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

Case No. 2020 NY Slip Op 04933 [186 AD3d 1351]
Regular Panel Decision
Sep 16, 2020

Lemus v. New York B Realty Corp.

The plaintiff, a construction worker, sustained injuries while maneuvering heavy steel beams at ground level on a construction site. He filed a lawsuit against the building owner, New York B Realty Corp., alleging a violation of Labor Law § 240 (1). The Supreme Court, Queens County, granted the defendant's motion for judgment as a matter of law, dismissing the Labor Law § 240 (1) cause of action, ruling that the plaintiff's injuries did not stem from an elevation-related risk as contemplated by the statute. The plaintiff appealed this decision. The Appellate Division, Second Department, affirmed the lower court's judgment, agreeing that Labor Law § 240 (1) is applicable only to injuries resulting from physically significant elevation differentials and inadequate safety devices against such risks, which were not present in this case.

Construction site injuryLabor Law § 240(1)Elevation-related riskJudgment as a matter of lawWorker safetySteel beamsGround level hazardAppellate reviewPersonal injuryPremises liability
References
6
Case No. ADJ446518 (MON 0327707)
Regular
Jul 22, 2009

LINO LEMUS vs. CALIFORNIA SKATE FACTORY, STATE COMPENSATION INSURANCE FUND

In this workers' compensation case, the defendant sought reconsideration of an award granting the applicant 64% permanent disability for a right hand and psyche injury. The original judge relied on the Agreed Medical Examiner's (AME) report for the disability rating, but later conceded in his reconsideration report that the AME's opinion was unreliable. The Appeals Board granted reconsideration, rescinded the award, and returned the case to the trial level. This action was taken because the Appeals Board could not affirm the award based on the judge's conflicting statements about which medical evidence he actually relied upon.

Workers' Compensation Appeals BoardLino LemusCalifornia Skate FactoryState Compensation Insurance FundADJ446518ReconsiderationFindings and AwardPermanent DisabilityIndustrial InjuryAgreed Medical Examiner
References
0
Case No. ADJ11556777
Regular
Oct 02, 2020

LISANDRO LEMUS vs. SGL TECHNIC, LLC, SOMPO AMERICA

In this case, the Workers' Compensation Appeals Board (WCAB) dismissed Lisandro Lemus's Petition for Removal. The WCAB found the petition to be moot and incorporated the reasoning from the workers' compensation administrative law judge's report. Consequently, the petition was dismissed without prejudice.

Petition for RemovalWCJ reportmootWorkers' Compensation Appeals BoardDismissalLisandro LemusSGL TechnicSompo AmericaADJ11556777Los Angeles District Office
References
0
Case No. ADJ3767193
Regular
Nov 28, 2012

MARIA CARMEN LEMUS vs. J. G. BOSWELL COMPANY, ACCLAMATION

The Workers' Compensation Appeals Board (WCAB) dismissed a Petition for Removal filed by J.G. Boswell Company and Acclamation against Maria Carmen Lemus. The dismissal was primarily because the Petition was not verified. Even if it had been verified, the WCAB would have denied the petition on its merits, adopting the reasoning of the workers' compensation administrative law judge. Therefore, the Petition for Removal was dismissed in its entirety.

Petition for RemovalDismissalVerified PetitionWorkers' Compensation Appeals BoardWCJ ReportMeritProcedural DefectLegal DocumentAdministrative Law JudgeApplicant
References
0
Case No. ADJ977533 (GOL 0101844)
Regular
Dec 16, 2013

VICTOR LEMUS vs. BACARA RESORT & SPA, LIBERTY MUTUAL FIRE INSURANCE COMPANY

This case involves a petition for reconsideration filed by the defendants, Bacara Resort & Spa and Liberty Mutual Fire Insurance Company, regarding a September 24, 2013 decision. The applicant is Victor Lemus. The defendants have withdrawn their petition for reconsideration. Consequently, the Workers' Compensation Appeals Board has dismissed the petition.

Petition for ReconsiderationWithdrawn PetitionDismissed PetitionWorkers' Compensation Appeals BoardBacara Resort & SpaLiberty Mutual Fire Insurance CompanyVictor LemusADJ977533GOL 0101844Van Nuys District Office
References
0
Case No. ADJ12910087
Regular
Dec 28, 2020

ESTHER LEMUS SALDANA vs. TAO TAI HOMES CORPORATION, INSURANCE COMPANY OF THE WEST

This case concerns a dispute over the correct Qualified Medical Evaluator (QME) panel for applicant Esther Lemus Saldana. The defendant sought reconsideration of an order finding the applicant's chiropractic QME panel valid and the defendant's orthopedic panel invalid. The Workers' Compensation Appeals Board denied the petition, upholding the administrative law judge's decision. The Board found the applicant properly requested a new panel after retaining counsel, and despite a service error on the chiropractic panel, the defendant had opportunity to contest the specialty. Therefore, the applicant's chiropractic QME panel remains the correct one for the medical-legal evaluation.

QME PanelChiropractic QMEOrthopedic QMEPetition for ReconsiderationFindings of Fact and OrdersMedical-Legal EvaluationQualified Medical EvaluatorAdministrative Director RuleRomero v. Costco WholesaleLabor Code Section 4062.1
References
9
Case No. ADJ12194461
Regular
Dec 10, 2020

Antonio Lemus vs. STEVE P. RADOS, INC., STARR INDEMNITY & LIABILITY COMPANY

This case concerns applicant Antonio Lemus's entitlement to home health care following an admitted industrial head injury. Defendant sought reconsideration of a WCJ's award enforcing a Utilization Review (UR) determination that modified but approved home health aide services. The defendant argued the WCJ lacked jurisdiction to enforce the UR determination due to a second, later UR denial of the same request, which they claimed was timely. The Appeals Board affirmed the WCJ's decision, finding jurisdiction to enforce the initial UR approval and deeming the subsequent denial an improper "self-granted appeal." The Board concluded the applicant was entitled to the treatment approved by the first UR determination.

Workers' Compensation Appeals BoardUtilization ReviewRequest for AuthorizationIndependent Medical ReviewFindings Orders and AwardPetition for ReconsiderationNurse Case ManagerTraumatic Brain InjuryHome Health AideMedical Treatment
References
2
Case No. ADJ7915283
Regular
Nov 01, 2013

GUILLERMO LEMUS vs. G & K MANAGEMENT, INC., CHUBB INSURANCE GROUP, GALLAGHER BASSETT SERVICES, INC.

This case involves an applicant, Guillermo Lemus, and defendants G & K Management, Inc., and Chubb Insurance Group. The Workers' Compensation Appeals Board (WCAB) issued an order dismissing a Petition for Reconsideration filed in this matter. The WCAB adopted the reasoning of the workers' compensation administrative law judge, noting the petition was skeletal and unverified. Even on the merits, the petition would have been denied based on the WCJ's report.

Petition for ReconsiderationWCABAdministrative Law JudgeLien ClaimantUnverifiedSkeletalDismissalChubb Insurance GroupGallagher Bassett ServicesG&K Management
References
0
Case No. ADJ7531724, ADJ7531690
Regular
Dec 01, 2017

AURORA LEMUS vs. FREEBIRDS WORLD BURRITO, GRANITE STATE INSURANCE COMPANY, MARK ORFALIA, REDWOOD FIRE AND CASUALTY COMPANY

This case involves a dispute between Granite State Insurance Company and Redwood Fire and Casualty Company regarding contribution for workers' compensation benefits paid to applicant Aurora Lemus. Granite, initially denied contribution by the WCJ, petitioned for reconsideration. The parties subsequently settled the contribution claim for $22,500.00 through mediation, which has been approved by the Board. This stipulation fully resolves Granite's claims against Redwood.

Workers' Compensation Appeals BoardReconsiderationContributionReimbursementJoint Findings of FactCompromise and ReleaseStipulationVoluntary MediationCommissioners' Settlement ConferenceInsurer
References
0
Case No. ADJ9358203
Regular
Nov 26, 2018

OCTAVIO LEMUS vs. HASA, INC.; COMMERCE & INDUSTRY INSURANCE COMPANY; administered by AIG PROPERTY CASUALTY; INSURANCE COMPANY OF THE WEST

Defendants seek reconsideration of a WCJ's award finding 71% permanent disability for applicant Octavio Lemus, arguing the judge erred by not apportioning disability and by failing to address non-industrial factors identified by a QME. The Appeals Board granted reconsideration, agreeing the record on apportionment was undeveloped and that the EDD lien and other defendant contentions require further consideration. The case is returned to the trial level for further proceedings and a new decision addressing all raised issues, including apportionment.

Workers Compensation Appeals BoardReconsiderationPermanent DisabilityApportionmentCumulative TraumaQualified Medical EvaluatorTemporary DisabilityLife PensionEmployment Development DepartmentLiens
References
7
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