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

Case No. ADJ605947 (MON 0274664)
Regular
Feb 02, 2009

LESLIE CELLUCCI vs. FLORENCE MACHINE PRODUCTS, STATE COMPENSATION INSURANCE FUND

This case concerns a workers' compensation claim for injuries to the applicant's hands, upper extremities, and neck, resulting in chronic pain syndrome and a sleep disorder. The defendant disputed the extent of permanent disability and the diagnoses of chronic pain syndrome and sleep disorder. The Appeals Board affirmed the finding of industrial injury and the 85% permanent disability rating, including the diagnoses of chronic pain syndrome and sleep disorder. The Board also granted reconsideration to amend the award to include a life pension for the applicant, as required by law for an 85% permanent disability finding.

Workers' Compensation Appeals BoardLeslie CellucciFlorence Machine ProductsState Compensation Insurance FundADJ605947Opinion and Order Granting ReconsiderationFindings and AwardPermanent DisabilityChronic Pain SyndromeSleep Disorder
References
0
Case No. MISSING
Regular Panel Decision
Dec 14, 2010

Francis v. Jewelry Box Corp. of America

Claimant sustained a work-related crush injury to his right hand in 1987 and was granted a lump-sum nonschedule adjustment in 1993, closing his case. He subsequently sought to reopen his claim, submitting a psychologist's report alleging total disability due to chronic major depression, posttraumatic stress disorder, and chronic pain disorder stemming from the original accident. The Workers’ Compensation Board denied his application, citing his prior waiver of the right to establish a psychiatric injury and insufficient proof of an unanticipated change in his established condition. The Appellate Division affirmed the Board's decision, concluding that the claimant failed to demonstrate an unanticipated change in his medical condition that would warrant reopening the claim, especially given his prior waiver regarding psychiatric injury.

Workers' CompensationPermanent Partial DisabilityLump-Sum SettlementReopening ClaimPsychiatric InjuryWaiver of RightsChange in ConditionWorkers' Compensation BoardAppellate DivisionAffirmed Decision
References
2
Case No. MISSING
Regular Panel Decision
Sep 04, 2013

Matter of Madigan v. ARR ELS

In 1994, the claimant sustained a low back injury during employment as a machinist, leading to workers' compensation benefits. Liability for the case was transferred to the Special Fund for Reopened Cases in 2003. Due to poor surgical outcomes, the claimant has been on pain medication, including oxycontin, since at least 2007, with doses escalating. A consultant for the Special Fund questioned the necessity of the increased medication, prompting a hearing. A Workers’ Compensation Law Judge ruled that the pain medications should continue, with the Special Fund covering the costs, until new Board guidelines or physician recommendations advised otherwise. The Workers’ Compensation Board affirmed this decision, citing that their Medical Treatment Guidelines for chronic pain were still in draft form at the time. The appellate court subsequently affirmed the Board's decision, noting that the guidelines were not yet in effect at the time of the Board's ruling and that the Board's interim guidance was rational.

Workers' CompensationPain ManagementOpioid PrescriptionsMedical Treatment GuidelinesSpecial FundReopened CasesLumbar InjuryOxycontinAppellate ReviewAdministrative Law
References
4
Case No. ADJ1088522 (RIV 0015524)
Regular
Jan 03, 2013

SAMANTHA VAN DUINHOVEN vs. SPA HOTEL & CASINO, CALIFORNIA CASUALTY, Administered by GAB ROBINS NORTH AMERICA

This case involved an applicant who claimed industrial injury to her neck, back, left shoulder, psyche, and associated chronic pain syndrome, resulting in a finding of permanent total disability. The defendant sought reconsideration, arguing the medical evidence did not support injury to the low back or a diagnosis of chronic pain syndrome. The Appeals Board reversed the findings on the low back and chronic pain syndrome, finding no substantial evidence to support them. Consequently, the applicant's permanent disability award was amended to 70%, based on ratings for her neck, left shoulder, and psyche.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPermanent Total DisabilityChronic Pain SyndromeAgreed Medical EvaluatorQualified Medical EvaluatorMedical Record ReviewIndustrial InjuryPermanent Disability Indemnity
References
0
Case No. 2024 NY Slip Op 00599 [224 AD3d 428]
Regular Panel Decision
Feb 06, 2024

Matter of New Millennium Pain & Spine Medicine, P.C. v. Garrison Prop. & Cas. Ins. Co.

This case involves two appeals by New Millennium Pain & Spine Medicine, P.C. against Garrison Property & Casualty Insurance Company and GEICO Casualty Company. New Millennium sought to vacate master arbitration awards that denied its claims for no-fault benefits for medical services. The Supreme Court denied these applications. The Appellate Division, First Department, affirmed the Supreme Court's decisions, stating that an arbitrator's award will not be set aside unless it is irrational. The court also addressed the argument regarding a 20% wage offset in no-fault benefits, finding it unavailing under Insurance Law § 5102 (b). Ultimately, New Millennium was not entitled to attorneys' fees as it was not the prevailing party.

No-fault benefitsarbitration awardvacaturinsurance lawwage offsetappellate reviewmedical servicesno-fault policy exhaustionattorneys' feesCPLR Article 75
References
8
Case No. ADJ8817939
Regular
Sep 17, 2019

MARIA MONRIAL vs. GLORIA RUBALCABA, ALLSTATE INSURANCE COMPANY, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board granted reconsideration, overturning a previous award of 91% permanent disability. The Board found that the applicant is permanently totally disabled (100%) based on vocational evidence demonstrating she cannot benefit from rehabilitation due to industrial injuries. Additionally, the Board amended the findings to include a sleep disorder and chronic pain disorder as compensable injuries stemming from the admitted industrial injury. The case is remanded for a new award of permanent disability reflecting these findings.

ADJ8817939Petition for ReconsiderationPermanent Total DisabilitySleep DisorderChronic Pain DisorderAgreed Medical ExaminerQualified Medical EvaluatorWhole Person ImpairmentVocational RehabilitationDiminished Future Earning Capacity
References
3
Case No. ADJ8782360
Regular
Jun 01, 2018

Eldridge Taylor vs. California Department of Corrections and Rehabilitation, STATE COMPENSATION INSURANCE FUND

The California Workers' Compensation Appeals Board denied a petition for reconsideration, affirming a prior award to Eldridge Taylor. The award included permanent disability for cumulative trauma injuries, sleep disorder, and hearing loss. The employer argued the sleep disorder rating was subsumed by orthopedic pain, the hearing loss lacked substantial evidence, and the WCJ failed to properly apportion non-industrial factors. The Board adopted the WCJ's report, finding sufficient medical evidence for the sleep disorder and hearing loss. The dissenting opinion argued the sleep disorder award should be rescinded as it stemmed solely from industrial pain already rated.

Workers' Compensation Appeals BoardEldridge TaylorCalifornia Department of Corrections and RehabilitationLegally UninsuredState Compensation Insurance FundADJ8782360Cumulative TraumaCorrectional OfficerParole OfficerSleep Disorder
References
1
Case No. ADJ6521264
Regular
Oct 11, 2013

ANGELA STUART-KNIGHTS vs. EMPLOYMENT DEVELOPMENT DEPARTMENT, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of an award finding the applicant sustained 66% permanent disability due to a cumulative trauma injury. The applicant argued that the Agreed Medical Examiner's (AME) report rebutted the permanent disability rating, particularly regarding her chronic pain syndrome. However, the WCAB affirmed the original award, deferring to the judge's credibility determination regarding the applicant's demeanor and testimony, which contradicted the AME's assessment of severe pain. Furthermore, the AME himself deferred to another physician on the issue of chronic pain, undermining his report's evidentiary value on that point.

WCABReconsiderationFindings of FactAwardAdministrative Law JudgeWCJCumulative TraumaPermanent DisabilityAMA GuidesAlmaraz/Guzman
References
4
Case No. MISSING
Regular Panel Decision

Law v. Barnhart

Plaintiff Sherdic Law challenged the Commissioner of Social Security’s denial of Social Security Income disability benefits, alleging disability due to various impairments including chronic leg pain, lower back pain, hepatitis C, and hyperthyroidism. The Administrative Law Judge (ALJ) denied Law's claim, finding he could perform sedentary work. U.S. District Judge Mukasey vacated the SSA's decision and remanded the case for further proceedings. The court found that the ALJ failed to adequately develop the administrative record regarding Law’s chronic leg pain, specifically omitting to obtain and review his EMG report despite objective medical evidence and Law’s testimony. This failure resulted in Law not receiving a full and fair hearing.

Social Security IncomeDisability BenefitsChronic Leg PainHerniated DiscHepatitis CHyperthyroidismHypertensionLumbar SpineAdministrative Law JudgeRemand
References
23
Case No. MISSING
Regular Panel Decision
May 05, 2000

Pain Resource Center v. Travelers Insurance

This case addresses a dispute regarding the payment of first-party no-fault benefits to a health provider, Pain Resource Center, as the assignee of John Hiotis, who was injured in an auto accident. The defendant, Travelers Ins. Co., challenged the validity of the assignment and the necessity of the medical services provided. The court affirmed the validity of the assignment under New York's Insurance Law and related regulations. However, based on conflicting expert testimonies, the court limited the compensable medical services to six hours and awarded the plaintiff $566.10, along with statutory interest and attorney's fees.

No-Fault InsuranceFirst-Party BenefitsAssignment ValidityMedical ServicesPeer ReviewInsurance LawHealth Provider ClaimAutomobile AccidentDamagesStatutory Interpretation
References
5
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