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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

Horner v. Schweiker

Mrs. Georgia P. Horner sought disability health-insurance benefits under the Social Security Act, alleging disability due to a back condition since September 16, 1977. The administrative judge denied her claim, finding she retained the residual functional capacity for her past work as a cook, waitress, or laundry worker. Medical evidence from orthopedists Drs. Fardon and Brown found no significant objective pathology in her back, while general practitioners Drs. Lynch and Cooper opined she was disabled, though their findings were questioned for consistency and objective support. A psychological evaluation indicated normal intelligence and no significant mental impairment limiting work. The District Court affirmed the Secretary's final decision, granting the defendant's motion for judgment on the pleadings, concluding that Mrs. Horner failed to prove a severe impairment precluding substantial gainful activity by the required date of September 30, 1980.

Social Security ActDisability BenefitsJudicial ReviewAdministrative LawMedical EvidenceBack ConditionResidual Functional CapacityVocational TrainingOrthopedicsNeurology
References
9
Case No. MISSING
Regular Panel Decision

Saucedo v. Horner

Jesus Delgado Saucedo appealed the trial court's order granting summary judgment in favor of Alejandro Acosta Horner, Laura Acosta, and Carolyn Rabe. Saucedo, a maintenance employee from Mexico, was injured while performing yard work arranged by the Acostas for Carolyn Rabe. He sued the defendants for non-subscriber negligence, intentional infliction of emotional distress, and breach of the duty of good faith and fair dealing, alleging an employer-employee relationship. The appellate court affirmed the summary judgment, concluding that Saucedo was an independent contractor, thus negating the duty element for negligence and the special relationship requirement for good faith and fair dealing. Additionally, Saucedo failed to address a challenged element regarding the severity of emotional distress, leading to affirmation on that claim as well.

NegligenceIndependent ContractorSummary JudgmentEmployer-Employee RelationshipEmotional DistressGood Faith and Fair DealingTexas Labor LawAppellate ReviewDuty of CareTort Law
References
24
Case No. MISSING
Regular Panel Decision

Claim of Joslin v. City of Albany Fire Department

The claimant appealed a Workers’ Compensation Board decision regarding the method of payment for his hearing loss benefits, specifically challenging the biweekly installment plan. The claimant argued that Workers’ Compensation Law § 49-bb, which governs occupational loss of hearing claims, mandated a different payment method. The court rejected this contention, asserting that Workers’ Compensation Law § 15 (3) (m), which covers schedule awards for hearing losses generally, and § 49-cc, which directs occupational loss of hearing compensation to align with § 15 (3), govern the payment. Consequently, the court affirmed that the claimant was entitled to biweekly scheduled payments, consistent with other schedule loss awards.

Hearing lossWorkers' CompensationOccupational diseaseSchedule awardBiweekly paymentsStatutory interpretationAppealCompensation benefitsWorkers' Compensation Board
References
2
Case No. MISSING
Regular Panel Decision
Nov 09, 1989

De Leon v. Hospital of Albert Einstein College of Medicine

Plaintiffs Joyce De Leon and her infant son Hector De Leon sued Montefiore Hospital and Medical Center (Einstein) following Hector's birth in 1977, alleging injuries due to a nurse's actions during delivery. The lawsuit, initiated in 1988, asserted multiple causes of action including negligent hiring, *in utero* assault, medical malpractice, and fraudulent concealment. Defendants argued the entire action was time-barred by the medical malpractice Statute of Limitations. The Supreme Court initially denied the defendants' Statute of Limitations defense. The Appellate Division modified this decision, ruling that only the negligent hiring claim sounded in simple negligence and was therefore timely, while dismissing the remaining causes of action as time-barred medical malpractice claims.

Negligent HiringMedical MalpracticeStatute of LimitationsInfant InjuryHospital NegligenceProfessional JudgmentMedical TreatmentAppellate ReviewAssault ClaimsFraudulent Concealment
References
13
Case No. MISSING
Regular Panel Decision

Claim of Marchese v. New York State Department of Correctional Services

Claimant, injured in October 1997, initially received full wages from their employer, then workers' compensation benefits after employment termination. Following an award of benefits in February 2000, a dispute arose regarding the payment of claimant's counsel fee. The Workers’ Compensation Board ruled that the fee should be paid in installments from continuing payments to the claimant, rather than from the portion reimbursing the employer. Claimant appealed this decision, arguing that continuing payments were subject to adjustment and thus not an award of compensation. The Appellate Division affirmed the Board's decision, emphasizing the Board's broad discretion under Workers’ Compensation Law § 24 and finding no unfairness in the payment method, as the award was sufficient to cover both employer reimbursement and the attorneys' lien.

Attorney FeesWorkers' Compensation LawLien on CompensationContinuing PaymentsBoard DiscretionAppellate ReviewEmployer ReimbursementAward Payment MethodStatutory InterpretationCounsel Fee
References
2
Case No. 08-08-00340-CV
Regular Panel Decision
Aug 31, 2010

Jesus Delgado Saucedo v. Alejandro Acosta Horner, A/K/A Alejandro Acosta, Laura Acosta, Carolyn Rabe, Individually and as the Administratrix of the Est. of Carlyle J. Rabe, Jr.

Jesus Delgado Saucedo, a maintenance employee, sustained a thumb injury while working at the Rabe house after being referred by the Acostas. Saucedo sued the Acostas and Mrs. Rabe alleging non-subscriber negligence, intentional infliction of emotional distress, and breach of the duty of good faith and fair dealing. The trial court granted summary judgment in favor of all defendants. The appellate court affirmed the summary judgments, finding that Saucedo was an independent contractor, not an employee. Consequently, the defendants owed no legal duty of care or good faith and fair dealing, thereby defeating Saucedo's claims.

Summary JudgmentAppellate ReviewIndependent ContractorEmployer-Employee RelationshipNegligenceDuty of CareIntentional Infliction of Emotional DistressBreach of Good Faith and Fair DealingTexas Labor CodeWorkers' Compensation Act
References
22
Case No. MON 0339411
Regular
Jul 21, 2008

Dionisio Jimenez vs. NUPAC APARTMENTS, STATE COMPENSATION INSURANCE FUND

This case involves a dispute over the proper method used to rate the applicant's permanent disability following a back and leg injury. The defendant contends the Agreed Medical Examiner improperly used the Range of Motion (ROM) method instead of the Diagnosis-Related Estimate (DRE) method per the AMA Guides. The Appeals Board rescinded the prior award and returned the case to the trial level for further development of the record. This development will address why the ROM method was used and clarify the appropriate rating methodology.

Workers' Compensation Appeals BoardDionisio JimenezNupac ApartmentsState Compensation Insurance FundMON 0339411Opinion and Decision After ReconsiderationFindings and AwardIndustrial InjuryBack InjuryRight Leg Injury
References
2
Case No. ADJ10489999
Regular
Feb 01, 2019

Sean Lawson vs. Zenith Insurance Company

This case involves a dispute over the permanent disability rating for applicant Sean Lawson's low back injury. The defendant, Zenith Insurance Company, argues that the Range of Motion (ROM) method used by the Qualified Medical Evaluator (QME) was inappropriate, and the Diagnosis-Related Estimates (DRE) method should have been applied as there was only one level of radiculopathy. The Workers' Compensation Appeals Board (WCAB) affirmed the WCJ's finding that the ROM method was appropriate based on the QME's expert opinion and the AMA Guides' provision for its use with multi-level involvement. However, one Commissioner dissented, believing the DRE method was mandated given the lack of evidence for multi-level radiculopathy.

WCABPetition for ReconsiderationPermanent DisabilityApportionmentNon-industrial factorsDiagnosis-Related Estimates (DRE) methodRange of Motion (ROM) methodQualified Medical Evaluator (QME)AMA GuidesMultilevel radiculopathy
References
1
Case No. ADJ 4200496 (GRO 0030688)
Regular
Jan 19, 2010

FRANCISCO MARTINEZ-REYES vs. SOLAMAR FARMS, INC., STATE COMPENSATION INSURANCE FUND

This case concerns the proper method for calculating permanent disability award commutations for a farm laborer with 100% disability sustained on February 10, 2004. The applicant appeals the administrative law judge's decision favoring the Uniformed Reduction (UR) method, arguing the Uniformed Increasing Reduction (UIR) method better accounts for state average weekly wage (SAWW) increases mandated by Labor Code section 4659. The Appeals Board granted reconsideration, rescinded the prior decision, and remanded the case for a new decision. The Board found the UIR method better serves the goal of consistent periodic payments, and the SAWW increase commencement date was not moot.

Workers' Compensation Appeals BoardUniformed Reduction (UR)Uniformed Increasing Reduction (UIR)State Average Weekly Wage (SAWW)Permanent Disability AwardCommutationLabor Code Section 4659Life PensionTotal Permanent DisabilityCost of Living Adjustment (COLA)
References
1
Case No. ADJ9344211
Regular
Dec 01, 2017

Patricia Preston vs. Los Angeles Unified School District, SEDGWICK CLAIMS MANAGEMENT SERVICES

The applicant sought reconsideration of a workers' compensation award, challenging the permanent disability rating primarily based on the chosen medical evaluation method. The applicant argued the Range-of-Motion (ROM) method, favored by her treating physician, should have been used instead of the Diagnosis-Related Estimates (DRE) method employed by a Qualified Medical Evaluator (QME). Additionally, she contended that her vocational expert's opinion supported a finding of total permanent disability. The Board denied reconsideration, affirming the administrative law judge's decision, finding the QME's DRE rating supported by substantial evidence and the applicant's vocational evidence insufficient to prove total disability. A dissenting opinion argued that findings of multi-level spinal involvement supported the use of the ROM method for a potentially higher rating and questioned the QME's justification for choosing DRE.

Workers' Compensation Appeals BoardPatricia PrestonLos Angeles Unified School DistrictSedgwick Claims Management ServicesADJ9344211Permanent Disability RatingRange-of-Motion MethodDiagnosis-Related Estimates MethodApportionmentDr. Fenton
References
6
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