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Case Law Database

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

Case No. 526688
Regular Panel Decision
Dec 27, 2018

Matter of Bufearon v. City of Rochester Bur. of Empl. Relations

Claimant Kamren Bufearon sustained work-related injuries in a motor vehicle collision on March 4, 2016, for which his workers' compensation claim was established for injuries to his left shoulder, left hip, and lower back. Subsequently, he sought to amend his claim to include a causally-related cervical spine injury, which was initially approved by a Workers' Compensation Law Judge. However, the Workers' Compensation Board reversed this decision, finding that the claimant failed to sufficiently demonstrate a causal relationship between his cervical spine condition and the March 4, 2016 incident. The Appellate Division affirmed the Board's decision, noting that the medical testimony from two physicians contained conflicting findings and equivocal narratives regarding causation. The court concluded that the Board was entitled to reject the physicians' opinions as speculative, particularly since neither physician had reviewed the claimant's prior medical records for a pre-existing cervical spine fusion surgery.

Cervical spine injuryCausal relationshipMedical evidenceSubstantial evidence reviewAppellate DivisionWorkers' Compensation BoardPre-existing conditionCredibility of physiciansBurden of proofMotor vehicle accident
References
13
Case No. SAL 0107786
Regular
Oct 16, 2007

MOLLY KIRKPATRICK vs. DOMINICAN SANTA CRUZ HOSPITAL, PSI ADMINISTERED BY OCTAGON RISK SERVICES

This case concerns an injured worker who had cervical spine surgery involving diskectomy, vertebrectomy, decompression, and fusion. The defendant sought reconsideration of an award granting temporary disability benefits beyond the statutory 104-week limit, arguing the surgery was not an amputation. The Appeals Board rescinded the prior award and returned the matter for further proceedings, as the definition of "amputation" in precedent excludes internal body parts like those removed during spinal fusion.

Workers' Compensation Appeals BoardDominican Santa Cruz HospitalOctagon Risk ServicesMolly KirkpatrickIndustrial InjuryCervical Spine SurgeryTemporary Disability IndemnityLabor Code Section 4656(c)AmputationDiskectomy
References
1
Case No. ADJ1438639 (GRO 0024593) ADJ3262777 (GRO 0025366)
Regular
Sep 20, 2011

Dennis Timmons vs. CALIFORNIA MENS COLONY, STATE COMP. INS. FUND, SUBSEQUENT INJURIES BENEFITS TRUST FUND

This case concerns applicant Dennis Timmons' petition for reconsideration of a denial of Subsequent Injuries Benefits Trust Fund (SIBTF) benefits. The Appeals Board reversed a prior award, finding applicant failed to prove a pre-existing permanent partial disability from a 1991 cervical fusion surgery prior to his 2000 industrial injury. Applicant argued the fusion itself constituted a previous impairment and that SB 899's apportionment changes should apply, but the Board affirmed its decision. The Board reiterated that contemporaneous medical evidence is required for SIBTF eligibility, and that SB 899 did not alter SIBTF's established requirements.

Subsequent Injuries Benefits Trust FundSIBTFpermanent disabilitypre-existing disabilitycervical fusionApril 132000 industrial injurySB 899apportionment to causationLabor Code section 4751
References
2
Case No. ADJ10443530
Regular
Apr 10, 2017

ARMANDO MATA vs. SUPERMERCADO MI TIERRA, LLC, CALIFORNIA INSURANCE COMPANY, APPLIED RISK SERVICES

The Workers' Compensation Appeals Board denied the employer's Petition for Removal but granted reconsideration for the limited purpose of deferring the issue of unreasonable delay in providing medical treatment. The Board affirmed the finding that the applicant is in need of cervical fusion surgery approved by utilization review. However, the Board ruled that the employer did not timely dispute the UR approval and therefore cannot defer payment, but the issue of unreasonable delay under Labor Code section 5814 was not properly before the Administrative Law Judge.

Workers' Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationFindings of FactUtilization Review (UR)Panel Qualified Medical Evaluator (QME)Cervical Fusion SurgeryIndustrial InjuryCausationUnreasonable Delay
References
3
Case No. MISSING
Regular Panel Decision

Schlesinger v. New York City Employees' Retirement System

Petitioner Michael Schlesinger, a former correction officer, challenged the denial of his accident disability retirement pension by the New York City Employees’ Retirement System Board of Trustees through a CPLR article 78 proceeding. Schlesinger sustained a neck injury in 2002, leading to a two-level cervical fusion. Although the Medical Board found him disabled, it repeatedly denied causation between the injury and the 2002 incident. The Board of Trustees adopted the Medical Board's recommendation without an independent evaluation of causation, which the court found to be an arbitrary and capricious abdication of its responsibility. Consequently, the court annulled the Board of Trustees' determination and remanded the matter for an independent evaluation of causation.

accident disability retirementpension denialcorrection officer injurycausationadministrative reviewCPLR Article 78 proceedingBoard of TrusteesMedical Boardarbitrary and capriciousremand
References
5
Case No. 535144
Regular Panel Decision
Nov 17, 2022

In the Matter of the Claim of Hope Jennings

Hope J. Jennings, a supermarket clerk, sustained a work-related shoulder injury in 2007, leading to established workers' compensation benefits. She was classified with a nonschedule permanent partial disability in 2012, subject to a durational cap for wage loss benefits, which expired in November 2018. Following a causally-related cervical fusion surgery in July 2019, claimant sought temporary total disability benefits, arguing these should not count towards the permanent partial disability cap. The Workers' Compensation Board, on full Board review, rescinded an earlier decision and ruled that the expiration of the durational cap did not preclude claimant from seeking temporary total disability benefits after subsequent surgeries. The Appellate Division affirmed the Board's decision, clarifying that temporary total disability benefits under Workers' Compensation Law § 15 (2) are distinct from permanent partial disability benefits under § 15 (3) (w) and are not subject to the latter's durational caps.

Workers' CompensationTemporary Total DisabilityPermanent Partial DisabilityDurational CapWage Loss BenefitsCervical Fusion SurgeryShoulder InjuryAppellate ReviewStatutory InterpretationWorkers' Compensation Law § 15
References
4
Case No. 2022 NY Slip Op 06531
Regular Panel Decision
Nov 17, 2022

Matter of Jennings v. Stop & Shop

Claimant, Hope J. Jennings, a supermarket clerk, suffered a work-related shoulder injury in 2007, leading to a classification of nonschedule permanent partial disability with a 50% loss of wage-earning capacity in 2012, subject to a 300-week durational cap for benefits. Following further causally-related surgeries in 2017 (shoulder) and 2019 (cervical fusion), claimant sought temporary total disability benefits after the durational cap on her permanent partial disability benefits had expired. The Workers' Compensation Board (WCB) ultimately ruled that the expiration of the durational cap on permanent partial disability benefits does not preclude a claimant from seeking temporary total disability benefits following a causally-related surgery. The Appellate Division, Third Department, affirmed the Board's decision, emphasizing that Workers' Compensation Law § 15 (2) (temporary total disability) and § 15 (3) (w) (permanent partial disability) operate under distinct statutory provisions, and the durational cap applies only to benefits payable under the latter paragraph.

Workers' Compensation Law § 15Temporary Total DisabilityPermanent Partial DisabilityDurational CapWage Loss BenefitsCervical Fusion SurgeryShoulder InjuryReclassification of DisabilityStatutory InterpretationAppellate Review
References
4
Case No. ADJ7924562
Regular
Sep 19, 2014

RAUL HERNANDEZ vs. LOS ANGELES UNIFIED SCHOOL DISTRICT

The applicant sought reconsideration of a WCJ decision that found an industrial injury to the low back but not the cervical spine or left ankle, with no permanent disability or further medical treatment. The applicant argued the QME's reports were insubstantial and that prior permanent disability was not considered. The Appeals Board granted reconsideration to amend the original award to include injury to the cervical spine, affirming the remainder of the decision. Therefore, the applicant sustained injury to his low back and cervical spine.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryLow Back InjuryCervical Spine InjuryPermanent DisabilityFurther Medical TreatmentPanel Qualified Medical EvaluatorLabor Code Section 4664(b)
References
0
Case No. MISSING
Regular Panel Decision

Claim of Pulos v. Asplundh Tree

Claimant, a tree trimmer, had an existing claim for bilateral carpal tunnel syndrome and later sought to include a cervical spine condition as an occupational disease. A workers' compensation law judge initially disallowed this amendment, but the Workers' Compensation Board reversed, finding the cervical condition was dormant and non-disabling, and that the claimant's work activities aggravated it. The employer appealed this decision. The court affirmed the Board's ruling, concluding there was substantial evidence to support the finding that the claimant's preexisting cervical condition was activated by the distinctive features of his employment.

Occupational DiseaseCervical Spine InjuryCarpal Tunnel SyndromePreexisting ConditionAggravation of InjuryWorkers' Compensation LawJudicial ReviewAppellate DecisionTree TrimmingWork Activities
References
3
Case No. ADJ1337074 (GRO 0034564) ADJ1286218 (GRO 0034565)
Regular
Jun 24, 2009

Dave Gerletti vs. SANTA MARIA AIRPORT DISTRICT, GREGORY BRAGG STOCKTON

The Workers' Compensation Appeals Board denied Dave Gerletti's petition for reconsideration of an award for a cumulative trauma injury to his cervical spine and lungs. The original award found 35% permanent disability, apportioning 50% of the cervical spine disability to non-industrial factors based on a Qualified Medical Evaluator's opinion of degenerative changes. The majority affirmed the WCJ's reliance on this opinion, finding it adequately explained. A dissenting opinion argued the QME's apportionment was speculative and improperly based on age and genetics, recommending an unapportioned award for the cervical spine injury.

Workers' Compensation Appeals Boardcumulative traumacervical spinelungspermanent disabilityapportionmentQualified Medical EvaluatorAgreed Medical Examinerarthritic degenerationnon-industrial factors
References
1
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