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

Case No. ADJ8209536, ADJ8209481
Regular
Nov 28, 2017

ALBERTINA FUNEZ vs. CHARLES RIVER LABS, ACE USA, ESIS

The applicant, Albertina Funez, sought removal of a WCJ's order setting her case for trial on all issues, arguing it prejudiced her ability to prove her claims. She contended that discovery was incomplete and a psychiatric PQME determination was a prerequisite to a full trial. The majority of the Appeals Board denied the petition, agreeing with the WCJ that trial was the most effective means to resolve the PQME dispute and that applicant had not suffered irreparable harm. Commissioner Sweeney dissented, believing a trial on all issues was premature given deficiencies in the record, particularly regarding the psychiatric PQME, and that this could be wasteful of resources.

Petition for RemovalPsychiatric PQMEOrthopedic DisabilityPermanent DisabilityTemporary DisabilityCompensable InjuryDiscoveryMedical RecordsExpert Medical OpinionJudicial Resources
References
0
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. 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. ADJ6872612
Regular
Oct 22, 2013

AIDA LOPEZ vs. C&S WHOLESALE GROCERIES

The Workers' Compensation Appeals Board (WCAB) rescinded a prior order reinstating findings that applicant sustained an industrial psychiatric injury and ordered a new psychiatric PQME due to alleged ex-parte communication. The WCAB found that crucial evidence regarding the communication, specifically letters between the defendant and the PQME, was not admitted into the record. Therefore, the case is returned to the trial level for clarification of the evidence and a new decision, while also cautioning against gamesmanship and suggesting an Agreed Medical Examination (AME) to expedite the process.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationOrder Reinstating Findings and OrderPanel Qualified Medical Examiner (PQME)Labor Code section 4062.3(e)Ex-parte communicationDiscoveryAgreed Medical Examination (AME)Writ of ReviewPanel striking
References
2
Case No. ADJ7785936
Regular
Feb 28, 2014

LISA VALDEZ vs. SAINT HELENA HOSPITAL

The Workers' Compensation Appeals Board reversed a prior order denying a lien claimant's fee, allowing payment for a psychiatric consultation. The Panel Qualified Medical Examiner (PQME) Dr. Burt reasonably requested the consultation with Dr. Goldfield under former AD Rule 32, which permitted PQMEs to obtain necessary consultations. The defendant failed to investigate the potential psychiatric component of the applicant's industrial injury as required by AD Rule 10109, despite being notified by the PQME. Therefore, the Board found that Dr. Goldfield should be compensated for services rendered in the interest of substantial justice.

AD Rule 32Panel Qualified Medical Examiner (PQME)psychiatric consultationlien claimantindustrial injuryregistered nursepermanent disabilityfuture medical treatmentreconsiderationsubstantial justice
References
0
Case No. ADJ1088185 (SAC 0369416)
Regular
May 25, 2012

DEBORAH COIL vs. CITY OF RANCHO CORDOVA

The Workers' Compensation Appeals Board (WCAB) dismissed Deborah Coil's petition for reconsideration because the WCJ's order was procedural, not a final determination of substantive rights. The WCAB reasoned that Coil's contentions about the PQME's familiarity with the AMA Guides were misplaced as those guides are not relevant to psychiatric impairment ratings. Therefore, the WCAB denied removal and dismissed the petition, allowing the PQME another opportunity to re-evaluate the applicant without her husband present. A concurring and dissenting opinion argued for removal, citing the PQME's repeated inability to produce substantial medical evidence.

Panel Qualified Medical EvaluatorPQMEPetition for ReconsiderationRemovalLabor Code Section 5900Labor Code Section 5310Final OrderSubstantial Medical EvidenceAMA GuidesAlmaraz/Guzman
References
7
Case No. ADJ10774716
Regular
Feb 10, 2023

REBECCA MILLS vs. STATE COMPENSATION INSURANCE FUND, AIMS

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant argued the applicant's stroke and psychiatric injury were not work-related, but the Board adopted the Workers' Compensation Judge's findings. The Judge relied on medical evidence, including reports from the applicant's primary care physician and a psychiatric QME, concluding that workplace stress was a contributing factor to the applicant's stroke and subsequent psychiatric injury. The defense's arguments regarding the internal medicine PQME's findings were found to be inconsistent with his own deposition testimony concerning the plausibility of work stress causing the stroke.

Workers' Compensation Appeals BoardPetition for ReconsiderationDenying PetitionStrokePsychiatric InjuryCumulative TraumaClaims AdjusterCardiac Vascular AccidentWork StressCausation
References
3
Case No. ADJ16528931
Regular
Apr 25, 2025

Marisa Kelly vs. Sacramento County Child Protective Services, PSI, County of Sacramento

Defendant sought reconsideration of a Findings of Fact, Awards and Orders (F&O) issued on February 5, 2025, which found that the applicant, Marisa Kelly, sustained a work-related psychiatric injury. The defendant contended that the medical evidence supporting this finding, specifically from the Panel Qualified Medical Examiner (PQME), was not substantial. The Workers' Compensation Appeals Board, after reviewing the petition and the WCJ's report, determined that the PQME's reasoning clearly supported the causation of the applicant's temporary disability and need for medical treatment. The Board concluded that the PQME's use of 'exacerbation' instead of 'aggravation' was immaterial, and therefore, the petition for reconsideration was denied.

Workers' Compensation Appeals BoardSacramento County Child Protective ServicesMarisa KellyPetition for ReconsiderationFindings of Fact Awards and OrdersInjury Arising Out of and Occurring in the Course of EmploymentAOE/COEPsycheMedical EvidencePanel Qualified Medical Examiner
References
6
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