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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

Lawliss v. Quellman

Plaintiff sustained a right shoulder injury at work, leading his orthopedic specialist to recommend immediate surgery for a ruptured biceps. However, his employer's workers' compensation carrier disputed the need for surgery and mandated an independent medical examination (IME) by the defendant, an orthopedic specialist. The defendant reported to the carrier that surgery was unnecessary, advocating physical therapy instead. This advice resulted in the carrier denying surgery, and the plaintiff's subsequent physical therapy proved ineffective, as did delayed surgery, allegedly causing an 80% loss of shoulder use. Consequently, plaintiff initiated a medical malpractice action against the defendant, asserting that the negligent advice given during the IME caused the detrimental delay in his treatment. The Supreme Court denied the defendant's motion for summary judgment, a decision which the appellate court affirmed, citing the presence of factual questions regarding an implied physician-patient relationship, negligence, and foreseeable reliance.

medical malpracticeindependent medical examinationphysician-patient relationshipsummary judgmentworkers' compensationappellate decisionorthopedic injurynegligent advicedelayed surgeryloss of use
References
10
Case No. 525358
Regular Panel Decision
Jun 07, 2018

Matter of Busat v. Ramapo Manor Nursing Ctr.

Claimant, a food service worker, suffered work-related injuries to his back, neck, and right shoulder in 1997, receiving workers' compensation benefits. In 2014, claimant resumed treatment for his right shoulder and was found to have a 50% temporary disability. During a vacation, he underwent an unrelated cardiac procedure, which prevented him from receiving medical clearance for planned shoulder surgery due to ongoing heart medication. The Workers' Compensation Board initially ruled that claimant's departure from employment was unrelated to his disability and that he failed to remain attached to the labor market. The Appellate Division, Third Department, found the Board's reasoning contradicted by consistent medical evidence indicating claimant's inability to obtain shoulder surgery clearance due to his cardiac condition. Consequently, the court reversed the Board's decisions and remitted the matter for further proceedings.

Workers' CompensationDisability BenefitsLabor Market AttachmentMedical ClearanceCardiac ConditionShoulder InjuryBoard ReconsiderationAppellate ReviewMedical EvidenceCausation
References
3
Case No. ADJ6630817
Regular
Dec 27, 2010

NADINE WHITEEAGLE vs. CENTRAL RECRIGERATOR SERVICES, GREAT WEST CASUALTY

This case concerns an applicant's shoulder injury resulting in 12% permanent disability. The defendant argued the Permanent Medical Evaluator (PQME) found 0% impairment and objected to the rater's consideration of surgery. However, the Appeals Board affirmed the WCJ's decision, finding the rating instruction was properly based on substantial medical evidence from the PQME's report, which included the applicant's shoulder surgery. The Board also noted the defendant's objection to the rating was untimely.

Workers' Compensation Appeals BoardReconsiderationFindings Award and OrderPermanent DisabilityPanel Qualified Medical Evaluator (PQME)Whole Person Impairment (WPI)AMA Guides to the Evaluation of Permanent ImpairmentDistal Clavicle ResectionRater InstructionsDEU Rater
References
1
Case No. LAO 0857845
Regular
Oct 12, 2007

NATIVIDAD URIAS vs. VISHAY TRANSDUCERS, LIBERTY MUTUAL INSURANCE COMPANY

This case involves a workers' compensation applicant seeking further medical treatment for admitted industrial injuries to her right shoulder and bilateral upper extremities. The Workers' Compensation Appeals Board granted reconsideration to clarify the scope of awarded medical treatment. The Board affirmed the need for a right carpal tunnel release surgery as recommended by the applicant's physician but reversed the award of arthroscopic shoulder surgery, finding it premature without a specific recommendation or request for authorization.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardExpedited HearingFurther Medical TreatmentArthroscopic Shoulder SurgeryCarpal Tunnel ReleasePrimary Treating PhysicianQualified Medical EvaluatorUtilization Review
References
0
Case No. MISSING
Regular Panel Decision

Claim of Sanchez v. Consolidated Edison Co.

In January 2000, claimant suffered work-related injuries to her neck, shoulder, and wrist, leading to two shoulder surgeries in June 2000 and October 2002. Following the second surgery, she never returned to work and was terminated by her employer in 2003. The Workers’ Compensation Board classified her as permanently partially disabled but terminated her benefits in July 2004, finding she voluntarily withdrew from the labor market by failing to seek employment within her medical restrictions. Claimant appealed this decision. The appellate court affirmed the Board's determination, citing the claimant's own testimony that she had not looked for work at all and failed to provide evidence linking her inability to find employment to her disability.

Workers' CompensationLabor Market WithdrawalPermanent Partial DisabilityShoulder InjuryEmployment TerminationMedical RestrictionsSubstantial EvidenceAppellate ReviewFactual QuestionBenefit Termination
References
5
Case No. MISSING
Regular Panel Decision
Jun 02, 2008

Claim of Laezzo v. New York State Thruway Authority

The claimant suffered a work-related slip and fall in 2002, leading to injuries including his head, neck, back, and knees. His morbid obesity contributed to his back and knee issues, prompting him to seek authorization for gastric bypass surgery. The Workers’ Compensation Law Judge approved the surgery, a decision affirmed by the Workers’ Compensation Board, which found the surgery causally related to the compensable injuries. The employer and its carrier appealed, challenging the causal link. The court affirmed the Board's decision, noting substantial evidence that the claimant's weight gain was a result of the sedentary lifestyle imposed by his injuries, and that the surgery would aid in his recovery.

Workers' CompensationConsequential InjuryGastric Bypass SurgeryMorbid ObesityMedical Treatment AuthorizationCausationKnee InjuryBack InjurySedentary LifestyleBoard Decision Appeal
References
2
Case No. SFO 0425862 SFO 0425863
Regular
May 14, 2008

William Bishop vs. IGC POLYCOLD SYSTEMS, ROYAL & SUN ALLIANCE

This case involves a workers' compensation applicant claiming injury to his right shoulder and seeking a new vocational rehabilitation plan. The Appeals Board affirmed the WCJ's denial of a new vocational plan and the finding of no industrial injury to the right shoulder. However, they reversed the WCJ to award benefits resulting from right shoulder surgery, deeming it a consequence of the compensable left shoulder injury.

Workers' Compensation Appeals BoardReconsiderationVocational Rehabilitation PlanIndustrial InjuryRight ShoulderLeft ShoulderTemporary DisabilityQualified Medical EvaluationCausationNon-Industrial
References
8
Case No. 2022 NY Slip Op 06531
Regular Panel Decision
Nov 17, 2022

Matter of Jennings v. Stop & Shop

Claimant, Hope J. Jennings, a supermarket clerk, suffered a work-related shoulder injury in 2007, leading to a classification of nonschedule permanent partial disability with a 50% loss of wage-earning capacity in 2012, subject to a 300-week durational cap for benefits. Following further causally-related surgeries in 2017 (shoulder) and 2019 (cervical fusion), claimant sought temporary total disability benefits after the durational cap on her permanent partial disability benefits had expired. The Workers' Compensation Board (WCB) ultimately ruled that the expiration of the durational cap on permanent partial disability benefits does not preclude a claimant from seeking temporary total disability benefits following a causally-related surgery. The Appellate Division, Third Department, affirmed the Board's decision, emphasizing that Workers' Compensation Law § 15 (2) (temporary total disability) and § 15 (3) (w) (permanent partial disability) operate under distinct statutory provisions, and the durational cap applies only to benefits payable under the latter paragraph.

Workers' Compensation Law § 15Temporary Total DisabilityPermanent Partial DisabilityDurational CapWage Loss BenefitsCervical Fusion SurgeryShoulder InjuryReclassification of DisabilityStatutory InterpretationAppellate Review
References
4
Case No. MISSING
Regular Panel Decision
Sep 07, 2004

Claim of Senecal v. Allied Bendix

Claimant sustained a work-related left shoulder injury in 1991, leading to surgery in 1992 and retirement in 1995. In 2002, he sought workers' compensation benefits for a consequential right shoulder injury, claiming it resulted from favoring his left shoulder. While a Workers' Compensation Law Judge initially established a causally related consequential injury, a Board panel reversed this decision. The Appellate Division affirmed the Board's ruling, finding substantial evidence that the right shoulder condition, which manifested 10-11 years post-initial injury and 7 years post-retirement, was consistent with natural aging and not causally related to the prior work injury.

Workers' CompensationConsequential InjuryRight Shoulder PainLeft Shoulder InjuryCausationMedical EvidenceDegenerative ChangesSpecial Fund for Reopened CasesAppellate ReviewSubstantial Evidence
References
1
Case No. MISSING
Regular Panel Decision

Claim of Casiano v. CCIP/Union Settlement Home Care

In March 2001, claimant sustained a work-related back injury. Neurosurgeon Richard J. Radna recommended and performed decompression surgery despite the workers' compensation carrier denying preauthorization for the procedure. Both a Workers’ Compensation Law Judge and the Workers’ Compensation Board subsequently ruled that the surgery was not medically necessary, thereby absolving the carrier of liability for its cost. Claimant and Radna appealed this determination to the appellate court. Radna's appeal was dismissed due to lack of standing, and the Board's decision was affirmed, as it was within its purview to resolve the conflicting medical evidence presented by Radna and the carrier's neurosurgeon regarding the necessity of the surgery.

Workers' Compensation LawMedical NecessitySurgical ProcedurePreauthorization DenialNeurological InjuryConflicting Medical OpinionsAppellate ReviewStanding IssueCarrier LiabilityBack Injury
References
3
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