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

Case No. ADJ3218661 (OAK 0339889)
Regular
Feb 07, 2011

CHANCE ROLLINS vs. JOHN MARTIN STABLES, INC.; AMERICAN HOME ASSURANCE administered by AIG, CLAIMS SERVICES

The Appeals Board vacated its prior order granting reconsideration and dismissed the defendant's petition for reconsideration, finding the WCJ's ruling was not a final order. However, the Board granted removal, rescinded the WCJ's order, and denied the applicant's request for a neurology consultation under Labor Code §4601(a). The matter was returned to the trial level with instructions to issue an order for a new QME panel in neurology, as Dr. Jamasbi's request for a consultative neurological evaluation constituted good cause for a new panel under 8 Cal. Code Regs. §31.7. Attorney fees for the ex parte communication were upheld.

WCABPetition for ReconsiderationPetition for RemovalLabor Code 4601(a)Labor Code 4062.3QMEAgreed Medical EvaluatorNeurological ConsultMedical DirectorSpecialty Panel
References
0
Case No. G107 435
Regular Panel Decision
Jun 02, 2023

Matter of Marku v. ABM Industries

This case concerns the claim of Denise Perry under the Workers' Compensation Law. The Workers' Compensation Law Judge (WCLJ) previously found that the employer, Adventist Home Care, established a violation of Workers' Compensation Law § 114-a by the claimant for willfully making false statements to obtain benefits. Consequently, the WCLJ disallowed indemnity benefits and imposed both mandatory and discretionary penalties. A Board Panel decision filed on February 17, 2022, affirmed the WCLJ's findings. The claimant subsequently filed an application for reconsideration on March 18, 2022, which the Board Panel reviewed. After considering the claimant’s arguments, the Board Panel determined that the application did not raise new issues or present new material evidence, nor did it demonstrate an erroneous statement of material fact or law in the prior decision. Therefore, the Board Panel, by a majority vote, affirmed its prior decision.

Workers' Compensation FraudFalse RepresentationIndemnity Benefits DisallowanceWCL § 114-a PenaltyApplication for Reconsideration DeniedBoard Panel AffirmationWillful MisrepresentationWorkers' Compensation Law Judge DecisionEmployer Established Violation
References
0
Case No. MISSING
Regular Panel Decision

Long Island Neurological Assocs., P.C. v. Highmark Blue Shield & Reed Smith LLP

Plaintiff Long Island Neurological Associates, P.C. sued Highmark Blue Shield and Reed Smith LLP for under-reimbursement of surgical services under ERISA. The case involved a 4-year-old patient who received complex out-of-network surgery from Dr. Schneider due to the unavailability of in-network providers. Highmark significantly under-reimbursed the billed amount and denied multiple appeals, failing to provide requested documentation. The patient's parents assigned their rights to the Plaintiff, leading Defendants to move for dismissal, asserting an anti-assignment provision in their Administrative Service Agreement (ASA). The Court denied the motion, ruling that the ASA is not an ERISA plan document and thus its anti-assignment clause is not binding on plan participants, confirming Plaintiff's standing. The Rule 12(b)(6) motion was also denied as abandoned.

ERISAMotion to DismissAnti-assignment clauseAdministrative Service Agreement (ASA)Plan DocumentSubject Matter JurisdictionStandingUnder-reimbursementOut-of-network providerHealth Insurance
References
27
Case No. ADJ14784661
Regular
Aug 01, 2025

Jeremy Vietmeier vs. Northrop Grumman Systems Corporation, American Home Assurance Company

Applicant Jeremy Vietmeier sought reconsideration of a WCJ's May 8, 2025 Findings of Fact and Orders (F&O) which found good cause for an additional neurology QME panel but denied one in psychiatry. The Appeals Board dismissed the petition for reconsideration but granted it as a petition for removal. They rescinded the original F&O and substituted new findings, determining that good cause exists for additional QME panels in both neurology and psychiatry. The Board also provided guidance regarding the admissibility of a psychiatric report from David Kauss, Ph.D., disagreeing with a dissenting commissioner on its immediate inadmissibility, noting the issue was not yet ripe for a ruling.

WCABPetition for ReconsiderationPetition for RemovalQualified Medical Evaluator (QME)Medical DirectorDivision of Workers' Compensation (DWC)AdmissibilityPsychiatric ReportGood CauseFinal Order
References
17
Case No. MISSING
Regular Panel Decision

Matter of Burns v. New York State Workers' Compensation Board

Claimant sought workers' compensation benefits due to injuries from an automobile accident. As an employee of the Workers’ Compensation Board, his claim was processed through a neutral outside arbitration process. An arbitrator established his claim and average weekly wage. Claimant appealed, arguing his average weekly wage should have been calculated differently due to a recent promotion, as per Workers’ Compensation Law § 14 (2). An arbitration panel declined to address this argument because it was not raised before the arbitrator. The appellate court affirmed the panel's decision, citing that the panel could decline review of issues not previously raised, consistent with 12 NYCRR 300.13 [e] [1] [iii].

ArbitrationAverage Weekly WageWorkers' CompensationAppellate ReviewIssue PreservationAdministrative LawProcedural Due ProcessStatutory InterpretationWorkers’ Compensation Board
References
2
Case No. MISSING
Regular Panel Decision

Claim of Mulligan v. Workers' Compensation Board

The claimant, a former workers' compensation law judge, appealed the denial of reduced earning benefits, which stemmed from his claim that stress from his job caused him to voluntarily withdraw from the labor market. He had previously received benefits for a 1995 angina attack. An arbitrator and subsequent arbitration panel concluded that he voluntarily withdrew from the labor market, a determination the claimant contested, asserting his retirement was due to work-related stress. The court, led by Judge Carpinello, found substantial evidence supported the panel's decision, noting the claimant never complained of stress to supervisors, sought accommodations, or applied for disability retirement. The court affirmed the arbitration panel's decision, denying the claimant's appeal.

Voluntary Withdrawal from Labor MarketReduced Earning BenefitsWorkers Compensation BenefitsArbitration Panel DecisionSubstantial EvidenceDisability RetirementJob-Related StressAppellate ReviewLabor Market WithdrawalClaim Denial
References
8
Case No. WCB No. G076 2707
Regular Panel Decision
Dec 09, 2021

Matter of Duncan v. John Wiley & Sons, Inc.

This Board Panel Decision concerns an appeal by the applicant, Joseph Lafayette, regarding a Workers' Compensation Law Judge's (WCLJ) finding on the causal relationship of his back injury. The applicant sustained injuries to his back, neck, and shoulder during his employment. The WCLJ had previously established a causal relationship for the neck and shoulder injuries but disallowed the claim for the back injury. Upon review, the Board Panel determined that the medical evidence in the record supports a causal relationship between the claimant's employment and his lower back injury. As a result, the Panel modified the WCLJ's decision to establish a causal relationship for the back injury, while affirming the other aspects of the original decision.

Workers' CompensationBack InjuryNeck InjuryShoulder InjuryCausal RelationshipMedical EvidencePanel ReviewWCLJ DecisionModificationAppeal
References
2
Case No. MISSING
Regular Panel Decision

Leone v. Columbia Sussex Corp.

Alfred Leone sustained injuries when a scaffold plank broke at a construction site owned and operated by Columbia Sussex Corp. He was an employee of Smith Glass Co., a subcontractor, and the scaffold was erected by another subcontractor, Panelized Systems, Ltd. Columbia Sussex Corp. appealed orders denying its motion to amend its answer with a Workers’ Compensation Law defense and denying summary judgment on its third-party complaint against Panelized. The appellate court reversed the denial to amend, finding a question of fact on whether Leone was a special employee of Columbia, thus allowing the Workers' Compensation defense to be asserted. However, the court affirmed the denial of summary judgment for indemnification against Panelized, ruling contractual indemnification inapplicable and common-law indemnification premature.

Personal InjuryScaffold AccidentWorkers' Compensation LawSpecial EmploymentAmended AnswerSummary JudgmentContractual IndemnificationCommon-Law IndemnificationSubcontractor LiabilityConstruction Accident
References
9
Case No. G0699450
Regular Panel Decision
Aug 10, 2023

Matter of Von Maack v. Wyckoff Heights Medical Center

The claimant, Yvette Robles, sustained a work-related injury to her left knee. The Workers' Compensation Law Judge (WCLJ) initially established accident, notice, and causal relationship. However, the employer and carrier appealed, contending the claim was untimely filed. A Board Panel modified the WCLJ's decision, determining that the claim was barred by Workers' Compensation Law § 28 due to untimely filing. The Full Board subsequently affirmed the Board Panel's decision, upholding the bar to the claim.

Timeliness of ClaimWCL § 28Board Panel ReviewAccident, Notice, and Causal RelationshipLeft Knee InjuryEmployer AppealFull Board ReviewClaim BarredStatute of LimitationsWork-Related Injury
References
0
Case No. ADJ9379623
Regular
May 18, 2018

ETHERY AMARI vs. CHILDREN'S HOSPITAL OF LOS ANGELES

The Workers' Compensation Appeals Board granted the applicant's petition for removal, rescinding a prior order that denied her request for an additional neurology Qualified Medical Evaluator (QME). The applicant sustained admitted injuries including to her spine and shoulder, and also claimed headaches. Her treating physician recommended a neurology consult twice, and the applicant testified about worsening headaches post-injury. The Board found that these factors constituted good cause and demonstrated significant prejudice, warranting the appointment of a neurology QME panel.

Petition for RemovalPanel Qualified Medical EvaluatorNeurology QMEWCABFindings and OrderIndustrial InjuryCervical SpineLumbar SpineHeadachesPrimary Treating Physician
References
1
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