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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

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

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. 01-13-00469-CV
Regular Panel Decision
Mar 06, 2014

Texas Department of Aging and Disability Services v. Esther Iredia

The Texas Department of Aging and Disability Services (DADS) appealed the denial of its plea to the jurisdiction concerning employment discrimination claims brought by Esther Iredia. Iredia, a former DADS employee, alleged sexual harassment, racial discrimination, and national origin discrimination by her supervisor. The Court of Appeals for the First District of Texas affirmed the trial court's denial of DADS's plea regarding the sex discrimination claim, concluding that Iredia provided sufficient evidence of a hostile work environment. However, the court reversed the denial and dismissed Iredia's race and national origin discrimination claims due to her failure to present a prima facie case.

Employment DiscriminationSexual HarassmentHostile Work EnvironmentRace DiscriminationNational Origin DiscriminationSovereign ImmunityPlea to the JurisdictionAppellate Court DecisionLabor LawSupervisor Misconduct
References
31
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. 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

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

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

Browne v. DiNapoli

The petitioner, a police officer, sought accidental and performance of duty disability retirement benefits after being injured in 2005. His applications were denied, and this denial was upheld after a hearing, finding he was not permanently incapacitated. The petitioner initiated a CPLR article 78 proceeding to challenge this determination. The court considered conflicting medical evidence, including the petitioner's evidence of a 30% shoulder loss of use and radiculopathy, and an orthopedist's report for the New York State and Local Retirement System concluding the petitioner was not disabled. The court ultimately confirmed the respondent's determination, citing substantial evidence from the orthopedist's rational and fact-based medical opinion.

Disability RetirementPolice Officer InjuryAccidental DisabilityPerformance of Duty DisabilityCPLR Article 78Medical IncapacitationConflicting Medical EvidenceOrthopedic EvaluationRadiculopathyShoulder Injury
References
4
Case No. 13-10-00126-CV
Regular Panel Decision
May 26, 2011

Department of Aging and Disability Services, a Texas State Agency v. Deborah K. Powell

The Department of Aging and Disability Services appealed the trial court's denial of its plea to the jurisdiction in Deborah K. Powell's workers' compensation retaliation case. Powell, a former food-service worker, alleged she was terminated in retaliation for filing a workers' compensation claim after an on-the-job injury. The Department argued that its sovereign immunity had not been clearly and unambiguously waived, citing Texas Government Code Ann. § 311.034. The appellate court reviewed the plea to the jurisdiction de novo and relied on the Texas Supreme Court's precedent in Kerrville State Hosp. v. Fernandez, which held that the State Applications Act (SAA) contained a waiver of sovereign immunity for such claims. The court found that legislative intent to waive immunity for workers' compensation retaliation claims remained clear and unambiguous despite the later enactment of § 311.034. Consequently, the court affirmed the trial court's denial of the Department's plea to the jurisdiction, concluding that the Department, as a state agency, is not immune from claims of workers' compensation retaliation.

Sovereign immunityPlea to the jurisdictionWorkers' compensation retaliationState Applications ActGovernmental immunity waiverLegislative intentAppellate reviewTexas Labor CodeTexas Government CodeInterlocutory appeal
References
8
Case No. MISSING
Regular Panel Decision

Allen v. McCall

A police officer, the petitioner, sought accidental disability retirement benefits after injuring his shoulder and neck while apprehending a suspect. The petitioner claimed the injury occurred during a struggle while attempting to handcuff the suspect, resulting in a fall. However, reports given to the Workers’ Compensation Board and an orthopedic surgeon stated the injury occurred while lifting a prisoner from the ground. The respondent denied the application, crediting the latter evidence and concluding that lifting a prisoner is a normal duty of a police officer, thus not an 'accident'. The court found substantial evidence to support the respondent’s determination, confirmed the denial, and dismissed the petition.

Police OfficerAccidental Disability RetirementShoulder InjuryNeck InjuryApprehension of SuspectWorkers' Compensation BoardOrthopedic SurgeonNormal DutiesSubstantial Evidence
References
0
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