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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

Smith v. Bayer Corp. Long Term Disability Plan

Plaintiff Terry Smith, a former Diabetes Sales Specialist for Bayer Corporation, filed an action under ERISA to recover long-term disability benefits, claiming wrongful denial due to psychiatric impairments including depression, panic disorder, and bi-polar disorder. The Plan administrator, Bayer, upheld the denial based on reviews by non-examining physicians. However, Smith's treating psychiatrists, Dr. LeBuffe and Dr. McCool, consistently found him disabled. The court found the Plan's reliance on non-examining doctors, who 'cherry-picked' medical records and distorted findings, to be arbitrary and capricious. Consequently, the court granted Smith's motion for benefits, denying Bayer's, and also awarded partial disability benefits, ruling that Smith's failure to seek rehabilitation approval was excused by the prior wrongful denial.

ERISALong-term disabilityDisability benefits denialPsychiatric impairmentDepressionPanic disorderBi-polar disorderAttention Deficit Disorder (ADD)Treating physician ruleArbitrary and capricious standard
References
26
Case No. MISSING
Regular Panel Decision
Sep 17, 1980

Bass v. Westchester Concrete, Inc.

This case involves an appeal from a Workers’ Compensation Board decision, which was initially filed on March 14, 1980, and later amended on September 17, 1980. The employer's insurance carrier sought reimbursement from the Special Disability Fund under Workers’ Compensation Law § 15(8), claiming a known prior physical impairment of bilateral deafness in the claimant. The record established that the claimant's total disability stemmed from a severe psychoneurotic disorder, with a pre-existing psychiatric condition materially and substantially exacerbating the present disability due to a compensable accident. However, the appeal found no substantial evidence that the employer had prior knowledge of this psychiatric condition; only the bilateral deafness was known, which was deemed incidental to the current disability. Consequently, the Board's decision, which presumably denied reimbursement, was affirmed, with costs awarded to the Special Disability Fund.

Workers' CompensationSpecial Disability FundReimbursement ClaimPrior Physical ImpairmentBilateral DeafnessPsychoneurotic DisorderPre-existing ConditionEmployer KnowledgeTotal DisabilityCompensable Accident
References
0
Case No. MISSING
Regular Panel Decision
Jun 19, 1980

Claim of Pollara v. Air France

The Workers' Compensation Board ruled that the claimant's permanent partial disability stemmed entirely from a May 20, 1976, accident, precluding apportionment despite a prior 1953 back injury. The claimant, a former Navy boiler tender, had undergone back surgery in 1953 but returned to full duty and subsequently worked over two decades in physically demanding roles without significant issues until the 1976 incident at an airline. The appellate court affirmed the Board's decision, finding substantial evidence, including medical testimony, supported the finding that the claimant had no pre-existing compensable disability at the time of the 1976 injury. The court noted that apportionment is inapplicable when a prior condition did not constitute a compensation-related disability.

ApportionmentDisabilityBack injuryLaminectomyPre-existing conditionWorkers' CompensationMedical testimonySubstantial evidencePermanent partial disabilityAppellate review
References
8
Case No. MISSING
Regular Panel Decision

Claim of Huss v. Tops Markets, Inc.

In 1985, claimant sustained a right shoulder injury while employed by Dunlop Tire, resulting in a permanent partial disability. In 1998, he re-injured the same shoulder while working for Tops Markets, Inc., leading to a new workers' compensation claim. An impartial specialist attributed 85% of the disability to the 1985 injury and 15% to the 1998 injury. Although a Workers' Compensation Law Judge initially rejected apportionment, the Board reversed and applied the 85/15 apportionment. Claimant appealed, contending apportionment was unwarranted due to his disclosure of the prior injury and lack of prior disability symptoms. The Appellate Division affirmed the Board's decision, finding substantial medical evidence to support the apportionment.

Workers' CompensationPermanent Partial DisabilityApportionmentPrior InjuryShoulder InjuryCausal RelationshipMedical Expert TestimonyBoard DecisionAppellate ReviewExacerbation
References
3
Case No. MISSING
Regular Panel Decision

Donaldson v. Texas Department of Aging & Disability Services

David Donaldson appealed a trial court's summary judgment in favor of the Texas Department of Aging and Disability Services (DADS) on claims of race and disability discrimination, retaliation, and hostile work environment under the TCHRA and Title VII. Donaldson, an African-American employee diagnosed with multiple conditions including prostate cancer and PTSD, alleged DADS failed to accommodate his disabilities and discriminated against him through various adverse actions, culminating in his termination. The appellate court affirmed the summary judgment for DADS on the race discrimination, retaliation, and hostile work environment claims, finding insufficient evidence of discriminatory intent or materially adverse actions in those areas. However, the court reversed and remanded the reasonable accommodation claim, concluding that Donaldson presented a fact issue regarding DADS's failure to provide continued assistance for his disabilities despite initial accommodations. This decision partially reverses the trial court's judgment, necessitating further proceedings on the reasonable accommodation aspect of the disability discrimination claim.

DiscriminationRetaliationHostile Work EnvironmentDisability DiscriminationRace DiscriminationReasonable AccommodationSummary JudgmentTexas Commission on Human Rights ActTitle VIIEmployment Law
References
83
Case No. MISSING
Regular Panel Decision

Claim of Hogan v. Hilltop Manor of Niskayuna

Claimant, a respiratory therapist, sustained a work-related back injury in November 1999. She had a history of intermittent back pain but consistently performed her job duties without restriction and missed minimal work prior to the incident. Initially, a Workers’ Compensation Law Judge rejected apportionment, but the Workers’ Compensation Board reversed, attributing 50% of the disability to a preexisting condition. The appellate court reversed the Board's decision, clarifying that apportionment is not warranted where a claimant's prior condition was not disabling in a compensation sense and did not prevent them from effectively performing their job. The matter was remitted to the Workers’ Compensation Board for further proceedings.

ApportionmentPreexisting ConditionDisabilityWorkers' Compensation BoardBack InjuryRespiratory TherapistSubstantial EvidenceAppellate ReviewDegenerative Disc DiseaseJob Duties
References
7
Case No. 2023 NY Slip Op 02156 [215 AD3d 1201]
Regular Panel Decision
Apr 27, 2023

Matter of Holder v. Office for People with Dev. Disabilities

Claimant's husband, a house manager for the Office for People with Developmental Disabilities, contracted COVID-19 and passed away in March 2020. Claimant filed for workers' compensation death benefits, alleging his death was causally related to his employment. Initially, a Workers' Compensation Law Judge established the death benefits claim. However, the Workers' Compensation Board reversed this decision, concluding there was insufficient evidence to prove COVID-19 was prevalent in the decedent's work environment prior to his symptoms. The Appellate Division, Third Department, affirmed the Board's decision, finding that the claimant failed to meet her burden of establishing that the decedent contracted COVID-19 in the course of his employment.

COVID-19 DeathWorkers' Compensation BenefitsCausal RelationEmployment ExposureHouse ManagerGroup HomeBurden of ProofSubstantial EvidenceAppellate ReviewAdministrative Review
References
13
Case No. MISSING
Regular Panel Decision
Oct 07, 2009

Claim of Ceplo v. Raymond Corp.

A claimant sustained a work-related injury in 1998 and received workers’ compensation benefits. In 2002, the self-insured employer sought reimbursement from the Special Disability Fund, citing a prior injury under Workers’ Compensation Law § 15 (8) (d). However, the Workers’ Compensation Board denied the employer's claim for reimbursement, ruling that the required C-250 form had been inadequately completed, specifically lacking crucial details about the prior injury and its associated workers' compensation claim. The employer and its third-party administrator subsequently appealed this decision. The Appellate Division affirmed the Board's determination, emphasizing the necessity of strict adherence to the prescribed regulations for claims seeking reimbursement from the Special Disability Fund.

Workers' CompensationSpecial Disability FundReimbursementForm C-250Prior InjuryStrict ComplianceAdministrative AppealAppellate DivisionEmployer LiabilitySelf-insured
References
3
Case No. 32 — 24
Regular Panel Decision

Howard v. Monahan

This case involves a review of a compensation order issued by a deputy commissioner concerning the claims of Lula Howard and her stepchildren, Soloman, Leroy, and Elinor Dave. The claims stemmed from the injury and subsequent death of Tusan Howard, who was employed in Houston, Texas, and insured by Texas Employers’ Insurance Association. The commissioner had rejected both a claim for disability prior to Tusan Howard's death and a claim for death benefits, concluding the death was not caused by the injury. District Judge Hutcheson, presiding over the review, affirmed the commissioner's rejection of the death claim, finding ample evidence to support that conclusion. However, the judge reversed the commissioner's failure to make an award for disability prior to death, remanding that specific part of the case for further findings and order.

Longshoremen's ActHarbor WorkersCompensation ClaimDisability BenefitsDeath BenefitsJudicial ReviewCommissioner's OrderFindings of FactRemandTexas
References
1
Case No. OAK 0307233
Regular
Oct 16, 2007

LESLEY MORRIS vs. PERMANENTE MEDICAL GROUP, ATHENS ADMINISTRATORS

The applicant sought reconsideration of a workers' compensation award, arguing that the five percent permanent disability apportionment was incorrectly applied to the wrong knee and that no prior award existed for her right knee. The Board denied the petition, finding that a prior award for both knees existed, establishing a conclusive presumption of permanent disability. Because the current disability entirely subsumed the prior disability, the Board upheld the apportionment of the five percent permanent disability from the prior award.

Workers' Compensation Appeals BoardPermanente Medical GroupAthens AdministratorsOAK 0307233Petition for ReconsiderationCorrected Supplemental FindingsAward and Orderpermanent disabilityapportionmentLabor Code section 4664
References
3
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