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Case Law Database

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

Case No. MISSING
Regular Panel Decision

Claim of Musicus v. Broadway Pastry Shop, Inc.

A billing clerk (claimant) suffered a fall and injury to her left arm and shoulder at work on April 10, 1978. Despite a history of high blood pressure and dizzy spells at home, the claimant denied such incidents at work, and a co-worker could not explain the fall. The Workers’ Compensation Board found the accident compensable, relying on the statutory presumption of Workers’ Compensation Law § 21. The appeal contended the fall was idiopathic and thus the presumption should not apply. The court affirmed the Board's decision, concurring that no substantial evidence rebutted the statutory presumption, as the injury occurred within the course of employment.

Workers' CompensationIdiopathic FallStatutory PresumptionCourse of EmploymentInjuryBilling ClerkHigh Blood PressureDizzy SpellsAppealCompensability
References
3
Case No. MISSING
Regular Panel Decision

Claim of Milz v. J & R Amusement Corp.

This case involves an appeal by an employer and its carrier from a Workers’ Compensation Board decision filed on May 20, 1981. The central issue is whether the appellants successfully overcame the statutory presumption (Workers’ Compensation Law, § 21, subd 4) that the injured employee’s death did not result solely from intoxication while on duty. The Board, relying on an autopsy report and Trooper O’Brien's testimony, found that the carrier failed to overcome this presumption, concluding that other factors contributed significantly to the employee's demise. The court affirmed the Board's decision, emphasizing that the strong statutory presumption is rebutted only when evidence unequivocally shows intoxication as the sole cause, a heavy burden for the appellants. Despite a high alcohol concentration in the decedent's body, the court noted contributing factors like the decedent working all day, consuming only four drinks, acting normally before driving, and the accident occurring on a dark, curving road. Thus, the employer and carrier failed to establish intoxication as the exclusive cause of death.

Intoxication defenseWorkers' Compensation LawStatutory presumptionBurden of proofDeath benefits claimAppellate reviewAccident causationSole causeEvidence insufficiency
References
3
Case No. 2020 NY Slip Op 02509 [182 AD3d 944]
Regular Panel Decision
Apr 30, 2020

Matter of Women's Project & Prods., Inc. (Commissioner of Labor)

The Women's Project and Productions, Inc. (WPP), a non-profit theater company, appealed two decisions by the Unemployment Insurance Appeal Board. The Board found WPP liable for additional tax contributions on remuneration paid to certain individuals, including artistic advisors and directors, whom WPP had treated as independent contractors. The Department of Labor, however, considered these individuals employees. The Board modified an Administrative Law Judge's decision, concluding that WPP failed to rebut the statutory presumption of employment under Labor Law § 511 (1) (b) (1-a). The Appellate Division affirmed the Board's decisions, ruling that WPP's arguments were unpersuasive and that the Board rationally concluded WPP failed to rebut the statutory presumption of employment. Consequently, the additional tax contributions imposed upon WPP were upheld.

Unemployment InsuranceIndependent ContractorEmployee ClassificationPerforming ArtsStatutory PresumptionLabor LawTax ContributionsAppeal BoardRebuttalArtistic Services
References
5
Case No. ADJ9750276
Regular
Aug 21, 2017

SANDRA KIMBER (DECEASED) vs. CITY OF LOS ANGELES; Permissibly SelfInsured

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award finding Sandra Kimber's death compensable under the police officer pneumonia presumption. The Board found the decedent's cause of death, acute bronchiotracheopneumonitis, is medically distinct from pneumonia and therefore not covered by the statutory presumption. The case was returned for further proceedings to determine if the injury is compensable absent the presumption and to establish dependency for death benefits.

Workers' Compensation Appeals BoardSandra Kimber (Deceased)City of Los Angelesself-insuredADJ9750276Petition for ReconsiderationFindings and Awardindustrial injurydeath benefitLabor Code section 3212
References
0
Case No. ADJ9719037
Regular
Jun 13, 2019

WILLIAM MICHELS vs. UNIVERSITY OF CALIFORNIA SAN FRANCISCO

In this workers' compensation case, the defendant sought reconsideration of a finding that the applicant sustained a cumulative trauma injury. The defendant argued that a Qualified Medical Examiner's report, obtained after the 90-day statutory period, should be admissible to rebut the presumption of compensability. The Workers' Compensation Appeals Board denied the petition, adopting the judge's reasoning that the defendant failed to timely deny the claim, triggering the presumption. The Board found no admissible evidence presented to overcome this presumption within the required timeframe.

cumulative trauma injuryLabor Code section 5402presumption of compensabilitytimely denialQualified Medical ExaminerEli HendelM.D.90-day periodrebut presumptionPetition for Reconsideration
References
0
Case No. ADJ7941040
Regular
Sep 30, 2014

JESSE NICASIO vs. CITY OF MODESTO, Administered by YORK INSURACE SERVICES

The applicant, a former fire chief, sustained industrial injuries to his heart and multiple myeloma. The Appeals Board affirmed the WCJ's finding that his heart trouble was industrially caused, based on the presumption under Labor Code section 3212 and the AME's opinion that it developed during employment. Regarding cancer, the Board found the applicant's multiple myeloma developed within the statutory timeframe, making it presumptively compensable under Labor Code section 3212.1, and the defendant failed to rebut this presumption. Therefore, the applicant is entitled to benefits for both conditions.

Labor Code section 3212.1heart trouble presumptioncancer presumptionmultiple myelomabenzene exposureleft ventricular hypertrophyfire chieflatency periodmanifestationdevelopment
References
21
Case No. ADJ1940516 (GOL 0101910)
Regular
Apr 29, 2011

TONY COSTANTINO (Deceased), ELLIE COSTANTINO (Widow), CIERA MILLENDER (Dependent) vs. SANTA BARBARA SCHOOL DISTRICT

This case concerns whether a stepdaughter is entitled to the conclusive presumption of total dependency for workers' compensation death benefits under Labor Code section 3501. The Workers' Compensation Appeals Board (WCAB) rescinded the prior award, holding that the conclusive presumption does not apply to stepchildren absent legal adoption. The Board found insufficient evidence regarding the stepdaughter's actual dependency and returned the matter for further proceedings to develop the record on this issue. The WCAB clarified that while stepchildren can be dependents, the specific statutory presumption of total dependency is limited to "children" under the law.

Workers' Compensation Appeals BoardIndustrial InjuryDeath BenefitsDependencyLabor Code Section 3501Conclusive PresumptionStepchildPartial DependentReconsiderationWCJ
References
3
Case No. ADJ2596572 (MON 0357137)
Regular
May 29, 2018

CRISTINA CORIA vs. CITY OF SANTA MONICA

This case involves a police officer's claim for industrial injury, specifically to her low back. The applicant contends the WCJ erred by not applying the Labor Code section 3213.2 "duty belt presumption" and improperly apportioning cervical spine disability. The Appeals Board rescinded the WCJ's decision, finding the independent medical evaluator's opinions did not properly rebut the presumption. The case is returned to the trial level for a determination on the applicability of the duty belt presumption and whether the injury manifested within the statutory timeframe. Issues regarding apportionment are preserved for further proceedings.

Workers' Compensation Appeals BoardPetition for ReconsiderationPolice OfficerCumulative InjuryBilateral Carpal Tunnel SyndromeBilateral Cubital Tunnel SyndromePermanent DisabilityApportionmentLabor Code Section 3213.2Duty Belt Presumption
References
0
Case No. MISSING
Regular Panel Decision

Cortijo v. Ilfin Corp.

A decedent, employed as a building superintendent, was found dead from a 12-gauge shotgun wound on his employer's premises during working hours. The Workers' Compensation Board determined that the unexplained death, occurring on the employer's property and during working hours, raised a presumption of compensability under section 21 of the Workers' Compensation Law. This presumption led to the conclusion that the death arose out of and in the course of employment, justifying an award of death benefits to the claimant. The Board found that police testimony regarding the decedent's prior illegal activities was insufficient to rebut this statutory presumption. The appellate court affirmed the Board's decisions, finding them supported by substantial evidence.

Workers' CompensationDeath BenefitsPresumption of CompensabilityUnexplained DeathEmployment InjuryOn-Premises DeathStatutory PresumptionRebuttal of PresumptionSubstantial EvidenceAppellate Review
References
0
Case No. ADJ6892644
Regular
Nov 23, 2016

William Davis, III vs. STATE OF CALIFORNIA, DEPARTMENT OF FORESTRY AND FIRE PROTECTION, STATE COMPENSATION INSURANCE FUND

This case involves a firefighter, William Davis III, claiming cumulative trauma injury to his nervous and respiratory systems due to exposure to fire retardant. The applicant sought reconsideration of a "take nothing" order, arguing entitlement to a statutory presumption of industrial causation under Labor Code section 3212.85. The Workers' Compensation Appeals Board affirmed the prior order, denying reconsideration. The Board found that the applicant failed to establish the applicability of the presumption because the fire retardant was not a "biochemical substance" as defined for weapons of mass destruction, and even if it were, the presumption was rebutted by the Agreed Medical Examiner's opinion attributing the applicant's condition to an infectious process rather than occupational exposure.

Workers' Compensation Appeals BoardIndustrial InjuryCumulative TraumaFirefighterDepartment of Forestry and Fire ProtectionLabor Code Section 3212.85Presumption of Industrial CausationAgreed Medical Examiner (AME)Dr. Robert HarrisonToxic Exposure
References
0
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