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

Case No. 2017 NY Slip Op 27428
Regular Panel Decision
Dec 14, 2017

New York State Workers' Compensation Bd. v. Compensation Risk Mgrs., LLC

This action was brought by the New York State Workers' Compensation Board (WCB), as an assignee of former members of the Healthcare Industry Trust of New York (HITNY), against Compensation Risk Managers, LLC (CRM), HITNY trustees, and auditing firm UHY LLP. The WCB alleged mismanagement, breach of fiduciary duty, and negligent auditing, leading to the Trust's insolvency. Defendants moved to dismiss on grounds of standing, statute of limitations, and pleading particularity. The court dismissed certain derivative claims and negligent misrepresentation claims against some trustees due to standing issues and statute of limitations. All claims against UHY LLP were dismissed for lack of a near-privity relationship or prior precedent. An implied indemnity claim against the trustees was sustained. The WCB's cross-motion to consolidate related actions was denied.

Workers' Compensation LawGroup Self-Insured Trust (GSIT)Fiduciary DutyNegligenceNegligent MisrepresentationStatute of LimitationsStandingDerivative ActionImplied IndemnityAuditing Firm Liability
References
46
Case No. CV-23-1451
Regular Panel Decision
Nov 07, 2024

In the Matter of the Claim of Domenico Amato

Domenico Amato appealed a Workers' Compensation Board decision regarding a schedule loss of use (SLU) award for bilateral arm injuries. Amato underwent surgeries for shoulder and biceps tears. Two orthopedic consultants, Frank Hudak and Lee Kupersmith, evaluated him for permanency, with differing SLU percentages. The Workers' Compensation Board rejected both opinions as unreliable, citing inconsistent range of motion measurements, and instead calculated a 20% SLU for each arm based on Kupersmith's earlier, non-permanency evaluations. The Appellate Division found the Board's rejection of the permanency evaluations permissible but ruled that the Board improperly fashioned its own SLU percentages using premature and incomplete medical reports. Consequently, the court modified the decision by reversing the 20% SLU awards and remitted the matter back to the Workers' Compensation Board for further consideration.

Workers' compensationSchedule Loss of Use (SLU)Bilateral shouldersBiceps tendon tearArthroscopic surgeryMaximum Medical Improvement (MMI)Range of Motion (ROM)Medical opinion reliabilityEvidentiary standardsRemittal
References
9
Case No. ADJ8181938; ADJ8702275
Regular
Apr 10, 2023

KAREN MILLER vs. STATE OF CALIFORNIA, VENTURA YOUTH CORRECTIONAL FACILITY, STATE COMPENSATION INSURANCE FUND, STATE CONTRACT SERVICES

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant argued against the statutory 15% increase, the method of evaluating spine impairment, and the inclusion of a sleep disorder. The Board adopted the WCJ's report, finding no error in the application of the 15% increase or the evaluation of the spine impairment using the ROM method as deemed appropriate by the agreed medical examiner. Furthermore, the Board upheld the finding of an industrially caused sleep disorder, noting that formal sleep studies are not always required for diagnosis and that the physician's rating falls within the AMA Guides.

WCABPetition for ReconsiderationDeniedVentura Youth Correctional FacilityAdjudication NumbersOccupational Group 214Cervical SpineLumbar SpineBilateral ShouldersGastrointestinal System
References
1
Case No. MISSING
Regular Panel Decision

Matter of Petrillo v. Comp USA

Claimant appealed a Workers' Compensation Board decision that found she violated Workers’ Compensation Law § 114-a and disqualified her from future wage replacement benefits. The employer's workers' compensation carrier alleged claimant failed to report employment while receiving benefits, specifically a part-time training position at a florist. Claimant initially testified she was unpaid but later admitted receiving $430, though she maintained it was for vocational evaluation, not actual employment. The Board found claimant made false representations regarding material facts and imposed permanent disqualification from wage replacement benefits. The Appellate Division affirmed the Board's determination, finding it supported by substantial evidence and the discretionary penalty warranted.

Workers' Compensation Law § 114-aFraudMisrepresentationPermanent DisqualificationWage Replacement BenefitsSubstantial EvidenceCredibility DeterminationAppellate ReviewWorkers' Compensation Board DecisionFalse Representation
References
5
Case No. 2018 NY Slip Op 08227
Regular Panel Decision
Nov 29, 2018

Matter of Kelly v. New York State Workers' Compensation Bd.

In 2006, claimant Grace Kelly established a workers' compensation claim for an occupational disease. The State Insurance Fund (SIF) repeatedly sought to transfer liability to the Special Fund for Reopened Cases, which was denied by Workers' Compensation Law Judges. The Workers' Compensation Board affirmed these denials and assessed $500 penalties against both SIF and its counsel, Walsh and Hacker, for filing an application for review without reasonable grounds. Walsh and Hacker appealed the penalty imposed against them to the Appellate Division, Third Department. The Appellate Division found insufficient evidence to support the Board's finding that Walsh and Hacker's application lacked reasonable grounds, and therefore reversed the penalty against them, modifying and affirming the Board's decision.

PenaltiesAppellate ReviewSpecial Fund for Reopened CasesWorkers' Compensation Law § 25-aWorkers' Compensation Law § 114-aAttorney SanctionsAdministrative LawBoard DecisionJudiciary Law § 431
References
4
Case No. CV-23-1298
Regular Panel Decision
May 30, 2024

In the Matter of the Claim of Michael Garofalo

Michael Garofalo, a lineman, sustained a left hand crush injury in January 2020 while working for Verizon New York, Inc. His workers' compensation claim was established. Following a permanency evaluation, his treating physician, Brian J. Harley, assessed a 35% schedule loss of use (SLU) of the left hand, using the 2012 New York State Guidelines for Determining Impairment. An independent medical examiner, Thomas R. Haher, initially concurred but later revised his opinion to 50% SLU based on the 2018 Guidelines. A Workers' Compensation Law Judge (WCLJ) adopted Harley's 35% SLU opinion, which the Workers' Compensation Board upheld. On appeal, the Appellate Division found that Harley improperly relied on the 2012 Guidelines instead of the applicable 2018 Guidelines, as the first medical evaluation occurred after January 1, 2018. The court determined that the Board's decision, relying on Harley's erroneous application of the guidelines, lacked substantial evidence. The decision was reversed, and the matter was remitted to the Workers' Compensation Board for a new determination of the appropriate SLU percentage.

Workers' CompensationSchedule Loss of UseLeft Hand InjuryMedical Guidelines2018 Impairment GuidelinesAppellate ReviewRemittalMedical Opinion ConflictTraumatic InjuryFractures
References
7
Case No. ADJ10091553
Regular
May 06, 2019

DWIGHT STILLWELL vs. WYLATTI RESOURCE MANAGEMENT, INC., STATE COMPENSATION INSURANCE FUND

In this workers' compensation case, the applicant challenged the administrative law judge's (WCJ) permanent disability rating of $76\%$. The applicant argued that the WCJ improperly combined medical impairments when an agreed medical evaluator suggested adding them for a higher rating of $88\%$. The WCJ acknowledged misinterpreting the medical evidence in their report, admitting that the agreed medical evaluator did indicate adding impairments was more appropriate. Consequently, the Workers' Compensation Appeals Board granted reconsideration to allow the WCJ to re-evaluate the permanent disability rating based on the correct understanding of the medical evidence.

Agreed Medical EvaluatorAMA GuidesPermanent Disability RatingPetition for ReconsiderationWorkers' Compensation Appeals BoardFindings and AwardCVCSchedule for Rating Permanent DisabilitiesOrthopedistIndustrial Injury
References
0
Case No. ADJ3374876 (SJO 0268303)
Regular
Feb 25, 2010

SUSAN MOYERS vs. COUNCIL ON AGING, STATE COMPENSATION INSURANCE FUND, SUBSEQUENT INJURIES BENEFITS TRUST FUND

In this case, the Subsequent Injuries Benefits Trust Fund (SIBTF) sought to compel the applicant to use the same Agreed Medical Examiner (AME) from her original workers' compensation claim for her SIBTF claim. The Workers' Compensation Appeals Board affirmed the WCJ's order allowing the applicant to obtain new medical-legal evaluations for her SIBTF claim with a different physician, independent of the original AME. The Board determined that the discovery procedures for workers' compensation claims, as outlined in Labor Code section 4062.2, do not apply to SIBTF claims due to their distinct legal issues. Therefore, SIBTF is responsible for reasonable costs of these independent evaluations, ensuring due process for developing evidence specific to the SIBTF claim.

Subsequent Injuries Benefits Trust FundSIBTFMedical-Legal DiscoveryAgreed Medical ExaminerAMEQualified Medical ExaminerQMELabor Code Section 4062.2Workers' Compensation ClaimMedical Evaluations
References
0
Case No. CV-23-1516
Regular Panel Decision
Jan 30, 2025

In the Matter of the Claim of Marnie Johnston

Marnie Johnston, a factory metal worker, sustained a work-related left shoulder injury in June 2020. After two surgeries and several medical evaluations, a Workers' Compensation Law Judge (WCLJ) initially found her injury reached maximum medical improvement (MMI) and awarded a 50% schedule loss of use (SLU) for her left arm, a decision affirmed by the Workers' Compensation Board. Johnston appealed this decision. The Appellate Division, Third Judicial Department, modified the Board's decision, ruling that it was improper to determine the SLU percentage based on medical reports not specifically conducted for permanency evaluation or without proper Range of Motion (ROM) measurements as per the 2018 guidelines. The case has been remitted to the Workers' Compensation Board for further proceedings consistent with the Appellate Division's decision.

Workers' CompensationSchedule Loss of Use (SLU)Maximum Medical Improvement (MMI)Range of Motion (ROM)Appellate DivisionMedical EvaluationOrthopedic InjuryShoulder InjurySurgical ProcedureMedical Guidelines
References
8
Case No. MISSING
Regular Panel Decision

Claim of McKenzie v. New York Jockey Injury Compensation Fund

Claimant, an exercise rider at Belmont Racetrack, suffered pelvic injuries in December 2003 while working a horse. Despite an expired license, a Workers’ Compensation Law Judge (WCLJ) established his case and determined he was a covered employee of the New York Jockey Injury Compensation Fund, holding the Fund responsible for medical treatment. The Workers’ Compensation Board upheld this decision. The Appellate Division affirmed, referencing *Matter of Adames v New York Jockey Injury Compensation Fund, Inc.* (15 AD3d 696 [2005]), which established that an exercise rider is a covered employee of the Fund under relevant Workers’ Compensation Law and Racing, Pari-Mutuel Wagering and Breeding Law provisions, irrespective of license expiration. The court found the Fund’s remaining contentions lacked merit.

Exercise RiderWorkers' CompensationJockey Injury Compensation FundExpired LicenseCovered EmployeeThoroughbred RacingPelvic InjuryAppellate DecisionBoard DecisionStatutory Interpretation
References
1
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