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

Case No. Axelrod I, Axelrod II, Veit
Regular Panel Decision
Feb 19, 1985

Society of the New York Hospital v. Axelrod

This case concerns the Commissioner of Health of New York State's establishment of Medicaid, Blue Cross, workers' compensation, and no-fault insurance reimbursement rates for hospitals. In response to increased labor costs for hospitals affiliated with the League of Voluntary Hospitals, SHIF (Supplemental Hospital Index Factor) benefits were introduced to provide waivers based on actual increased labor costs. Eligibility for SHIF was determined by an "affordability" factor, utilizing a current ratio analysis where a ratio of current assets to liabilities less than 1:1 indicated eligibility. The Society of The New York Hospital and The New York Eye & Ear Infirmary were denied SHIF benefits due to their current ratios, while some other hospital groups with similar financial statuses received benefits. The Supreme Court initially found a rational basis for the rates but questioned the uniform application. The Appellate Division modified the decision, finding the application of eligibility tests to Hospital and Infirmary to be arbitrary, capricious, and discriminatory, thereby violating equal protection clauses. The court granted summary judgment to Hospital and Infirmary, declaring the denial of SHIF benefits arbitrary and capricious, and remanded for an assessment of due benefits.

Reimbursement RatesMedicaidWorkers' CompensationNo-Fault InsurancePublic Health LawSHIF BenefitsAffordability FactorCurrent Ratio TestArbitrary and CapriciousEqual Protection
References
5
Case No. MISSING
Regular Panel Decision
Nov 19, 1987

SOC'Y OF NY HOSP v. Axelrod

The Court of Appeals of New York reviewed a challenge by Society of the New York Hospital and New York Eye & Ear Infirmary against the Commissioner of Health, David Axelrod, concerning the denial of Supplemental Hospital Index Factor (SHIF) waivers. These waivers would allow hospitals to be reimbursed for actual, rather than projected, labor cost increases. The Commissioner denied the applications based on an "affordability" test, deeming the hospitals sufficiently affluent. The Court found this "affordability" test to be arbitrary and capricious, exceeding the statutory mandate under Public Health Law § 2807 (3), which focused on costs related to efficient service production. The decision modified the Appellate Division's order, remitting the case to the Commissioner for reconsideration without the "affordability" factor, rather than directing an immediate award of benefits.

Hospital reimbursementLabor cost waiversAdministrative discretionPublic Health LawArbitrary and capriciousStatutory interpretationRate-settingAgency overreachHealthcare financeJudicial review of administrative action
References
6
Case No. 2017 NY Slip Op 04341 [151 AD3d 1152]
Regular Panel Decision
Jun 01, 2017

Matter of Durkot v. Newsday

In this workers' compensation case, claimant Daniel Durkot, a pressman, sought benefits for occupational hearing loss due to workplace noise exposure since 2010. His requests for a schedule loss of use award were repeatedly denied as premature by a Workers' Compensation Law Judge and affirmed by the Workers' Compensation Board. The Board ruled that setting the date of disablement was premature under Workers' Compensation Law § 49-bb because he continued to work in the same position and was exposed to the same noise, even with ear protection. The Appellate Division affirmed the Board's decision, concluding that substantial evidence supported the finding that claimant had not been "removed from exposure to harmful noise" for the requisite three-month period, as his continued use of the same ear protection that failed to prevent the initial hearing loss did not constitute effective removal.

Occupational Hearing LossWorkers' Compensation BenefitsSchedule Loss of Use AwardDate of DisablementWorkplace Noise ExposureEar Protection DevicesSubstantial EvidenceAppellate ReviewClaimant AppealEmployer Responsibility
References
4
Case No. ADJ828729 (VNO 0514052)
Regular
Feb 11, 2010

LEONEL ARRIOLA vs. SPRINT PCS NEXTEL, CNA RISK MANAGEMENT

Applicant sought reconsideration of a November 24, 2009, Findings and Award which found an industrial injury to the back, neurologic system, headaches, and ears, but excluded psychological injury. The WCJ later vacated that award due to clerical error. Applicant's petition for reconsideration, filed after the award was vacated, is therefore moot. The Board dismissed the petition and returned the matter to the trial level for further proceedings.

WCABArriolaSprint PCS NextelCNA Risk ManagementPetition for ReconsiderationFindings and AwardWCJindustrial injuryback injuryneurologic system
References
0
Case No. ADJ2566375 (ANA 0382563)
Regular
Dec 21, 2012

JEFFREY FREEMAN vs. CITY OF HUNTINGTON BEACH, ACCLAMATION INSURANCE MANAGEMENT SERVICES

This case involves a fire captain's workers' compensation claim for industrial injuries to his ears, heart, neck, back, and left shoulder/hip. The applicant sought reconsideration of a 76% permanent disability rating, arguing the rating instructions for his left shoulder injury were unclear. The Appeals Board granted reconsideration, deferring the issues of permanent disability and attorney's fees. The matter is returned to the trial level to clarify the medical restrictions for the applicant's left shoulder injury.

Workers' Compensation Appeals BoardFindings Award and OrderPermanent DisabilityReconsiderationAdministrative Law JudgeDisability Evaluation UnitRating InstructionsAgreed Medical EvaluatorOrthopedicLeft Shoulder
References
1
Case No. ADJ6780439
Regular
Nov 13, 2018

CHARLES GRANDELL vs. SEARES VALLEY MINERALS, ZURICH INSURANCE COMPANY, IMC CHEMICAL, INC., CONSTITUTION STATE SERVICE COMPANY, RELIANCE NATIONAL

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration and dismissed their petition for removal. The Board affirmed the WCJ's findings that the applicant sustained a continuous trauma injury to his spine, ears, eyes, and psyche arising out of and in the course of employment. The Board found that the defendant's arguments regarding the post-termination defense and reliance on a specific PQME were without merit. Finally, the Board determined that removal was inappropriate as reconsideration was the correct procedural remedy for the issues raised.

continuous traumapost-termination defensePanel Qualified Medical EvaluatorPQMEMcDuffie OrderPetition for ReconsiderationPetition for RemovalFindings of Factarising out of or in the course of employmentAOE/COE
References
7
Case No. ADJ6545187
Regular
Feb 19, 2013

VERONICA DURAZO vs. RIVERSIDE COUNTY SHERIFF'S DEPARTMENT, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the Administrative Law Judge's findings of industrial injury to the applicant's head, ears, vision, and in the form of headaches and strokes. The Board found the Agreed Medical Evaluator's reports constituted substantial evidence of industrial causation for the applicant's strokes, despite the defendant's arguments. The Board also noted the defendant's submission of extraneous documents violated WCAB rules and warned of potential sanctions for future violations.

Workers' Compensation Appeals BoardIndustrial InjuryCumulative InjuryHead InjuryEar InjuryVision InjuryHeadachesStrokesHypertensionSubstantial Medical Evidence
References
5
Case No. ADJ6653749
Regular
Nov 10, 2010

JOHN KABALA vs. CITY OF ALHAMBRA FIRE DEPARTMENT, ADMINSURE

This case involves an employee's claim for industrial injuries to his internal system, heart, eyes, ears, and pulmonary conditions. The defendant employer petitioned for removal after the administrative law judge (WCJ) vacated submission to allow completion of the medical record, including depositions. The Appeals Board granted removal, finding no statutory good cause to reopen discovery as the applicant had ample time to develop the record prior to trial. The Board rescinded the WCJ's order and returned the matter for decision.

Petition for RemovalOrder Vacating SubmissionDisposition to Complete Medical RecordPanel Qualified Medical Evaluator (QME)Agreed Medical Evaluators (AMEs)Cardiac IssuesHypertensive IssuesPulmonary ConditionsDiscovery ClosureLabor Code Section 5502(e)(3)
References
1
Case No. ADJ8700032
Regular
Jul 10, 2017

GENARO SALINAS, MARIA SALNIAS vs. T.J. OBATA FARMS, STAR INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration to correct a clerical error. The original award found the applicant sustained industrial injury to his ears, brain, nervous system, and musculoskeletal system with weekly earnings of $923.05. The Board amended the award to reflect the applicant's correct weekly earnings as $932.05. Otherwise, the Board affirmed the original findings regarding the date of injury, statute of limitations, absence of a post-termination defense, and the finding of industrial injury.

Petition for ReconsiderationFindings and AwardGuardian Ad LitemDate of InjuryLabor Code section 5412Statute of LimitationsPost-termination defenseAttorney's feesCommutationStatewide average weekly wage
References
0
Case No. MISSING
Regular Panel Decision
Mar 10, 1977

King v. Rochester Products

This case concerns an appeal from a Workers' Compensation Board decision that disallowed medical benefits. The claimant, along with other workers, was referred by their union for an ear examination. No hearing loss was detected, and the employer refused to cover the medical expenses, which totaled $4,493.88 across all workers, with the claimant's bill being $41.90. Initially, a referee ordered the employer to pay, but the Workers’ Compensation Board reversed this decision, ruling that the medical bills were not properly chargeable to the employer. The appellate court concurred with the Board's reversal, affirming the decision without costs.

Medical BenefitsEar ExaminationHearing LossEmployer LiabilityUnion ReferralWorkers' Compensation BoardAppellate ReviewMedical Bills DisallowedInjury Arising Out of Employment
References
1
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