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Case Law Database

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

Case No. 533217
Regular Panel Decision
Jun 23, 2022

Matter of Kromer v. UPS Supply Chain Solutions

Claimant Douglas A. Kromer established a workers' compensation claim for a work-related rotator cuff tear in his left shoulder. While a Workers' Compensation Law Judge (WCLJ) initially found a 35% schedule loss of use (SLU) of the left arm, the Workers' Compensation Board modified this to 20%, crediting the opinion of Gerald Coniglio, an orthopedic surgeon. The Board further ruled that Kromer was not entitled to a further SLU award due to prior left elbow SLU awards totaling 30%, which exceeded the current 20% award. The Appellate Division reversed the Board's decision, remitting the matter for further consideration. The court found that the Board failed to consider whether the shoulder injury resulted in an increased loss of use of the left arm beyond the prior elbow injuries and also lacked a rational basis for not adding value for a posterior extension defect in the SLU calculation, departing from its own precedent.

Workers' CompensationSchedule Loss of Use (SLU)Rotator Cuff InjuryShoulder InjuryLeft ArmPrior Injury OffsetMedical OpinionImpairment GuidelinesAppellate ReviewRemittal
References
19
Case No. ADJ3149661 (SDO 0271415)
Regular
Apr 27, 2012

Elsa Cervantes vs. COSTCO WHOLESALE CORPORATION, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board granted reconsideration to find that applicant Elsa Cervantes sustained an industrial injury to her left shoulder, overturning the WCJ's prior decision. The Board found substantial medical evidence supported that the rotator cuff tear arose from the April 27, 2000 incident, reversing the WCJ's reliance on Dr. Lane's opinion. Applicant is entitled to further medical treatment, including surgery, and continuing temporary disability benefits for the left shoulder injury. However, the Board affirmed the WCJ's decision regarding the defendant's right to control medical treatment through its Medical Provider Network, finding no contrary evidence of substantiality to overturn the credibility findings.

Workers Compensation Appeals BoardElas CervantesCostco Wholesale CorporationSedgwick Claims Management Servicesindustrial injuryneck injuryleft trapezius muscle injurypsyche injuryleft shoulder injuryMedical Provider Network (MPN)
References
0
Case No. 534536
Regular Panel Decision
Jun 09, 2022

Matter of Harmon v. Office of Children & Family Servs.

Claimant Wesley Harmon appealed a Workers' Compensation Board decision finding a 20% schedule loss of use (SLU) of his left arm and reducing his counsel fees. Harmon sustained a left shoulder injury in 2018, with conflicting medical opinions from orthopedists John Goldblatt (20% SLU) and Frederick Kaempffe (50% SLU). The Board credited Goldblatt's assessment, finding it consistent with Harmon's medical history and current guidelines which no longer add a percentile for rotator cuff tears, and reduced counsel fees. The Appellate Division affirmed the Board's determination, holding that it was supported by substantial evidence and that the Board exercised proper discretion in weighing medical evidence and setting counsel fees.

Workers' CompensationSchedule Loss of UseLeft Arm InjuryShoulder Impingement SyndromeRotator Cuff TearMedical Expert OpinionConflicting Medical EvidenceMaximum Medical ImprovementAppellate ReviewCounsel Fees
References
12
Case No. MISSING
Regular Panel Decision
Sep 28, 2017

Barrett v. Berryhill

Plaintiff Brian Scott Barrett challenged the Commissioner of Social Security's denial of his disability benefits application. The Administrative Law Judge (ALJ) initially found Barrett not disabled, concluding he could perform light work despite impairments like a right knee meniscal tear, left shoulder rotator cuff tear, neck and low back degenerative disc disease, and depressive disorder. The Appeals Council denied review, making the ALJ's decision final. Barrett moved for judgment on the pleadings, arguing errors in weighing medical opinions, RFC determination, and credibility. The Court denied both motions for judgment on the pleadings and remanded the case to the ALJ, citing the ALJ's failure to properly apply the treating physician rule to Dr. Dowling's opinions and to clarify reliance on a Single Decisionmaker's RFC assessment.

Disability BenefitsSocial Security ActTreating Physician RuleAdministrative Law JudgeResidual Functional CapacityDepressive DisorderKnee InjuryShoulder InjuryBack PainNeck Pain
References
38
Case No. MISSING
Regular Panel Decision

Claim of Anderson v. New York City Department of Design & Construction

Claimant appealed a Workers' Compensation Board decision from April 25, 2013, which denied his application to include a partial right rotator cuff tear under his existing 2002 work-related injury claim. The Board found that claimant failed to establish a causal link between the 2002 automobile accident and the 2009 rotator cuff tear, despite the opinion of his orthopedist. The orthopedist acknowledged that age-related degeneration could cause such tears independently of trauma. The Appellate Division affirmed the Board's decision, concluding there was substantial evidence to support the finding that the orthopedist's testimony did not convincingly prove a causal relationship.

Rotator cuff tearCausal relationshipWorkers' CompensationMedical evidenceDisabilityWork-related injuryAutomobile accidentShoulder painOrthopedist opinionSubstantial evidence
References
4
Case No. 518426
Regular Panel Decision
Oct 02, 2014

MatterofAndersonvNewYorkCityDepartmentofDesign&Construction

Donald Anderson, the claimant, sought workers' compensation benefits for injuries sustained in a 2002 work-related automobile accident. Initially, his claim was established for neck and back injuries, but in 2005, the Workers' Compensation Board determined he had no continuing disability, noting he was magnifying symptoms. In 2009, Anderson was diagnosed with a partial right rotator cuff tear, which he sought to include under his existing claim, alleging a causal link to the 2002 accident. The Board denied this application, finding a lack of established causal relationship. The Appellate Division affirmed the Board's decision, concluding that Anderson failed to present convincing evidence from his orthopedist or any other proof to establish the necessary causal connection between the 2002 accident and his right rotator cuff tear.

Workers' CompensationCausally Related InjuryRotator Cuff TearAutomobile AccidentMedical EvidenceDisability BenefitsAppellate ReviewShoulder InjurySubstantial EvidenceCausation
References
4
Case No. MISSING
Regular Panel Decision
Feb 21, 2012

Claim of Borgal v. Rochester-Genesee Regional Transportation Authority

In January 2009, the claimant sustained work-related injuries to his left shoulder and right hand, leading to total temporary disability benefits after undergoing shoulder surgery in July 2009. An MRI in August 2010 revealed a retearing of the rotator cuff. The self-insured employer initiated surveillance and alleged that the claimant violated Workers’ Compensation Law § 114-a by misrepresenting his work activities and the extent of his disability on benefits questionnaires. However, a Workers’ Compensation Law Judge and subsequently the Workers’ Compensation Board found that the claimant had not violated the law. The Appellate Division affirmed this decision, concluding that there was substantial evidence to support the Board's determination, noting that the claimant's minimal renovation-related activities did not constitute work for the purpose of misrepresentation and that medical opinions supported his reported disability level.

Workers' Compensation LawFraud allegationMisrepresentation of disabilitySurveillance evidenceRotator cuff injuryTotal temporary disabilitySubstantial evidenceAppellate reviewClaimant credibilityRenovation activities
References
11
Case No. CV-23-0067
Regular Panel Decision
May 16, 2024

In the Matter of the Claim of Raymond Garrow

Claimant, a delivery driver, sustained a left arm injury in 2004, leading to a biceps rupture and subsequent surgeries. The Workers' Compensation Board ruled he was entitled to a 33⅓% schedule loss of use (SLU) award for his left arm, applying special consideration 6 of the 2018 Workers' Compensation Guidelines for Determining Impairment. Claimant appealed, arguing that this Court's prior decision in Matter of Blue v New York State Off. of Children & Family Servs. applied, allowing for a higher SLU award due to additional diagnoses like a torn rotator cuff. The Appellate Division disagreed with the Board's narrow interpretation of Blue, finding it applicable to shoulder injuries as well as knee injuries, and remitted the matter for a proper assessment of medical evidence regarding claimant's additional deficits.

Schedule Loss of UseSLU AwardLeft Arm InjuryBicep Tendon RuptureRotator Cuff TearWorkers' Compensation GuidelinesSpecial Consideration 6Medical EvidenceRemittalAppellate Review
References
3
Case No. ADJ2934117 (STK 0214084)
Regular
Jun 06, 2011

BENNIE MADAVE vs. STOCKTON UNIFIED SCHOOL DISTRICT

This case involves an applicant seeking workers' compensation for a right shoulder rotator cuff repair surgery denied by a WCJ. The WCJ ruled the need for surgery stemmed from a subsequent non-industrial accident, not the initial industrial injury. The Appeals Board granted reconsideration, rescinded the original order, and returned the case for further medical record development. This is because the medical evidence failed to definitively determine if the surgery was necessary to cure or relieve the effects of the industrial injury, even if the tear itself wasn't solely industrially caused.

Rotator cuff repairIndustrial injuryNon-industrial accidentUtilization reviewPanel Qualified Medical EvaluatorPQMEApportionmentPermanent disabilityInextricably linkedFurther development of medical record
References
1
Case No. ADJ1313860
Regular
Mar 07, 2017

Kevin Voelker vs. D. Frey Plastering Co., State Compensation Insurance Fund

This case involves a workers' compensation applicant challenging an Independent Medical Review (IMR) determination that denied authorization for shoulder surgery. The applicant argued the IMR incorrectly applied guidelines for acromioplasty/impingement syndrome instead of guidelines for a rotator cuff tear, which was the actual condition for which surgery was requested. The Appeals Board granted reconsideration, finding the IMR's determination was based on a plainly erroneous mistake of fact readily apparent from the submitted records, not requiring expert opinion. Consequently, the Board rescinded the IMR determination and remanded the matter for a new IMR process.

Workers' Compensation Appeals BoardIndependent Medical ReviewPetition for ReconsiderationFindings and OrderPlainly Erroneous Finding of FactMedical Treatment Utilization ScheduleRequest for AuthorizationRotator Cuff TearAcromioplastyImpingement Syndrome
References
3
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