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Case Law Database

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

Case No. MISSING
Regular Panel Decision

In re Desiree X.

Karen X. left her child, Desiree X., with her live-in boyfriend, Demetrius AA., who was later found to have caused the child's vaginal injuries. Petitioner filed a child abuse petition, which Family Court dismissed on abuse grounds but sustained on neglect grounds, adjudicating Desiree X. a neglected child and placing her in petitioner's custody. Karen X. appealed the neglect finding against her. The appellate court found insufficient evidence to establish neglect by Karen X., reasoning she had no prior reason to distrust Demetrius AA. The court reversed the neglect finding against Karen X. and remitted the matter for further proceedings, but affirmed the order as modified, noting the unchallenged neglect finding against Demetrius AA. still stands.

Child NeglectChild AbuseFamily LawParental SupervisionVaginal InjuryMedical ExaminationPreponderance of EvidenceRemittalAppellate Review
References
2
Case No. MISSING
Regular Panel Decision

Rosado v. Shalala

The plaintiff filed an application for disability insurance benefits due to a back injury. Despite opinions from treating physicians indicating total disability, an MRI and X-rays of the lumbar spine were negative. The government's physician also found the plaintiff walked normally with minimal physical abnormalities. The Administrative Law Judge deemed the plaintiff's pain testimony incredible and found him capable of light work. The court affirmed the Secretary's decision to deny benefits, concluding it was supported by substantial evidence, as workers' compensation standards differ from those for disability insurance benefits.

Social Security BenefitsDisability ClaimBack InjuryMedical EvidenceCredibility AssessmentAdministrative Law JudgeSubstantial EvidenceTreating Physician RuleLumbar SpineMRI Negative
References
8
Case No. MISSING
Regular Panel Decision

Santiago v. Bowen

The plaintiff, a 58-year-old man with an 8th-grade education and a history of physical labor, sought Supplemental Security Income (SSI) disability benefits after injuring his lumbar spine in 1986. His treating chiropractor, Dr. Serafín Izquierdo, opined he was totally disabled due to acute low back derangement, a possible herniated disc, and other related conditions. A consultative physician, Dr. Shu-mofsky, found minimal x-ray findings but noted severe pain during a straight leg raising test. The ALJ initially found the plaintiff capable of light work, a decision upheld by the Appeals Council. The District Court reversed this decision, ruling that the treating chiropractor's opinion on disability, within their field of expertise, should be given binding effect, especially when supported by evidence and not substantially contradicted. The court found Dr. Izquierdo's opinion uncontradicted and remanded the case for the calculation and disbursement of benefits.

Disability benefitsSupplemental Security Income (SSI)Chiropractor's opinionTreating physician ruleMedical evidenceLumbar spine injuryResidual functional capacityAdministrative Law JudgeAppeals CouncilReversal and remand
References
8
Case No. ADJ10679103
Regular
Dec 14, 2017

LARRY SYKES vs. THE ANSCHUTZ CORPORATION, STARR INDEMNITY & LIABILITY COMPANY

The Workers' Compensation Appeals Board granted reconsideration of a prior finding of industrial injury to the applicant's lumbar spine. The Board found that the existing medical reporting from Dr. Hong, Dr. Jamasbi, and the PQME Dr. Schofferman did not constitute substantial evidence to support this lumbar spine injury finding. Therefore, the case is returned to the trial level to develop the record further on the lumbar spine injury issue.

Workers' Compensation Appeals BoardPetition for ReconsiderationIndustrial InjuryCervical SpineThoracic SpineLumbar SpineStagehandSecurity OfficerMedical Treatment RecordsSubstantial Evidence
References
0
Case No. ADJ10384099
Regular
Jan 29, 2018

RODOLFO RODRIGUEZ vs. ROBERT BOSCH AFTERMARKET DIVISION, ZURICH NORTH AMERICA

The Appeals Board granted reconsideration to amend the finding of fact, clarifying that the applicant sustained a compensable injury to his lumbar spine arising out of and occurring within the course of employment. While medical evidence supported the lumbar spine injury, the Board deferred the issue of lower extremities as an injured body part for further development. This decision affirmed the original finding regarding the lumbar spine, based on applicant's credible testimony and medical opinions from Drs. Hutchinson and Schaffzin.

AOE/COELumbar spineLower extremitiesPetition for ReconsiderationFinding of FactWCJMedical evidencePreexisting conditionAggravationLighting up
References
14
Case No. AD10769216
Regular
Dec 13, 2019

Richard Hovannisian vs. UCLA, Permissibly Self-Insured, Administered By SEDGWICK CMS

The WCAB granted reconsideration and deferred issues of lumbar spine injury and permanent disability from a prior award. The WCJ's decision relied on a QME report that failed to establish industrial causation for the lumbar spine injury and lacked sufficient explanation for departing from AMA Guides methodology for permanent disability ratings. The Board found these deficiencies meant the decision was not based on substantial medical evidence. Further proceedings are required for the QME to adequately address causation, rating methodology, and lumbar spine classification.

WCABPetition for ReconsiderationFindings of Fact & Awardindustrial injurylumbar spinepermanent disabilitysubstantial medical evidencedue processDisability Evaluation Unitpanel qualified medical evaluator
References
4
Case No. MISSING
Regular Panel Decision

In re Shaun X.

The case concerns a father (respondent) who appealed a Family Court decision finding him to have abused and neglected his son, Shaun X., and issuing an order of protection prohibiting contact until the child's 18th birthday. The petitioner, a social services agency, initiated the proceedings in February 1994, following a history of prior allegations and a conviction for sexual misconduct involving a niece. The Family Court sustained the allegations based on testimony from the child's mother, a social worker, and a psychologist, all indicating sexual abuse. The appellate court affirmed the Family Court's findings, rejecting the respondent's contentions regarding diligent efforts and the sufficiency of the evidence. The court also upheld the order of protection, deeming it reasonable given the risks, the child's wishes, and the respondent's past failure to comply with court-ordered counseling.

Child AbuseChild NeglectSexual AbuseOrder of ProtectionSupervised VisitationFamily Court ActSocial Services LawAppellate ReviewPreponderance of EvidenceOut-of-Court Statements
References
12
Case No. 2024 NY Slip Op 00599 [224 AD3d 428]
Regular Panel Decision
Feb 06, 2024

Matter of New Millennium Pain & Spine Medicine, P.C. v. Garrison Prop. & Cas. Ins. Co.

This case involves two appeals by New Millennium Pain & Spine Medicine, P.C. against Garrison Property & Casualty Insurance Company and GEICO Casualty Company. New Millennium sought to vacate master arbitration awards that denied its claims for no-fault benefits for medical services. The Supreme Court denied these applications. The Appellate Division, First Department, affirmed the Supreme Court's decisions, stating that an arbitrator's award will not be set aside unless it is irrational. The court also addressed the argument regarding a 20% wage offset in no-fault benefits, finding it unavailing under Insurance Law § 5102 (b). Ultimately, New Millennium was not entitled to attorneys' fees as it was not the prevailing party.

No-fault benefitsarbitration awardvacaturinsurance lawwage offsetappellate reviewmedical servicesno-fault policy exhaustionattorneys' feesCPLR Article 75
References
8
Case No. ADJ11756808
Regular
Apr 04, 2023

JASON KOLB vs. TAMPA BAY DEVIL RAYS, TRAVELERS INDEMNITY COMPANY

This case involves a professional athlete claiming cumulative industrial injury to multiple body parts. The Appeals Board granted reconsideration, finding that the initial judge erred by solely awarding benefits for the left shoulder, despite unanimous medical evidence of injury to other areas. The Board adopted the opinions of Dr. Kim, finding industrial injury to the cervical spine, lumbar spine, right shoulder, left elbow, wrists, hands, fingers, hips, and left knee. Consequently, the applicant's permanent disability award was increased from 3% to 41%.

ADJ11756808Petition for ReconsiderationFindings and AwardPermanent DisabilityIndustrial InjuryCervical SpineLumbar SpineRight ShoulderLeft ElbowWrists
References
4
Case No. ADJ8413521
Regular
Apr 13, 2020

STEVEN KING vs. COUNTY OF SAN BERNARDINO

This Workers' Compensation Appeals Board case involves applicant Steven King's claims for injury arising out of and occurring in the course of employment, including bilateral shoulders, lumbar spine, cardiac system, hernia, skin disorder, hearing loss, and hypertension. The Board affirmed the finding of injury AOE/COE and the hypertension rating but remanded the case for further development of the record regarding the applicant's lumbar spine impairment. The administrative law judge's prior rejection of the Agreed Medical Examiner's (AME) supplemental opinion on lumbar spine disability was deemed an improper disregard of substantial medical evidence.

Workers' Compensation Appeals BoardPetition for ReconsiderationAmended Findings and Awardinjury arising out of and occurring in the course of employmentbilateral shoulderslumbar spinecardiac systemherniaskin disorderhearing loss
References
8
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