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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

Truly v. Regan

Petitioner, employed by Brooklyn Developmental Center, sustained a lower back and left leg injury in January 1986. After a period of inactivity, she stopped working in March 1987 due to her injuries and began receiving workers' compensation benefits. In February 1988, her applications for ordinary disability retirement benefits (under Retirement and Social Security Law art 14) and article 15 disability retirement benefits (under art 15) were denied by the respondent. The ordinary disability application was denied because she was not 'in service' at the time of filing, having been terminated in May 1987. The article 15 disability application was deemed untimely, as it was filed in February 1988, beyond the three-month window from her last payroll date of March 27, 1987, and she lacked approved medical leave. The court confirmed the denial and dismissed her petition.

Disability RetirementOrdinary Disability BenefitsArticle 15 Disability BenefitsIn Service RequirementTimely FilingCPLR Article 78 ProceedingEmployment TerminationMedical LeaveNew York State Employees' Retirement SystemAlbany County
References
5
Case No. 2017-06-1778
Regular Panel Decision
Apr 11, 2018

Demotte, Julie v. UPS

Julie Demotte sustained a workplace injury involving a broken hip and leg in November 2016 while working for UPS. UPS initially accepted the claim and provided temporary disability benefits. Dr. Jason Evans, the authorized treating physician, placed Ms. Demotte at maximum medical improvement and assigned a three-percent whole-person impairment rating. A compensation hearing was held to determine Ms. Demotte's entitlement to permanent disability, temporary disability, and future medical benefits. The Court ordered UPS to provide lifetime medical benefits for Ms. Demotte's workplace injury, but denied her claims for both temporary and permanent disability benefits. The denial of permanent disability was based on the inadmissibility of Form C-30A as proof of impairment, as Ms. Demotte failed to present admissible evidence. Additionally, the claim for further temporary disability benefits was denied due to an earlier overpayment by UPS that exceeded any subsequent amounts due.

Workplace InjuryFuture Medical BenefitsTemporary Disability BenefitsPermanent Disability BenefitsAdmissibility of Medical ReportsForm C-30AForm C-32Impairment RatingHearsayMaximum Medical Improvement
References
2
Case No. MISSING
Regular Panel Decision

Smith v. Bayer Corp. Long Term Disability Plan

Plaintiff Terry Smith, a former Diabetes Sales Specialist for Bayer Corporation, filed an action under ERISA to recover long-term disability benefits, claiming wrongful denial due to psychiatric impairments including depression, panic disorder, and bi-polar disorder. The Plan administrator, Bayer, upheld the denial based on reviews by non-examining physicians. However, Smith's treating psychiatrists, Dr. LeBuffe and Dr. McCool, consistently found him disabled. The court found the Plan's reliance on non-examining doctors, who 'cherry-picked' medical records and distorted findings, to be arbitrary and capricious. Consequently, the court granted Smith's motion for benefits, denying Bayer's, and also awarded partial disability benefits, ruling that Smith's failure to seek rehabilitation approval was excused by the prior wrongful denial.

ERISALong-term disabilityDisability benefits denialPsychiatric impairmentDepressionPanic disorderBi-polar disorderAttention Deficit Disorder (ADD)Treating physician ruleArbitrary and capricious standard
References
26
Case No. MISSING
Regular Panel Decision

York v. Comm'r of Soc. Sec.

The plaintiff appealed the Commissioner of Social Security's denial of disability benefits. An Administrative Law Judge (ALJ) initially found the plaintiff not disabled, a decision affirmed by the Appeals Council. The plaintiff subsequently moved for judgment on the pleadings, requesting a remand for benefits or further administrative proceedings. The court found that the ALJ erred in evaluating the plaintiff's spinal impairments under Listing 1.04 and in assessing medical opinion evidence from Dr. Harbinder Toor. Consequently, the court granted the plaintiff's motion, denied the Commissioner's cross-motion, and remanded the case for further proceedings, including a reassessment of Listing 1.04 and reconsideration of Dr. Toor's opinion.

Disability BenefitsSocial Security ActALJ Decision ReviewRemandLumbar Spinal StenosisDegenerative Disc DiseaseMedical Opinion EvidenceResidual Functional Capacity (RFC)Vocational Expert TestimonyAppeals Council
References
7
Case No. MISSING
Regular Panel Decision

Cowley v. Berryhill

Plaintiff appeals the Commissioner of Social Security's denial of disability benefits. The District Court affirmed the Commissioner's decision, upholding the Administrative Law Judge's (ALJ) finding that the plaintiff was not disabled under the Social Security Act. The court found that the ALJ properly assessed medical opinions from a treating therapist and a consulting psychologist, giving appropriate weight and providing sufficient explanations. The ALJ's determination of the plaintiff's residual functional capacity (RFC) and the vocational expert's testimony regarding suitable alternative employment were also supported by substantial evidence. Consequently, the plaintiff's motion for judgment on the pleadings was denied, and the Commissioner's cross-motion was granted.

Disability BenefitsSocial Security ActAdministrative Law JudgeMedical Opinion AssessmentResidual Functional CapacityVocational Expert TestimonyMental Health ImpairmentsAsthmaBipolar DisorderMajor Depressive Disorder
References
13
Case No. 2016-01-0035 / 67325-2014
Regular Panel Decision
Aug 07, 2017

Findley, Jack v. Volswagen Group of America, Inc.

This case involves an employee, Jack Keith Findley, who sustained a back injury while working for Volkswagen. He sought temporary and additional permanent partial disability benefits, leading to a dispute over his impairment rating, maximum medical improvement date, and the compensability of his condition. The Court of Workers' Compensation Claims sided with Mr. Findley, awarding him the requested disability benefits and future medical care under Dr. Jolley, based on Dr. Hodges' medical opinion regarding his work-related injury and functional limitations. The court also allowed Volkswagen to offset short-term disability payments.

Workers' CompensationPermanent Partial DisabilityTemporary Partial DisabilityMedical BenefitsImpairment RatingMaximum Medical ImprovementVoluntary ResignationMedical Opinion ConflictBack InjuryLumbar Disc Herniation
References
5
Case No. MISSING
Regular Panel Decision
Jul 09, 1984

Claim of Holmes v. Cornell University

A claimant challenged Cornell University's denial of disability benefits, arguing he was not an academic employee excluded from coverage under the Disability Benefits Law. The Workers’ Compensation Board affirmed an administrative law judge's decision, ruling the claimant was not engaged in a professional capacity and thus eligible for benefits. Cornell appealed, but the court affirmed the board's decision, finding its interpretation of the statute within its area of competence was not irrational. The court noted Cornell had previously deducted disability benefit payments from the claimant's paycheck, further supporting the board's classification.

Disability Benefits LawProfessional CapacityAcademic EmployeeCoverage ExclusionWorkers' Compensation BoardStatutory InterpretationPayroll DeductionsEligibility for BenefitsAppellate Review
References
1
Case No. MISSING
Regular Panel Decision

Manney v. McCall

Petitioner, a hospital nursing station clerk, was injured while assisting an X-ray technician and sought accidental disability retirement benefits. Her application was initially denied. Following a hearing, the Hearing Officer upheld the denial, concluding that the petitioner had not demonstrated permanent incapacitation from her duties. This determination was affirmed by the respondent. The court confirmed the respondent's decision, emphasizing that the respondent has exclusive authority to evaluate competing medical opinions, and credited the Retirement System's expert who found only a mild partial disability. The court also noted that awards from Social Security or workers' compensation are not binding on the respondent.

Accidental disability retirement benefitsPermanent incapacitationMedical opinion evaluationCPLR article 78 proceedingNew York State and Local Retirement SystemWorkers' compensation benefitsSocial Security benefitsJudicial reviewAdministrative determinationEvidentiary weight
References
3
Case No. MISSING
Regular Panel Decision

Smith v. New York State & Local Retirement Systems

Petitioner, a taxpayer services representative, sustained a back injury in March 1981 while lifting forms, leading to a decline in attendance and eventual termination in November 1989. She applied for accidental and ordinary disability retirement benefits, both of which were denied by the Comptroller. The accidental disability claim was denied because the incident was not deemed an 'accident' under Retirement and Security Law § 63. The ordinary disability claim was denied as untimely, having been filed approximately six months after her termination, exceeding the 90-day limit stipulated by Retirement and Social Security Law § 62. The Supreme Court dismissed the challenge to the ordinary disability denial due to untimeliness and transferred the accidental disability challenge to this Court. This Court confirmed the Comptroller's determination on both counts, rejecting the petitioner's estoppel argument regarding the untimely ordinary disability application and finding substantial evidence to support the finding that the injury did not constitute an 'accident' within the meaning of the relevant law, as it resulted from ordinary employment duties without an unexpected event.

Disability Retirement BenefitsAccidental DisabilityOrdinary DisabilityUntimely ApplicationEstoppel Against GovernmentWork-Related InjuryBack InjuryDefinition of AccidentOrdinary Employment DutiesSubstantial Evidence Review
References
16
Case No. MISSING
Regular Panel Decision

Di Guida v. McCall

Petitioner, a food service worker, sought accidental and ordinary disability retirement benefits after being injured in a fall on milk crates while leaving work. Respondent denied the application for accidental disability benefits, finding the petitioner was not "in service" at the time of the injury, a determination upheld by the court based on substantial evidence and the resolution of a credibility issue. The denial of ordinary disability benefits was also affirmed, supported by a physician's report that found no significant neck or shoulder injury or functional disability. Consequently, the determination was confirmed, and the petition dismissed.

accidental disabilityordinary disabilityretirement benefitsfood service workerfall injuryin servicecredibilitymedical examinationfunctional disabilityCPLR article 78
References
2
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