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

Case No. ADJ9210498
Regular
Apr 04, 2017

ELEANOR DEFRANCO vs. MONTEREY FISH COMPANY, ENSTAR (US) INC., dba ENSTAR ADMINISTRATORS FOR SEABRIGHT INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior award that found industrial injury to applicant's right ankle, right shoulder, and back, but not her right knee. The WCAB rescinded the finding of industrial injury to the back, while otherwise affirming the prior decision. Specifically, the WCAB affirmed the finding that the applicant sustained industrial injury to her right ankle and right shoulder, and that medical treatment for her right knee is compensable to relieve the effects of the industrial injuries. The WCAB adopted the WCJ's reasoning for these decisions, including the application of the *Braewood* principle for treating the non-industrial knee condition.

Workers' Compensation Appeals BoardEleanor DefrancoMonterey Fish CompanyEnstarSeabright Insurance CompanyIndustrial InjuryRight AnkleRight ShoulderRight KneeBack Injury
References
1
Case No. 533068
Regular Panel Decision
Jun 23, 2022

In the Matter of the Claim of Robert Diamond Jr.

Claimant, a building maintenance mechanic, sustained a right ankle fracture in a 2018 work-related slip and fall. His claim for workers' compensation benefits was established. Medical examiners, Adam Suslak and Dominic Belmonte, agreed on a 30% schedule loss of use (SLU) of the right ankle, but differed on apportionment for a prior ankle injury from 40 years ago. A WCLJ initially apportioned the award, attributing only 10.5% to the 2018 injury, but the Workers' Compensation Board modified this, finding insufficient evidence for apportionment. The Appellate Division affirmed the Board's decision, reiterating that apportionment is generally not applicable where a preexisting non-compensable condition did not hinder job performance, and the medical evidence lacked documentation for the prior injury to support an SLU finding.

Workers' CompensationSchedule Loss of UseApportionmentAnkle InjuryPreexisting ConditionMedical EvidenceMaximum Medical ImprovementJudicial ReviewAppellate DivisionNew York Law
References
12
Case No. ADJ2697898
Regular
Mar 06, 2013

ROBERT WALKER vs. SISKIYOU FOREST PRODUCTS, STATE COMPENSATION INSURANCE FUND, THE SUBSEQUENT INJURIES BENEFIT TRUST FUND

This case involves a Subsequent Injuries Benefit Trust Fund (SIBTF) claim where the applicant sustained industrial injuries to his left knee and right ankle, resulting in incontinence. The Board affirmed the finding of 41% permanent disability for the subsequent injury, finding the applicant eligible for SIBTF benefits under Labor Code § 4751(a) due to corresponding prior and subsequent injuries to opposite limbs. The Board amended the award to specify that the attorney's fee of 15% is calculated on the SIBTF weekly payments, not commuted as a lump sum upfront, to comply with statutory prohibitions. The Court also addressed apportionment, pre-existing disability, and the unreliability of stipulated percentages when SIBTF was not a party.

Subsequent Injuries Benefit Trust FundPermanent DisabilityApportionmentLabor Code Section 4751Industrial InjuryPre-existing DisabilityLabor-DisablingOpposite and Corresponding MemberCommutation of BenefitsVocational Expert
References
3
Case No. MISSING
Regular Panel Decision

Claim of Hilbrandt v. Village of Red Hook

The claimant, a volunteer emergency medical technician, was injured on August 26, 2005. Her initial workers’ compensation claim was established for left ankle/leg and consequential right shoulder injuries. In April 2008, she sought to amend her claim to include a consequential right hip injury. The Workers’ Compensation Law Judge (WCLJ) dismissed the right hip claim as time-barred under Workers’ Compensation Law § 28, a decision upheld by the Workers’ Compensation Board. On appeal, the court affirmed the Board's decision, finding that while Volunteer Firefighters’ Benefit Law § 41 should have been applied, the claim for the right hip injury was time-barred under either statute as it was a direct injury from the 2005 accident and not claimed until April 2008.

Volunteer Firefighters' BenefitsStatute of LimitationsTime-barred ClaimConsequential InjuryDirect InjuryRight Hip InjuryEmergency Medical TechnicianDutchess CountyMedical EvidenceAppellate Review
References
6
Case No. ADJ8195644, ADJ8195735, ADJ8195670
Regular
May 03, 2018

ENRIQUE CASTRO vs. CITY OF GLENDALE

This case involves the City of Glendale's petition for reconsideration of workers' compensation awards for firefighter Enrique Castro. The appeals board granted reconsideration to amend the award for injuries sustained on October 23, 2008 (ADJ8195735), specifically reducing the permanent disability from the inclusion of a right ankle injury. The WCAB affirmed the WCJ's findings for the cardiovascular and GERD claims from 2009-2010 (ADJ8195644) and the July 20, 2009 heart injury (ADJ8195670). The decision ultimately modifies the permanent disability award for ADJ8195735 to 23% without the right ankle contribution.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardWhole Person ImpairmentCardiovascular DiseaseGERDRight Ankle InjuryFire FighterPermanent DisabilityDisability Indemnity
References
3
Case No. ADJ6955370
Regular
Nov 06, 2014

JOHN DELVA vs. ANDREW INTERNATIONAL aka ADVANCED TECH SECURITY, ARCH INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) rescinded a prior award finding industrial injury to the applicant's right ankle. This decision followed the defendant's petition for reconsideration, arguing against the ankle injury finding. The WCAB gave significant weight to the Agreed Medical Evaluator's (AME) final opinion, which, after further review and deposition, concluded the applicant did not sustain an industrial injury to his ankle. Consequently, the WCAB found no industrial injury to any body part and awarded nothing to the applicant.

WORKERS' COMPENSATION APPEALS BOARDINDUSTRIAL INJURYRIGHT ANKLEAGREED MEDICAL EVALUATORCONTINUOUS TRAUMASPECIFIC TRAUMARECONSIDERATIONFINDINGS AND AWARDWCJSUPPLEMENTAL REPORT
References
0
Case No. MISSING
Regular Panel Decision

Claim of Wilcox v. Niagara Mohawk Power Corp.

Claimant sustained a work-related injury to their right ankle in December 2004, twelve years after an unrelated surgery on the same ankle. Following the 2004 incident, the claimant's treating physician opined a 45% schedule loss of use of the right foot, not attributing any part of the loss to the earlier noncompensable injury. The employer's medical examiner concurred on the 45% loss but concluded that 50% was attributable to the prior injury. A Workers' Compensation Law Judge initially granted the 45% award, rejecting the employer's claim of apportionment, a decision subsequently upheld by the Workers' Compensation Board. The appellate court affirmed the decision, finding insufficient medical evidence to support apportionment given the unavailability of records from the 1992 surgery and the speculative nature of opinions regarding a preexisting loss of use.

Workers' CompensationApportionmentSchedule Loss of UseAnkle InjuryPreexisting ConditionMedical EvidenceConflicting Medical OpinionsWorkers' Compensation BoardTreating PhysicianMedical Examiner
References
4
Case No. ADJ6509769
Regular
Aug 16, 2010

JOAN VALENTINE vs. CB RICHARD ELLIS, INC., ZURICH NORTH AMERICA

The applicant sought reconsideration of a WCJ decision that awarded $4\%$ permanent disability for a low back injury but denied claims for right knee, right ankle, and sleep disorder injuries. The applicant contended the WCJ erred by not finding an industrial injury to her right knee, arguing her attorney failed to enter relevant medical reports into evidence. The Appeals Board granted reconsideration, rescinded the original award, and returned the matter to the trial level. This action was based on the potential insufficiency of the PQME's review, as the applicant's testimony regarding her knee injury was corroborated by contemporaneous medical reports that may not have been fully considered.

Petition for reconsiderationPro perFindings and AwardIndustrial injuryLow back injuryPermanent disabilityRight knee injuryRight ankle injurySleep disorderVerified petition
References
8
Case No. 535725
Regular Panel Decision
Dec 14, 2023

In the Matter of the Claim of Odaliris Allen

Claimant sustained a work-related back and right knee injury in January 2000, establishing a workers' compensation claim. In 2008, liability for the claim transferred to the Special Fund for Reopened Cases. Following a 2011 decision awarding benefits for a 37.5% schedule loss of use of the right leg, the claim was later amended in 2019 to include a consequential right ankle injury, and again in October 2021 for a consequential left achilles tendon injury. In December 2021, claimant sought additional indemnity awards, but the Workers' Compensation Law Judge (WCLJ) denied this request, ruling that Workers' Compensation Law § 123 precluded further awards due to the significant lapse of time since the injury and last compensation payment. The Workers' Compensation Board affirmed this denial on administrative review. The Appellate Division, Third Judicial Department, affirmed the Board's decision, concluding that substantial evidence supported the finding that the case was truly closed, and thus, the time limitations of Workers' Compensation Law § 123 were applicable, barring any additional indemnity benefits.

Workers' Compensation Law § 123Special Fund for Reopened CasesIndemnity benefitsSchedule Loss of UseSLUConsequential injuryCase closureInformal reopeningTime limitationsAppellate Division
References
13
Case No. MISSING
Regular Panel Decision
Nov 14, 2000

Claim of Martin v. Levest Electric Corp.

The claimant, having suffered work-related injuries, pursued both workers' compensation benefits and a third-party personal injury action, which was subsequently settled. A contention arose concerning the workers' compensation carrier's entitlement to offset future benefits against the net settlement proceeds, as outlined in Workers' Compensation Law § 29. The Workers’ Compensation Board determined that the carrier had correctly preserved its right to this offset. On appeal, the claimant argued that the carrier had consented to the settlement, thereby waiving its offset right, and that a court possessed the authority to waive such a right. The appellate court upheld the Board's finding, concluding that there was no substantial evidence of carrier consent to the settlement, and reaffirmed that a court cannot override a carrier's explicit reservation of its offset rights.

Workers' CompensationThird-Party ActionSettlementOffset RightsCarrier ConsentFuture BenefitsJudicial ReviewAppellate DecisionBoard RulingReservation of Rights
References
4
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