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

Case No. 2021 NY Slip Op 07401
Regular Panel Decision
Dec 23, 2021

Matter of Carola B.-M. v. New York State Off. of Temporary & Disability Assistance

Petitioners Carola B.-M. and Tiara M. challenged the denial of their supplemental nutrition assistance program (SNAP) benefits by the New York State Office of Temporary and Disability Assistance and the Orleans County Department of Social Services. The benefits were denied because they were deemed ineligible college students. The Appellate Division, Fourth Department, reversed this determination, holding that participation in the Adult Career and Continuing Education Services, Vocational Rehabilitation program (ACCES-VR) qualifies as a Job Training Partnership Act (JTPA) program. This status exempts the students from certain SNAP eligibility requirements. The court found that the original determination was based on an unreasonable interpretation of relevant regulations, annulled the decision, granted the petition, and remitted the case for a calculation of retroactive benefits.

SNAP benefitscollege student eligibilityJob Training Partnership ActACCES-VRvocational rehabilitationCPLR article 78regulatory interpretationpublic assistancefood stampsAppellate Division
References
28
Case No. MISSING
Regular Panel Decision

Claim of Bruzzese v. Guardsman Elevator Co.

In 1994, the claimant sustained head, neck, and back injuries at work, leading to an award for permanent partial disability, which included a wage expectancy adjustment under Workers’ Compensation Law § 14 (5). Following back surgery in 1998, the case was reopened, and the claimant was found to be temporarily totally disabled. Benefits for this temporary total disability were calculated based on the claimant's average weekly wage at the time of injury, without applying the wage expectancy adjustment. The claimant appealed, arguing that since the permanent partial disability preceded the temporary total disability, the wage expectancy adjustment should also apply to the latter period. The court disagreed, affirming the Workers’ Compensation Board's decision, citing established case law that Workers’ Compensation Law § 14 (5) is applicable only to awards for permanent partial disability and not temporary disability.

Wage expectancyTemporary total disabilityPermanent partial disabilityWorkers' Compensation benefitsBack injuryAppellate reviewDisability calculationWorkers' Compensation BoardAverage weekly wage
References
1
Case No. ADJ7054442
Regular
Jan 11, 2013

JARRAD JELSMA vs. WINE GROUP, INC.; TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Board denied the defendant's petition for reconsideration of the WCJ's award of temporary disability indemnity. The defendant failed to demonstrate due diligence in producing a wage statement discovered after trial, which it claimed would lower the indemnity rate. While denying reconsideration of the retroactive award, the Board allowed the defendant to petition to reopen the award to prospectively adjust the temporary disability indemnity rate based on the disputed wage statement. The Board also denied credit to the defendant for any retroactive overpayment of temporary disability indemnity.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardAverage Weekly EarningsTemporary Disability IndemnityWage StatementDue DiligenceNewly Discovered EvidenceReopen AwardRetroactive Overpayment
References
0
Case No. 5674395Z
Regular Panel Decision
Dec 01, 2011

Baines v. Berlin

Mashon Baines, a homeless and disabled mother of three, initiated a CPLR article 78 proceeding to challenge the New York State Office of Temporary and Disability Assistance's August 31, 2011 decision to discontinue her temporary housing assistance. This decision stemmed from an alleged altercation with a shelter director, Marilyn Gonzalez, during a fire drill, leading to Baines's arrest. Baines argued that her due process rights were violated because the discontinuance notice cited only the assault on Ms. Gonzalez, while the administrative decision was based on multiple uncharged wrongdoings and failed to adequately consider video evidence. The court found that respondents failed to adequately apprise Baines of all charges, thereby violating her due process rights, and consequently annulled the August 31, 2011 fair hearing decision. The court also granted Baines's request for attorneys' fees, costs, and disbursements.

Due ProcessAdministrative HearingHomeless AssistanceShelter BenefitsDiscontinuance of BenefitsNotice RequirementsCPLR Article 78Judicial ReviewAttorneys' FeesSelf-Incrimination
References
8
Case No. ADJ2318045 (LAO 0874347) ADJ2880487 (LAO 0874346) ADJ2783382 (LAO 0889171)
Regular
Apr 25, 2016

Donnie Lewis vs. ALHATTI CORPORATION, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration to address the applicant's claims regarding retroactive permanent disability advances and associated penalties. The original award confirmed temporary disability and a penalty on unpaid temporary benefits but deferred issues of permanent disability advances, sanctions, and attorney fees for those advances. The Board remanded the case to the trial level to determine the amount of permanent disability advances owed and assess penalties and fees for the defendant's failure to pay them, while confirming that prejudgment interest on temporary disability was not awarded.

WORKERS' COMPENSATION APPEALS BOARDDONNIE LEWISALHATTI CORPORATIONSTATE COMPENSATION INSURANCE FUNDPetition for ReconsiderationFindings and AwardTemporary DisabilityPermanent DisabilityPenaltiesLabor Code section 4650
References
2
Case No. ADJ2862109 (SAL 0094850)
Regular
Oct 20, 2017

ERNIE GONZALES vs. STATE OF CALIFORNIA, DEPARTMENT OF CORRECTIONS AND REHABILITATION; STATE COMPENSATION INSURANCE FUND

This case involved a correctional officer's claim for permanent total disability due to a 2001 knee and psyche injury. The Workers' Compensation Appeals Board reconsidered an award that had found temporary total disability extended through August 17, 2011, and imposed a penalty for delayed payments. The Board rescinded the temporary disability finding, stating it was previously determined and not properly raised. They affirmed the defendant's liability for retroactive permanent disability payments at the temporary disability rate for periods where the applicant wasn't receiving benefits, citing the *Brower* decision. However, the Board rescinded the statutory penalty against the state agency, finding it exempt.

Workers Compensation Appeals BoardPetition for ReconsiderationPermanent Total DisabilityTemporary Total DisabilityPermanent and Stationary StatusLabor Code section 4661.5Labor Code section 5814Labor Code section 5814.5PenaltiesRetroactive Permanent Disability
References
1
Case No. ADJ11645837; ADJ11645835
Regular
May 12, 2025

Navin Razo vs. State of California, Department of Insurance, State Compensation Insurance Fund/State Contract Services

Navin Razo, a senior insurance examiner/financial analyst, sustained multiple injuries arising out of and in the course of employment with the State of California, Department of Insurance, across two adjudication numbers (ADJ11645837 and ADJ11645835). The Workers' Compensation Administrative Law Judge (WCJ) awarded retroactive temporary disability and permanent disability based on combined impairment. The defendant sought reconsideration, contending that medical reports relied upon by the WCJ were not substantial medical evidence and that the retroactive temporary disability award conflicted with prior findings. The Workers' Compensation Appeals Board reviewed the petition and the WCJ's report, ultimately denying the petition for reconsideration, finding the medical evidence substantial and no conflict with prior orders.

AOE/COEPetition for Reconsiderationsubstantial medical evidencetemporary disabilitypermanent disabilityWCJAppeals Boardcumulative traumaspecific injurymedical opinion
References
10
Case No. ADJ4427273 (AHM 150950)
Regular
Jun 15, 2010

ANTONIO GONZALES vs. SAN DIEGO SHUTTERS COMPANY, INC., YORK CLAIMS SERVICES

The Workers' Compensation Appeals Board granted reconsideration of a prior award finding applicant sustained a spinal injury and was entitled to ongoing temporary total disability. Defendant sought reconsideration, arguing the relied-upon medical opinion was unsubstantial and favored the treating physician's earlier maximal medical improvement finding. While the parties later reached a stipulation settling retroactive temporary disability and penalties, the stipulation's scope regarding ongoing temporary disability was unclear. Consequently, the Board rescinded the original award and returned the case to the trial level for further proceedings and clarification on the disability status.

WCABFindings and AwardReconsiderationTemporary Total DisabilityQualified Medical ExaminerMaximal Medical ImprovementTreating PhysicianStipulation and OrderIndustrial InjurySpine Injury
References
0
Case No. ADJ11094232
Regular
May 21, 2019

HERIBERTO FUERTE ALVAREZ vs. CITY OF LOS ANGELES

The Workers' Compensation Appeals Board granted reconsideration and amended the original decision. The amended decision affirmed the prior ruling but modified the temporary disability indemnity award. Specifically, it now includes an award for temporary disability indemnity beginning October 3, 2017, continuing thereafter, with a 15% reduction for retroactive temporary disability payable to the applicant's attorneys. This amendment is subject to Labor Code Section 4656.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ reportDecision After ReconsiderationTemporary disability indemnitystatutory rateOctober 32017Law Offices of Torkan and FarzanpourLabor Code Section 4656
References
0
Case No. ADJ17092437
Regular
Jul 01, 2025

Vince Miller vs. Automobile Club of Southern California, Old Republic Insurance

Defendant sought reconsideration of an Amended Findings of Fact and Order (F&O) that found the applicant had not reached maximum medical improvement (MMI) and was entitled to retroactive temporary disability benefits. The defendant contended a lack of substantial medical evidence for the MMI status and temporary disability, arguing for reliance on the qualified medical evaluator's (QME) report. The Workers' Compensation Appeals Board reviewed the petition and the WCJ's report. The Board ultimately granted the Petition for Reconsideration, rescinded the F&O, and returned the matter to the WCJ for further proceedings to determine if disputed body parts were due to industrial injury before reassessing MMI or temporary disability.

Workers' Compensation Appeals BoardMaximum Medical ImprovementTemporary Total DisabilityPetition for ReconsiderationQualified Medical EvaluatorSubstantial Medical EvidenceFindings of Fact and OrderRescindedReturned to Trial LevelLabor Code Section 5909
References
5
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