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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

People v. Young

An attorney representing an indigent defendant in Monroe County filed an application seeking reimbursement for legal services at a rate of $200 per hour, mirroring the rate charged by the Special Prosecutor, rather than the statutory rates under County Law § 722-b. The attorney argued that the significant disparity in hourly compensation violated the defendant's right to equal protection and that his qualifications justified the requested rate. The New York State Association of Criminal Defense Lawyers supported the application as amicus curiae, while Monroe County opposed it, arguing the request was untimely and lacked extraordinary circumstances. Presiding Judge Donald J. Mark, J., acknowledged the court's authority to grant compensation in excess of statutory limits under extraordinary circumstances but ultimately denied the application. The denial was based on the court's reasoning that an analogous argument was previously rejected, that linking assigned counsel rates to prosecutor rates would render County Law § 722-b ineffective, and that extraordinary circumstances could not be demonstrated prior to the conclusion of the criminal action. The court, however, reserved the right to reconsider an increased hourly fee upon the case's termination if such circumstances are then proven.

Assigned CounselLegal Aid CompensationCounty Law Section 722-bHourly Rate DisputeSpecial Prosecutor FeesIndigent RightsJudicial DiscretionExtraordinary CircumstancesMonroe County LawEqual Protection Challenge
References
16
Case No. ADJ4258585 (OXN 0130492) ADJ220258 (OXN 0130487)
Regular
Apr 17, 2018

ENRIQUE HERRERA vs. MAPLE LEAF FOODS, U.S. FIRE INSURANCE COMPANY, ALEA NORTH AMERICAN INSURANCE COMPANY

This notice informs parties that the Workers' Compensation Appeals Board (WCAB) intends to admit its rating instructions and a disability rater's recommended permanent disability rating into evidence. The WCAB previously granted reconsideration for further study. Parties have seven days to object to the rating instructions or the recommended rating, with specific procedures for addressing objections. If no timely objection is filed, the matters will be submitted for decision thirty days after service.

WORKERS' COMPENSATION APPEALS BOARDPermanent Disability RatingDisability Evaluation UnitRating InstructionsRecommended Permanent Disability RatingJoint RatingReconsiderationObjectionRater Cross-ExaminationRebuttal Evidence
References
0
Case No. ADJ1904323 (GRO 0034275) ADJ3208896 (GRO 0034276) ADJ649343 (GRO 0034277)
Regular
Nov 01, 2010

SARAH SHIPP vs. GOTTSCHALKS, SPECIALTY RISK SERVICES

The Appeals Board granted reconsideration, rescinding the prior award due to the Workers' Compensation Judge's (WCJ) improper reliance on an Agreed Medical Evaluator's (AME) hernia analogy to rate upper extremity impairment. This analogy violated *Almaraz II* by not adhering to the AMA Guides and potentially incorporating pre-2005 rating schedules. The rater also used an incorrect impairment number and occupational adjustment. The case is remanded for further proceedings and a new decision by the WCJ, ensuring the rating is not based on the flawed hernia analogy.

Workers' Compensation Appeals BoardSarah ShippGottschalksSpecialty Risk ServicesJoint Findings and Awardindustrial injuryright shoulderleft shoulderright elbowthumb
References
4
Case No. ADJ1030139 (STK 0203781)
Regular
Nov 19, 2014

GERALD REESE vs. MICRODENTAL LABORATORIES, AMERICAN HOME ASSURANCE, AIG CLAIMS SERVICES

The Appeals Board granted reconsideration to review the permanent disability rating for applicant Gerald Reese, who sustained an industrial injury in 2006. The primary issue was whether to include a deconditioning impairment, rated by a PQME using analogy, into the permanent disability award. The Board affirmed the WCJ's decision but amended it to defer the issue of permanent disability for further proceedings. This deferral is to allow the WCJ to issue rating instructions based on the established legal framework for incorporating AMA Guides impairments, even those addressed by analogy.

PQMEdeconditioningAMA Guideswhole person impairmentanalogyLabor Code section 4660Almaraz/Guzman IIMilpitas Unified School Dist.City of Sacramento v. Workers' Comp. Appeals Bd.rating instructions
References
3
Case No. ADJ8718778
Regular
Jul 06, 2015

BETOEL GOMEZ vs. UNITED PALLET SERVICES, CIGA

This case concerns applicant Betoel Gomez's claim for permanent disability due to a right hand and bilateral wrist injury. The defendant, United Pallet Services, sought reconsideration of a $21\%$ permanent disability award, arguing the Qualified Medical Evaluator (QME) improperly used an analogical rating rather than AMA Guides' scheduled ratings. The Appeals Board granted reconsideration, agreeing the QME failed to adequately justify the analogical rating in his supplemental report. Ultimately, the Board amended the award to $10\%$ permanent disability, based on the QME's initial report which applied the AMA Guides to grip strength loss.

Workers' Compensation Appeals BoardCIGAUllico Casualty Companyliquidationpermanent disabilityWhole Person ImpairmentWPIAMA GuidesAlmaraz/GuzmanQualified Medical Evaluator
References
2
Case No. ADJ10121570
Regular
Aug 19, 2016

TRACY BAKER vs. FOOTHILL DEANZA COMMUNITY COLLEGE DISTRICT

In this Workers' Compensation Appeals Board case, the defendant sought reconsideration of an award finding the applicant sustained a work-related rib and chest injury. The defendant argued the QME's opinion on permanent disability and future medical treatment lacked substantial medical evidence, as it relied on analogy due to the absence of a specific rating in the AMA Guides. The Appeals Board affirmed the original award but deferred the issues of permanent disability and attorney's fees, finding the QME's analogical rating was conclusory and unsupported by sufficient reasoning. A dissenting commissioner argued the analogy was permissible under precedent allowing clinical judgment for poorly understood conditions manifesting solely as subjective symptoms.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardPermanent DisabilityFuture Medical TreatmentQualified Medical EvaluatorWhole Person ImpairmentSubstantial Medical EvidenceAMA GuidesClinical Judgment
References
7
Case No. ADJ7238353
Regular
Dec 10, 2012

Arthur Cannon vs. CITY OF SACRAMENTO

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to review the denial of permanent disability for Arthur Cannon, a police officer injured in 2008. An Agreed Medical Examiner (AME) opined that while objective findings were minimal, the applicant's heel pain justified a 7% Whole Person Impairment rating by analogy to gait derangement. The WCAB found the AME's analogy was permissible under *Almaraz/Guzman* to address impairments not specifically covered by the AMA Guides, thus rescinding the original award. The dissenting opinion argued there was no objective evidence of impairment in earning capacity, normal member use, or competitive handicap, and therefore no basis for the rating.

Workers' Compensation Appeals BoardArthur CannonCity of SacramentoReconsiderationPermanent Disability Rating ScheduleAgreed Medical ExaminerAMA GuidesWhole Person ImpairmentPlantar FasciitisGait Derangement
References
5
Case No. MISSING
Regular Panel Decision

Claim of Perrin v. Builders Resource, Inc.

The case concerns an appeal from a Workers' Compensation Board decision regarding the reimbursement rate for home health aide services provided to a claimant by their sister. Initially, the carrier denied payment but was later directed to pay. The Workers’ Compensation Law Judge set the reimbursement rate at $12 per hour for services starting in 2011, which the Board affirmed. The claimant appealed, solely challenging this rate. The court dismissed the appeal, ruling that the claimant was not an aggrieved party concerning the reimbursement rate, as the dispute was between the care provider (the sister) and the carrier. The court affirmed that the claimant received the care sought and could not raise issues on behalf of the care provider.

Workers' CompensationHome Health Aide ServicesReimbursement RateAppeal DismissalAggrieved PartyCare ProviderWorkers' Compensation BoardAppellate ProcedureNew York LawCarrier Liability
References
4
Case No. MISSING
Regular Panel Decision

Anthony L. Jordan Health Corp. v. Axelrod

The Anthony L. Jordan Health Center, a not-for-profit corporation, challenged the New York State Department of Health's recalculation of its Medicaid reimbursement rates for the 1983-1984 and 1984-1985 periods. Following an appeal, the parties entered into a stipulation agreement. However, the Department, while recalculating the rates in accordance with the stipulation, unilaterally changed the group composition, resulting in a significant negative adjustment and recoupment from Jordan. The court determined that this regrouping constituted an 'error of judgment,' not a permissible correction for mathematical error or an audit finding. Consequently, the court found that the Department did not have the right to retroactively adjust the rates based on this discretionary change. The petition was granted.

Medicaid ReimbursementRate RecalculationAdministrative ReviewStipulation AgreementError of JudgmentGroup CompositionRetroactive AdjustmentHealth Care LawJudicial ReviewDepartment of Health
References
5
Case No. MISSING
Regular Panel Decision

In re Striley

This case addresses an employer's constitutional challenge to the New York State Unemployment Insurance Law concerning payments to striking workers and the application of the 'experience rating' method (Labor Law, § 581). The employer questioned the constitutionality under both Federal and State Constitutions. The court referenced W. H. H. Chamberlin, Inc., v. Andrews, which previously affirmed the constitutionality of taking money from employers for a general fund to pay strikers, and extended this principle to the 'experience rating' method. The decision emphasized that the method of assessment is a legislative matter and found no unreasonable or arbitrary act or constitutional violation in the change from a percentage ratio to 'experience rating'. The court affirmed the decision of the Unemployment Insurance Board.

Unemployment Insurance LawConstitutionalityExperience RatingStriking WorkersLabor LawLegislative IntentJudicial ReviewStatutory InterpretationEmployer ContributionsBenefit Payments
References
3
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