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

Case No. MISSING
Regular Panel Decision

Singletary v. Apfel

Plaintiff Sylvester M. Singletary appealed the Commissioner of Social Security's denial of disability insurance benefits, leading to this action under 42 U.S.C. § 405(g). The Court reviewed the final determination, including an Administrative Law Judge's decision, which the Appeals Council upheld. The central issue revolved around the ALJ's rejection of Singletary's treating physician's opinion of total disability, which the ALJ deemed unsupported by objective evidence, specifically the absence of disc herniation. The Court found that the ALJ arbitrarily substituted his lay opinion for competent medical evidence and ignored other objective findings like degenerative disc disease and disc bulging. Consequently, the Commissioner’s decision was not supported by substantial evidence, and the case was remanded solely for the calculation of benefits, with the plaintiff's motion for judgment on the pleadings granted.

Disability BenefitsSocial Security ActTreating Physician RuleSubstantial Evidence ReviewDegenerative Disc DiseaseChronic PainSpinal ImpairmentALJ ErrorRemandFederal Court Review
References
13
Case No. ADJ9070475
Regular
Dec 15, 2017

CARTO GROZCO vs. SUNSET MASONRY & CONCRETE, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for TOWER CASTLEPOINT INSURANCE

Radiology Disc of Encino's petition for reconsideration is dismissed because it was not filed from a final order. The Appeals Board grants removal, rescinds the previous order, and returns the case to the trial level. This allows Radiology Disc an opportunity to argue its jurisdiction and present evidence regarding its medical-legal services. The WCJ should have adjudicated jurisdiction rather than taking the case off calendar.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalOff-Calendar OrderFinal OrderSubstantive RightInterlocutory OrderMedical-Legal Expense DisputeWCJRemoval Granted
References
7
Case No. FRE 191206
Regular
Nov 20, 2007

MARY SEPEDA vs. SEPEDA BROTHERS DAIRY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of FREMONT INDEMNITY, in liquidation, REPUBLIC INDEMNITY

This case involves an applicant seeking reconsideration of a workers' compensation award concerning a low back injury sustained through July 13, 1995. The applicant, supported by her treating physician, argued for additional disc replacement surgery at the L4-5 level beyond the previously awarded L5-S1 spinal fusion. The Workers' Compensation Appeals Board granted reconsideration and amended the award to include the L4-5 disc replacement surgery, finding it reasonably required to cure or relieve the applicant's injury based on the treating physician's opinion.

CIGAFremont IndemnityRepublic Indemnitylow back injurypermanent disabilityfurther medical treatmentspinal surgeryL5-S1 fusionL4-5 disc replacementtreating physician
References
2
Case No. MISSING
Regular Panel Decision

Claim of Scalzo v. St. Joseph's Hospital

The claimant, a patient account representative, suffered a back injury (herniated L5-S1 disc and bulging discs) on May 18, 2000, after abruptly rising from her chair to avoid an object at work. Her claim for workers' compensation benefits was controverted by her employer and its carrier, arguing the injury was idiopathic. However, both a Workers' Compensation Law Judge and the Workers' Compensation Board found the accident established, relying on medical evidence, lay testimony, and the presumption under Workers’ Compensation Law § 21 (1). The employer appealed this decision. The appellate court affirmed the Board's decision, concluding that substantial evidence supported the finding that the injury arose out of and in the course of employment, and that credibility issues were for the Board to resolve.

Workplace InjuryBack InjuryHerniated DiscBulging DiscWorkers' Compensation BenefitsAccident Arising Out of EmploymentCourse of EmploymentPresumption of Arising Out of EmploymentCredibility IssueSubstantial Evidence
References
6
Case No. 531582
Regular Panel Decision
May 13, 2021

Matter of Matteliano v. Trinity Health Corp.

Caitlyn Matteliano, a nurse assistant, suffered work-related back, knee, and leg injuries in 2015 and 2018. Her treating orthopedic surgeon, Franco Vigna, requested authorization for multi-level lumbar fusion surgery and an external bone growth stimulator due to persistent pain and degenerative disc disease, despite conservative treatments. The employer denied this request based on an independent medical examination by Anthony Leone, who deemed the surgery aggressive and inappropriate given the lack of instability. A Workers' Compensation Law Judge initially denied the request, but the Workers' Compensation Board approved it. The employer appealed, and the Appellate Division, Third Department, affirmed the Board's decision, finding substantial evidence in Vigna's testimony to support the surgery's authorization under medical treatment guidelines for degenerative disc disease where non-surgical management has failed.

Workers' CompensationLumbar Fusion SurgeryMedical Treatment GuidelinesDegenerative Disc DiseaseDiscogenic Back PainIndependent Medical ExaminationPrior AuthorizationAppellate ReviewNurse AssistantWork Injury
References
9
Case No. MISSING
Regular Panel Decision

Claim of Avila v. St. Francis Hospital

In this Workers' Compensation case, the claimant, an orderly, sustained a low back injury in 1965 while employed by St. Francis Hospital. Initially diagnosed with a lumbo-sacral strain and an unstable back, a lump-sum settlement was approved in 1969 based on a mild causally related partial disability. Nearly a decade later, in 1978, the claimant applied to reopen the settlement due to severe leg pain and a confirmed extruded disc at L5-S1, requiring a laminectomy. The Workers’ Compensation Board reversed a Law Judge's finding, determining that there was a change in condition and degree of disability not contemplated at the time of the original settlement. The Special Fund for Reopened Cases appealed this decision, arguing against the reopening. The Appellate Division affirmed the Board's decision, citing that the definitive change from a mild disability to a herniated disc requiring surgery was an uncontemplated medical condition change, justifying the reopening under Workers’ Compensation Law § 15 (5-b).

Reopened CaseLump-Sum SettlementPermanent Partial DisabilityHerniated Lumbar DiscLaminectomyChange of ConditionUncontemplated Medical ConditionWorkers' Compensation Board DecisionAppellate ReviewMedical Evidence
References
2
Case No. SAC 286368
Regular
Jan 25, 2008

DALE OLIVER vs. BRIAN WILLIAMS CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

This case involves an applicant seeking approval for disc replacement surgery for a work-related back injury. The defendant argued the surgery is experimental per ACOEM guidelines, thus not covered. The Board denied reconsideration, finding the applicant's physician rebutted the presumption of experimental status. The Board determined the surgery is no longer experimental, citing FDA approval, and is reasonably required for the applicant's specific condition, supported by expert medical opinion.

Workers' Compensation Appeals BoardBrian Williams ConstructionState Compensation Insurance Fundindustrial injuryright anklefootelbowshoulderskneesleft lower extremity
References
0
Case No. SFO 0492831
Regular
Jan 23, 2008

ELIAS MONTOYA vs. ASTON BARNES, INC., STATE COMPENSATION INSURANCE FUND

The Board granted reconsideration to clarify the application of Labor Code section 4656 regarding temporary disability indemnity limits. The Board held that "new and further" disability does not extend the 104-week limit under section 4656(c)(1), nor do spinal disc excisions and bone grafts qualify as "amputations" under section 4656(c)(2)(C). Consequently, the applicant is entitled to temporary disability indemnity only up to two years from the date of the first payment.

Workers' Compensation Appeals BoardElias MontoyaAston Barnes Inc.State Compensation Insurance FundSFO 0492831Opinion and Decision After ReconsiderationTemporary Disability IndemnityIndustrial InjuryThoracic SpineChest Injury
References
3
Case No. SAL 0119321
Regular
Jun 16, 2008

DAVID MARTONE vs. CENTRAL FIRE PROTECTION DISTRICT, GREGORY BRAGG & ASSOCIATES

The Workers' Compensation Appeals Board granted reconsideration to amend a prior award, finding that the applicant's current low back injury should be apportioned at 20% to a prior industrial injury. This apportionment, based on medical opinion and MRI evidence showing injury to the same disc level, reduces the current permanent disability award to 8%. The decision emphasizes that apportionment is required under Labor Code section 4663, even when different rating schedules are involved.

Workers' Compensation Appeals BoardIndustrial InjuryFire CaptainLow Back InjuryPermanent DisabilityApportionmentQualified Medical ExaminerPrimary Treating PhysicianLabor Code Section 4663SB 899
References
7
Case No. MISSING
Regular Panel Decision

Kubica v. New York State Employees' Retirement System

The petitioner sought ordinary disability retirement benefits, but the Comptroller denied the application. The case involved conflicting medical opinions regarding the petitioner's ability to return to work as a food service worker due to chronic disc problems. The court upheld the Comptroller's decision, stating that the Comptroller could properly credit the opinion of the respondent's physician, who found the petitioner not permanently disabled. Since the determination was supported by substantial evidence, it was confirmed, and the petition was dismissed.

Disability Retirement BenefitsMedical Opinion ConflictSubstantial Evidence ReviewComptroller DeterminationFood Service WorkerChronic Disc ProblemsAdministrative LawJudicial ReviewArticle 78 Proceeding
References
2
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