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

Case No. ADJ2778117 (RIV 0032584)
Regular
Dec 31, 2009

KEYIN MORALES vs. RALPHS GROCERY CO., SEDGWICK CLAIMS MANAGEMENT SERVICES

The WCAB granted the petition for reconsideration and amended the Findings and Award to find 18 1/2 percent permanent disability, after apportionment of 50 percent to applicant's non-industrial peripheral neuropathy.

ApportionmentPeripheral neuropathyCausationPermanent disabilityAgreed medical examinerWCJPetition for reconsiderationFindings and AwardWork restrictionsIndustrial injury
References
4
Case No. ADJ9509417
Regular
Apr 05, 2023

ELIZABETH ARBOGAST vs. CALIFORNIA HIGHWAY PATROL, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed an award for further medical treatment and attorney fees for an applicant diagnosed with ovarian cancer, hernia, peripheral neuropathy, and colon issues sustained during her employment with the California Highway Patrol. The Board found the applicant's ovarian cancer to be an insidious and progressive disease, warranting a reservation of jurisdiction over permanent disability. This reservation allows for future determination of permanent disability if the condition worsens or recurs.

Workers' Compensation Appeals BoardCalifornia Highway Patrolmedically uninsuredState Compensation Insurance FundAdjudication NumberOpinion and Decision After ReconsiderationFindings and Awardworker's compensation administrative law judgeovarian cancerhernia
References
11
Case No. ADJ8878991
Regular
Jan 31, 2014

JAY SCHETTLER vs. ALLIED BEVERAGES, INC.; CYPRESS INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration of the administrative law judge's finding of injury. The applicant, a route salesman, claimed he stepped on glass, injuring his left foot, which was corroborated by medical records showing a cut and the applicant's delayed awareness due to diabetic neuropathy. Defense witness testimony also supported the applicant's claim of cutting his toe at work. The Board found the applicant's testimony credible and the medical evidence sufficient to establish the injury arose out of and in the course of employment.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Factterritory route salesmanmechanism of injurydiabetic neuropathycredibilitymedical recordsReport and Recommendationurgent care
References
1
Case No. MISSING
Regular Panel Decision

Tahir v. Progressive Casualty Insurance

This case addresses a no-fault health services provider's claims for compensation for current perception threshold (CPT) and sensory nerve conduction threshold (sNCT) testing. The defendant insurer argued these tests were not compensable under Medicare and constituted provider fraud. The court rejected the Medicare defense, clarifying that New York's no-fault statute relies on workers' compensation fee schedules, not Medicare standards. Furthermore, the court categorized the fraud defense as a medical necessity issue, requiring timely assertion with supporting evidence. Finding the insurer failed to meet its burden, the court ruled in favor of the plaintiff, entitling them to attorney fees and statutory interest.

No-fault insuranceCPT testingsNCT testingMedical necessityProvider fraudMedicare compensationWorkers' compensation fee schedulesElectrodiagnostic testSensory neuropathyChiropractic services
References
26
Case No. MISSING
Regular Panel Decision

Newsome v. Astrue

Gordon C. Newsome challenged the Commissioner of Social Security's final determination denying him social security disability benefits. The Administrative Law Judge (ALJ) had found Newsome not disabled, attributing his impairments primarily to alcohol abuse and a temporary hip fracture. The District Court identified several legal errors by the ALJ, including improper assessment of neuropathy and DVT diagnoses, mischaracterization of a treating physician's report, and failure to adequately develop the record regarding the materiality of alcohol abuse to Newsome's physical limitations. Consequently, the Plaintiff's motion for judgment on the pleadings was granted, the Commissioner's cross-motion was denied, and the case was remanded to the ALJ for further proceedings consistent with the court's decision.

Social Security DisabilityAlcohol AbuseSeizure DisorderPancreatitisNeuropathyDeep Vein Thrombosis (DVT)Credibility AssessmentTreating Physician RuleRemandAdministrative Law Judge (ALJ)
References
54
Case No. MISSING
Regular Panel Decision

O'DELL v. Barnhart

Plaintiff William O'Dell sought disability insurance benefits due to carpal tunnel syndrome, ulnar neuropathy, and tendinitis, which he claimed prevented him from working since 1996. The Commissioner of Social Security, Jo Anne B. Barnhart, denied benefits, asserting O'Dell retained the residual functional capacity to perform other work. After an Administrative Law Judge and the Appeals Council upheld the denial, O'Dell initiated this review action in the District Court under 42 U.S.C. § 405(g). The District Court, presided over by Judge Larimer, affirmed the Commissioner's final determination, concluding that the ALJ's findings were supported by substantial evidence regarding O'Dell's capacity for other work in the national economy.

Social Security ActDisability Insurance BenefitsResidual Functional CapacityTreating Physician OpinionAdministrative Law JudgeVocational Expert TestimonyCarpal Tunnel SyndromeUlnar NeuropathyTendinitisFederal District Court Review
References
6
Case No. 534831
Regular Panel Decision
Oct 12, 2023

In the Matter of the Claim of Susan Zuhlke

Susan Zuhlke appealed two decisions by the Workers' Compensation Board concerning a schedule loss of use (SLU) award for her right leg injuries. Zuhlke, a teacher, suffered right ankle and knee/tibia fractures in October 2018, later including fibular neuropathy. While a 25.8% SLU for her right foot was stipulated, a dispute arose over the right knee, with the Board ultimately affirming a 15% SLU based on the carrier's medical consultant's opinion and denial of reconsideration. The Appellate Division affirmed the Board's determination, finding substantial evidence supported the 15% SLU award for the right knee, consistent with impairment guidelines and prior Board decisions regarding tibial plateau fractures.

Workers' CompensationSchedule Loss of UseSLURight Leg InjuryTibial Plateau FractureFibular NeuropathyMaximum Medical ImprovementImpairment GuidelinesMedical OpinionsAppellate Review
References
9
Case No. MISSING
Regular Panel Decision

Claim of Delee v. Crouse Hinds Division of Cooper Industries

Claimant sustained a work-related back injury in 1991, resulting in a permanent partial disability and workers' compensation benefits. After being terminated and later finding new employment, she developed breast cancer, leading to neuropathy and cardiomyopathy from chemotherapy, preventing her return to work. The employer's carrier argued her current inability to work was solely due to cancer, not the back injury. The Workers’ Compensation Board reversed a Workers’ Compensation Law Judge's decision, continuing claimant's reduced earnings award. The Appellate Division affirmed, holding that supervening nonindustrial causes do not absolve an employer if the established permanent partial disability still contributes to reduced earning capacity, which is a factual determination for the Board, supported by substantial evidence in this case.

Workers' CompensationPermanent Partial DisabilityReduced EarningsSupervening Nonindustrial CausesCausationAppellate ReviewMedical OpinionBack InjuryChemotherapy ComplicationsBoard Findings
References
5
Case No. MISSING
Regular Panel Decision

K.R. ex rel. Matthew R. v. New York City Department of Education

Plaintiffs, parents of Matthew R., sued the New York City Department of Education (DOE) under the Individuals with Disabilities Education Act (IDEA) after a State Review Officer (SRO) reversed an Impartial Hearing Officer's (IHO) decision that awarded tuition reimbursement for Matthew's private school placement. The parents sought to reverse the SRO's decision and reinstate the IHO's award, while the DOE cross-moved for dismissal. The court granted the parents' motion, concluding that the DOE committed both procedural violations by impeding the parents' participation in Matthew's IEP development and substantive violations regarding Matthew's sensory needs at the proposed public school placement. Consequently, the IHO's findings that the Rebecca School was an appropriate placement and that equities favored reimbursement were upheld.

Individuals with Disabilities Education ActFree Appropriate Public Education (FAPE)Individualized Education Program (IEP)Tuition ReimbursementPrivate School PlacementProcedural ViolationSubstantive ViolationSensory NeedsFunctional GroupingDue Process
References
26
Case No. 534831
Regular Panel Decision
Oct 12, 2023

Matter of Zuhlke v. Lake George Cent. Sch. Dist.

Claimant, a teacher, suffered right ankle and knee/tibia fractures in October 2018, later amended to include causally-related fibular neuropathy. She underwent evaluations by two independent medical examiners to determine a schedule loss of use (SLU) award. While an agreement was reached for the right ankle (25.8% SLU), the parties disputed the SLU for the right knee. A Workers' Compensation Law Judge awarded a 15% SLU for the right knee, a decision affirmed by the Workers' Compensation Board. Claimant's subsequent application for reconsideration and/or full Board review was denied. The Appellate Division, Third Department, affirmed the Board's decisions, finding substantial evidence to support the 15% SLU award based on the carrier's consultant's interpretation of impairment guidelines, and upheld the denial of reconsideration.

Schedule Loss of Use (SLU)Tibial Plateau FractureFibular NeuropathyRight Knee InjuryRight Ankle InjuryMedical Impairment GuidelinesIndependent Medical Examination (IME)Workers' Compensation Board AppealAppellate ReviewConflicting Medical Opinions
References
11
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