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Case Law Database

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

Case No. MISSING
Regular Panel Decision

Lyublinsky v. Barnhart

A 73-year-old disabled plaintiff, who has received Social Security Disability (SSD) benefits since 1993, brought this action to review the Commissioner's final determination concerning his benefit rate calculation. The plaintiff argued that his benefit rate was improperly calculated, citing discrepancies in earnings records and claims of discrimination. The case has a lengthy procedural history, including multiple remands from the District Court due to issues like denial of a fair hearing and lack of legal representation. The Court conducted a de novo review of the Social Security Administration's (SSA) benefit calculations, utilizing the Average Indexed Monthly Earnings (AIME) method, and found no mathematical errors. Ultimately, the plaintiff failed to present compelling evidence to disprove the SSA's records, which are considered conclusive after a statutory period. Consequently, the Commissioner's motion for judgment on the pleadings was granted, the complaint was dismissed, and the Administrative Law Judge's (ALJ) decision was affirmed.

Social Security DisabilityBenefit CalculationAIME MethodAdministrative Law JudgePro Se PlaintiffFederal Court ReviewEarnings RecordsBurden of ProofRemandJudgment on the Pleadings
References
3
Case No. MISSING
Regular Panel Decision

Claim of Reasoner v. New York State Department of Motor Vehicles

This appellate decision addresses whether the Workers' Compensation Board correctly calculated the claimant's average weekly wage. The employer and carrier argued that due to the claimant's limited employment as an MVRSAB member, the compensation rate should be based on actual earnings, not the 200 multiple outlined in Workers’ Compensation Law § 14 (3). The Board determined that neither Workers’ Compensation Law § 14 (1) nor (2) was applicable, thus applying Workers’ Compensation Law § 14 (3). It also found no evidence that the claimant voluntarily limited participation in the labor market, based on testimony of availability and continued business operation. The court affirmed the Board's calculation.

average weekly wageworkers' compensation lawcompensation rateemployment limitationlabor marketstatutory interpretationappellate reviewMVRSAB member
References
8
Case No. ADJ3711842 (ANA 0409880)
Regular
Jun 21, 2013

SEAN GILBERT vs. OAKLAND RAIDERS, ACE USA

This case concerns disputed attorney fees in a workers' compensation claim. The applicant seeks to correct a clerical error in the award regarding the distribution of permanent disability benefits between himself and his counsel. The defendant challenges the calculation of attorney fees, arguing they should be based on the present value of the award, not its full value, and claims improper ex parte communication by a DEU rater. The Appeals Board granted reconsideration, rescinded the prior award, and returned the case for further proceedings to address these issues and ensure proper calculation and distribution of fees.

Workers' Compensation Appeals BoardReconsiderationPermanent Disability IndemnityAttorney's FeesPresent ValueEx Parte CommunicationDEU RaterCross-examinationClerical ErrorLife Pension
References
0
Case No. MISSING
Regular Panel Decision

Romero v. Albany Medical Center Hospital

The case involves an appeal from a Workers' Compensation Board decision concerning a claimant's wage expectancy calculation. The employer challenged the Board's consideration of the claimant's potential earnings as a physician, rather than a part-time nursing aide, given her age and career aspirations. The court affirmed the Board's decision, emphasizing that the rule limiting wage expectancy to similar employment does not apply in atypical situations, especially when a claimant is actively pursuing a higher-earning career path like medicine, with their current job being secondary.

Wage ExpectancyFuture EarningsWorkers' Compensation BoardAppellate ReviewCareer ProgressionAtypical EmploymentAverage Weekly WageMedical CareerPart-time WorkUnder 25 Claimant
References
3
Case No. MISSING
Regular Panel Decision

Claim of Whittaker v. Central Square Central School District

The claimant appealed the Workers’ Compensation Board's calculation of his average weekly wage following a work-related injury to his right elbow and hand. The Board used a 200 multiplier under Workers’ Compensation Law § 14 (3), which the claimant contended did not accurately reflect his annual salary as a school bus driver working 10 months a year. The court found that applying a 200 multiplier, although a minimum, was erroneous as it did not rationally correspond to the claimant's actual work days and resulted in an average weekly wage that was not fair or reasonable. Therefore, the court reversed the Board's decision and remitted the case back to the Workers’ Compensation Board for further proceedings consistent with its ruling.

Average Weekly WageWorkers' Compensation Law200 MultiplierAnnual Salary CalculationSchool Bus DriverWork-Related InjuryJudicial ReviewError in CalculationRemittal
References
1
Case No. MISSING
Regular Panel Decision
Mar 20, 2000

Claim of Hamm v. USF Red Star

A truck driver, referred to as 'claimant', was injured while crossing a street to get a meal before starting a new assignment. The Workers’ Compensation Board found the injury compensable, categorizing the claimant as an 'outside employee' entitled to expanded coverage. The employer and its insurance carrier appealed, arguing the accident occurred during a deviation from employment. The court affirmed the Board's decision, ruling that the activity was reasonable and within the course of employment. The court also dismissed an appeal concerning the calculation of benefits due to abandonment by the claimant.

Traveling EmployeePortal-to-Portal CoverageCourse of EmploymentDeviation from EmploymentCompensable InjuryAccidentTruck DriverMeal BreakOff-Duty InjuryBoard Resolution
References
7
Case No. ADJ3107039 (SAL 0114548) ADJ1050422 (SAL 0104052)
Regular
Jan 19, 2012

ESTELA LUIS vs. COMMUNITY BRIDGES, STATE COMPENSATION INSURANCE FUND

The Appeals Board denied reconsideration of an Amended Findings and Award, affirming the judge's decision. The Board rejected a request to increase the applicant's attorney's fee due to untimeliness and failure to provide required notice to the applicant. The defendant's petition for reconsideration was denied because they failed to meet their burden to rebut the DEU's use of a 4.6% COLA for calculating permanent disability and attorney fees, as it's a reasonable methodology based on a 50-year average.

Petition for ReconsiderationWorkers' Compensation Appeals BoardAmended Findings and Awardattorney's feeuntimelyWCAB Rule 10778independent counseljurisdictionCost of Living Adjustment (COLA)State Average Weekly Wage (SAWW)
References
5
Case No. ADJ7315205
Regular
Jul 08, 2010

JOSE H. HERNANDEZ vs. COVE BUILDERS, INC., STATE COMPENSATION INSURANCE FUND

This case involves a dispute over the calculation of permanent disability (PD) payments for an applicant with 100% PD. The defendant appealed an order that adjusted PD payments based on a calculation by T. Blair McGowan, arguing that McGowan's calculations incorrectly applied a 15% increase under Labor Code section 4658(d)(2) and improperly included cost of living adjustments (COLA) prior to the date of injury. The Board granted reconsideration, finding the 15% increase inapplicable to 100% PD cases. However, due to the unsettled legal status of COLA calculations following *Duncan v. WCAB*, the Board rescinded the prior order and remanded the case for further proceedings to determine the correct PD rate.

Workers' Compensation Appeals BoardReconsiderationClerical ErrorPermanent Disability RateLabor Code Section 4658(d)(2)Labor Code Section 4659(c)Cost of Living AdjustmentDate of Injury100% Permanent DisabilityPermanent Partial Disability
References
1
Case No. ADJ9824920, ADJ9834667
Regular
Jan 25, 2016

MIKE GUEVARA vs. STATE OF CALIFORNIA, WASCO STATE PRISON, STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES

This case involves a petition for reconsideration of a workers' compensation award for two knee injuries. The defendant argued the permanent partial disability for the 1996 injury was calculated incorrectly and that a credit for overpayment of temporary disability was improperly calculated. The Appeals Board granted reconsideration, amending the award to correct the indemnity calculation for the 1996 injury and a typographical error. However, the Board upheld the original credit for overpayment, deeming it a discretionary matter and acknowledging precision difficulties.

Workers' Compensation Appeals BoardPetition for ReconsiderationPermanent Partial DisabilityTemporary Total DisabilityOverpaymentCreditFindings of FactJoint AwardSpecific InjuryRight Knee
References
1
Case No. ADJ6712588
Regular
Aug 12, 2010

MARIA NAVARRO vs. STAFF CHEX, AIG INSURANCE

The Workers' Compensation Appeals Board granted reconsideration for Applicant Maria Navarro, rescinding a prior award. The Board found a potential due process violation because the Applicant claimed she was never served with the Disability Evaluation Unit's (DEU) rating. As the DEU rating was not found in the official record of proceedings, the Board returned the case for further proceedings, ordering the DEU rating be properly added to the record and served on all parties. This ensures the Applicant has an opportunity to challenge the rating and exercise her due process rights.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardPermanent DisabilityDue ProcessNoticeCross-examinationDisability Evaluation UnitDEUProof of Service
References
5
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