. The Appellate Division, Third Department, affirmed the Board's determination, finding substantial medical evidence supported the nonschedulable permanent partial disability classification due to the claimant's ongoing chronic pain and worsening ptosis, consistent with not receiving both schedule loss of use and nonschedule permanent partial disability awards for the same work-related accident.

Workers' Compensation LawPermanent Partial DisabilitySchedule Loss of UseReflex Sympathetic Dystrophy (RSD)Complex Regional Pain Syndrome (CRPS)Facial DisfigurementWage-Earning CapacityAppellate ReviewMedical EvidenceSubstantial Evidence
References
9
Case No. ADJ363747 (RDG 0125429)
Regular
May 05, 2009

CAROLYN BETTIS vs. SISKIYOU DEVELOPMENT CO. INC., STATE COMPENSATION INSURANCE FUND

The WCAB granted reconsideration, rescinded the July 15, 2009 Findings and Award, and returned the matter for a new decision consistent with Dr. Horner's medical opinion which found that the applicant's CRPS was not industrially caused.

Complex Regional Pain SyndromeCRPSindustrial causationsubstantial evidencequalified medical evaluatorpermanent and stationary datetemporary disabilitywhole person impairmentmedical opinionburden of proof
References
8
Case No. ADJ12180865
Regular
Dec 01, 2022

FRANCELIA DIAZ vs. MEDTRONIC, INC., ACE AMERICAN INSURANCE COMPANY

The Appeals Board granted reconsideration and rescinded the WCJ's order for an additional pain management QME panel. The Board found the applicant did not demonstrate good cause for the panel, as the current orthopedic QME's reports sufficiently addressed the applicant's diagnoses, including CRPS. The Board substituted new findings acknowledging the applicant's AOE/COE injuries but denying the request for a pain management QME panel.

Workers' Compensation Appeals BoardMedtronicInc.Ace American Insurance CompanyAdjudication Number ADJ12180865Petition for ReconsiderationAmended Opinion on DecisionFindings of Fact and OrderInjury AOE/COEQuality Control Inspector
References
10
Case No. ADJ8029128, ADJ8029129
Regular
Nov 07, 2019

KALENA BUHMAN vs. BORDERS GROUP, LIBERTY INSURANCE

This case involves Kalena Buhman's claim for workers' compensation due to two industrial injuries resulting in psyche, CRPS, and other physical ailments. The defendant, Borders Group and Liberty Insurance, contested the finding of permanent total disability and the awarded temporary disability period. The Board affirmed the finding of permanent total disability, finding the applicant's inability to participate in vocational rehabilitation rebutted the scheduled rating. However, reconsideration was granted to defer the award of temporary disability for further determination at the trial level.

Workers' Compensation Appeals BoardKalena BuhmanBorders GroupLiberty InsuranceJoint Findings Award and OrderWCJIndustrial InjuriesPsycheComplex Regional Pain SyndromeRight Foot and Ankle
References
3
Case No. ADJ8376717
Regular
Apr 12, 2019

SOOHYUN KIM vs. VALENTINO, Permissibly Self-Insured, Administered By GALLAGHER BASSETT SERVICES, INC.

The Workers' Compensation Appeals Board (WCAB) affirmed the finding of industrial injury for Complex Regional Pain Syndrome (CRPS) but rescinded the finding of chronic pain. The WCAB also rescinded the finding of permanent and total disability, finding the medical evidence supported a scheduled disability rating between 64-81%. The vocational expert's opinion was deemed insufficient to rebut the scheduled rating or establish permanent total disability. The case was returned to the trial level for further proceedings and a new permanent disability finding based on the medical reports.

Complex Regional Pain SyndromeCRPSIndustrial InjuryPermanent and Total DisabilityReconsiderationVocational ExpertMedical EvidencePermanent Disability RatingAMA GuidesLabor Code
References
14
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