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Case Law Database

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

Case No. ADJ2891866 (SFO 0502133)
Regular
Jan 18, 2013

JULIO PAIZ vs. SAN RAMON MARRIOTT HOTEL

The Workers' Compensation Appeals Board granted reconsideration and affirmed the original award for industrial injury to the applicant's right hand, psyche, and internal system, resulting in 45% permanent disability. The Board amended the decision to allow attorney's fees, awarding $6,142.00 to the applicant's former attorney and $2,000.00 to his current attorney for their respective services. The original award of 45% permanent disability was maintained as substantial evidence supported the agreed medical examiners' opinions.

Workers' Compensation Appeals BoardSan Ramon Marriott HotelJulio Paizindustrial injuryright hand injurypsyche injuryinternal system injurypermanent disabilitymedical treatmentagreed medical examiners
References
5
Case No. ADJ13303390
Regular
Feb 15, 2023

JULIO PINEDA vs. CITY OF RANCHO CUCAMONGA, LWP CLAIMS SOLUTIONS, INC.

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to review the administrative law judge's (WCJ) finding of a compensable psychiatric injury. The defendant argued the psychiatric Qualified Medical Examiner's (QME) opinion lacked substantial evidence and that a "good faith personnel action" defense applied. The WCAB rescinded the award, finding the WCJ's decision failed to include a detailed analysis of the "good faith personnel action" defense as required by *Rolda v. Pitney Bowes*. The matter is returned to the WCJ to issue a new decision addressing all relevant issues under the preponderance of evidence standard.

Psychiatric injuryGood faith personnel action defenseRolda analysisSubstantial causePredominant causeQualified Medical Examiner (QME)Findings and Award (F&A)RescindReturn to WCJLabor Code section 3208.3
References
2
Case No. MISSING
Regular Panel Decision

Estepa v. Shad

Plaintiff Julio Estepa, a white male born in Puerto Rico, sued John S.R. Shad, Chairman of the SEC, for age and national origin discrimination after being denied a promotion to Support Services Supervisor (SSS) in the SEC's New York Regional Office. Estepa, 64, applied for the SSS position in 1982 but Alfred White, 58, was selected. The Court found that the defendant articulated legitimate, nondiscriminatory reasons for White's promotion, including his supervisory experience and knowledge of File Room operations, and Estepa failed to prove these reasons were pretextual. Estepa also failed to establish a prima facie case of age discrimination as the age difference with White was not 'substantially younger.' Additionally, Estepa's motion to amend the complaint to include Fifth Amendment due process claims was denied as federal employment discrimination claims have exclusive judicial remedies.

Age DiscriminationNational Origin DiscriminationTitle VII Civil Rights ActADEAEmployment DiscriminationNon-promotionPretextPrima Facie CaseFifth AmendmentDue Process
References
17
Case No. ADJ9784410, ADJ9997593, ADJ9784413
Regular
Jul 18, 2018

JULIO V. JIMENEZ vs. CR & R, XL SPECIALTY INS.

This case involves Julio Jimenez's workers' compensation claims against CR&R for injuries sustained while employed as a driver. The Appeals Board rescinded the prior WCJ's decisions, finding that Jimenez's claims were not barred by Labor Code section 3600(a)(10), which generally prevents claims filed after termination. The Board found sufficient evidence that the employer had notice of or medical records documented the eye and finger injuries prior to termination, and that Jimenez reported the knee and foot injury from the truck fire to his supervisor. The matter was returned to the trial level for further proceedings and new decisions by the WCJ, as the record needed further development, particularly regarding medical causation and specific body parts claimed.

Workers' Compensation Appeals BoardLabor Code Section 3600(a)(10)post-termination claimscumulative traumaspecific injuryreconsiderationrescinded decisionsfurther proceedingsmedical recordsnotice of injury
References
9
Case No. 2024 NY Slip Op 04610 [230 AD3d 1065]
Regular Panel Decision
Sep 26, 2024

Mosquera v. TF Cornerstone Inc.

Julio Mosquera, the plaintiff, initiated a lawsuit against TF Cornerstone Inc. and other defendants under Labor Law § 240 (1) after falling from a bathtub while painting due to unsuitable ladders. The Supreme Court denied the defendants' motion for summary judgment to dismiss the claim and granted the plaintiff's motion for partial summary judgment on his Labor Law § 240 (1) claim. The Appellate Division affirmed this decision, rejecting the defendants' arguments concerning a Workers' Compensation questionnaire, uncertified medical reports, and an expert's testimony. The court found these pieces of evidence flawed and insufficient to create a question of fact, and also concluded that TF Cornerstone Inc. and Midtown West A GC LLC were proven to be the owner's agents for purposes of the Labor Law.

Labor LawSummary JudgmentAppellate ReviewPersonal InjuryConstruction AccidentWorkplace SafetyLadder FallOwner's AgentPrima FacieExpert Testimony
References
8
Case No. ADJ9957492 ADJ9957588 ADJ10160287
Regular
Jul 14, 2017

JULIO NUNEZ vs. BARRETT BUSINESS SERVICES, INC., ACE AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board denied a petition for reconsideration by Barrett Business Services, Inc. and Ace American Insurance Company. The defendants sought to overturn a finding that the applicant, Julio Nunez, was entitled to choose his own psychotherapy provider due to a delay in treatment authorization. The Board agreed with the WCJ that the defendant's failure to authorize treatment with a chosen MPN provider after receiving proper notification established the applicant's right to seek care outside the MPN. This entitlement arose from specific instances of delayed and denied authorization for psychotherapy.

Workers' Compensation Appeals BoardReconsiderationJoint Findings and OrderPsychotherapy treatmentMedical Provider NetworkMPNProvider of choiceAuthorizationDelay of treatmentDenial of treatment
References
0
Case No. 2023 NY Slip Op 00202
Regular Panel Decision
Jan 18, 2023

Chicas v. Cassar

Julio Chicas initiated a legal malpractice action against Christopher J. Cassar and his law firm. The claim stemmed from the defendants' handling of a personal injury case, where the settlement proceeds were entirely consumed by a workers' compensation lien and attorney fees, leaving the plaintiff without any recovery. Chicas alleged the defendants failed to adequately investigate and pursue additional recovery avenues, including claims against the alleged tortfeasor personally and Supplemental Underinsured Motorist (SUM) benefits. The Supreme Court initially granted summary judgment dismissing the malpractice complaint but denied the defendants' motion for sanctions against Chicas. On appeal, the Appellate Division, Second Department, reversed the dismissal of the malpractice claim, determining that the defendants failed to establish prima facie that Chicas suffered no actual and ascertainable damages; the denial of sanctions against Chicas was affirmed.

Legal MalpracticeSummary JudgmentAppellate ReviewSanctionsDamagesWorkers' Compensation LienMotor Vehicle AccidentPersonal InjurySupplemental Underinsured Motorist
References
3
Case No. ADJ8430146 ADJ7912960 ADJ7914352
Regular
Apr 16, 2019

JULIO BALVANEDA vs. OPTIONS A CHILD CARE AND HUMAN SERVICES, EVEREST NATIONAL INSURANCE COMPANY, SPARTA INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed a WCJ's award of 95% permanent disability for industrial injuries sustained by Julio Balvaneda while employed as a gardener. The Board clarified that the specific number and dates of cumulative trauma injuries must be re-determined by the WCJ, as the record suggests a single continuous trauma due to ongoing treatment and work activities. The WCJ's finding of combined permanent disability was upheld, particularly concerning intertwined psychiatric and orthopedic impairments, referencing established case law. The matter was returned to the trial level for further proceedings on the cumulative trauma issue.

Workers' Compensation Appeals BoardReconsiderationCumulative TraumaApportionmentBensonAustinColtharpCombined Value ChartAgreed Medical EvaluatorPermanent Disability Rating
References
14
Case No. 2025 NY Slip Op 02363 [237 AD3d 1126]
Regular Panel Decision
Apr 23, 2025

Sisalima v. Thorne Constr., Inc.

The plaintiff, Julio Wilmer Sisalima, allegedly sustained injuries after falling from a roof on January 4, 2019, while working on a project for Limonejo's Framing Corp. He subsequently initiated an action claiming a violation of Labor Law § 240 (1). Both the plaintiff's motion for summary judgment on liability and the defendant Limonejo's Framing Corp.'s cross-motion for summary judgment on its defenses (sole proximate cause and recalcitrant worker) were denied by the Supreme Court, Suffolk County. The Appellate Division, Second Department, affirmed the Supreme Court's order, concluding that there were triable issues of fact regarding whether adequate safety devices were provided and if their absence proximately caused the accident. Additionally, the court found that the defendant failed to prima facie establish that the plaintiff was the sole proximate cause or a recalcitrant worker, as there was no evidence he was specifically instructed to use ropes and disregarded them.

Fall from RoofLabor Law ViolationSafe Place to WorkProximate CauseRecalcitrant Worker DefenseSummary Judgment DeniedPersonal InjuryAppellate ReviewConstruction AccidentSafety Devices
References
14
Case No. 2019 NY Slip Op 07746 [176 AD3d 627]
Regular Panel Decision
Oct 29, 2019

Encarnacion v. 3361 Third Ave. Hous. Dev. Fund Corp.

Plaintiff Julio Encarnacion moved for partial summary judgment on a Labor Law § 240 (1) claim, which was granted by the Supreme Court. Defendants appealed this decision. The case concerns plaintiff's injury during the disassembly of a formwork structure when an unsecured 1,500-pound brace frame fell and struck him. The appellate court found that the activity involved a substantial gravity-related risk, bringing it under Labor Law § 240 (1). It further determined that defendants violated the Labor Law by failing to provide adequate safety devices. The defendants' contention that plaintiff was the sole proximate cause of the accident was rejected as it constituted comparative negligence, not a defense under Labor Law § 240 (1). Consequently, the Appellate Division unanimously affirmed the lower court's grant of partial summary judgment to the plaintiff.

Labor LawGravity-related RiskFormwork DisassemblySummary JudgmentProximate CauseSafety DevicesAppellate ReviewConstruction AccidentNegligenceFalling Object
References
6
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