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

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. MISSING
Regular Panel Decision

Claim of Steuber v. Home Properties, Inc.

Claimant applied for workers' compensation benefits after a March 2010 work fall, establishing injuries to his back, left knee, and left hip. After thoracic spine surgery in 2011, the employer and its workers' compensation carrier objected to coverage, arguing it was not causally connected to the initial claim. The Workers’ Compensation Board agreed, a decision which the appellate court affirmed. The court credited an independent medical examiner's opinion that the thoracic condition and subsequent falls were unrelated to the compensable accident, despite the claimant's orthopedic surgeon's testimony suggesting otherwise.

Workers' Compensation BenefitsCausal RelationThoracic Spine InjuryDegenerative ConditionIndependent Medical ExaminationSubsequent FallsBoard DecisionAppellate ReviewCredibility AssessmentSubstantial Evidence
References
3
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. ADJ6626529
Regular
Nov 05, 2015

NICOLAS WALKER vs. LOS ANGELES UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to further study the issues in this case. The WCAB rescinded the prior Findings of Fact & Award, denied the defendant's motion to be relieved of stipulation regarding the thoracic spine, and found that the applicant sustained industrial injury to his cervical spine, shoulders, and thoracic spine. The WCAB deferred issues of permanent disability, apportionment, and attorney's fees, returning the matter to the WCJ for further record development.

Workers' Compensation Appeals BoardNicolas WalkerLos Angeles Unified School DistrictSedgewick Claims Management ServicesInc.ADJ6626529Opinion and Decision After ReconsiderationFindings of Fact & AwardWCJcervical spine
References
5
Case No. ADJ7924562
Regular
Sep 19, 2014

RAUL HERNANDEZ vs. LOS ANGELES UNIFIED SCHOOL DISTRICT

The applicant sought reconsideration of a WCJ decision that found an industrial injury to the low back but not the cervical spine or left ankle, with no permanent disability or further medical treatment. The applicant argued the QME's reports were insubstantial and that prior permanent disability was not considered. The Appeals Board granted reconsideration to amend the original award to include injury to the cervical spine, affirming the remainder of the decision. Therefore, the applicant sustained injury to his low back and cervical spine.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryLow Back InjuryCervical Spine InjuryPermanent DisabilityFurther Medical TreatmentPanel Qualified Medical EvaluatorLabor Code Section 4664(b)
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. ADJ7969168; ADJ9330687
Regular
Mar 23, 2016

Mario Alcantar vs. Alfredo Melchor, Zenith Insurance Company

This case involves applicant Mario Alcantar's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The WCAB previously rescinded a joint finding and substituted a new one finding applicant sustained a lumbar spine injury but not a cervical spine injury during specified employment periods. Alcantar sought reconsideration to include a cervical spine injury during a different, unspecified period. The WCAB denied the petition, affirming its prior decision and incorporating it by reference.

Petition for ReconsiderationDecision After ReconsiderationJoint Findings of Factcumulative periodlumbar spinecervical spineindustrial injuryarising out of and occurring in the course of employmentWorkers' Compensation Appeals BoardZenith Insurance Company
References
0
Case No. ADJ9841969
Regular
Jul 23, 2019

MARIA ALBERTO vs. GUARDIAN HOME CARE, ZURICH AMERICAN INSURANCE COMPANY

This case involves a workers' compensation applicant who sustained injuries to her left elbow, left upper extremity, lumbar spine, and right knee. The WCAB granted reconsideration of an administrative law judge's decision to re-evaluate specific injuries and permanent disability. The Board found that further development of the medical record was necessary concerning alleged injuries to the right wrist, thoracic spine, and cervical spine. Consequently, the decision defers these issues and the determination of permanent disability pending further medical evidence.

WCABReconsiderationPanel Qualified Medical EvaluatorAdministrative Law JudgePermanent DisabilityIndustrial InjuryCervical SpineThoracic SpineRight WristMedical Opinion
References
3
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. ADJ790852
Regular
Apr 05, 2016

LAURA BREITIGAN vs. COUNTY OF RIVERSIDE

The Workers' Compensation Appeals Board granted the applicant's petition for reconsideration, amending the award to include attorney fees on accrued unpaid permanent disability benefits and correcting clerical errors. The Board denied the defendant's petition for reconsideration, upholding the finding of 100% permanent disability and injury to the lumbar spine. The defendant was also admonished for filing a document exceeding the page limit without prior permission. The applicant, a nurse, sustained industrial injuries to her thoracic spine, lumbar spine, and psyche.

Workers' Compensation Appeals BoardLaura BreitiganCounty of RiversideFindings and Awardindustrial injurythoracic spinelumbar spinepsychepermanent disabilityapportionment
References
0
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