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

Case No. ADJ9944770
Regular
Oct 19, 2018

Sam Zavalata vs. Conifer Value Based Care, LLC

This case involves applicant Sam Zavaleta's workers' compensation claim for psychiatric and orthopedic injuries against Conifer Value Based Care, LLC. The Workers' Compensation Appeals Board (WCAB) rescinded the trial judge's decision, finding that the medical opinions from both the orthopedic and psychiatric evaluators required further development. Specifically, issues exist regarding the orthopedic causation of cumulative trauma injury to the applicant's psyche, back, neck, and wrist, as well as the substantial causation of the psychiatric injury in relation to the defendant's good faith personnel action defense. The matter is returned to the trial level for further proceedings and a new decision.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderPsychiatric InjuryCumulative TraumaPersonnel Action DefenseGood FaithCausationMedical OpinionApportionment
References
12
Case No. ADJ3817836 (SJO 0250881)
Regular
May 31, 2012

ZUFAN A. REDA vs. FRY'S ELECTRONICS, INC., ZURICH NORTH AMERICAN INSURANCE

This case concerns applicant Zufan A. Reda's claim for permanent total disability due to a psychiatric injury. The Workers' Compensation Appeals Board (WCAB) is ordering the development of the record because neither the applicant's QME, Dr. Sidle, nor the defendant's QME, Dr. Keins, provided substantial evidence regarding the apportionment of psychiatric permanent disability. The WCAB found that Dr. Sidle's report incorrectly addressed causation of injury rather than apportionment of disability, and Dr. Keins' report was rejected as non-substantial due to prior rulings on industrial causation. Therefore, the WCAB has appointed Dr. Roy Curry as a "regular physician" to conduct a new evaluation on the issue of psychiatric permanent disability.

Petition for ReconsiderationDevelopment of RecordLabor Code section 5701Industrial InjuryPsychiatric InjuryCompensable ConsequenceSection 5803Section 5804Section 5410Permanent Total Disability
References
3
Case No. MISSING
Regular Panel Decision

Mott v. Central New York Psychiatric Center

The claimant, a guard at a state-run psychiatric center, suffered a work-related injury and received workers’ compensation benefits. During his disability, he used personal leave time for which he received full wages. The employer sought reimbursement for these advance payments, but the Workers’ Compensation Board denied reimbursement for the personal leave portion. The Appellate Division reversed this decision, differentiating personal leave from sick leave by noting that personal leave could not be accrued or converted, thus not conferring a permanent benefit to the employer or a detriment to the claimant. The court concluded that denying reimbursement would result in the claimant receiving both full wages and compensation for the same period, a disfavored outcome, and therefore, reimbursement should be granted.

ReimbursementAdvance PaymentsPersonal LeaveSick LeaveWorkers' Compensation BenefitsDisabilityEmployer ReimbursementDisproportionate ResultAppellate DivisionNew York
References
9
Case No. MISSING
Regular Panel Decision

Kevin M. v. South Beach Psychiatric Center

Kevin M. was arrested for stalking Grammy-winning singer Robyn Fenty (Rihanna) after sending her hundreds of delusional letters and frequently appearing near her Manhattan apartment. Found unfit to stand trial, he was civilly committed to South Beach Psychiatric Center (SBPC). During a subsequent hearing, medical experts testified to his severe psychotic disorder, continuous delusions, and assessment as a danger to himself and others. The court denied Kevin M.'s application for release, finding existing Mental Hygiene Law inadequate to protect Ms. Fenty. Exercising its general equity jurisdiction, the court issued a permanent injunction and an order of protection, prohibiting Kevin M. from any contact with Ms. Fenty or her properties, and allowing for immediate arrest if violated, addressing perceived gaps in New York law concerning dangerously mentally ill individuals with specific targets.

StalkingMental IllnessInvoluntary CommitmentOrder of ProtectionPermanent InjunctionPsychotic DisorderPublic SafetyCriminal Procedure LawMental Hygiene LawEquity Jurisdiction
References
23
Case No. MISSING
Regular Panel Decision

Claim of Regenbogen v. New York State Willard Psychiatric Center

The case involves an appeal regarding a workers' compensation claim for mental injury filed by a former employee of Willard Psychiatric Center, who later worked for the Workers’ Compensation Board. The claim, initially found compensable, faced jurisdictional challenges after a March 1997 amendment to Workers’ Compensation Law § 20 (2) (a) mandated neutral arbitration for Board employees' claims pending on or after its effective date. The court found that the Workers’ Compensation Board lacked jurisdiction to issue its June 1997 amended decision because the claim was still 'pending' after the amendment's effective date. Consequently, the court reversed the Board's decisions and remitted the entire matter for arbitration, emphasizing that the legislative intent was to remove any appearance of partiality in such claims.

Workers' Compensation BoardJurisdictional DisputeRetroactive Application of LawStatutory AmendmentArbitration MandateMental Stress ClaimAppellate ProcedurePending ClaimsBoard Employee ClaimsAdministrative Law
References
5
Case No. 2021 NY Slip Op 04404
Regular Panel Decision
Jul 15, 2021

Matter of Decandia v. Pilgrim Psychiatric Ctr.

Claimant, a security and security officer, filed a workers' compensation claim nearly six years after allegedly being bitten by ticks in June 2013, seeking benefits for consequential Lyme disease. The Workers' Compensation Board reversed a Workers' Compensation Law Judge's award of benefits, ruling that the claim was untimely under Workers' Compensation Law § 28 and that there was insufficient medical evidence to establish Lyme disease or a causal connection to his employment. The Appellate Division affirmed the Board's decision, agreeing that the claim was untimely given the nearly six-year delay in filing and that the Board's finding of insufficient medical evidence for Lyme disease and causation was supported by substantial evidence.

Workers' Compensation Law § 28Timeliness of ClaimLyme Disease DiagnosisCausal RelationshipSufficiency of Medical EvidenceTick-borne DiseaseStatute of LimitationsAppellate Division Third DepartmentWorkers' Compensation BoardEmployer Liability
References
7
Case No. MISSING
Regular Panel Decision

Claim of Keser v. New York State Elmira Psychiatric Center

This case addresses whether late payment penalty provisions of Workers’ Compensation Law § 25 (3) (f) apply to reimbursements made by an employer’s compensation carrier for wages paid during an employee's disability, and if so, whether they apply when reimbursement is in a form other than monetary payment to the employee. The Court affirmed the Appellate Division's decision, answering both questions in the affirmative. A 20% penalty was upheld against the State Insurance Fund for late reimbursement to the New York State Elmira Psychiatric Center, the employer of claimant Peter Keser. The ruling emphasizes that for penalty purposes, no distinction should be made between awards payable directly to claimants and those payable to an employer as reimbursement, and the mechanics of payment (e.g., accounting credit) do not alter the need for timely compliance with award terms, promoting prompt payment of workers' compensation benefits.

Workers' CompensationLate Payment PenaltyEmployer ReimbursementDisability BenefitsStatutory InterpretationSection 25(3)(f)Compensation DefinitionCarrier LiabilityPrompt PaymentAccrued Leave
References
6
Case No. ADJ9674255
Regular
Jul 10, 2017

YAN LIU vs. HAWAIIAN GARDENS CASINO, INSURANCE COMPANY OF THE WEST

This case concerns an applicant who alleges both orthopedic and psychiatric injuries from her employment as a casino dealer. While the Board affirmed the finding of orthopedic injury, it deferred the issue of psychiatric injury. The Board clarified that Labor Code § 4660.1(c) does not bar psychiatric claims arising directly from employment events, but it requires a medical apportionment of causation between direct psychiatric injury and injury as a consequence of physical injury. The matter was returned to the trial level for further development of the record regarding the psychiatric injury and its apportionment.

AOE/COELabor Code Section 4660.1(c)psychiatric injurycompensable consequenceviolent actsubstantial medical evidencetreating physicianQMEcontinuous traumaharassment
References
10
Case No. ADJ10715455
Regular
Mar 18, 2019

MICHAEL KAMM vs. COUNTY OF MONTEREY, P.S.I., administered by INTERCARE HOLDINGS INSURANCE SERVICES, INC.

In this case, the Appeals Board partially rescinded the WCJ's award for psychiatric injury due to inconsistencies in the medical opinion regarding predominant causation. While the Board affirmed the rejection of the good faith personnel action defense, it found Dr. Lopez's opinion lacked clarity on whether employment events were the predominant cause of the applicant's overall psychiatric disability. Therefore, the matter is returned to the WCJ for further development of the medical record to clarify predominant causation before a new decision can be issued.

Workers' Compensation Appeals BoardReconsiderationPsychiatric InjuryPredominant CausationLabor Code Section 3208.3(h)Good Faith Personnel Action DefensePanel Qualified Medical Evaluator (PQME)Dr. LopezAnxiety DisorderMajor Depression
References
3
Case No. ADJ10625165
Regular
Apr 26, 2019

Rafael Arevalo vs. STATE OF CALIFORNIA, CALIFORNIA DEPARTMENT OF CORRECTIONS & REHABILITATION, CALIFORNIA CORRECTIONAL INSTITUTE-TEHACHAPI

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to address the applicant's claim for a psychiatric injury. The initial finding by the WCJ recognized industrial hypertension but denied a psychological injury despite medical evidence of PTSD. The WCAB found the medical opinions regarding causation were not substantial evidence due to an incorrect factual history and potential confusion between legal standards. Therefore, the case is remanded for further proceedings to develop the record, particularly concerning the applicant's psychiatric injury causation and the definition of "actual events of employment."

WCABAOE/COEHypertensionPsyche injuryPosttraumatic Stress DisorderPTSDViolent actActual events of employmentPredominant causeSubstantial cause
References
14
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