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

Case No. ADJ9141002 [death claim] ADJ6796445 [inter vivos]
Regular
Jan 16, 2014

RAMON PRIETO (Deceased) vs. APACHE AUTO, INC., ZENITH INSURANCE COMPANY, MEADOWBROOK/STAR INSURANCE

The Workers' Compensation Appeals Board granted reconsideration and amended a previous award. The amendment changed the cumulative trauma period for the deceased applicant's industrial injury to his heart and neurological system from December 2007-December 2008 to November 2008-December 26, 2008. This change was made to reflect the correct insurance carrier's coverage period. The Board otherwise affirmed the original findings regarding industrial injury and death.

Workers' Compensation Appeals Boarddeath claiminter vivosindustrial injuryheart/cardiovascular systemneurologic systematrial fibrillationcumulative traumaauto wrecker salespersonZenith Insurance Company
References
0
Case No. 2021 NY Slip Op 02039
Regular Panel Decision
Apr 01, 2021

Matter of Sanchez v. Jacobi Med. Ctr.

Claimant Rurico Sanchez was injured in a work-related accident in 2008, leading to a permanent partial disability classification. Following spinal surgeries in 2014 and 2015, the Workers' Compensation Board reclassified his disability and applied various benefit periods against his 300-week durational limit. This appeal addresses the Board's subsequent reclassification decision upon remittal from a prior Appellate Division ruling. The Court found insufficient evidence for the Board's reclassification of claimant as permanently partially disabled for the period following his March 2014 surgery (September 4, 2014 to December 10, 2015) and remitted this portion. However, it affirmed the reclassification for the period following the December 2015 surgery (September 15, 2016 to November 6, 2017). The Court also reversed the Board's reclassification of claimant from temporary total disability to permanent partial disability for periods between surgeries, citing a violation of due process for lack of notice and opportunity to be heard. The matter is remitted to the Workers' Compensation Board for further proceedings consistent with the decision.

Workers' CompensationPermanent Partial DisabilityTemporary Total DisabilityDurational LimitsWage Loss BenefitsReclassificationDue ProcessMedical OpinionSpinal SurgeryAppellate Review
References
7
Case No. ADJ2115086 (SAC 0340405)
Regular
Feb 19, 2013

Barbara Sharon vs. The Kroger Company, dba Food 4 Less/Foods Co

This case concerns an applicant seeking to reopen a prior workers' compensation award for new and further disability due to bilateral knee injuries. The Board granted reconsideration, finding good cause to reopen based on new medical evidence. However, it rescinded the prior finding that the 1997 Permanent Disability Rating Schedule applied. Instead, the Board determined that the 2005 Schedule applies, as there was no qualifying pre-2005 treating physician or medical-legal report indicating permanent disability. The December 4, 2012 decision is otherwise affirmed.

ReconsiderationNew and Further DisabilityPermanent Disability Rating SchedulePDRS1997 Schedule2005 ScheduleLabor Code Section 4660(d)Agreed Medical Examiner (AME)Treating Physician ReportMedical-Legal Report
References
0
Case No. ADJ15495436
Regular
Feb 18, 2025

Calvin Grigsby vs. Grigsby and Associates, State Farm Fire and Casualty Company

The Workers' Compensation Appeals Board considered two petitions from the applicant, Calvin Grigsby: a December 9, 2024 Petition for Reconsideration and/or Removal, and a December 24, 2024 Petition for Removal. The Board dismissed the reconsideration aspect of the December 9th petition as it pertained to non-final orders and denied removal, finding no demonstration of irreparable harm. The subsequent December 24th petition was also dismissed as it challenged the same December 4, 2024 orders. The Board also noted the applicant's failure to comply with page limits for the petition.

Petition for ReconsiderationPetition for RemovalNonfinal OrdersLabor Code Section 5909Electronic Adjudication Management SystemFinal OrderInterlocutory DecisionsSubstantial PrejudiceIrreparable HarmSupplemental Pleadings
References
15
Case No. ADJ4102884
Regular
May 01, 2008

ERIC HASKINS vs. LAIDLAW EDUCATIONAL SERVICES, THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA

This case involves an applicant's petition for reconsideration that was dismissed as untimely. The applicant sought reconsideration of two prior decisions: a July 26, 2007 decision that rescinded an award and returned the case for further development, and a December 1, 2008 decision that dismissed a prior untimely petition. Both the July 2007 and December 2008 decisions were served by mail, triggering statutory time limits for filing a petition for reconsideration. The March 2, 2009 petition was filed well beyond these deadlines, rendering it untimely.

Petition for ReconsiderationUntimely FilingDismissalWCJInterim OrderFinal OrderAggrieved PartySuccessive PetitionWrit of ReviewJurisdiction
References
6
Case No. 2020 NY Slip Op 00768 [179 AD3d 1519]
Regular Panel Decision
Jan 31, 2020

Carcione v. Essex Homes of WNY, Inc.

Plaintiff Thomas Carcione sustained a work-related injury on November 4, 2008, leading to workers' compensation benefits paid by nonparty The Hartford Insurance Company, which then claimed a lien on any recovery. Carcione moved to reduce this lien, arguing that some benefits related to injuries sustained after the original incident, for which no claims were filed. The Supreme Court granted the reduction, but The Hartford Insurance Company appealed. The Appellate Division, Fourth Department, reversed the Supreme Court's order, ruling that the court lacked authority to reduce the lien beyond litigation expenses, as Hartford's payments were solely tied to the November 4, 2008, injury claim, thus upholding the insurer's full lien amount.

Workers' Compensation LienPersonal InjuryThird-Party ActionInsurance SubrogationStatutory InterpretationAppellate ReviewLien ReductionWork-Related AccidentSupreme Court ReversalNew York Law
References
5
Case No. MISSING
Regular Panel Decision
Nov 02, 2001

Claim of Medina v. Building Maintenance Service

Claimant sustained work-related injuries in July 1999. Her physician, Dr. Magdy Elamir, failed to file medical reports with the Workers' Compensation Board after August 1999 and before April 18, 2001, and with the State Insurance Fund until April 18, 2001. This led to a controversy over insurance coverage between Fireman’s Fund and State Fund. Initially, a WCLJ awarded benefits, but the Board rescinded the award for October 4, 1999, to April 18, 2001, citing prejudice to State Fund. On appeal, the court determined that State Fund was not prejudiced from October 4, 1999, to December 21, 2000, and reversed that part of the Board's decision, while affirming the denial of benefits from December 21, 2000, to April 18, 2001.

Workers' CompensationMedical Report FilingPrejudiceInsurance Coverage DisputeDenial of BenefitsAppellate ReviewAdministrative DeterminationSubstantial EvidenceRegulatory ComplianceNeurologist
References
7
Case No. 98 Civ. 8611
Regular Panel Decision
Nov 25, 2003

Flaherty v. Metromail Corp.

Plaintiff Mary Flaherty sued Metromail Corporation and Experian Marketing Solutions, Inc. for gender and age discrimination under New York State and City Human Rights Laws. Defendants moved for summary judgment, citing collateral estoppel, statutes of limitations, and a failure to raise genuine issues of material fact. The court granted defendants' motion in part and denied it in part. Claims prior to December 4, 1995, were deemed time-barred. The court denied summary judgment for claims involving alleged discrimination during Reynolds' and Cardonsky's tenure (December 4, 1995, through February 1997) due to sufficient evidence of discriminatory animus. However, summary judgment was granted for claims related to Kaiser's tenure, as plaintiff failed to provide sufficient evidence of discrimination by him.

Gender discriminationAge discriminationSummary judgmentCollateral estoppelStatute of limitationsAdverse employment actionDiscriminatory animusPrima facie caseNew York State Human Rights LawNew York City Human Rights Law
References
15
Case No. MISSING
Regular Panel Decision

King v. New York City Employees Retirement System

David King, a former New York City employee, initiated a federal action against NYCERS after his Tier 1 pension reinstatement was revoked, reducing his benefits to Tier 4. King had worked for the EPA (1971-1977, Tier 1) and TBTA (1984-2000, Tier 4). After applying in 2004, NYCERS initially confirmed his Tier 1 eligibility and paid benefits from March 2008. However, in September 2008, NYCERS declared the reinstatement an error. His state Article 78 proceeding challenging this was dismissed as untimely. The federal district court, following a remand from the Second Circuit, found that equitable estoppel applied to the statute of limitations for King's due process claim, and that NYCERS failed to provide an adequate pre-deprivation hearing. The court also sustained his breach of contract claim. The General Business Law claim was dismissed. The parties ultimately settled the action based on the state contract claim.

Pension BenefitsTier 1Tier 4Due ProcessBreach of ContractEquitable EstoppelStatute of LimitationsFederal Court JurisdictionNew York City Employees' Retirement System (NYCERS)Administrative Law
References
103
Case No. ADJ6864635
Regular
Mar 16, 2017

AUDREY KNOX vs. DEPARTMENT OF HOSPITALS/PATTON, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to correct clerical errors in the original award. Specifically, the date of injury was amended to December 4, 2008, and injury to the right shoulder and right knee were added, consistent with stipulations and evidence. The WCAB affirmed the original award's findings on permanent disability and medical treatment. However, the WCAB denied the applicant's request for a 15% increase in permanent disability, agreeing that the employer met the statutory timeframe for offering return-to-work options.

Petition for ReconsiderationFindings and AwardPermanent DisabilityLabor Code section 4658(d)(2)Permanent and StationaryAgreed Medical ExaminerClerical ErrorReport and RecommendationStipulationsDepartment of State Hospitals
References
2
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