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

Case No. ADJ528016 (LAO 0797447) ADJ4708211 (LAO 0831457)
Regular
May 04, 2015

JORGE PAREDES vs. COASTCAST CORPORATION, STATE COMPENSATION INSURANCE FUND, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for SUPERIOR NATIONAL INSURANCE COMPANY/CALIFORNIA COMPENSATION INSURANCE COMPANY, in liquidation, LEGION INSURANCE COMPANY, in liquidation, SEDGWICK CLAIMS M

This case involves a workers' compensation applicant claiming industrial injury to his psyche, lower extremities, internal system, high blood pressure, and diabetes over a cumulative trauma period. The Administrative Law Judge (ALJ) found injury to the psyche and lower extremities, but not the internal system or conditions like high blood pressure and diabetes. The ALJ also found Republic Indemnity solely liable, with a specific date of injury. Both applicant and Republic sought reconsideration. The Appeals Board granted reconsideration, amending the findings to include chronic venous stasis and need for further medical treatment, but deferred key issues like the date of injury, liability, permanent disability, and attorney fees. The case is returned to the trial level for further proceedings and a new decision.

WCABPetition for ReconsiderationFindings and OrderLabor Code Section 5412Date of InjuryCumulative TraumaRepublic Indemnity CompanyCalifornia Insurance Guarantee Association (CIGA)Agreed Medical Examiner (AME)Chronic Venous Stasis
References
2
Case No. MISSING
Regular Panel Decision

Patnode v. Rome Development Center

The claimant, a mental hygiene therapy aide, experienced high blood pressure and anxiety attacks following a patient abuse investigation in 1983. He filed a claim for workers’ compensation benefits, asserting his condition was a posttraumatic neurosis and high blood pressure caused by the interrogation during the investigation. While his treating psychiatrist, Dr. Louis Patrizio, connected the condition to the investigation, the carrier’s consulting psychiatrist, Dr. Jonathan Ecker, found it difficult to link and did not believe work caused the disability. The Workers’ Compensation Law Judge initially found a causally related occupational disease, but the Workers’ Compensation Board reversed, concluding no accident or occupational disease. The appellate court affirmed the Board’s decision, stating that the claimant failed to qualify his condition as an occupational disease and the Board was authorized to weigh conflicting medical testimonies and credibility issues.

Occupational DiseasePsychiatric InjuryPosttraumatic NeurosisHigh Blood PressurePatient Abuse InvestigationCredibility IssueMedical TestimonyCausally RelatedAnxietyDepression
References
7
Case No. MISSING
Regular Panel Decision
Oct 15, 1998

High View Fund, L.P. v. Hall

Plaintiffs, The High View Fund, L.P. and The High View Fund, filed an Amended Complaint asserting claims against E. William Hall and Karen W. Hall for violations of federal securities laws, fraudulent inducement, Delaware Blue Sky laws, breach of fiduciary duty, unjust enrichment, conversion, and breach of contract. The claims stem from the plaintiffs' $1 million investment in United Golf Properties, Inc. and the defendants' alleged misuse of the company's assets and misrepresentations in an Offering Memorandum. Defendants moved to dismiss the Amended Complaint. The court, presided over by District Judge Scheindlin, granted dismissal for the federal securities law claims and common law fraud claims, allowing leave to amend. Additionally, the conversion and breach of contract claims were dismissed with prejudice. However, the motion to dismiss was denied for the Delaware Blue Sky law claims, breach of fiduciary duty, and unjust enrichment claims.

Securities FraudMotion to DismissRule 12(b)(6)Rule 9(b)Fiduciary DutyUnjust EnrichmentConversionBreach of ContractDelaware Blue Sky LawInvestment Fraud
References
50
Case No. MISSING
Regular Panel Decision

Claim of Boni-Phillips v. Oliver

The case involves an appeal from the Workers’ Compensation Board's decision to award death benefits to a claimant whose husband died from cardiac arrest at work. The Board initially found a presumption of compensability under Workers’ Compensation Law § 21 (1) due to the unwitnessed death. However, the employer presented substantial evidence of the decedent's preexisting heart conditions, including high blood pressure, high cholesterol, and coronary artery disease, which a medical expert opined were the cause of death. This evidence rebutted the presumption, shifting the burden to the claimant to prove a causal relationship. The court reversed the Board's decision, which incorrectly relied on the presumption, and remitted the matter for a determination on whether the claimant could establish that work activities contributed to the heart attack.

Workers' Compensation Death BenefitsCausal RelationshipPresumption of CompensabilityUnwitnessed DeathPreexisting ConditionCoronary Artery DiseaseMedical Expert TestimonyBurden of ProofAppellate ReviewRemand to Board
References
6
Case No. 2014-1081 K C
Regular Panel Decision
Oct 05, 2016

High Quality Med. Supplies, Inc. v. Mercury Ins. Group

This case involves an appeal concerning assigned first-party no-fault benefits sought by High Quality Medical Supplies, Inc., as assignee of Charles Botwee. The defendant, Mercury Ins. Group, appealed an order from the Civil Court that denied its motion for summary judgment to dismiss the complaint. Mercury Ins. Group contended that billing for durable medical equipment not listed in a fee schedule is not compensable. However, the Appellate Term affirmed the lower court's decision, citing 11 NYCRR 68.5, which specifically permits reimbursement for healthcare services not explicitly covered by fee schedules, thereby rejecting the defendant's argument.

No-Fault BenefitsFirst-Party BenefitsDurable Medical EquipmentFee ScheduleSummary JudgmentAppellate TermAssigned BenefitsInsurance LawReimbursementCivil Court
References
3
Case No. 2019 NY Slip Op 06638 [175 AD3d 1446]
Regular Panel Decision
Sep 18, 2019

Roblero v. Bais Ruchel High Sch., Inc.

The Appellate Division, Second Department, affirmed two Supreme Court orders in a personal injury action. Plaintiff Cristian Roblero, injured after falling from a scaffold while performing plumbing work for Bais Ruchel High School, Inc., was not provided with necessary safety devices. The Supreme Court granted Roblero summary judgment on liability under Labor Law § 240 (1) and denied Bais Ruchel's motions to dismiss Labor Law § 200 and common-law negligence claims, and for summary judgment on its third-party contractual indemnification claim against ADD Plumbing, Inc. The Appellate Division concluded that Roblero established a prima facie case for Labor Law § 240 (1) and Bais Ruchel failed to raise a triable issue of fact. Additionally, Bais Ruchel failed to establish it lacked supervisory authority for the Labor Law § 200/common-law negligence claims or its entitlement to indemnification.

Personal InjuryLabor Law § 240(1)Scaffold AccidentSummary JudgmentAppellate ReviewPremises LiabilityNondelegable DutyContractual IndemnificationThird-Party ActionConstruction Site Safety
References
20
Case No. MISSING
Regular Panel Decision

New York State Employment Relations Board v. Christ the King Regional High School

The New York State Employment Relations Board initiated a proceeding to enforce its order against Christ the King Regional High School, which mandated good-faith bargaining with the Lay Faculty Association and reinstatement of teachers. The School challenged this order on First Amendment grounds, specifically citing the Free Exercise and Establishment Clauses, arguing for an absolute exemption from the New York State Labor Relations Act. The Supreme Court and Appellate Division ruled in favor of the Board. The Court of Appeals affirmed these decisions, concluding that the Act, being a neutral and generally applicable regulatory measure, did not violate the First Amendment rights of the religious school in its labor relations with lay faculty. The court also upheld the reinstatement of teacher Gaglione, finding insufficient evidence of religious entanglement to preclude it.

First AmendmentFree Exercise ClauseEstablishment ClauseLabor LawCollective BargainingReligious SchoolsLay Faculty RightsEmployment DisputesJudicial ReviewAdministrative Order Enforcement
References
19
Case No. MISSING
Regular Panel Decision

Darowski v. High Meadow Cooperative No. 1

Joseph Darowski initiated a personal injury lawsuit against High Meadow Cooperative No. 1 and Anker Management Corporation for injuries sustained during asbestos removal. High Meadow and Anker subsequently filed a third-party action against Darowski's employer, Asbestos Industries of America, Inc. (AIA), seeking defense and indemnification due to a contract breach regarding liability insurance. AIA appealed an order that denied its motion to compel further discovery and granted summary judgment to High Meadow and Anker, declaring AIA's duty to defend and indemnify. The appellate court modified the order, ruling that AIA's motion to depose High Meadow and Anker representatives should be granted, but otherwise affirmed the summary judgment against AIA due to its failure to procure adequate insurance. The decision also clarified that a recent 1996 amendment to the Workers' Compensation Law, limiting third-party actions against employers, would not apply retroactively to this pending case.

Asbestos ExposurePersonal Injury DamagesThird-Party IndemnificationDuty to DefendSummary Judgment AppealDiscovery DisputeDeposition OrderBreach of ContractLiability Insurance PolicyWorkers' Compensation Law
References
5
Case No. ADJ9427814
Regular
Nov 25, 2015

REYNALDO SANTOS vs. COUNTY SANITATION DISTRICT OF LOS ANGELES COUNTY

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration, modifying the original award. The Board affirmed the finding of injury to the applicant's psyche and sleep disorder, but deferred the issue of injury to headaches and high blood pressure due to insufficient medical evidence. Additionally, a clerical error in the temporary disability end date was corrected. The case was returned to the WCJ for further proceedings regarding the deferred issues.

AOE/COEpsyche injurysleep disorderhypertensionheadachesinitial physical aggressor defenseinadmissible medical evidenceself-procured medical reportclerical errortemporary disability
References
7
Case No. ADJ1128865 (VNO 0244369), ADJ1909887 (VNO 0181430)
Regular
Jan 09, 2012

JOE NAVARRO vs. LOCKHEED MARTIN

The Workers' Compensation Appeals Board denied reconsideration of a decision regarding Joe Navarro's claims against Lockheed Martin. The Board adopted the Workers' Compensation Administrative Law Judge's report, which found Navarro to be an unreliable historian with significant symptom magnification. Consequently, the Board denied injury claims for heart and high blood pressure, and upheld a 27% permanent disability award for a psyche injury, based on the judge's credibility findings.

ADJ1128865ADJ1909887plastic parts fabricatorplastic parts fabricator supervisorcontinuous traumapsyche injurypermanent disabilitynon-industrial apportionmentcredible historiansymptom magnification
References
5
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