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

Case No. 2021 NY Slip Op 07401
Regular Panel Decision
Dec 23, 2021

Matter of Carola B.-M. v. New York State Off. of Temporary & Disability Assistance

Petitioners Carola B.-M. and Tiara M. challenged the denial of their supplemental nutrition assistance program (SNAP) benefits by the New York State Office of Temporary and Disability Assistance and the Orleans County Department of Social Services. The benefits were denied because they were deemed ineligible college students. The Appellate Division, Fourth Department, reversed this determination, holding that participation in the Adult Career and Continuing Education Services, Vocational Rehabilitation program (ACCES-VR) qualifies as a Job Training Partnership Act (JTPA) program. This status exempts the students from certain SNAP eligibility requirements. The court found that the original determination was based on an unreasonable interpretation of relevant regulations, annulled the decision, granted the petition, and remitted the case for a calculation of retroactive benefits.

SNAP benefitscollege student eligibilityJob Training Partnership ActACCES-VRvocational rehabilitationCPLR article 78regulatory interpretationpublic assistancefood stampsAppellate Division
References
28
Case No. MISSING
Regular Panel Decision

Claim of Bruzzese v. Guardsman Elevator Co.

In 1994, the claimant sustained head, neck, and back injuries at work, leading to an award for permanent partial disability, which included a wage expectancy adjustment under Workers’ Compensation Law § 14 (5). Following back surgery in 1998, the case was reopened, and the claimant was found to be temporarily totally disabled. Benefits for this temporary total disability were calculated based on the claimant's average weekly wage at the time of injury, without applying the wage expectancy adjustment. The claimant appealed, arguing that since the permanent partial disability preceded the temporary total disability, the wage expectancy adjustment should also apply to the latter period. The court disagreed, affirming the Workers’ Compensation Board's decision, citing established case law that Workers’ Compensation Law § 14 (5) is applicable only to awards for permanent partial disability and not temporary disability.

Wage expectancyTemporary total disabilityPermanent partial disabilityWorkers' Compensation benefitsBack injuryAppellate reviewDisability calculationWorkers' Compensation BoardAverage weekly wage
References
1
Case No. MON 0325729 MON 0325730
Regular
Jun 02, 2008

JORGE CORONA vs. LOS ANGELES UNIFIED SCHOOL DISTRICT, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board granted reconsideration of a prior award of temporary disability benefits. Defendant argued that Labor Code section 4656 prohibited the award, as more than two years had passed since temporary disability commenced. The Board found the record insufficient to determine when temporary disability payments actually began, rescinded the award, and returned the case for further proceedings to establish the commencement date of indemnity payments.

ReconsiderationTemporary DisabilityLabor Code section 4656Findings and AwardStipulated AwardNew and Further DisabilityCompensable WeeksDate of Commencement of Temporary Disability PaymentHawkins v. Amberwood ProductsBenefit Printout
References
1
Case No. SAC 349462
Regular
Mar 11, 2008

QAHER MOKDADI vs. HENDRICK AUTOMOTIVE, FEDERAL INSURANCE COMPANY

In this workers' compensation case, the Appeals Board clarified the commencement date for temporary disability payments under Labor Code section 4656(c)(1). Applying its en banc decision in *Hawkins v. Amberwood Products*, the Board held that the two-year period for temporary disability payments begins on the date indemnity is *first paid* to the worker, not when it is first owed or when unemployment benefits are reimbursed. Therefore, the commencement date was established as November 9, 2006, the date the applicant received his first temporary disability indemnity check.

Workers' Compensation Appeals BoardHendrick AutomotiveFederal Insurance CompanyQAHER MOKDADIauto service technicianleft shoulder and spine injuryEmployment Development Department (EDD)temporary disability indemnityLabor Code section 4656(c)(1)date of commencement
References
2
Case No. 5674395Z
Regular Panel Decision
Dec 01, 2011

Baines v. Berlin

Mashon Baines, a homeless and disabled mother of three, initiated a CPLR article 78 proceeding to challenge the New York State Office of Temporary and Disability Assistance's August 31, 2011 decision to discontinue her temporary housing assistance. This decision stemmed from an alleged altercation with a shelter director, Marilyn Gonzalez, during a fire drill, leading to Baines's arrest. Baines argued that her due process rights were violated because the discontinuance notice cited only the assault on Ms. Gonzalez, while the administrative decision was based on multiple uncharged wrongdoings and failed to adequately consider video evidence. The court found that respondents failed to adequately apprise Baines of all charges, thereby violating her due process rights, and consequently annulled the August 31, 2011 fair hearing decision. The court also granted Baines's request for attorneys' fees, costs, and disbursements.

Due ProcessAdministrative HearingHomeless AssistanceShelter BenefitsDiscontinuance of BenefitsNotice RequirementsCPLR Article 78Judicial ReviewAttorneys' FeesSelf-Incrimination
References
8
Case No. ADJ814222 (MON 0256079) ADJ855629 (MON 0236639) ADJ302781 (MON 0236638)
Regular
Jun 23, 2010

JEROME KELLMAN vs. CROSSROADS SCHOOL, XCHANGING/ CIGA for FREMONT COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board denied reconsideration of an order finding CIGA solely liable for temporary disability benefits for the period of July 25, 2007, to December 18, 2008. The Board adopted the WCJ's reasoning that there was no jurisdiction to order State Compensation Insurance Fund (State Fund) to pay these benefits, as the need for temporary disability did not commence within five years of State Fund's insured injuries. The Board also admonished the applicant for submitting unadmitted evidence and CIGA for attaching documents in violation of WCAB rules. The WCJ found CIGA solely responsible, rejecting arguments that State Fund was jointly liable or that the temporary disability should have commenced earlier.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCAB Rule 10842Administrative Law JudgeTemporary DisabilityPetition to ReopenNew and Further DisabilityState Compensation Insurance FundCalifornia Insurance Guarantee AssociationFremont Compensation Insurance Company
References
1
Case No. ADJ4254212 (SAC 0369491) ADJ3966016 (SAC 0369493)
Regular
Jul 19, 2010

Salem Najjar vs. MEEKS BUILDING CENTER, ZURICH AMERICAN INSURANCE COMPANY

The Appeals Board granted reconsideration, finding that a payment for attending a medical-legal examination under Labor Code section 4600(e)(1) does not trigger the 104-week limit on temporary disability indemnity under Labor Code section 4656(c)(1). The Board clarified that such payments are for wage loss reimbursement, not a commencement of actual temporary disability, distinguishing it from prior cases where other benefit types functionally served as temporary disability. The case was remanded to determine the actual date temporary disability payments began to establish the correct duration of benefits. Applicant's claim for temporary disability from March 17, 2009, and continuing will be re-evaluated.

Labor Code section 4656(c)(1)temporary disability indemnity104 week limitationmedical examinationQualified Medical Evaluation (QME)wage lossreconsiderationWCJLabor Code section 4600(e)(1)aggregate disability payments
References
5
Case No. ADJ4092048 (SAC 0315575)
Regular
Feb 03, 2012

CLINTON BAKER vs. TRAYLOR BROTHERS; ST. PAUL FIRE and MARINE UNSURANCE

This case concerns a dispute over temporary disability benefits awarded to applicant Clinton Baker. The Appeals Board granted reconsideration of a prior award finding total temporary disability from May 21, 2007, to the present. The Board determined that while jurisdiction exists to award temporary disability beyond five years post-injury if disability began within that period and a timely petition to reopen was filed, the prior award was rescinded. The matter is returned to the WCJ for further proceedings to clarify the correct commencement date of temporary disability, which applicant argues should be March 19, 2007, a date within the statutory five-year window.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardTemporary Total DisabilityPetition to ReopenFive-Year PeriodJurisdictionIndustrial InjurySpineRight Shoulder
References
3
Case No. ADJ3138312 (WCK 0059967)
Regular
Jul 05, 2011

GREGORY McBEE vs. AMERICAN DESIGN ROOFING, CIGA, LEGION INSURANCE COMPANY

The Appeals Board rescinded a prior award of temporary disability benefits because the applicant's period of temporary disability commenced more than five years after his date of injury. The Board found that Labor Code section 5410, which allows for claims of new and further disability within five years of injury, did not apply here. Jurisdiction to award temporary disability beyond five years is limited to continuous disability that began within that timeframe, which was not established. The case was returned for further proceedings on the issue of permanent disability.

Petition to reopennew and further disabilitytemporary disability indemnityjurisdictionfive-year limitationdate of injurystipulated awardAgreed Medical Evaluatorwrit deniedsubstantial medical evidence
References
4
Case No. SDO 0328208
Regular
Mar 17, 2008

ARMANDO ADAME vs. AUTOMOTIVE ENGINEERED PRODUCTS, INC. (dba JBA HEADERS), ZENITH INSURANCE COMPANY

The Appeals Board clarified that for Labor Code section 4656(c)(1) purposes, the commencement of temporary disability payments is the date the employer first mails a temporary disability indemnity check, not when EDD benefits begin. Furthermore, EDD benefits, even if reimbursed by the employer, do not count towards the 104-week cap on temporary disability payments. Consequently, the employer's liability for further temporary disability payments extends from the date of the first actual indemnity payment until October 6, 2007.

Workers Compensation Appeals BoardArmando AdameAutomotive Engineered ProductsZenith Insurance CompanyLabor Code section 4656(c)(1)Temporary Total DisabilityTemporary Disability IndemnityEmployment Development DepartmentUnemployment Compensation DisabilityHawkins v. Amberwood Products
References
2
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