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

Case No. ADJ869605
Regular
Nov 19, 2012

MILES GRAY vs. AT&T, permissibly self-insured, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves an applicant who sustained a severe right lower extremity injury, leading to multiple surgeries, significant leg length discrepancy, and fused ankle/foot, requiring constant mobility aids. The Agreed Medical Evaluator (AME) provided opinions on impairment, and vocational experts testified regarding the applicant's ability to return to work. The Workers' Compensation Appeals Board denied reconsideration of the prior award, finding substantial evidence supporting the applicant's unsuitability for rehabilitation. Defendant's supplemental reply did not alter this decision.

Agreed Medical EvaluatorVocational ExpertPetition for ReconsiderationDeniedRight Lower Extremity InjuryMultiple FracturesLeg Length DiscrepancyShoe LiftAnkle FusionGait Derangement
References
1
Case No. 529417
Regular Panel Decision
Feb 06, 2020

Matter of Johnson v. City of New York

Thomas Johnson, a patient care technician, sustained work-related knee injuries in a February 2006 fall. He subsequently sustained additional work-related injuries in November 2009 to his neck, back, shoulder, and hips, for which he received schedule loss of use (SLU) awards for his right arm, left leg, and right leg. The Workers' Compensation Board later ruled on the permanency of his 2006 injuries, finding an 80% SLU for his left leg and a 40% SLU for his right leg. However, the Board reduced these new awards by his previously received SLU awards for the 2009 injuries, resulting in a final 30% SLU for his left leg and a 0% SLU for his right leg. The Appellate Division affirmed the Board's decision, confirming that SLU awards for the knee and hip are encompassed within leg awards, and prior leg SLU awards must be deducted from subsequent leg SLU awards.

Schedule Loss of UseKnee InjuriesHip InjuriesLeg ImpairmentPrior SLU Award DeductionAppellate Division ReviewIndependent Medical ExaminationTreating Physician ReportPermanent Impairment GuidelinesWork-related Accident
References
9
Case No. MISSING
Regular Panel Decision

United States v. Jafari

This Decision and Order addresses the government's motion for a preliminary order of forfeiture against Defendant Nina Jafari, a licensed clinical social worker convicted of health care fraud. Jafari was found guilty on four counts of defrauding BlueCross BlueShield of Western New York by billing for psychotherapy sessions using an inflated CPT code, often misrepresenting session lengths or billing individual sessions for group therapy. The Court, presided over by District Judge Elizabeth A. Wolford, granted the government's motion, ordering the forfeiture of $125,000. This decision considered both uncharged and acquitted conduct related to Jafari's broader fraudulent scheme, finding the amount reasonable based on a preponderance of the evidence, despite discrepancies in the calculation methodologies.

health care fraudforfeitureCPT code 90808criminal forfeituresentencingpreponderance of evidenceacquitted conductuncharged conductmoney judgmentfraudulent billing
References
38
Case No. MISSING
Regular Panel Decision

In re the Claim of Trickel

In this case, the claimant appealed a decision by the Workers’ Compensation Board regarding a consequential injury claim. The claimant sustained a fractured right tibia and fibula in 1988 during employment, for which workers’ compensation benefits were granted. In 1991, the claimant suffered a lower back injury and contended it was a consequence of the 1988 leg injury and subsequent leg shortening. The Workers’ Compensation Board denied this claim, ruling the 1991 accident was new and unrelated, and apportioned disability with 50% attributed to the noncompensable 1991 incident, 25% to the 1988 leg injury, and 25% to a prior noncompensable leg injury. The court affirmed the Board's decision, stating that whether a disability is consequentially related is a factual question for the Board and that the Board was free to credit the carrier’s expert testimony which found no causal relationship.

Workers' CompensationAppealCausally Related InjuryBack InjuryLeg FracturePermanent DisabilityApportionmentMedical Expert TestimonySubstantial EvidenceNew Accident
References
3
Case No. MISSING
Regular Panel Decision
Dec 13, 1979

In re the Claim of D'Amore v. Town of Hempstead

A claimant appealed a decision from the Workers’ Compensation Board regarding injuries sustained during employment. The claimant was injured by a falling heater, striking his head, right big toe, and leg, leading to subsequent ulceration, gangrene, and amputations of the toe and leg. Although initial medical reports only noted a head injury, later testimony from the claimant and medical experts, Dr. Grauer and Dr. Ahmad, established the link between the workplace accident and the toe and leg injuries. The Board found the injuries causally related. The Appellate Division affirmed the Board's determination, concluding that substantial evidence supported the findings.

AmputationGangreneUlcerationToe injuryLeg injuryHead injuryWorkplace accidentCredibilitySubstantial evidenceWorkers' Compensation
References
1
Case No. ADJ2505068
Regular
May 28, 2013

MARIA FREITAS vs. SAVEMART SUPERMARKETS

The Workers' Compensation Appeals Board denied SaveMart Supermarkets' petition for reconsideration of an award finding the applicant's right leg injury to be a compensable consequence of her industrial back injury. The WCAB adopted the judge's report, which found the applicant's testimony credible, supported by medical opinions noting prior leg weakness and difficulty walking. The judge found that a contemporaneous surgeon's report, which stated the applicant missed a step, was less persuasive than the applicant's consistent testimony and supporting medical evidence. The WCAB upheld the judge's credibility determination and the finding that the leg injury was causally related to the admitted back injury.

Compensable Consequence InjuryCredibility FindingWCJ Report AdoptionTibia FractureCumulative Back InjuryMechanism of InjuryLower Extremity WeaknessAntalgic GaitSworn TestimonyMedical Opinion
References
1
Case No. 2024 NY Slip Op 04848 [231 AD3d 1213]
Regular Panel Decision
Oct 03, 2024

Matter of DiPippo v. Accurate Signs & Awnings

Michael DiPippo sustained work-related injuries in an August 2006 fall, leading to an established claim later amended to include consequential right leg deep vein thrombosis and obesity. He underwent amputations of both legs in 2014 and 2018. DiPippo sought to amend his claim to include the consequential amputation of his right leg, arguing it was caused by conditions linked to his initial injury. The Workers' Compensation Board disallowed the amendment, finding insufficient medical proof of a causal connection. The Appellate Division affirmed the Board's decision, ruling that DiPippo did not qualify as a medical expert and his independent analysis or generalized statements of possibility were inadequate to establish the required causal nexus.

Workers' CompensationAmputationCausal NexusMedical EvidenceExpert TestimonyBoard DecisionAppellate ReviewSubstantial EvidenceWork-Related InjuryClaimant Burden of Proof
References
12
Case No. MISSING
Regular Panel Decision

Cohen v. Shopwell, Inc.

Plaintiff tripped over a renovation worker's leg in a supermarket aisle while renovation was underway. The path was obstructed by workers lying prone, with their legs extending across the aisle. The plaintiff had successfully navigated past them in one direction and over two workers on his return, but tripped when a third worker raised his leg. The IAS court initially granted summary judgment to the defendants, citing the plaintiff's admitted awareness of the hazard. However, the appellate court reversed this decision, ruling that it is a question for the jury whether the defendants created an unreasonably dangerous condition by conducting renovations in an open aisle. The court also clarified that the focus should be on whether the defendants were negligent in creating or permitting the condition, rather than a failure to warn, as the danger was open and obvious to the plaintiff. Comparative fault on the part of the plaintiff is still a factor for the jury to consider.

Personal InjuryNegligencePremises LiabilitySummary JudgmentOpen and Obvious DangerComparative FaultRenovation AccidentTrip and FallDuty to WarnJury Question
References
14
Case No. 2018 NY Slip Op 05981 [164 AD3d 1509]
Regular Panel Decision
Sep 06, 2018

Matter of Genduso v. New York City Dept. of Educ.

Claimant Anthony Genduso appealed an amended decision by the Workers' Compensation Board regarding his schedule loss of use (SLU) award for a right leg injury sustained in 2013. Genduso argued that the Board improperly deducted his entire 20% SLU award from a 1997 injury to his right leg when calculating the 7.5% SLU for his 2013 injury, asserting that only the knee portion of the 1997 award should have been deducted. The Appellate Division, Third Department, found Genduso's argument unpersuasive, stating that SLU awards are for overall physical and functional impairments of a body part, such as the leg, rather than specific injuries to constituent parts like the ankle or knee. The court affirmed the Board's decision, noting that Genduso was also precluded from challenging the 1997 SLU award as he had not sought Board review at that time.

Workers' CompensationSchedule Loss of UseRight Leg InjuryPrior Injury DeductionAppellate ReviewMedical ReportsEmployer LiabilityBoard DecisionKnee InjuryAnkle Injury
References
2
Case No. ADJ7908593
Regular
Mar 19, 2012

LA WANNA MONTGOMERY vs. REACH LEARNING ACADEMY CENTER, SOUTHERN INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to address a discrepancy in the applicant's average weekly wage and temporary disability rate. The defendant challenged the WCJ's calculation, highlighting a significant difference between the applicant's tax return and evidence presented at trial. The Board rescinded the WCJ's decision and returned the case for further proceedings to resolve this discrepancy, which impacts the applicant's credibility. The WCJ must have the applicant explain the differing earnings figures.

Average Weekly WageTemporary Disability RateEarnings DiscrepancyFederal Tax ReturnW-2s1099sApplicant CredibilityIndustrial InjuryFibula FractureCEO
References
2
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