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

Case No. ADJ6776516
Regular
May 30, 2017

FRANCIS HARGREAVES vs. SOUTHWEST AIRLINES, ACE USA INSURANCE CO.

This case involves an applicant seeking workers' compensation benefits for injuries sustained on the job, including to his back, left shoulder, left wrist, and psyche, as well as complex regional pain syndrome, coronary artery disease, and a sleep disorder. The defendant sought reconsideration of the initial award, arguing that the medical evidence did not support the $90\%$ permanent disability finding. The Appeals Board granted reconsideration, affirming the findings of injury and treatment for Complex Regional Pain Syndrome but reducing the permanent disability to $88\%$ by excluding the sleep disorder impairment due to insufficient objective evidence. The applicant's permanent disability payments were recalculated and ordered to commence from January 21, 2011.

Workers' Compensation Appeals BoardFrancis HargreavesSouthwest AirlinesACE USA Insurance Co.Sedgwick CMSADJ6776516Opinion and Order Granting Petition for ReconsiderationFindings Award and OrderAOE/COEback injury
References
1
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The Appeals Board granted reconsideration and rescinded the prior award, finding the medical record inadequate to determine applicant's claim of Complex Regional Pain Syndrome (CRPS).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. 524271
Regular Panel Decision
Sep 06, 2018

Matter of Kemraj v. Garelick Farms

Claimant Balram Kemraj sustained a work-related injury to his left shoulder in 2005. He was initially awarded workers' compensation benefits, but his schedule loss of use was later rescinded, and the claim was amended to include complex regional pain syndrome. A Workers' Compensation Law Judge found no further causally-related disability after September 16, 2013, a decision affirmed by the Workers' Compensation Board. On appeal, the Appellate Division affirmed the Board's decision, finding substantial evidence to support it. The court relied on the opinion of neurologist Sheldon Staunton, who conducted an independent medical examination and concluded that the claimant had no objective neurological problems, was exaggerating symptoms, exhibited no signs of complex regional pain syndrome, and could return to work immediately.

Workers' Compensation BenefitsCausally-Related DisabilityIndependent Medical Examination (IME)Complex Regional Pain SyndromeSchedule Loss of UseSubstantial EvidenceAppellate ReviewMedical CredibilityShoulder InjuryReturn to Work
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. 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. 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
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. ADJ9854290
Regular
Apr 10, 2017

MARY VIEIRA vs. PASO ROBLES TANK, INCORPORATED., OLD REPUBLIC GENERAL INSURANCE CORPORATION, GALLAGHER BASSETT SERVICES

This case involves defendant's petition for reconsideration of a finding of total permanent disability due to an admitted industrial right ankle injury complicated by Complex Regional Pain Syndrome (CRPS). Defendant argues the Qualified Medical Evaluator's (QME) report lacks substantial evidence due to failure to review prior injury records and for not using DRE ratings. The Appeals Board granted reconsideration to admit a supplemental QME report that reviewed the prior injury records and did not alter the QME's opinions. The Board intends to admit this supplemental report unless good cause is shown within 15 days.

Complex Regional Pain SyndromeCRPSQualified Medical EvaluatorQMEsubstantial evidenceDRE ratingsAMA Guidessupplemental reportPetition for ReconsiderationFindings and Award
References
0
Case No. CV-23-1587
Regular Panel Decision
Feb 06, 2025

Matter of Carpenter v. Albany Dialysis Ctr.

Victoria A. Carpenter's workers' compensation claim for complex regional pain syndrome (CRPS) was established following a work injury in 2014, leading to temporary partial disability benefits. Surveillance video later revealed inconsistencies between Carpenter's reported medical condition and her actual functional abilities. A Workers' Compensation Law Judge found Carpenter violated Workers' Compensation Law § 114-a by making material misrepresentations, imposing penalties including rescission of past benefits and permanent disqualification from future wage replacement. The Workers' Compensation Board affirmed this decision, which was subsequently upheld by the Appellate Division, Third Department. The court found substantial evidence supported the Board's findings regarding Carpenter's material misrepresentations to physicians and that the penalties were proportionate.

Fraudulent ClaimMaterial MisrepresentationDisability Benefits SuspensionSurveillance EvidencePermanent DisqualificationCRPSIndependent Medical ExaminationAppellate Division ReviewJudiciary Law § 431Workers' Compensation Law § 114-a
References
9
Case No. MISSING
Regular Panel Decision

Ley v. Rochester Regional Joint Board, Local 14A

Rhonda P. Ley, Regional Director of the National Labor Relations Board, filed a petition against the Rochester Regional Joint Board, Local 14A (Union) seeking a preliminary injunction. Ley alleged that Article XXII of the collective bargaining agreement between the Union and Xerox Corporation (Employer) constituted an unlawful 'union signatory' agreement under Section 8(e) of the National Labor Relations Act. Furthermore, Ley claimed that the Union's continued attempts to enforce Article XXII violated Sections 8(b)(4)(ii)(A) and (B) of the Act. The Union argued that Article XXII was a lawful work preservation provision. The Court found reasonable cause to believe the Union was violating the Act and that a preliminary injunction was just and proper to prevent further statutory violations and maintain public interest. Consequently, the preliminary injunction was granted, enjoining the Union from enforcing Article XXII.

Labor LawPreliminary InjunctionUnfair Labor PracticeNational Labor Relations ActUnion Signatory AgreementWork PreservationCollective Bargaining AgreementSubcontractingArbitrationDistrict Court
References
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