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

Case No. ADJ10344515; ADJ10344543
Regular
Sep 26, 2016

ROGER EUGENE HERBEL vs. EV PLUMBING, INC., THE HARTFORD

The Appeals Board granted reconsideration and rescinded the WCJ's decision, which had authorized the applicant to obtain two separate Qualified Medical Evaluator (QME) panels. The defendant argued this violated Labor Code section 4062.3(j) and prior Appeals Board precedent regarding multiple QME requests for related claims. The Board found the record insufficient for a merits decision and returned the matter to the trial level for further proceedings to create a proper trial record. This decision emphasizes the need for a clear record and references precedent concerning QME panel entitlement for distinct but related industrial injury claims.

QME panelorthopedicchiropracticLabor Code section 4062.3(j)Navarro v. City of MontebelloPetition for ReconsiderationDeclaration of Readiness to Proceed to Expedited HearingMinutes of HearingOpinion and Order Granting Petition for ReconsiderationDecision After Reconsideration
References
7
Case No. MISSING
Regular Panel Decision

Paolucci v. Capital Newspapers, a Division of the Hearst Corp.

Claimant, an adult newspaper carrier for Capital Newspapers, sought workers’ compensation benefits after an injury. Both a Workers’ Compensation Law Judge and the Workers’ Compensation Board denied her claim, deeming her an independent contractor based on factors like profiting from resale and freedom in delivery methods. However, the Appellate Division noted that these factors mirrored a prior case, Matter of Pittman v Poughkeepsie Journal, where an employer/employee relationship was found. The Court ruled that the Board failed to either follow its own precedent or provide an explanation for its inconsistent decisions, as required by Matter of Field Delivery Serv. [Roberts]. Citing additional instances of the Board’s unexplained departures from precedent, the Appellate Division reversed the Board's decision and remitted the matter for further proceedings.

Workers' CompensationIndependent ContractorEmployment StatusAppellate ReviewPrecedentStare DecisisBoard DecisionRemittalNewspaper CarrierEmployer-Employee Relationship
References
7
Case No. ADJ795505 (LAO 0794863)
Regular
Feb 13, 2014

VICTORIA SHANLEY vs. HENRY MAYO NEWHALL MEMORIAL HOSPITAL, TRAVELERS INSURANCE CO.

The Appeals Board reconsidered a WCJ's decision upholding utilization review (UR) denials for an MRI and EMG. While other contentions regarding the UR physician's qualifications and licensing were dismissed based on precedent, the Board found the UR decisions invalid due to untimely communication. Specifically, the defendant failed to prove by substantial evidence that the UR decisions were communicated by phone, fax, or email within 24 hours of being made. The matter is returned to the trial level to determine medical necessity, as the UR denials are void.

Utilization ReviewLabor Code Section 4610Administrative Director Rule 9792.9Physician QualificationLicensing RequirementsCommunication TimeframesTimely CommunicationMedical NecessityIndependent Medical ReviewInvalid UR Decision
References
2
Case No. MISSING
Regular Panel Decision

Claim of Banful v. Skyline Credit Ride, Inc.

The Workers' Compensation Board determined that an employer-employee relationship existed between a claimant, a limousine driver, and Skyline Credit Ride, Inc., making the claimant eligible for benefits for injuries sustained in a motor vehicle accident. Skyline and its compensation carrier appealed this decision, arguing the claimant should be classified as an independent contractor. The appellate court affirmed the Board's finding, concluding there was substantial evidence of Skyline's control over its drivers, consistent with prior rulings like *Matter of Weingarten v XYZ Two Way Radio Serv.* Additionally, the court found the Board's explanation rational for distinguishing its current decision from an earlier, inconsistent one involving a different Skyline driver, as the Board explicitly stated its intention to adhere to the *Weingarten* precedent. The decision and amended decision of the Workers’ Compensation Board were affirmed without costs.

Workers' CompensationEmployer-Employee RelationshipIndependent ContractorLimousine DriverDispatch ServiceSubstantial EvidenceAppellate ReviewBoard DecisionPrecedentControl Test
References
4
Case No. MISSING
Regular Panel Decision
Sep 27, 1988

Claim of Pistor v. Pan American Airways

This case concerns an appeal from a Workers' Compensation Board decision that found the claimant sustained an accidental injury during employment. The claimant injured her back while transporting work materials, which she was required to have for her job and could not store at her workplace. The court affirmed the Board's decision, ruling that the injury occurred in the course of employment because the transporting of materials was a work requirement and not a personal choice. This decision was supported by substantial evidence and precedent.

Workers' CompensationAccidental InjuryCourse of EmploymentTransporting Work MaterialsSubstantial EvidenceAffirmationAppellate ReviewWork-Related InjuryEmployer LiabilityOff-Premises Injury
References
3
Case No. ADJ1378438 (SFO 0473342) ADJ583377 (SFO 0473348) ADJ565698 (SFO 0473345) ADJ1607507 (SFO 0473346) ADJ3222336 (SFO 0498751)
Regular
Jun 24, 2009

ELENA MATEU vs. UNIVERSITY OF CALIFORNIA SAN FRANCISCO

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior WCJ decision in this case. The matter has been returned to the trial level for further proceedings and a new decision by the WCJ. The WCJ is instructed to consider the application of the legal precedent set in *Weiner v. Ralphs Company*. This is not a final decision on the merits, and parties retain all rights to further appeals.

MateuUniversity of California San Franciscolawfully uninsuredADJ1378438ADJ583377ADJ565698ADJ1607507ADJ3222336Opinion and Order Granting ReconsiderationDecision After Reconsideration
References
1
Case No. MISSING
Regular Panel Decision

Sidari v. Orleans County

The plaintiff, Paul Sidari, a corrections officer, sued the Orleans County Sheriff's Department and individual defendants, alleging discrimination based on national origin and religion, and retaliation under Title VII and 42 U.S.C. § 1983. Earlier rulings had struck claims related to 'other persons similarly situated' and discrimination against inmates, which was affirmed by Judge Arcara. Sidari later moved for reconsideration and to file a supplemental complaint, both of which were denied by Magistrate Judge Scott, with the denial of reconsideration based on the precedent cited by Sidari being vacated. However, the District Court, acting sua sponte, modified the Decision & Order based on the recent Second Circuit case, Cruz v. Coach Stores, Inc. This modification reinstated certain paragraphs to the Amended Complaint, allowing evidence of racial and sexual discrimination against inmates and other employees to support Sidari's hostile work environment claim. The remainder of the Magistrate Judge's decision was affirmed.

Hostile Work EnvironmentEmployment DiscriminationRetaliationTitle VII ClaimsCivil RightsStanding LawMotion to SupplementMotion for ReconsiderationMagistrate Judge OrderAppellate Precedent
References
9
Case No. MISSING
Regular Panel Decision
Feb 25, 2009

Claim of Norcross v. Camden Central School

This case involves an appeal by the Special Fund for Reopened Cases from a Workers’ Compensation Board decision. The Board had affirmed a Workers’ Compensation Law Judge's ruling that shifted liability to the Special Fund under WCL § 25-a, regarding a claimant's work-related injury from 2001. The Special Fund contended that the Board's decision deviated from its own precedent by shifting liability without requiring proof that further medical or indemnity benefits were payable, which is a necessary condition for reopening a claim for this purpose. The court determined that the Board failed to provide a rational explanation for departing from its prior decisions, thereby rendering its determination arbitrary and capricious. Consequently, the Board's decision was reversed, and the matter was remitted for further proceedings.

Special Fund for Reopened CasesLiability ShiftAgency PrecedentRational ExplanationArbitrary and CapriciousRFA-2 formMedical BenefitsIndemnity BenefitsAppellate DivisionRemittal
References
7
Case No. MISSING
Regular Panel Decision

Claim of Green v. Kamalian

A decedent, hired by an employer to cut firewood, was killed by a falling tree. His widow, as administratrix of his estate, filed a wrongful death action against the employer, which resulted in a $65,000 settlement. Subsequently, the claimant sought death benefits, but the Workers’ Compensation Board denied the claim, citing a precedent that bars benefits after a successful negligence action settlement against the employer. The claimant appealed, arguing that prior cases negated this precedent by vesting primary jurisdiction in the Board, thereby rendering the Supreme Court settlement a nullity. The Appellate Division affirmed the Board’s decision, holding that the rule of primary jurisdiction does not divest the Supreme Court of all jurisdiction in such matters and that the precedent remained binding. The court also rejected the claimant’s argument regarding a lack of identity of parties.

Workers' CompensationWrongful DeathExclusive RemedyPrimary JurisdictionRes JudicataEstate LawAppellate ReviewNew York LawBoard DecisionSettlement Bar
References
7
Case No. MISSING
Regular Panel Decision

Claim of Buchanon v. Adirondack Steel Casting Co.

The Workers' Compensation Board's decision and amended decision, which found that the claimant did not have a total industrial disability, were affirmed on appeal. The employer's argument regarding the untimeliness of the claimant's supplemental notice of appeal was rejected due to lack of proof of service for the amended decision. The Board's plenary authority to modify previous decisions was upheld, as no facts indicated arbitrary or capricious action in amending its prior decision. The court concluded that the Board's finding of no total industrial disability was supported by substantial evidence, noting that the case involved a conflict of medical opinion, which is a factual matter for the Board to resolve. All remaining arguments by the claimant were considered and dismissed.

Workers' Compensation Law § 23Industrial DisabilityAppellate ReviewBoard Decision AffirmationMedical Opinion ConflictSubstantial EvidenceTimeliness of AppealArbitrary and Capricious StandardFactual DisputeClaimant's Appeal
References
4
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