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

Case No. ADJ11834433
Regular
Feb 05, 2020

DIETRICK TURNER vs. SUTTER AUBURN FAITH HOSPITAL

The Workers' Compensation Appeals Board granted the applicant's Petition for Reconsideration to amend a Finding of Fact and the order regarding record development. The Board affirmed the original Findings and Award but clarified that there is insufficient medical evidence to establish causation for the applicant's torn scapholunate ligament. The case is remanded for further development of the record specifically on the issue of causation for this injury.

Scapholunate ligamentWorkers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardMedical evidenceCausationAggravationJob dutiesPre-existing conditionDevelopment of the record
References
0
Case No. ADJ7732498
Regular
Apr 20, 2016

ERIC RINGER vs. RESTORATION HARDWARE, LIBERTY MUTUAL FIRE INSURANCE COMPANY

This case concerns a dispute over the necessity of an anterior cruciate ligament (ACL) reconstruction surgery for an industrial knee injury. The Workers' Compensation Appeals Board (WCAB) affirmed the administrative law judge's (ALJ) award of the surgery. The primary issue was the timeliness of the employer's utilization review (UR) denial of the proposed treatment. The WCAB found the UR decision invalid because it was issued outside the statutory timeframe after the request for authorization was received. Therefore, the proposed surgery was deemed authorized.

Utilization ReviewRequest For AuthorizationTimely DenialAllograft vs. AutograftACL ReconstructionLabor Code Section 4610Workers' Compensation Appeals BoardFindings And AwardReconsiderationAdministrative Director Rule 9792.9.1
References
2
Case No. ADJ7467262
Regular
Mar 15, 2018

OLGA ACOSTA vs. MOTEL 6, SUBSEQUENT INJURIES BENEFITS TRUST FUND

The Workers' Compensation Appeals Board granted reconsideration of a prior award of Subsequent Injuries Benefits Trust Fund (SIBTF) benefits to Olga Acosta. The Board found the medical evidence supporting the award, particularly Dr. Chen's opinion on the applicant's left ankle injury and resulting permanent total disability, insufficient. Specifically, the Board noted the absence of stress X-rays needed to support the AMA Guides rating for ligamentous instability and a lack of documentation for the pre-existing conditions contributing to total disability. Therefore, the matter was returned to the trial level for further development of the medical record.

Subsequent Injuries Benefits Trust FundSIBTFpermanent total disabilityopposite and corresponding memberlabor disablingsubstantial medical evidenceAMA Guidesstress x-rayCompromise and Release AgreementAgreed Medical Examiner
References
2
Case No. ADJ9887809
Regular
Jan 29, 2019

JOSEPH CAGLIA vs. CALIFORNIA DEPARTMENT OF REHABILITATION, legally uninsured, adjusted by STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration of a finding of five percent permanent partial disability. The Board adopted the Administrative Law Judge's (WCJ) report, which found the opinion of Dr. Pelton more persuasive than that of Dr. Purcell. The WCJ explained that Dr. Pelton's use of a Station and Gait Disorder rating was appropriate given the applicant's objective ligament tear and resulting subjective limitations, even if a conventional application of the AMA Guides yielded zero impairment. The WCJ's detailed report cured any potential defect under Labor Code § 5313, and the reliance on Dr. Pelton's report constituted substantial evidence.

WCABPetition for Reconsiderationsubstantial evidencemedical opinionsWCJ reportpermanent disabilityprimary treating physicianAMA GuidesAlmaraz-GuzmanStation & Gait Disorder
References
4
Case No. 2014 NY Slip Op 06377
Regular Panel Decision
Sep 25, 2014

National Union Fire Ins. Co. of Pittsburgh, PA v. 221-223 W. 82 Owners Corp.

The Appellate Division, First Department, reversed a Supreme Court order, granting National Union Fire Insurance Company's motion for summary judgment against JRP Contracting, Inc. The court declared that National Union had no duty to defend or indemnify JRP in an underlying personal injury action. National Union successfully argued that the plaintiff's alleged injuries (ligament and meniscal tears) were not "grave injuries" under Workers' Compensation Law § 11. Additionally, National Union's policy contained an exclusion for "liability assumed under a contract," further absolving it from the contractual indemnification claim. JRP's claim of prejudice due to National Union's withdrawal from defense was also rejected, as National Union had expressly reserved its rights.

Summary JudgmentGrave InjuryWorkers' Compensation LawDuty to DefendDuty to IndemnifyInsurance Policy ExclusionContractual IndemnificationPersonal InjuryAppellate Review
References
4
Case No. MISSING
Regular Panel Decision
Jan 15, 2008

Taylor v. American Radio Dispatcher, Inc.

The Supreme Court, Bronx County, granted defendants’ motion for summary judgment, dismissing the complaint on the ground that plaintiff did not suffer a “serious injury” within the meaning of Insurance Law § 5102 (d). The defendants established their prima facie case by submitting reports of independent medical examinations. The plaintiff failed to raise a triable issue of fact, as her experts’ reports, opining on a tear of the anterior talo-fibular ligament and a tear of the meniscus of the right knee, lacked objective, contemporaneous evidence of the extent and duration of alleged physical limitations. Additionally, there was no contemporaneous medical proof for her claim that her injury prevented her from performing substantially all of her usual activities for 90 of the 180 days following the accident. The Appellate Division unanimously affirmed the lower court's decision.

Serious injuryInsurance Lawsummary judgmentmedical examinationanterior talo-fibular ligamentmeniscus tearobjective evidencephysical limitationscustomary activitiesappellate division
References
3
Case No. MISSING
Regular Panel Decision
May 25, 2007

Claim of Hartwell v. Amphenol Interconnect Products

In 1991, a claimant suffered wrist injuries, leading to schedule loss of use awards paid by Liberty Mutual Insurance Company. The initial claim was closed in 1999 and reopened multiple times. A new claim was established in 2002 for scapholunate disassociation, with Travelers Insurance Company covering the authorized surgery. The current appeal concerns Liberty Mutual's request for relief from apportionment liability under Workers’ Compensation Law § 25-a for the 1991 claim, arguing it was truly closed. Both a Workers’ Compensation Law Judge and the Workers’ Compensation Board denied this, finding the 1991 claim was never truly closed due to unresolved issues and contemplated future proceedings. The Appellate Division affirmed the Board's decision, holding that the "no further action planned" designation does not definitively mean a claim is closed if further proceedings are still contemplated.

Special Fund for Reopened CasesApportionment LiabilityClaim Closure StatusDegenerative ArthritisCarpal Tunnel SyndromeScapholunate DisassociationWrist Injury CompensationMedical Change in ConditionWorkers' Compensation Law § 25-aBoard Fact Determination
References
6
Case No. MISSING
Regular Panel Decision

Claim of Mickelson v. Value Construction

Claimant, a carpenter, sought workers' compensation benefits for a left wrist injury in April 2013. The Workers' Compensation Board initially ruled the claim time-barred but later rescinded that decision, establishing the claim with a disablement date of May 6, 2013, corresponding to the diagnosis of a work-related ligament injury and arthritis. The employer and carrier appealed this decision. The Appellate Division, Third Department, affirmed the Board's finding regarding the timely filing and date of disablement, noting it was supported by substantial evidence, despite the claimant's earlier symptoms. However, the Court found that the Board failed to address a previously raised issue concerning whether the left wrist injury was consequentially related to a 2003 right wrist injury. Consequently, the Court modified the Board's decision by remitting the matter for further proceedings to address this unadjudicated issue.

Workers' CompensationTimeliness of ClaimDate of DisablementOccupational DiseaseLeft Wrist InjuryCarpal Tunnel SyndromeLigament InjuryArthritisMedical DiagnosisRemittal
References
3
Case No. 2024 NY Slip Op 03110 [228 AD3d 1028]
Regular Panel Decision
Jun 06, 2024

Grasse v. State of New York

Claimant Erik Grasse, a delivery driver, sustained ligament damage after falling into a pothole on South Chestnut Street in the Village of New Paltz on May 6, 2022, while unloading a package. Initially, he served a notice of claim on the Village, but was informed the road was not maintained by them. Grasse subsequently moved to file a late claim against the State of New York, which the Court of Claims denied, citing an unreasonable excuse for delay, potential prejudice to the State, lack of merit, and an available workers' compensation remedy. The Appellate Division, Third Department, reversed this decision, concluding that the delay was minimal, the State failed to demonstrate substantial prejudice given the pothole was patched shortly after the accident, and the claim demonstrated an appearance of merit regarding the State's duty to maintain roadways. The Court also affirmed that workers' compensation benefits, being a partial remedy, did not preclude granting the application.

Late Claim ApplicationCourt of Claims Act Section 10 (6)Pothole InjuryPersonal InjuryState NegligenceNotice of ClaimSubstantial PrejudiceAppearance of MeritConstructive NoticeRoadway Maintenance
References
18
Case No. MISSING
Regular Panel Decision
Sep 24, 2004

Sienicki v. 760 West End Avenue Owners, Inc.

The Supreme Court, New York County, denied plaintiffs' motion to set aside the verdict on damages and defendant Restore-It's cross-motion regarding liability and loss of services, but ordered a new trial on past medical expenses unless plaintiffs agreed to a reduction. The injured plaintiff suffered a fractured ankle, ligament tears, and underwent two operations, with a third pending. Three years post-accident, he still experiences pain, limps, and uses a cane, impacting his former activities as a construction worker and athlete. The jury's awards of $25,000 each for past and future pain and suffering were deemed inadequate, deviating materially from reasonable compensation. The court ordered a new trial on these damages unless Restore-It stipulated to increase the awards to $100,000 and $150,000, respectively. The $100,000 award for loss of services was affirmed, acknowledging the spouse's increased work and the husband's withdrawal. The defendant's argument regarding past medical expenses was found unavailing.

InjuryDamagesPain and SufferingLoss of ServicesVerdictAppellate ReviewPersonal InjuryMedical ExpensesJury AwardFractured Ankle
References
4
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