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

Case No. ADJ7464284, ADJ7464287
Regular
Oct 18, 2012

MIGUEL ANGEL GARCIA vs. INTERNATIONAL WINDOW, ZURICH NORTH AMERICAN INSURANCE

This case concerns a workers' compensation claim where the applicant, Miguel Angel Garcia, disputes a denial of his cumulative injury claim based on a post-termination defense. The applicant argues an exception applies because his date of injury, determined by when he first suffered disability, occurred after his termination notice. The Appeals Board found the record incomplete, as crucial medical evidence was marked for identification only and never formally admitted. Therefore, the Board rescinded the previous decision and remanded the case for the Administrative Law Judge to rule on evidence admissibility and issue a new decision based on admitted evidence.

Labor Code section 3600(a)(10)post-termination claimLabor Code section 3600(a)(10)(D)exceptiondate of injuryLabor Code section 5412temporary disabilitycumulative injurysubstantial medical evidenceadmitted evidence
References
2
Case No. ADJ6779017; ADJ6779034
Regular
Oct 13, 2012

YURI BARAJAS vs. KIMCO STAFFING SERVICES

This case involves a defendant's petition for removal regarding a workers' compensation lien claim. The Appeals Board granted the petition, rescinding a prior order that took issues off calendar. The Board found the administrative law judge erred by bifurcating issues and taking the case off calendar based on dissatisfaction with evidence. The Board emphasized that parties have the burden of proof and should present all necessary evidence at trial for decision. The case is returned to the trial level for a full decision based on submitted evidence.

Workers' Compensation Appeals BoardPetition for RemovalFindings and OrdersWCJlien claimantreasonableness of treatmentnecessity of treatmentMedical Provider Network (MPN)agreed medical evaluator (AME)burden of proof
References
1
Case No. MISSING
Regular Panel Decision

Claim of Quail v. Central New York Psychiatric Center

Claimant appealed a Workers' Compensation Board decision that awarded a 10% schedule loss of use of the right hand. The WCB's decision was based on a September 1998 report from the carrier's consultant, which found a 10% loss. The claimant's treating physician had reportedly found a 20% loss in a July 1998 report, but this report was not properly filed. Despite multiple directives to submit a final medical report from the treating physician, claimant failed to do so before the WCLJ's decision. After the WCLJ's ruling, claimant submitted a newly prepared report from his treating physician indicating a 20% loss. The Board declined to consider this new evidence, citing its discretion to refuse evidence that could have been presented earlier. The appellate court affirmed the Board's decision, finding no abuse of discretion in their refusal to consider the late evidence.

Schedule Loss of UseRight Hand InjuryMedical EvidenceAppellate ReviewBoard DiscretionFailure to Submit EvidenceTreating Physician ReportCarrier Consultant ReportProcedural IssuesPermanency Determination
References
2
Case No. LAO 0838241
Regular
Jun 26, 2008

LETICIA MUNOZ vs. CISCO BROTHERS, INC., ARCH INSURANCE

The Workers' Compensation Appeals Board granted reconsideration and rescinded the Supplemental Findings and Award because the WCJ's decision was not supported by substantial evidence in the record. The WCJ improperly relied on medical reports not admitted into evidence and potentially based her decision on inadmissible evidence. The case is returned to the trial level for further proceedings, a new decision, and to correct evidentiary errors.

Petition for ReconsiderationSupplemental Findings and AwardTemporary disabilityPermanent disabilityMedical treatmentPetition to TerminateExpedited HearingDeclaration of ReadinessAdmitted evidenceSubstantial evidence
References
4
Case No. MISSING
Regular Panel Decision

Banks v. Astrue

Plaintiff Tommy Lee Banks initiated this action to seek judicial review of the final decision by the Commissioner of Social Security, which denied his application for Supplemental Security Income (SSI). Plaintiff argued that Administrative Law Judge (ALJ) John P. Costello's decision was not supported by substantial evidence and was based on erroneous legal standards. The Court, however, found that the Commissioner's decision was supported by substantial evidence and conformed to applicable legal standards. Consequently, the Commissioner's motion for judgment on the pleadings was granted, Plaintiff's motion was denied, and Plaintiff's complaint was dismissed with prejudice.

Social Security ActSupplemental Security IncomeDisability BenefitsALJ DecisionResidual Functional CapacityPTSDDepressionAnxietyBlindnessMedical Evidence
References
14
Case No. MISSING
Regular Panel Decision

Claim of Estrella v. Broadway 69 Associates

Claimant, a painter and handyman, was injured in a fall in 2004. He initially sued Broadway 69 Associates, the building owner, who then argued for an employer-employee relationship to limit liability to workers' compensation. A Workers’ Compensation Law Judge (WCLJ) determined claimant was employed by a management company, not Broadway 69, a decision affirmed by the Workers’ Compensation Board. The Board also declined to consider new evidence from Broadway 69. On appeal, the court affirmed the Board's decision, finding no abuse of discretion in rejecting new evidence and substantial evidence to support the lack of an employer-employee relationship between claimant and Broadway 69 Associates, based on control of work, method of payment, and provision of materials by the management company.

Employer-employee relationshipWorkers' Compensation BoardSubstantial evidenceAppellate reviewDiscretion of BoardNew evidenceControl of workMethod of paymentManagement companyLiability
References
6
Case No. MISSING
Regular Panel Decision

Sidari v. Orleans County

The plaintiff, Paul Sidari, a corrections officer, sued the Orleans County Sheriff's Department and individual defendants, alleging discrimination based on national origin and religion, and retaliation under Title VII and 42 U.S.C. § 1983. Earlier rulings had struck claims related to 'other persons similarly situated' and discrimination against inmates, which was affirmed by Judge Arcara. Sidari later moved for reconsideration and to file a supplemental complaint, both of which were denied by Magistrate Judge Scott, with the denial of reconsideration based on the precedent cited by Sidari being vacated. However, the District Court, acting sua sponte, modified the Decision & Order based on the recent Second Circuit case, Cruz v. Coach Stores, Inc. This modification reinstated certain paragraphs to the Amended Complaint, allowing evidence of racial and sexual discrimination against inmates and other employees to support Sidari's hostile work environment claim. The remainder of the Magistrate Judge's decision was affirmed.

Hostile Work EnvironmentEmployment DiscriminationRetaliationTitle VII ClaimsCivil RightsStanding LawMotion to SupplementMotion for ReconsiderationMagistrate Judge OrderAppellate Precedent
References
9
Case No. ADJ10184876
Regular
Sep 06, 2017

JOSE MARTINEZ MARTINEZ vs. SNELLING STAFFING SERVICES, ACE AMERICAN INSURANCE

The Workers' Compensation Appeals Board granted reconsideration, rescinded the Amended Findings of Fact, and returned the case for further proceedings. This action was taken because the original decision was based on incomplete medical reports, leaving a gap in the evidence regarding the applicant's temporary total disability. The Board noted that decisions must be based on admitted evidence and that the record was not yet complete. Consequently, the merits of the defendant's arguments, including issues with the average weekly wage and penalties, were not addressed.

Workers' Compensation Appeals BoardPetition for ReconsiderationAmended Findings of FactTemporary Total DisabilityAverage Weekly WageEmployment Development DepartmentReimbursementPenaltyEmployer LiabilityInsurer Liability
References
2
Case No. MISSING
Regular Panel Decision
May 18, 2005

Hotel 57 LLC v. Harvard Maintenance, Inc.

In this case, the plaintiff hotel sought over $300,000 for replacing 16 scratched windows, attributing the damage to the defendant's window cleaners. The defendant denied responsibility, suggesting the scratches were preexisting. Crucially, the plaintiff destroyed and replaced the windows without notifying the defendant, sixteen months prior to filing the lawsuit. The Supreme Court initially denied the defendant's motion for summary judgment based on spoliation of evidence. However, the appellate court reversed this decision, emphasizing the plaintiff's intentional destruction of evidence critical to the lawsuit, granted the defendant's motion for summary judgment, and dismissed the complaint.

spoliation of evidencesummary judgmentappellate reviewwindow damageproperty damageintentional destruction of evidencecivil procedureNew York lawconstructionnegligence
References
0
Case No. MISSING
Regular Panel Decision
May 01, 1970

Claim of Gillespie v. Brookhaven Fire District

This case concerns an appeal from a decision by the Workmen's Compensation Board awarding weekly benefits to a volunteer fireman under the Volunteer Firemen's Benefit Law. The claimant sustained chest injuries in 1966. The Board found a 25% loss of earning capacity despite no diminution in the claimant's rate of compensation, based on the definition of earning capacity in the Volunteer Firemen’s Benefit Law. The appellate court reversed the Board's decision, finding insufficient evidence to support the award. The court noted the record lacked details on how the disability hampered the claimant's job performance and that medical evidence was not directed towards his ability to perform normal tasks. The claim was remitted for further proceedings to adduce additional proof on the effect of the disability on earning capacity, reiterating that benefits are based on earning capacity, not actual lost earnings or anticipated promotions.

Volunteer Firemen's Benefit LawPartial DisabilityLoss of Earning CapacityWorkmen's Compensation BoardAppealRemittalSufficiency of EvidenceJob PerformanceMedical EvidenceEarning Capacity Calculation
References
1
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