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

Case No. MISSING
Regular Panel Decision

Claim of Anderson v. New York City Department of Design & Construction

Claimant appealed a Workers' Compensation Board decision from April 25, 2013, which denied his application to include a partial right rotator cuff tear under his existing 2002 work-related injury claim. The Board found that claimant failed to establish a causal link between the 2002 automobile accident and the 2009 rotator cuff tear, despite the opinion of his orthopedist. The orthopedist acknowledged that age-related degeneration could cause such tears independently of trauma. The Appellate Division affirmed the Board's decision, concluding there was substantial evidence to support the finding that the orthopedist's testimony did not convincingly prove a causal relationship.

Rotator cuff tearCausal relationshipWorkers' CompensationMedical evidenceDisabilityWork-related injuryAutomobile accidentShoulder painOrthopedist opinionSubstantial evidence
References
4
Case No. 518426
Regular Panel Decision
Oct 02, 2014

MatterofAndersonvNewYorkCityDepartmentofDesign&Construction

Donald Anderson, the claimant, sought workers' compensation benefits for injuries sustained in a 2002 work-related automobile accident. Initially, his claim was established for neck and back injuries, but in 2005, the Workers' Compensation Board determined he had no continuing disability, noting he was magnifying symptoms. In 2009, Anderson was diagnosed with a partial right rotator cuff tear, which he sought to include under his existing claim, alleging a causal link to the 2002 accident. The Board denied this application, finding a lack of established causal relationship. The Appellate Division affirmed the Board's decision, concluding that Anderson failed to present convincing evidence from his orthopedist or any other proof to establish the necessary causal connection between the 2002 accident and his right rotator cuff tear.

Workers' CompensationCausally Related InjuryRotator Cuff TearAutomobile AccidentMedical EvidenceDisability BenefitsAppellate ReviewShoulder InjurySubstantial EvidenceCausation
References
4
Case No. MISSING
Regular Panel Decision
Sep 28, 2017

Barrett v. Berryhill

Plaintiff Brian Scott Barrett challenged the Commissioner of Social Security's denial of his disability benefits application. The Administrative Law Judge (ALJ) initially found Barrett not disabled, concluding he could perform light work despite impairments like a right knee meniscal tear, left shoulder rotator cuff tear, neck and low back degenerative disc disease, and depressive disorder. The Appeals Council denied review, making the ALJ's decision final. Barrett moved for judgment on the pleadings, arguing errors in weighing medical opinions, RFC determination, and credibility. The Court denied both motions for judgment on the pleadings and remanded the case to the ALJ, citing the ALJ's failure to properly apply the treating physician rule to Dr. Dowling's opinions and to clarify reliance on a Single Decisionmaker's RFC assessment.

Disability BenefitsSocial Security ActTreating Physician RuleAdministrative Law JudgeResidual Functional CapacityDepressive DisorderKnee InjuryShoulder InjuryBack PainNeck Pain
References
38
Case No. ADJ2934117 (STK 0214084)
Regular
Jun 06, 2011

BENNIE MADAVE vs. STOCKTON UNIFIED SCHOOL DISTRICT

This case involves an applicant seeking workers' compensation for a right shoulder rotator cuff repair surgery denied by a WCJ. The WCJ ruled the need for surgery stemmed from a subsequent non-industrial accident, not the initial industrial injury. The Appeals Board granted reconsideration, rescinded the original order, and returned the case for further medical record development. This is because the medical evidence failed to definitively determine if the surgery was necessary to cure or relieve the effects of the industrial injury, even if the tear itself wasn't solely industrially caused.

Rotator cuff repairIndustrial injuryNon-industrial accidentUtilization reviewPanel Qualified Medical EvaluatorPQMEApportionmentPermanent disabilityInextricably linkedFurther development of medical record
References
1
Case No. ADJ1313860
Regular
Mar 07, 2017

Kevin Voelker vs. D. Frey Plastering Co., State Compensation Insurance Fund

This case involves a workers' compensation applicant challenging an Independent Medical Review (IMR) determination that denied authorization for shoulder surgery. The applicant argued the IMR incorrectly applied guidelines for acromioplasty/impingement syndrome instead of guidelines for a rotator cuff tear, which was the actual condition for which surgery was requested. The Appeals Board granted reconsideration, finding the IMR's determination was based on a plainly erroneous mistake of fact readily apparent from the submitted records, not requiring expert opinion. Consequently, the Board rescinded the IMR determination and remanded the matter for a new IMR process.

Workers' Compensation Appeals BoardIndependent Medical ReviewPetition for ReconsiderationFindings and OrderPlainly Erroneous Finding of FactMedical Treatment Utilization ScheduleRequest for AuthorizationRotator Cuff TearAcromioplastyImpingement Syndrome
References
3
Case No. 534536
Regular Panel Decision
Jun 09, 2022

In the Matter of the Claim of Wesley Harmon

The claimant, Wesley Harmon, appealed a Workers' Compensation Board decision that determined a 20% schedule loss of use (SLU) of his left arm and reduced his counsel's fee. The Board had credited the opinion of his treating orthopedist, Dr. John Goldblatt, over the employer's independent medical examiner, Dr. Frederick Kaempffe, regarding the SLU percentage, and adjusted Goldblatt's calculation by removing a 10% addition for a rotator cuff tear based on current guidelines. The Appellate Division affirmed the Board's decision, finding that its resolution of conflicting medical evidence was supported by substantial evidence and that its exercise of discretion in awarding counsel fees was not arbitrary or capricious.

Schedule Loss of UseLeft Shoulder InjuryRotator Cuff TearMaximum Medical ImprovementWorkers' Compensation Board DecisionMedical Evidence EvaluationAppellate DivisionCounsel FeesIndependent Medical ExamOrthopedic Impairment
References
10
Case No. ADJ3149661 (SDO 0271415)
Regular
Apr 27, 2012

Elsa Cervantes vs. COSTCO WHOLESALE CORPORATION, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board granted reconsideration to find that applicant Elsa Cervantes sustained an industrial injury to her left shoulder, overturning the WCJ's prior decision. The Board found substantial medical evidence supported that the rotator cuff tear arose from the April 27, 2000 incident, reversing the WCJ's reliance on Dr. Lane's opinion. Applicant is entitled to further medical treatment, including surgery, and continuing temporary disability benefits for the left shoulder injury. However, the Board affirmed the WCJ's decision regarding the defendant's right to control medical treatment through its Medical Provider Network, finding no contrary evidence of substantiality to overturn the credibility findings.

Workers Compensation Appeals BoardElas CervantesCostco Wholesale CorporationSedgwick Claims Management Servicesindustrial injuryneck injuryleft trapezius muscle injurypsyche injuryleft shoulder injuryMedical Provider Network (MPN)
References
0
Case No. 534536
Regular Panel Decision
Jun 09, 2022

Matter of Harmon v. Office of Children & Family Servs.

Claimant Wesley Harmon appealed a Workers' Compensation Board decision finding a 20% schedule loss of use (SLU) of his left arm and reducing his counsel fees. Harmon sustained a left shoulder injury in 2018, with conflicting medical opinions from orthopedists John Goldblatt (20% SLU) and Frederick Kaempffe (50% SLU). The Board credited Goldblatt's assessment, finding it consistent with Harmon's medical history and current guidelines which no longer add a percentile for rotator cuff tears, and reduced counsel fees. The Appellate Division affirmed the Board's determination, holding that it was supported by substantial evidence and that the Board exercised proper discretion in weighing medical evidence and setting counsel fees.

Workers' CompensationSchedule Loss of UseLeft Arm InjuryShoulder Impingement SyndromeRotator Cuff TearMedical Expert OpinionConflicting Medical EvidenceMaximum Medical ImprovementAppellate ReviewCounsel Fees
References
12
Case No. MISSING
Regular Panel Decision
Feb 15, 2013

Claim of Storm v. Phillips Lighting Co.

The claimant, a machine operator, sustained a work-related right shoulder injury in 2002, leading to surgery in 2010 for a rotator cuff tear. An occupational physician, Michael Lax, diagnosed an occupational disease in November 2011, attributing it to repetitive arm motion. Subsequently, the claimant applied for workers\' compensation benefits in 2012. While a Workers’ Compensation Law Judge initially deemed the claim time-barred and related to the 2002 accident, the Workers’ Compensation Board reversed, establishing the claim. On appeal, the Board\'s determination was affirmed, with the court finding substantial evidence that the claim was timely filed due to the claimant\'s knowledge date in November 2011, and that the claimant suffered from a distinct occupational disease aggravated by her employment duties.

Workers\' CompensationOccupational DiseaseRepetitive Motion InjuryShoulder InjuryRotator Cuff TearTimeliness of ClaimDate of DisablementAggravationWorkers\' Compensation Board AppealAppellate Review
References
6
Case No. MISSING
Regular Panel Decision
Mar 08, 2006

Nazario v. Fortunato & Fortunato, PLLC

The plaintiff initiated a legal malpractice action against a law firm and its members, alleging their failure to timely commence a personal injury action for injuries sustained in a workplace accident in August 2000. Plaintiff claimed a falling pipe caused a right rotator cuff tear and herniated discs, although the defendants successfully handled the workers' compensation claim. The defendants moved for summary judgment, arguing a lack of causal relationship between the 2000 accident and the claimed injuries, revealing plaintiff's extensive history of similar injuries from prior and subsequent automobile accidents, which he failed to disclose to treating physicians. The Supreme Court initially denied the motion, but the Appellate Division reversed, granting summary judgment to the defendants. The court found that the plaintiff failed to counter the defendants' evidence and raise a triable issue of fact regarding the causation of his injuries from the August 2000 incident.

Legal MalpracticeSummary JudgmentCausationPrior AccidentsUndisclosed Medical HistoryWorkers' Compensation ClaimPersonal InjuryRotator CuffHerniated DiscsAppellate Division
References
2
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