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

Case No. CV-22-2032
Regular Panel Decision
Mar 14, 2024

In the Matter of the Claim of John Deliso

This case involves an appeal from decisions of the Workers' Compensation Board regarding a claim filed by John Deliso, a maintenance supervisor, for work-related repetitive stress injuries. The claim for bilateral carpal tunnel syndrome and repetitive stress injuries to wrists and shoulders was established. However, the employer alleged a violation of Workers' Compensation Law § 114-a, providing surveillance videos that contradicted Deliso's reported functional abilities during permanency evaluations by his treating physician, Christopher Kyriakides. An independent medical examination by Sean Lager also found no functional impairment and symptom magnification. The Workers' Compensation Law Judge, affirmed by the Board, found that Deliso made material misrepresentations regarding his functional abilities, thus violating Workers' Compensation Law § 114-a. The Appellate Division affirmed the Board's decision, concluding that substantial evidence supported the finding of material misrepresentations and upholding the discretionary disqualification from future wage replacement benefits due to the egregious nature of the deception.

Workers' CompensationFraudMisrepresentationSurveillance EvidenceMedical EvaluationSchedule Loss of UseDisqualificationOccupational DiseaseAppellate ReviewMaterial Fact
References
12
Case No. MISSING
Regular Panel Decision

Continental Casualty Insurance Co. v. Functional Restoration Associates

Continental Casualty Insurance Company (Continental) sought judicial review after the Texas Workers’ Compensation Commission (Commission) affirmed a decision holding Continental liable for medical treatment costs provided by Functional Restoration Associates (FRA) and Productive Rehabilitation Institute of Dallas for Ergonomics (PRIDE) to an injured employee. The trial court dismissed Continental's suit, citing a lack of statutory basis for judicial review of the Division of Medical Review (DMR) decisions. On appeal, Continental argued for both statutory and inherent rights to judicial review. The appellate court found no explicit or implied statutory right but concluded that Continental had an inherent right to judicial review because the Commission's decision affected Continental’s vested property interest (money). The court also rejected the Commission's argument regarding untimely filing. Consequently, the court reversed the dismissal and remanded the case for further proceedings to determine if the Commission's decision was arbitrary and capricious or unsupported by substantial evidence.

Judicial ReviewMedical Benefits DisputeWorkers' CompensationAdministrative LawDue ProcessProperty RightsStatutory InterpretationRemandTexas LawAppellate Court
References
30
Case No. 03-97-00103-CV
Regular Panel Decision
Mar 12, 1998

Continental Casualty Insurance Company v. Functional Restoration Associates Texas Workers' Compensation Commission And Productive Rehabilitation Institute of Dallas for Ergonomics

Continental Casualty Insurance Company (Continental) appealed a trial court's dismissal of its lawsuit against Functional Restoration Associates (FRA), Productive Rehabilitation Institute of Dallas for Ergonomics (PRIDE), and the Texas Workers' Compensation Commission (Commission). Continental sought judicial review of a Commission decision holding it liable for medical costs for an injured employee, James Hood. The trial court had dismissed the suit, citing a lack of statutory jurisdiction for judicial review of Division of Medical Review (DMR) decisions. On appeal, Continental asserted both statutory and inherent bases for jurisdiction. The appellate court found no explicit or necessarily implied statutory right to judicial review of DMR decisions. However, it concluded that Continental possessed an inherent right to judicial review because the Commission's decision directly affected Continental's vested property interest in the money it was ordered to pay. Consequently, the appellate court reversed the trial court's judgment of dismissal and remanded the cause for further proceedings, including a review of whether the Commission's decision was arbitrary and capricious or unsupported by substantial evidence.

Workers' CompensationJudicial ReviewAdministrative LawDue ProcessVested Property RightsMedical Benefits DisputeAppellate JurisdictionTexas LawStatutory InterpretationSubstantial Evidence
References
28
Case No. MISSING
Regular Panel Decision
Dec 20, 2001

Mulhern v. Eastman Kodak Co.

The case involves Kevin Mulhern, a former employee of Eastman Kodak Company, who sued Kodak for discrimination under the Americans With Disabilities Act (ADA), Family and Medical Leave Act (FMLA), and New York State Human Rights Law (NYHRL) due to his Nail-Patella Syndrome. Mulhern alleged that Kodak failed to reasonably accommodate his disability by not allowing him to work exclusively in the less physically demanding PRS area, despite his ability to perform those tasks. Kodak argued that rotation to more strenuous 3R tasks was an essential job function and that Mulhern's disability application statements contradicted his ability to work. The court denied Kodak's motion for summary judgment, finding triable issues of fact regarding the essential functions of Mulhern's job, the reasonableness of the requested accommodation, and the interpretation of his disability application statements. The court also found triable issues of fact regarding the FMLA claim.

ADAFMLANYHRLDisability DiscriminationReasonable AccommodationEssential Job FunctionsSummary JudgmentWork RestrictionsMedical LeaveJudicial Estoppel
References
17
Case No. MISSING
Regular Panel Decision

Guttierez v. Berryhill

Betsy Lee Guttierez applied for disability insurance benefits and Supplemental Security Income, alleging disability due to various mental health impairments. Her applications were denied by an Administrative Law Judge and the Appeals Council. Guttierez sought judicial review, arguing that the ALJ failed to properly assess her residual functional capacity (RFC) by rejecting the only medical opinion on her mental ability to work without providing adequate reasons or a function-by-function analysis. The Court agreed, finding the ALJ's RFC assessment unsupported by substantial evidence, as the ALJ, a non-medical professional, made a determination of Guttierez's mental capacity without relying on a medical opinion. Consequently, the Court granted Guttierez's motion, denied the Commissioner's motion, and remanded the case for further administrative proceedings.

Social Security ActDisability BenefitsSSIALJ Decision ReviewRFC AssessmentMedical EvidenceMental Health ImpairmentsBipolar DisorderAnxiety DisorderTreating Physician Rule
References
13
Case No. MISSING
Regular Panel Decision
Jun 27, 2013

Karabinas v. Colvin

Dimitrios N. Karabinas challenged the Commissioner of Social Security's denial of his Disability Insurance Benefits application, arguing the Administrative Law Judge (ALJ) committed several legal errors. The court identified flaws in the ALJ's Residual Functional Capacity (RFC) assessment, including failure to accommodate Karabinas's moderate difficulties in concentration, persistence, and pace, and an incomplete function-by-function analysis of his work abilities. Furthermore, the court found the ALJ improperly weighed medical opinions, specifically downplaying the detailed report from Karabinas's chiropractor, and based its credibility determination on a circular logic. Concluding that the ALJ's errors led to an unsupported denial of benefits, the District Court reversed the Commissioner's decision. The case was remanded for the sole purpose of calculating and providing benefits to Karabinas for the specified period.

Disability Insurance BenefitsSocial Security ActRFC AssessmentMedical OpinionCredibility AssessmentVocational ExpertCervical Disc ProblemsPain ManagementChiropractic TreatmentWork Limitations
References
34
Case No. MISSING
Regular Panel Decision

Cohen v. Chu

This CPLR article 78 proceeding involved a petitioner, an insurance agent, challenging a determination by the State Tax Commission that he was liable for unincorporated business taxes for 1979 and 1980. The central issue was whether the petitioner functioned as an employee or an independent contractor for Provident Mutual Life Insurance Company. The court considered various factors, including the contract, company-provided resources, benefits, and the petitioner's ability to broker insurance with other companies. The decision emphasized the petitioner's ability to earn a significant portion of his income from other companies as substantial evidence supporting the determination that he was an independent contractor. Consequently, the court confirmed the determination of the State Tax Commission and dismissed the petition.

Independent ContractorTax AssessmentUnincorporated Business TaxInsurance AgentEmployer-Employee RelationshipState Tax CommissionJudicial ReviewSubstantial EvidenceProvident Mutual Life Insurance CompanyTax Law
References
6
Case No. MISSING
Regular Panel Decision

O'HALLORAN v. Barnhart

The plaintiff, Kathleen O’Halloran, sought judicial review of a final determination by the Commissioner of Social Security denying her Disability Insurance Benefits. The District Court found that the Administrative Law Judge (ALJ) made several legal errors in assessing O’Halloran’s disability claim. These errors included failing to properly evaluate her mental impairments and functional limitations, not fully developing the record with "other source" evidence from treating therapists, nurses, and family, and misapplying standards regarding her residual functional capacity and ability to perform past work. The court also noted the ALJ's incorrect evaluation of the materiality of O'Halloran's alcohol abuse. Consequently, the court reversed the Commissioner's decision and remanded the case for further proceedings consistent with its order.

Social Security ActDisability Insurance BenefitsMental ImpairmentParanoid SchizophreniaAlcohol AbuseAdministrative Law JudgeResidual Functional CapacitySequential Evaluation ProcessMental Impairments EvaluationPast Relevant Work
References
12
Case No. MISSING
Regular Panel Decision

Guerrero Toro v. Northstar Demolition

Plaintiff Alexander Guerrero Toro, a pro se asbestos handler, sued NorthStar Demolition & Remediation LP under the Americans with Disabilities Act (ADA) and New York State Human Rights Law (NYSHRL), alleging failure to accommodate his carpal tunnel syndrome, wrongful termination, workplace harassment, and retaliation. After experiencing pain in his right arm, Plaintiff was placed on restricted duty, limiting his ability to perform essential job functions. Defendant provided various temporary light-duty assignments, but eventually, no suitable tasks remained due to seasonal changes and Plaintiff's ongoing limitations. Plaintiff also claimed harassment from co-workers and supervisors, and retaliation for filing administrative complaints. The court granted Defendant's motion for summary judgment, dismissing all claims, concluding that Plaintiff failed to demonstrate he could perform essential job functions with or without reasonable accommodation, or that a hostile work environment or retaliation existed based on admissible evidence. The NYSHRL claims were also dismissed, with some being jurisdictionally barred due to the election of remedies.

Americans with Disabilities ActDisability DiscriminationCarpal Tunnel SyndromeReasonable AccommodationHostile Work EnvironmentRetaliationSummary JudgmentPro Se LitigationEmployment LawNew York State Human Rights Law
References
122
Case No. MISSING
Regular Panel Decision

Clemente v. Schweiker

The plaintiff initiated an action under 42 U.S.C. § 405 to appeal a final decision by the defendant, which had denied his application for a period of disability and disability insurance benefits. An Administrative Law Judge (ALJ) previously concluded in May 1982 that the 62-year-old plaintiff, a longshoreman suffering from chronic bronchitis, emphysema, arthritis, and other severe conditions, was not disabled, deeming his impairments mild and resulting from the aging process. The District Judge found that the ALJ had misapplied 20 C.F.R. § 404.1521 by focusing on the plaintiff's ability to perform 'most jobs' rather than assessing whether his impairments significantly limited his ability to perform 'basic work activities,' such as lifting. Medical reports from treating physician Dr. Harold Coppersmith and consulting neurologist Dr. Stephen Gilbert consistently indicated the plaintiff's inability to perform heavy work and, in Dr. Gilbert's opinion, rendered him totally disabled due to conditions like cervical spondylosis, labyrinthine disturbance, and cervical radiculitis. Consequently, the case was remanded for further proceedings within 120 days, instructing the ALJ to properly consider the plaintiff's residual functional capacity, age, education, and past work experience as required by law.

Disability Insurance BenefitsSocial Security ActAdministrative Law JudgeSevere ImpairmentBasic Work ActivitiesResidual Functional CapacityLongshoremanCervical SpondylosisLabyrinthine DisturbanceVocational Factors
References
1
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