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

Case No. 2021 NY Slip Op 02039
Regular Panel Decision
Apr 01, 2021

Matter of Sanchez v. Jacobi Med. Ctr.

Claimant Rurico Sanchez was injured in a work-related accident in 2008, leading to a permanent partial disability classification. Following spinal surgeries in 2014 and 2015, the Workers' Compensation Board reclassified his disability and applied various benefit periods against his 300-week durational limit. This appeal addresses the Board's subsequent reclassification decision upon remittal from a prior Appellate Division ruling. The Court found insufficient evidence for the Board's reclassification of claimant as permanently partially disabled for the period following his March 2014 surgery (September 4, 2014 to December 10, 2015) and remitted this portion. However, it affirmed the reclassification for the period following the December 2015 surgery (September 15, 2016 to November 6, 2017). The Court also reversed the Board's reclassification of claimant from temporary total disability to permanent partial disability for periods between surgeries, citing a violation of due process for lack of notice and opportunity to be heard. The matter is remitted to the Workers' Compensation Board for further proceedings consistent with the decision.

Workers' CompensationPermanent Partial DisabilityTemporary Total DisabilityDurational LimitsWage Loss BenefitsReclassificationDue ProcessMedical OpinionSpinal SurgeryAppellate Review
References
7
Case No. SJO 0245781
En Banc

Michael A. Willette vs. AU Electric Corporation, State Compensation Insurance Fund

The Workers' Compensation Appeals Board, in an en banc decision, holds that medical treatment disputes for unrepresented employees following a utilization review must be resolved by a panel Qualified Medical Examiner (QME). The reports from the QME, treating physician, and utilization review physician are all admissible. The prior award was rescinded and the case was remanded to follow this procedure.

Workers Compensation Appeals BoardReconsiderationFindings and AwardIndustrial InjuryLow BackTailboneAlarm InstallerState Compensation Insurance FundMedical TreatmentUtilization Review
References
25
Case No. ADJ9866898
Regular
Sep 28, 2018

MARIA GARIBAY vs. CARL KARCHER ENTERPRISES RESTAURANTS, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board denied the Petition for Reconsideration in Maria Garibay's case. The denial was based on the finding that the parties failed to follow the mandatory procedure outlined in Labor Code section 4062.2 for obtaining a medical-legal evaluation. This statute dictates a specific process involving agreement or a QME panel selection, which was not demonstrated to have been followed in this case. Therefore, the petition was denied as the necessary procedural requirements were not met.

Workers' Compensation Appeals BoardLabor Code Section 4062.2Medical-legal evaluationQME panelAgreed medical evaluatorPetition for ReconsiderationDeniedDisputed issueRepresented employeeInjury
References
0
Case No. MON 0327319
Regular
Jun 02, 2008

RAMIRO DIAZ vs. THE VONS COMPANIES, INC.

This case concerns a workers' compensation claimant, Ramiro Diaz, terminated from Vons Companies after returning to work with restrictions following an industrial shoulder injury. The Appeals Board denied Vons's reconsideration request, affirming the finding that Vons violated Labor Code section 132a by illegally discriminating against the injured employee. The Board found Vons failed to follow its own progressive discipline policy and lacked credible business necessity for immediate termination, inferring retaliation for the injury.

Labor Code section 132aPrima facie caseDiscriminatory actsImpeached testimonyBusiness reality defenseProgressive disciplineSubstantial evidenceDisparate treatmentIndustrial injuryRetaliation
References
14
Case No. ADJ8415524
Regular
Jun 26, 2015

SYLVIA FERRAR BALCOMBE vs. WEST END YMCA, UNITED STATE FIRE INSURANCE COMPANY

This case concerns an applicant's petition for reconsideration following a Workers' Compensation Appeals Board decision. The Board denied the petition, adopting the judge's report which found the applicant's attorney failed to follow proper procedure in requesting medical panels. The judge also determined that medical reports from specific doctors were inadmissible due to this procedural error and lack of persuasive medical evidence. Consequently, the Board denied reconsideration and admonished the applicant's attorney regarding future fee requests.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ ReportCal. Code Regs tit. 8 § 10778Attorney's FeesInjuriesGERDIBSSpineQME
References
2
Case No. ADJ16667156
Regular
Oct 14, 2025

Astghik Ajamian vs. Coalinga State Hospital, State Compensation Insurance Fund

Defendant petitioned for reconsideration of the Findings of Fact and Award (F&A) issued July 8, 2025, which found 39% disability, contending the WCJ should have followed the parties' stipulation of 27% disability. The Appeals Board granted reconsideration, rescinded the F&A, and returned the case to the trial level for further proceedings. This decision was based on due process concerns, as the parties were not noticed in advance that their stipulation would not be followed. Additionally, the Board found the July 10, 2024, report from PQME Dr. Woodcox insufficient as substantial evidence on the issue of disability, necessitating further development of the record.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and AwardStipulationPermanent DisabilityApportionmentQualified Medical Examiner (PQME)substantial evidenceDue ProcessLabor Code section 5909
References
20
Case No. ADJ3130090 (SFO 0488450)
Regular
Mar 12, 2009

GUSTAVO CORDON vs. GARL FORCE CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration to address the defendant's challenges to a prior award. The administrative law judge had determined a $42\%$ permanent disability rating by rebutting the diminished future earning capacity (DFEC) provisions of the 2005 Schedule. However, the Board rescinded the award, remanding the case due to the WCJ's failure to follow the procedural requirements for rebutting the DFEC established in the en banc decision of *Ogilvie*. The Board emphasized that the WCJ must follow *Ogilvie* and may also consider further evidence on AMA Guides rebuttal issues consistent with *Almaraz*.

DFECpermanent disability ratingvocational rehabilitation expertSchedule for Rating Permanent DisabilitiesAMA Guidesrebuttableen banc decisionOgilvie v. City and County of San FranciscoAlmaraz v. Environmental Recovery ServicesLabor Code section 5811
References
6
Case No. ADJ1994269 (LBO 0278150)
Regular
Feb 04, 2013

RAYMOND LANE vs. CAMPBELL HALL SCHOOL, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for FREMONT COMPENSATION INSURANCE COMPANY

This Workers' Compensation Appeals Board case concerns applicant Raymond Lane's permanent disability rating following a myocardial infarction and subsequent psychiatric injury. The Board granted reconsideration, modifying the previous award to reflect a 93.5% permanent disability rating. This adjustment was based on the Board's finding that while cardiac permanent disability is apportionable, psychiatric permanent disability is not to be apportioned to non-industrial factors, aligning with expert medical opinions and statutory requirements. The applicant is awarded a specific weekly payment for a set period, followed by a life pension, with provisions for attorney fees.

Workers' Compensation Appeals BoardPetition for ReconsiderationDecision After ReconsiderationPermanent DisabilityApportionmentLabor Code Sections 4663Labor Code Sections 4664Myocardial InfarctionPsychiatric InjuryAgreed Medical Evaluators (AMEs)
References
0
Case No. MISSING
Regular Panel Decision

Keith v. New York State Thruway Authority

Petitioner, an assistant division engineer, was terminated by respondent for misconduct. The misconduct stemmed from a scheme to deceive toll collectors into believing asbestos removal had begun prematurely at the Newburgh toll station, causing panic and union threats. This followed an earlier reprimand for failing to take safety precautions during an asbestos exposure incident at the New Paltz station. Following a hearing, the Hearing Officer found petitioner guilty of misconduct, leading to his dismissal on June 21, 1985. This CPLR article 78 proceeding was initiated to review the termination, with the court ultimately confirming the determination and dismissing the petition.

Employee misconductWorkplace safetyAsbestos exposureCPLR Article 78Termination of employmentDue processJudicial reviewAdministrative determinationCivil Service LawSupervisory responsibility
References
8
Case No. ADJ2192154
Regular
Feb 22, 2011

IRMA ZAMORA vs. STATE OF CALIFORNIA DEPARTMENT OF AGRICULTURE, Legally Uninsured

This case involves an applicant's petition to reopen for new and further disability following a previous workers' compensation award for back injury. The defendant sought reconsideration, arguing the judge erred by not crediting prior disability payments and by awarding a penalty on the entire new and further disability. The Workers' Compensation Appeals Board denied reconsideration, finding the judge's award implicitly credited prior payments and that a penalty was warranted due to unreasonable delay in payment following receipt of an Agreed Medical Examiner's report indicating increased disability. The Board corrected a clerical error in the award to clarify credit was given.

WORKERS' COMPENSATION APPEALS BOARDLegally UninsuredPetition to Reopennew and further disabilitypermanent disabilitypenaltydelayed paymentStipulated AwardAgreed Medical ExaminerLabor Code §4650
References
2
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