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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

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

Matejka v. Barnhart

Plaintiff, Ms. Matejka, alleging disability since March 31, 2000, applied for Disability Insurance Benefits, which was denied by an Administrative Law Judge (ALJ). The plaintiff sought review in District Court, arguing the ALJ's decision lacked sufficient inquiry into past relevant work, a reasoned finding on credibility, a proper residual functional capacity assessment, and a correct determination of the severity of her depression. The District Court found the ALJ's conclusions not supported by substantial evidence due to these deficiencies, particularly regarding the exertional requirements of past work, the evaluation of the plaintiff's credibility, the lack of a function-by-function RFC analysis, and the failure to adequately assess the severity of her depression, especially in light of uncontradicted medical opinions. Consequently, the Court reversed the Commissioner's decision and remanded the case for a new hearing consistent with its findings.

Disability Insurance BenefitsAdministrative Law JudgeResidual Functional CapacityCredibility AssessmentMedical EvidencePsychological AssessmentSpinal StenosisChronic Back PainDepressionRemand
References
24
Case No. MISSING
Regular Panel Decision
Dec 30, 2015

Matter of Curcio v. Sherwood 370 Management LLC

The claimant, a building engineer, sustained a work-related back and neck injury, initially classified as a permanent total disability by a Workers' Compensation Law Judge (WCLJ) with awarded counsel fees. The Workers' Compensation Board (Board) modified this, finding a permanent partial disability with a 90% loss of wage-earning capacity and reduced counsel fees due to an improperly completed application. The appellate court affirmed the Board's decision, citing substantial medical evidence supporting a partial disability and a 90% loss of wage-earning capacity based on the claimant's age, education, work history, and functional abilities. The court also upheld the reduction of counsel fees due to the attorney's failure to accurately complete the required fee application form.

Permanent Partial DisabilityWage-Earning Capacity LossWorkers' Compensation BenefitsCounsel FeesMedical EvidenceVocational FactorsOC-400.1 ApplicationAdministrative AppealAppellate DivisionMedical Impairment Guidelines
References
12
Case No. MISSING
Regular Panel Decision

Pereira v. Astrue

Plaintiff Jose Pereira sought judicial review of a final decision by the Commissioner of Social Security denying his disability benefits claim. He applied for Social Security Disability and Supplemental Security Income benefits in 2006, alleging disability since 2004 due to a work-related back injury. His claim was initially denied by an Administrative Law Judge (ALJ) in 2008 and subsequently upheld by the Appeals Council in 2009. The court found that the ALJ failed to properly apply the treating physicians rule, which requires considering specific factors when evaluating medical opinions, and did not conduct a required function-by-function analysis of the claimant's capacity. Consequently, the Commissioner's decision was reversed, and the case remanded for further administrative proceedings consistent with the court's opinion, as the record was not conclusive for an immediate award of benefits.

Disability BenefitsSocial Security ActJudicial ReviewTreating Physician RuleResidual Functional Capacity (RFC)Administrative Law Judge (ALJ)Lumbar Spine DisorderBack InjuryRemand for Further ProceedingsSubstantial Evidence
References
22
Case No. ADJ6721939
Regular
Mar 01, 2010

BERTHA NORIEGA GARCIA vs. PATRICK L. HINRICHSEN, CIVIL SERVICE EMPLOYEES INSURANCE COMPANY

This case is remanded for further proceedings because the Administrative Law Judge (ALJ) did not fully analyze the Diminished Future Earning Capacity (DFEC) adjustment factor under the *Ogilvie* decisions. The ALJ improperly relied solely on applicant's testimony for lost earnings without a proper *Ogilvie* analysis, including the duration of post-injury earnings and consideration of other factors affecting earning capacity. The ALJ must conduct a complete *Ogilvie* analysis, weigh the evidence, and explain how the adjusted DFEC factor reflects the applicant's actual earning capacity compared to the scheduled rating. The Board also clarified that temporary disability indemnity is not to be treated as post-injury earnings.

Diminished Future Earning CapacityDFECOgilvie analysisRebuttalScheduled Permanent Disability RatingPost-injury earningsEarnings lossTemporary disability indemnityPermanent and stationary dateTriers-of-fact
References
3
Case No. MISSING
Regular Panel Decision

Ortiz Torres v. Colvin

Luz Leida Ortiz Torres appealed the denial of her Supplemental Security Income (SSI) benefits by the Commissioner of the Social Security Administration. The District Court found that the Administrative Law Judge (ALJ) improperly discounted the treating physician's opinion regarding Ortiz's physical limitations based on a conservative treatment regimen. Consequently, the court vacated the Commissioner's decision in part and remanded the case for a more comprehensive physical residual functional capacity assessment. However, the court affirmed the ALJ's findings on Ortiz's mental residual functional capacity and credibility, deeming them supported by substantial evidence.

Supplemental Security Income (SSI)Disability BenefitsSocial Security Administration (SSA)Residual Functional Capacity (RFC)Degenerative Disc DiseaseDepressionMedical-Vocational Guidelines (Grid)Treating Physician RuleCredibility DeterminationRemand Order
References
26
Case No. MISSING
Regular Panel Decision
Dec 31, 2015

Drake v. SRC, Inc.

The claimant appealed a Workers’ Compensation Board decision from December 31, 2015, which ruled he sustained a permanent partial disability and a 15% loss of wage-earning capacity after a December 2010 work injury. The claimant argued for a 32% loss of wage-earning capacity, which would extend benefit duration, based on post-injury wages. The court affirmed the Board's decision, distinguishing between calculating loss of wage-earning capacity for benefit duration based on vocational factors and wage-earning capacity based on actual earnings. It found substantial evidence supported the 15% loss of wage-earning capacity, considering the claimant's functional abilities, impairment severity, age, education, and language proficiency.

Permanent Partial DisabilityLoss of Wage-Earning CapacityWorkers' Compensation BenefitsVocational FactorsAppellate ReviewSubstantial EvidenceBenefit DurationWork InjuryNeck InjuryBack Injury
References
10
Case No. ADJ2786471 (AHM 0131183)
Regular
Feb 12, 2013

RENEGARCIA vs. CITY OF ANAHEIM, PRESSURE

The Appeals Board rescinded the prior award due to the physician's flawed methodology in determining permanent disability. The physician improperly used the *Almaraz/Guzman* analysis by considering both functional capacity and ability to compete in the labor market. Furthermore, the physician's supplemental report failed to correct this error and used speculative cumulative losses. The matter is returned for a new rating strictly applying the AMA Guides.

Workers' Compensation Appeals BoardCity of AnaheimRene GarciaReconsiderationJoint Findings and AwardPermanent DisabilityCumulative TraumaLeft KneeRight KneeBack Injury
References
0
Case No. MISSING
Regular Panel Decision

Matter of Williams v. Preferred Meal Systems

Claimant, a driver, suffered injuries to his right knee and back in 2009 while making a delivery, leading to an established workers' compensation claim. The claim was later amended to include consequential adjustment disorder, and the Workers' Compensation Board ultimately found that claimant had sustained a permanent total disability from May 2012 onward. The employer, workers’ compensation carrier, and policy administrator appealed this decision, arguing that further proof was needed regarding claimant's vocational and functional capacity. The court affirmed the Board's decision, holding that extensive evidence of vocational and functional capacity is not required when medical proof demonstrates a permanent total disability and inability to engage in any gainful employment, as benefits continue for life in such cases. The court found substantial evidence in the opinions of treating and independent medical examination orthopedists to support the finding of permanent total disability.

Workers' CompensationPermanent Total DisabilityWage-Earning CapacityMedical ProofVocational CapacityFunctional CapacityAppellate ReviewNew York LawDisability BenefitsClaimant Rights
References
4
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