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

Case No. ADJ7662819
Regular
Apr 27, 2015

JEWELL McKEE vs. MARTEN'S TRANSPORT, LTD, ACE AMERICAN INSURANCE COMPANY

This case involves an applicant alleging industrial injuries to various body parts, including psyche, hearing, and gait disorder, following a fall. The defendant sought reconsideration of the original award, primarily challenging the findings of psyche injury and gait disorder, as well as the award of temporary disability and a permanent disability increase. The Appeals Board granted reconsideration, deferring the issues of gait disorder and all permanent disability findings due to insufficient medical evidence on gait causation and the improper piecemeal determination of permanent disability. The Board otherwise affirmed the findings of industrial injury to psyche, additional temporary disability, and ordered further medical evaluation by an AME or IME.

Workers' Compensation Appeals BoardMarten's TransportACE American InsuranceIndustrial InjuryPsyche InjuryGait DisorderPermanent DisabilityLabor Code Section 4658(d)(2)Temporary DisabilityAgreed Medical Evaluator (AME)
References
0
Case No. MISSING
Regular Panel Decision

Smith v. New York State & Local Retirement Systems

Petitioner, a taxpayer services representative, sustained a back injury in March 1981 while lifting forms, leading to a decline in attendance and eventual termination in November 1989. She applied for accidental and ordinary disability retirement benefits, both of which were denied by the Comptroller. The accidental disability claim was denied because the incident was not deemed an 'accident' under Retirement and Security Law § 63. The ordinary disability claim was denied as untimely, having been filed approximately six months after her termination, exceeding the 90-day limit stipulated by Retirement and Social Security Law § 62. The Supreme Court dismissed the challenge to the ordinary disability denial due to untimeliness and transferred the accidental disability challenge to this Court. This Court confirmed the Comptroller's determination on both counts, rejecting the petitioner's estoppel argument regarding the untimely ordinary disability application and finding substantial evidence to support the finding that the injury did not constitute an 'accident' within the meaning of the relevant law, as it resulted from ordinary employment duties without an unexpected event.

Disability Retirement BenefitsAccidental DisabilityOrdinary DisabilityUntimely ApplicationEstoppel Against GovernmentWork-Related InjuryBack InjuryDefinition of AccidentOrdinary Employment DutiesSubstantial Evidence Review
References
16
Case No. MISSING
Regular Panel Decision
May 15, 2012

Hamzik v. Office for People with Developmental Disabilities

Plaintiff John J. Hamzik sued the Office for People with Developmental Disabilities (OPWDD) and several individual employees, alleging discrimination based on sex, age, and disability, as well as equal protection, due process, and retaliation claims under federal and state laws, including Title VII, ADEA, and ADA. Defendants moved to dismiss the amended complaint, and plaintiff cross-moved to file a second amended complaint. The District Court, finding that many claims were barred by Eleventh Amendment immunity or failure to exhaust administrative remedies, and that the remaining claims failed to state a plausible cause of action, granted the defendants' motion to dismiss. All federal claims were dismissed with prejudice, the cross-motion was denied as futile, and the remaining state law claims were dismissed without prejudice.

DiscriminationRetaliationDue ProcessEqual ProtectionTitle VIIADEAADAEleventh Amendment ImmunityAdministrative ExhaustionMotion to Dismiss
References
50
Case No. 2020 NY Slip Op 02301 [182 AD3d 821]
Regular Panel Decision
Apr 16, 2020

Matter of Community, Work, & Independence, Inc. v. New York State Off. for People with Dev. Disabilities

This case involves a CPLR article 78 proceeding initiated by Community, Work, and Independence, Inc. (petitioner) to challenge a determination affirming the objection to its proposed discharge of M.D., an individual with developmental disabilities, from day habilitation services. M.D.'s parents objected to the discharge, and an administrative hearing sustained their objection, a decision later affirmed by the Commissioner of the Office for People with Developmental Disabilities. The Appellate Division, Third Department, confirmed the Commissioner's determination, finding that the burden of proof was appropriately placed on the service provider. The court concluded that substantial evidence supported the finding that discharging M.D. was not reasonable, considering his needs, the lack of suitable alternative programs, and despite the petitioner's financial concerns. The court suggested that financial issues for service providers should be addressed by seeking increased funding rather than by discharging individuals.

Developmental DisabilityHCBS WaiverDischarge ServicesAdministrative HearingBurden of ProofSubstantial EvidenceFinancial ConcernsService ProviderMedicaid FundingAutism Spectrum
References
7
Case No. ADJ10908652, ADJ10908914
Regular
Sep 16, 2025

ZENAIDA AVILES vs. PIH HEALTH HOSPITAL, ATHENS ADMINISTRATORS

Applicant sought reconsideration of a Joint Findings and Award that denied industrial psyche injury (cumulative) and barred permanent disability from psyche injury (specific injury). Applicant contended that medical evidence supported cumulative psyche injury and that the WCJ erred in denying compensability of psychiatric permanent disability due to catastrophic consequences. The Appeals Board granted the petition for reconsideration, rescinded the prior Findings and Award, and returned the matter to the trial level for further proceedings, citing the need for further development of the medical record regarding intertwined disability and the application of the catastrophic injury exception.

Petition for ReconsiderationJoint Findings and AwardIndustrial InjuryPsycheCumulative PeriodSpecific InjuryPermanent DisabilityLabor Code section 4660.1Substantial Medical EvidenceQualified Medical Evaluator
References
27
Case No. ADJ1555118 (SAC 0336524) ADJ4532833 (SBR 0341290) ADJ457150 (SBR 0341294)
Regular
Jun 07, 2010

CLYTAN GUSMAN vs. STATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION, Legally Uninsured, Adjusted BY STATE COMPENSATION INSURANCE FUND

The WCAB granted reconsideration of a prior award finding 82% permanent disability due to industrial injuries to the applicant's psyche and internal systems. The primary reason for rescission was that the expert psychiatric evaluator applied an incorrect legal theory regarding apportionment of psyche disability by failing to consider non-work-related factors that are now apportionable under SB 899. The case is returned to the trial level for further development of the record, specifically concerning apportionment of psyche disability and potential consolidation of injury dates into a single cumulative trauma. The Board also instructed the WCJ to ensure the evidentiary record complies with exhibit listing rules.

Workers' Compensation Appeals BoardCautan GusmanState of California Department of Corrections and RehabilitationLegally UninsuredState Compensation Insurance FundPsyche disabilityHeart disabilityInternal systems disabilityPermanent disabilityApportionment
References
15
Case No. MISSING
Regular Panel Decision

Bullard v. St. Mary's Hospital

Claimant, a secretary at St. Mary's Hospital, developed rheumatoid arthritis, resulting in a permanent partial disability. The Workers' Compensation Board ruled it an occupational disease and awarded compensation. Liability was apportioned among three employers: Rochester Savings Bank, Woodward Health Center, and St. Mary's Hospital. The Special Disability Fund (SDF) was deemed liable for benefits after the initial 104-week disability period. SDF appealed, contending its reimbursement should be limited to St. Mary's Hospital's one-third share. The court affirmed the Board's decision, holding that Workers' Compensation Law § 44 makes the last employer (St. Mary's) responsible for total compensation, and Workers' Compensation Law § 15 (8) (d) requires SDF to fully reimburse the employer's carrier, Sedgwick James, for benefits paid after 104 weeks.

Occupational DiseaseRheumatoid ArthritisPermanent Partial DisabilityApportionmentSpecial Disability FundReimbursementWorkers' Compensation LawLast Employer LiabilityInsurance CarrierWorkers' Compensation Board
References
0
Case No. ADJ7427562
Regular
Feb 18, 2016

GEORGE UNSWORTH vs. GRANDVIEW REAL ESTATE, FIRE INSURANCE EXCHANGE

This Workers' Compensation Appeals Board case involves a dispute over permanent disability benefits for George Unsworth, who suffered an industrial injury to his spine, hips, legs, and psyche. The Board rescinded the trial judge's award of 75% permanent disability because the medical evidence, particularly from the Agreed Medical Examiners, did not support this high rating. The Board found that while the applicant sustained an industrial injury to his psyche, the extent of his permanent disability and apportionment between industrial and non-industrial causes required further evaluation. Therefore, the matter was returned to the trial level for a new permanent disability rating and attorney fee determination.

Workers' Compensation Appeals BoardReconsiderationPermanent DisabilityApportionmentAgreed Medical Examiner (AME)Psychiatric InjuryLabor Code section 3208.3AMA GuidesVocational EvaluationCompromise and Release
References
1
Case No. ADJ13002649, ADJ13002697
Regular
Oct 20, 2025

LORENZO TORRES vs. KOOS MANUFACTURING COMPANY, INC.; SAFETY NATIONAL CASUALTY COMPANY

The Workers' Compensation Appeals Board denied defendant's Petition for Reconsideration of a Joint Findings and Award (F&A) issued on July 21, 2025. The F&A, authored by a Workers' Compensation Judge, found that applicant Lorenzo Torres sustained injuries arising out of and in the course of employment (AOE/COE) to his lumbar spine and psyche (ADJ13002649), with the psychological injury not precluded by a good faith personnel action defense, resulting in temporary partial disability and 14% permanent disability to the lumbar spine. Additionally, applicant sustained AOE/COE injuries to his right and left shoulders (ADJ13002697), leading to 3% and 4% permanent disability respectively. Defendant challenged these findings, arguing insufficient evidence for the psyche injury, unjustified temporary partial disability, a lower lumbar spine impairment, and no industrial shoulder injury. The Appeals Board reviewed the matter, including the WCJ's Report and Recommendation, and found the WCJ's conclusions to be supported by substantial evidence. Consequently, the Board affirmed the original F&A and denied the reconsideration petition.

AOE/COEGood Faith Personnel Action DefensePsychological InjuryLumbar Spine InjuryShoulder InjuryTemporary Partial DisabilityPermanent DisabilityApportionmentQualified Medical EvaluatorSubstantial Evidence
References
11
Case No. ADJ267505 (BAK 0140579) ADJ1932429 (BAK 0140580)
Regular
Jun 11, 2009

SHERYLL HICKS vs. KERN COUNTY SUPERINTENDENT OF SCHOOLS; SELF INSURED SCHOOLS BAKERSFIELD

This case concerns an applicant's appeal of a workers' compensation award for industrial injuries to her lumbar spine and psyche. The applicant contended the defendant failed to pay the permanent disability award correctly and disputed the temporary disability end date. The Appeals Board granted reconsideration to correct a clerical error in the original findings of fact regarding injuries to other body parts. The Board affirmed the WCJ's decision, including the $6\%$ permanent disability for the lumbar spine and $100\%$ for the psyche.

Workers' Compensation Appeals BoardIndustrial InjuryLumber SpinePsychePermanent DisabilityTemporary Total DisabilityPermanent Total DisabilityPetition for ReconsiderationWCJClerical Error
References
0
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