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

Case No. ADJ1438639 (GRO0024593) ADJ3262777 (GRO0025366)
Regular
Jul 06, 2011

DENNIS TIMMONS vs. CALIFORNIA MENS COLONY, STATE COMP. INS. FUND, SUBSEQUENT INJURIES BENEFITS TRUST FUND

The Workers' Compensation Appeals Board granted reconsideration to reverse a prior award of Subsequent Injuries Benefits Trust Fund (SIBTF) benefits to the applicant, Dennis Timmons. The applicant sought SIBTF benefits based on a claimed pre-existing disability from a 1991 injury, arguing it imposed a prophylactic restriction from very heavy work that contributed to his 2000 industrial injury. However, the Board found no substantial medical evidence of a ratable pre-existing disability at the time of the 2000 injury, as prior medical reports indicated no residual disability and the applicant returned to work without restrictions. The Board concluded that a retroactive prophylactic restriction, without evidence of actual prior work limitations, is insufficient to establish SIBTF eligibility.

Subsequent Injuries Benefits Trust FundSIBTFpre-existing disabilityindustrial injurypermanent disabilityapportionmentAgreed Medical ExaminerAMEprophylactic restrictionWCJ
References
2
Case No. ADJ3134805 (BAK 0148440)
Regular
Feb 11, 2011

VELGRACE SMITH vs. KERN COUNTY SUPERIOR COURT

This case concerns a defendant seeking reconsideration of a decision that awarded a 15% increase in permanent disability indemnity payments. The administrative law judge (WCJ) found the employer failed to offer modified work within 60 days of the applicant's condition becoming permanent and stationary, as required by Labor Code section 4658(d)(2). The Appeals Board granted reconsideration, finding the WCJ's literal interpretation of the statute would lead to absurd consequences given the retroactive nature of medical findings and delayed service of reports. The Board held the 60-day period begins when the employer has knowledge of both the permanent and stationary status and work restrictions, and remanded the case to determine if the employer's modified work offer remained consistent with updated restrictions.

Workers' Compensation Appeals BoardReconsiderationPermanent DisabilityModified WorkLabor Code Section 4658(d)AggravationCumulative InjuryAgreed Medical EvaluatorPermanent and Stationary DateWork Restrictions
References
3
Case No. LBO 0327414
Regular
Jun 12, 2008

GREGORIO PEREZ vs. MSX INTERNATIONAL, CHUBB GROUP OF INSURANCE COMPANIES

The Workers' Compensation Appeals Board granted reconsideration to reduce applicant's permanent disability from 70% to 46% after apportionment. The Board found that while the applicant sustained an industrial injury to his left lower extremity and back, a significant portion of his back disability was attributable to pre-existing degenerative disc disease, as supported by medical evidence. The Board apportioned the back disability by comparing the applicant's current light work restriction to a prophylactic restriction from very heavy work due to his underlying condition.

ApportionmentPermanent DisabilityDegenerative Disc DiseaseIndustrial InjuryNon-Industrial FactorsMedical EvidenceSupplemental ReportDepositionWCJAppeals Board
References
3
Case No. GOL 0096107
Regular
Mar 05, 2008

MIGUEL ANGEL CRUZ vs. EARL CLARK, FARMERS INSURANCE EXCHANGE, SUBSEQUENT INJURIES BENEFITS TRUST FUND

This case concerns Miguel Angel Cruz's petition for reconsideration of a denial of Subsequent Injuries Benefits Trust Fund (SIBTF) benefits. The Workers' Compensation Appeals Board affirmed the denial, finding no evidence that Mr. Cruz's pre-existing degenerative spinal condition was "labor disabling" prior to his industrial injury. Crucially, the Board held that a retroactive prophylactic work restriction by a physician after the injury does not establish a pre-existing labor-disabling condition for SIBTF eligibility.

Subsequent Injuries Benefits Trust Fundpre-existing conditionlabor disablingpermanent disabilityapportioned disabilityindustrial injuryprimary treating physiciandegenerative changeslumbar spineprophylactic work restriction
References
7
Case No. ADJ8104549
Regular
Jul 05, 2017

MICHAEL KELLY vs. SUBSEQUENT INJURIES BENEFITS TRUST FUND

This case involves Michael Kelly seeking benefits from the Subsequent Injuries Benefits Trust Fund (SIBTF) based on a pre-existing disability that allegedly combined with his 2011 shoulder injury to create permanent total disability. The Workers' Compensation Appeals Board denied Kelly's petition for reconsideration, affirming the administrative law judge's finding. The Board found that the medical evidence Kelly relied upon was not substantial, particularly regarding his alleged pre-existing "labor disabling" condition. The Board concluded that the opinions of certain medical evaluators constituted impermissible retroactive prophylactic work restrictions, as Kelly's own account of his abilities at the time of injury contradicted their findings.

Subsequent Injuries Benefits Trust FundPermanent Partial DisabilityQualified Medical EvaluatorPre-existing DisabilityLabor DisablingRatable Permanent DisabilityRetroactive Prophylactic Work RestrictionApportionmentWCJ Report and RecommendationWorkers' Compensation Appeals Board
References
4
Case No. 2018 NY Slip Op 06537 [165 AD3d 667]
Regular Panel Decision
Oct 03, 2018

Matter of Heritage Mech. Servs., Inc. v. Suffolk County Dept. of Pub. Works

This case involves an appeal by Heritage Mechanical Services, Inc. (petitioner) from a judgment denying its petition to annul a determination by the Suffolk County Department of Public Works (DPW). The dispute stemmed from a general construction contract awarded to Posillico/Skanska, JV for a waste water treatment plant upgrade. Heritage was listed as a subcontractor for HVAC work, but a disagreement arose over the agreed-upon amount, with Heritage claiming a higher price for alternates not included in the initial bid figure. DPW approved Posillico's request to perform the HVAC work itself, citing Heritage's refusal as a 'legitimate construction need' under General Municipal Law § 101 (5). The Appellate Division, Second Department, affirmed the Supreme Court's judgment, finding DPW's determination was not arbitrary and capricious, affected by an error of law, or an abuse of discretion, and thus dismissed the proceeding.

Public Works ContractSubcontractor DisputeGeneral Municipal LawCPLR Article 78Administrative ReviewArbitrary and CapriciousProject Labor AgreementHVAC SubcontractBid DisputeContractual Interpretation
References
1
Case No. MISSING
Regular Panel Decision

Claim of Wiltsie v. Owens Corning Fiberglass

Claimant suffered a compensable low back injury in 1995, continuing work with restrictions and ADA accommodations. In 2003, the employer's decision to change his shift caused claimant stress, leading his primary physician to diagnose chest pain syndrome, agoraphobia, and depression, and advise him to stop working. Initially awarded benefits for a period, the Workers’ Compensation Board subsequently denied further benefits, concluding that claimant's departure from work was for reasons unrelated to his back disability. Claimant appealed, contending his back injury prevented him from the new shift, but the Board's determination, supported by other evidence, found he left due to stress from the shift dispute rather than his back condition. The Board's decision, which included an assessment of claimant's testimony and medical evidence, was affirmed, as it was supported by credible evidence.

Low Back InjuryAmericans with Disabilities Act (ADA)Workplace AccommodationShift Schedule ChangeStress-Related IllnessChest Pain SyndromeAgoraphobiaDepression DiagnosisCredibility of Medical OpinionPermanent Partial Disability
References
5
Case No. MISSING
Regular Panel Decision

Waterson v. Plank Road Motel Corp.

Suzanne Waterson, a former employee of Best Western Inn, sued for sexual harassment and discriminatory termination. Defendants moved to bar testimony on compensatory and punitive damages and to restrict the testimony of another former employee, Anne Marie Malinowski. The court ruled that the Civil Rights Act of 1991, which allows compensatory/punitive damages and jury trials for Title VII claims, was not retroactive to Waterson's alleged pre-1991 conduct. However, Waterson could seek compensatory damages and a jury trial under her supplemental New York State Human Rights Law claim, provided her state claim was dismissed for "administrative convenience." The court denied the motion to restrict Malinowski's testimony, finding it relevant to demonstrating a hostile work environment and discriminatory intent. Ultimately, the court granted in part and denied in part the motion regarding damages, allowing compensatory damages only for the state law claim, and denied the motion to restrict Malinowski's testimony.

Sexual HarassmentEmployment DiscriminationCivil Rights Act of 1964Civil Rights Act of 1991RetroactivityCompensatory DamagesPunitive DamagesJury TrialState Law ClaimNew York State Human Rights Law
References
18
Case No. 2017 NY Slip Op 08382 [155 AD3d 1049]
Regular Panel Decision
Nov 29, 2017

Matter of Soliman v. Suffolk County Dept. of Pub. Works

Nader I. Soliman, a Senior Civil Engineer for Suffolk County Department of Public Works, was terminated after an arbitration award found him guilty of misconduct for accessing unauthorized, sexually explicit websites during work hours. Soliman petitioned the Supreme Court, Suffolk County, to vacate the arbitration award, but the court denied the petition, dismissed the proceeding, and confirmed the award. On appeal, the Appellate Division, Second Department, affirmed the Supreme Court's judgment, finding that Soliman failed to demonstrate by clear and convincing evidence that the arbitration award was irrational or that the arbitrator exceeded their powers.

MisconductArbitration AwardVacaturCPLR Article 75Appellate ReviewPublic EmploymentTerminationEmployee MisconductRationality of AwardArbitrator Powers
References
10
Case No. 533112
Regular Panel Decision
Mar 17, 2022

Matter of Reyes v. H & L Iron Works Corp.

A claimant appealed a Workers' Compensation Board decision which found he violated Workers' Compensation Law § 114-a and permanently disqualified him from future indemnity benefits. The claimant, Leonel Reyes, sustained work-related injuries in 2016 and received benefits. However, he failed to fully disclose his disc jockey activities and the physical nature of this work to the Board, carrier, and examining physicians while collecting benefits. Surveillance videos showed him lifting heavy equipment, contradicting his testimony. The Workers' Compensation Board affirmed the WCLJ's finding of a violation and the imposition of both mandatory and discretionary penalties. The Appellate Division, Third Department, affirmed the Board's decision, concluding that substantial evidence supported the violation and that the permanent forfeiture of indemnity benefits was not a disproportionate penalty given the claimant's multiple egregious misrepresentations.

Workers' Compensation Law § 114-aFalse RepresentationIndemnity BenefitsPermanent DisqualificationUndisclosed EmploymentDisc JockeyMaterial MisrepresentationSubstantial EvidenceWitness CredibilityDiscretionary Penalty
References
7
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