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Case Law Database

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

Case No. ADJ10033983 ADJ11112700
Regular
Jul 08, 2019

PABLO PEREZ vs. TAYLOR FARMS, ZURICH NORTH AMERICA INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted applicant Pablo Perez's Petition for Removal, rescinding the prior finding that a Functional Capacity Evaluation (FCE) was not a reasonable and necessary medical-legal expense. The WCAB found that an FCE, recommended by Panel Qualified Medical Evaluator Dr. Ali Soozani to assess permanent impairment, provides crucial objective data not fully captured by subjective complaints or a standard physical examination. The Board reasoned that while a physical therapist conducts the FCE, this is permissible under Labor Code section 3209.5 for medical treatment and does not violate Labor Code section 4628 when viewed as a distinct diagnostic tool supporting the QME's overall evaluation. Consequently, the WCAB issued a new Finding of Fact and Order deeming the FCE reasonable and necessary.

Functional Capacity EvaluationMedical-Legal ExpensePanel Qualified Medical EvaluatorPermanent ImpairmentActivities of Daily LivingSubstantial EvidenceAlmaraz/GuzmanLabor Code Section 4628Diagnostic ToolMedical Opinion
References
4
Case No. ADJ9201223
Regular
Feb 06, 2020

JOHN INMAN vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration of a decision finding the applicant permanently and totally disabled. The defendant challenged the vocational expert's opinion, arguing it was based on an inconsistent Residual Functional Capacity Evaluation (FCE) by the Agreed Medical Examiner. The Board rescinded the award, finding the FCE results were a "rough estimate" and ordered a new, accurate FCE to clarify the applicant's permanent disability.

Workers' Compensation Appeals BoardPermanent Total DisabilityResidual Functional Capacity EvaluationAgreed Medical ExaminerVocational ExpertScheduled RatingOgilvie v. Workers' Comp. Appeals Bd.LeBoeuf v. Workers' Comp. Appeals Bd.Gainful EmploymentLabor Market Access
References
2
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
Case No. ADJ2973393 (LAO 0883929)
Regular
Mar 27, 2014

CLEVETTE THOMAS vs. WELLPOINT, INC.; ZURICH NORTH AMERICA

The Workers' Compensation Appeals Board granted reconsideration to a lien claimant seeking reimbursement for a Functional Capacity Evaluation (FCE). The Board found sufficient evidence that the FCE was requested by the applicant's primary treating physician, Dr. Mays, despite the lack of formal designation. The Board also noted the defendant's failure to respond to the authorization request for the FCE. Ultimately, the Board rescinded the judge's denial and ordered reimbursement for the lien claimant's services.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationFindings and OrdersAdministrative Law JudgeFunctional Capacity Examination (FCE)Primary Treating PhysicianReimbursementCompromise and Release AgreementCumulative Trauma Injury
References
0
Case No. 2017 NY Slip Op 04343
Regular Panel Decision
Jun 01, 2017

Claim of Villalobos v. RNC Industries LLC

The claimant sustained a work-related injury in 2012 after falling from a ladder, affecting his head, neck, and back. A Workers' Compensation Law Judge initially determined a 73.5% loss of wage-earning capacity and found the claimant had reattached to the labor market. However, the Workers' Compensation Board subsequently reversed this decision, concluding that the claimant was not attached to the labor market and reduced his loss of wage-earning capacity to 40%. On appeal, the Appellate Division, Third Department, affirmed the Board's decision, deferring to its assessment of the claimant's credibility regarding his job search efforts. The court also found substantial evidence supported the 40% loss of wage-earning capacity, considering the independent medical examiner's report, claimant's functional abilities, age, work history, education, and language proficiency.

Workers' CompensationLoss of Wage-Earning CapacityAttachment to Labor MarketPermanent Partial DisabilityMedical ImpairmentCredibility AssessmentSubstantial EvidenceAppellate ReviewVocational RehabilitationJob Search
References
8
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. 2018 NY Slip Op 07814
Regular Panel Decision
Nov 15, 2018

Matter of Varrone v. Coastal Envt. Group

In the Matter of Varrone v Coastal Environment Group, the Appellate Division, Third Department, affirmed a Workers' Compensation Board decision. Claimant Joseph Varrone appealed the Board's modification of his loss of wage-earning capacity, reducing it from 50% to 15% following work-related injuries to his neck, right shoulder, and wrists. The Board considered the nature of his permanent partial disability, his functional capabilities, and vocational factors such as age, education, and skills. The court found substantial evidence, including the opinion of an independent medical examiner and claimant's own testimony, to support the Board's determination. This ruling upholds the Board's assessment of a 15% loss of wage-earning capacity.

Permanent Partial DisabilityWage-Earning CapacityAppellate ReviewMedical ImpairmentVocational FactorsSubstantial EvidenceClaimant AppealBoard Decision ModificationConstruction Project ManagerRepetitive Use Injury
References
4
Case No. MISSING
Regular Panel Decision

Gallishaw v. Comm'r of Soc. Sec.

Plaintiff William Gallishaw sought judicial review of the Social Security Administration's denial of Social Security Disability Insurance (SSDI) benefits. An Administrative Law Judge (ALJ) had previously found Plaintiff not disabled, a decision affirmed by the Appeals Council. The District Court determined that the ALJ erred by improperly discounting the opinions of Plaintiff's treating and examining physicians (Dr. Nangia, Dr. Thukral, Dr. Fkiaras) and his credibility, while unduly relying on a non-examining physician (Dr. Fuchs). The Court found the ALJ's residual functional capacity (RFC) determination and step-five findings regarding available jobs to be unsupported by substantial evidence. Consequently, the Court granted Plaintiff's motion for judgment on the pleadings, denied the Commissioner's cross-motion, and remanded the case for a determination of benefits, concluding there was persuasive proof of disability.

Disability benefitsSocial Security ActAdministrative Law JudgeResidual Functional CapacityTreating Physician RuleMedical evidenceCredibility assessmentLumbar spine myofascitisChronic synovitisLeft knee derangement
References
31
Case No. MISSING
Regular Panel Decision
Nov 03, 1967

Holloway v. Board of Examiners

The petitioner, a school social worker, initiated an Article 78 proceeding to compel the respondent to provide copies of medical and other reports that led to an unsatisfactory rating in an examination for a Supervisor of School Social Workers license. The Supreme Court, Kings County, initially dismissed the petition. However, the appellate court reversed this judgment, granting the petition to the extent of directing the respondent to furnish the reports to a physician designated by the petitioner, rather than directly to the petitioner. The case was remanded to the Special Term for further proceedings, including a determination on allowing the petitioner more time to appeal the unsatisfactory rating.

Article 78 CPLRLicense ExaminationSchool Social WorkerMedical ReportsDisclosureAdministrative AppealUnsatisfactory RatingAppellate ReversalRemandPhysician Disclosure
References
3
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
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