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

Case No. ADJ10351995
Regular
Jun 25, 2018

ARACELY HERRERA-MARTINEZ vs. 24 HOUR PERSONNEL SERVICES, INC., and ZURICH NORTH AMERICA INSURANCE, administered by GALLAGHER BASSETT SERVICES, INC.

The Appeals Board denied the applicant's petition for reconsideration, upholding the WCJ's finding that she did not sustain a cumulative injury. This decision was based on the Qualified Medical Examiner's (QME) report, which was deemed substantial evidence. The QME found the applicant to be a poor historian with exaggerated symptoms and lacking objective findings to support her claims. The Board found the applicant's treating physician's report insufficient due to an inaccurate understanding of job duties.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderQualified Medical ExaminerSubstantial EvidenceCumulative InjuryPrimary Treating PhysicianInjury AOE/COEMedical HistoryPhysical Examination
References
0
Case No. STK 166227
Regular
Jan 25, 2008

Celestino Aguilar-Maldonado vs. GALLO WINERY, Permissibly Self-Insured

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration of the finding that he did not sustain new and further psychological disability. The Board found that substantial evidence, including expert opinions from Drs. Mendel and Panzarella, did not support a finding of compensable psychiatric injury, noting significant exaggeration of symptoms by the applicant. Furthermore, the Board concluded that any psychological issues predated the original stipulated award and thus did not constitute "new and further" disability.

Workers' Compensation Appeals BoardNew and Further DisabilityPsyche InjuryBack InjuryStipulations with Request for AwardPetition to ReopenQualified Medical Examiner (QME)Symptom MagnificationMalingeringPredominant Cause
References
9
Case No. 2019 NY Slip Op 05736
Regular Panel Decision
Jul 18, 2019

Matter of Rosario v. Consolidated Edison Co. of N.Y. Inc.

Claimant Matthew Rosario filed for workers' compensation benefits due to repetitive stress injuries. A Workers' Compensation Law Judge initially found he violated Workers' Compensation Law § 114-a by exaggerating his injuries, permanently disqualifying him from benefits. However, a panel of the Workers' Compensation Board disagreed, finding no willful misrepresentation and returned the case for a decision on schedule loss of use. The employer and its carrier appealed this Board decision. The Appellate Division, Third Department, affirmed the Board's decision, concluding that substantial evidence supported the Board's finding that the claimant did not deliberately overstate his symptoms for the purpose of obtaining an award.

Workers' Compensation Law § 114-aOccupational DiseaseRepetitive Stress InjuriesTendinitisNeuralgiaSchedule Loss of UseClaimant MisrepresentationCredibility AssessmentSubstantial EvidenceAppellate Division
References
7
Case No. ADJ8725567
Regular
Feb 07, 2017

MARTHA ROMERO vs. DEPARTMENT OF SOCIAL SERVICES, INHOME SUPPORTIVE SERVICES; Permissibly Self-Insured; YORK RISK SERVICES GROUP

The Workers' Compensation Appeals Board denied Martha Romero's petition for reconsideration. The Board affirmed the finding that Romero sustained industrial cumulative trauma to her knees, shoulders, neck, trunk, ankles, and low back, but not to her head, arms, wrists, extremities, feet, psyche (hypertension, sleep disorder), or gastritis. This denial was based on the WCJ's report, which found Romero failed to meet her burden of proof regarding additional injuries and that her medical evidence was unsubstantial due to an inaccurate history and her failure to demonstrate due diligence in developing the record. The Board also noted the QME's opinion that Romero exaggerated her symptoms, supported by sub rosa video evidence.

Workers' Compensation Appeals BoardCumulative Trauma InjuryIndustrial InjuryPetition for ReconsiderationFindings and OrderAdministrative Law JudgeQualified Medical EvaluatorSub Rosa VideoMagnifying SymptomsDue Diligence
References
3
Case No. 524271
Regular Panel Decision
Sep 06, 2018

Matter of Kemraj v. Garelick Farms

Claimant Balram Kemraj sustained a work-related injury to his left shoulder in 2005. He was initially awarded workers' compensation benefits, but his schedule loss of use was later rescinded, and the claim was amended to include complex regional pain syndrome. A Workers' Compensation Law Judge found no further causally-related disability after September 16, 2013, a decision affirmed by the Workers' Compensation Board. On appeal, the Appellate Division affirmed the Board's decision, finding substantial evidence to support it. The court relied on the opinion of neurologist Sheldon Staunton, who conducted an independent medical examination and concluded that the claimant had no objective neurological problems, was exaggerating symptoms, exhibited no signs of complex regional pain syndrome, and could return to work immediately.

Workers' Compensation BenefitsCausally-Related DisabilityIndependent Medical Examination (IME)Complex Regional Pain SyndromeSchedule Loss of UseSubstantial EvidenceAppellate ReviewMedical CredibilityShoulder InjuryReturn to Work
References
7
Case No. 530839
Regular Panel Decision
Jul 07, 2022

In the Matter of the Claim of Robert Strohschein

Claimant Robert Strohschein, an iron worker, filed for workers' compensation benefits due to a right biceps injury. The Workers' Compensation Board (WCB) modified a WCLJ's decision, finding that the claimant violated Workers' Compensation Law § 114-a by misrepresenting his medical condition and exaggerating symptoms during an independent medical examination. Surveillance video showed activities inconsistent with his reported limitations. The Board assessed mandatory penalties and permanently disqualified him from future wage replacement benefits, also finding he failed to demonstrate attachment to the labor market. The Appellate Division affirmed the WCB's decision, finding substantial evidence supported the Board's determination regarding the claimant's knowing material misrepresentations and upholding the discretionary penalty as not an abuse of discretion.

Workers' Compensation Law § 114-aMisrepresentation of medical conditionDisqualification of benefitsWage replacement benefitsLabor market attachmentSurveillance video evidenceIndependent Medical Examination (IME)Appellate reviewAbuse of discretionSubstantial evidence
References
16
Case No. 2022 NY Slip Op 03799 [206 AD3d 451]
Regular Panel Decision
Jun 09, 2022

Moises-Ortiz v. FDB Acquisition LLC

Arch Insurance Group, Inc., the insurer for plaintiff's employer, RNC Industries, LLC, appealed an order from the Supreme Court, New York County, which denied Arch's motion for summary judgment. Arch sought to dismiss common-law indemnification and contribution claims asserted against its insured, RNC. Arch presented evidence, including a neuropsychologist's report, indicating that the plaintiff did not sustain a 'grave injury' under Workers' Compensation Law § 11, as the plaintiff's symptoms were exaggerated, and he could return to work. The Appellate Division, First Department, found that Arch made a prima facie showing and that the defendants failed to raise an issue of fact. Consequently, the Appellate Division unanimously reversed the lower court's order, granting Arch's motion for summary judgment and dismissing the claims.

Summary JudgmentGrave InjuryWorkers' Compensation Law § 11IndemnificationContribution ClaimsAppellate DivisionNeuropsychological EvaluationPrima Facie ShowingExaggerated SymptomsTemporary Total Disability
References
5
Case No. MISSING
Regular Panel Decision

Claim of Neal v. Blue Circle Cement

The claimant, a laborer, suffered a compensable back injury in November 1998 and returned to work after eight months. In January 2002, he sustained another back injury. A Workers’ Compensation Law Judge determined that the January 2002 injury was an aggravation of the prior 1998 injury, assigned disability levels from January 2002 to April 2003, and found no compensable lost time thereafter. The Workers’ Compensation Board affirmed this decision. The Appellate Division found substantial evidence, including medical testimony and MRI comparisons, to support the Board’s determination regarding the aggravation of the injury and the disability levels. The court also upheld the Board's prerogative to resolve conflicting medical evidence and make credibility determinations, particularly in light of evidence that the claimant exaggerated his symptoms.

Workers' CompensationBack InjuryAggravation of InjuryDisability LevelsMedical EvidenceCredibility AssessmentEmployer LiabilityJudicial ReviewAppellate DivisionAdministrative Law
References
4
Case No. MISSING
Regular Panel Decision
Mar 24, 1998

Nicholson v. Mohawk Valley Community College

A secretary at Mohawk Valley Community College developed symptoms consistent with "sick building syndrome" after relocating to a newly renovated building in 1991, leading her to file a workers' compensation claim in 1993. Despite her symptoms subsiding after relocation and initial air quality tests being normal, a Workers’ Compensation Law Judge initially ruled in her favor. However, this decision was subsequently reversed by a Board panel following a full Board review. The Appellate Division affirmed the panel's reversal, concluding there was substantial evidence to support the finding of no causal connection between the claimant's symptoms and her employment, as physicians could not identify specific workplace-exclusive allergens.

Workers' CompensationSick Building SyndromeOccupational DiseaseCausationMedical EvidenceAppellate ReviewBoard DecisionAir QualityEnvironmental AllergensEmployment Link
References
4
Case No. MISSING
Regular Panel Decision

Claim of Lesch v. Wile

This case involves an appeal from a Workers’ Compensation Board decision, filed May 24, 2000, which found the claimant’s application for workers’ compensation benefits to be timely. The claimant filed a claim in June 1997 for carpal tunnel syndrome, an occupational disease. The employer and its carrier disputed the claim’s timeliness, arguing that the claimant’s symptoms dated back to 1989. However, the claimant testified that the pain experienced in 1996 was different from earlier symptoms and that she did not receive a definitive diagnosis until June 30, 1997. A treating orthopedist supported this, stating that the 1996 symptoms were unrelated to previous injuries. The Board credited the claimant's testimony, setting the date of disablement as June 30, 1997, and its decision was ultimately affirmed.

occupational diseasecarpal tunnel syndrometimeliness of claimdate of disablementWorkers' Compensation Boardappellate reviewmedical evidencetreating physiciandefinitive diagnosisstatutory interpretation
References
2
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