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

Case No. 2021 NY Slip Op 07401
Regular Panel Decision
Dec 23, 2021

Matter of Carola B.-M. v. New York State Off. of Temporary & Disability Assistance

Petitioners Carola B.-M. and Tiara M. challenged the denial of their supplemental nutrition assistance program (SNAP) benefits by the New York State Office of Temporary and Disability Assistance and the Orleans County Department of Social Services. The benefits were denied because they were deemed ineligible college students. The Appellate Division, Fourth Department, reversed this determination, holding that participation in the Adult Career and Continuing Education Services, Vocational Rehabilitation program (ACCES-VR) qualifies as a Job Training Partnership Act (JTPA) program. This status exempts the students from certain SNAP eligibility requirements. The court found that the original determination was based on an unreasonable interpretation of relevant regulations, annulled the decision, granted the petition, and remitted the case for a calculation of retroactive benefits.

SNAP benefitscollege student eligibilityJob Training Partnership ActACCES-VRvocational rehabilitationCPLR article 78regulatory interpretationpublic assistancefood stampsAppellate Division
References
28
Case No. MISSING
Regular Panel Decision

Claim of Bruzzese v. Guardsman Elevator Co.

In 1994, the claimant sustained head, neck, and back injuries at work, leading to an award for permanent partial disability, which included a wage expectancy adjustment under Workers’ Compensation Law § 14 (5). Following back surgery in 1998, the case was reopened, and the claimant was found to be temporarily totally disabled. Benefits for this temporary total disability were calculated based on the claimant's average weekly wage at the time of injury, without applying the wage expectancy adjustment. The claimant appealed, arguing that since the permanent partial disability preceded the temporary total disability, the wage expectancy adjustment should also apply to the latter period. The court disagreed, affirming the Workers’ Compensation Board's decision, citing established case law that Workers’ Compensation Law § 14 (5) is applicable only to awards for permanent partial disability and not temporary disability.

Wage expectancyTemporary total disabilityPermanent partial disabilityWorkers' Compensation benefitsBack injuryAppellate reviewDisability calculationWorkers' Compensation BoardAverage weekly wage
References
1
Case No. MON 0322465
Regular
Jan 03, 2008

AFRA CORNEJO vs. COUNTY OF LOS ANGELES

This case involved separate appeals from the applicant and defendant regarding an administrative law judge's findings on permanent disability apportionment and temporary disability overpayment. The applicant argued against apportionment of permanent disability, while the defendant sought credit for alleged overpayment of temporary disability. The Workers' Compensation Appeals Board denied both petitions, affirming the administrative law judge's decision. The Board clarified that Labor Code section 4656(b) limits temporary partial disability, not temporary total disability, thus the defendant was not entitled to a credit for overpayment.

Workers Compensation Appeals BoardAgreed Medical EvaluatorApportionmentPermanent DisabilityTemporary Disability IndemnityLabor Code Section 4656(b)Temporary Partial DisabilityTemporary Total DisabilityCreditRestitution
References
1
Case No. ADJ12340832
Regular
Sep 14, 2022

JOSE PEREZ vs. VILLA PARK LANDSCAPE, CALIFORNIA INSURANCE COMPANY, APPLIED RISK SERVICES

The applicant sought reconsideration of an award that found industrial injury to his back and entitled him to disability benefits, but also granted the defendant a credit for temporary disability overpayment. The Appeals Board affirmed the award of disability benefits but deferred the issue of the credit for temporary disability overpayment. This deferral is due to the defendant failing to present evidence or provide a clear explanation for the alleged overpayment, and the potential conflict between temporary and permanent disability indemnity purposes. Further proceedings are recommended to determine if the credit should be awarded.

WCABReconsiderationFindings of Fact and AwardIndustrial InjuryTree TrimmerTemporary DisabilityPermanent DisabilityCredit for OverpaymentAgreed Medical Examination (AME)Primary Treating Physician (PTP)
References
12
Case No. MON 328728 MON 328729
Regular
Jan 30, 2008

RICARDO GARAY vs. INDUSTRIAL CONTAINER SERVICES, AMERICAN HOME ASSURANCE COMPANY, AIG CLAIM SERVICES

This case involves a dispute over temporary disability indemnity payments and a claimed overpayment by the defendant. The Appeals Board rescinded the prior findings on temporary disability due to conflicting evidence regarding payment dates and disability periods. The matter is returned to the trial level for further development of the record and new findings on temporary disability, potential overpayments, and the priority of liens, while affirming the findings of industrial injury, permanent disability, and the need for future medical treatment.

Workers Compensation Appeals BoardRicardo GarayIndustrial Container ServicesAmerican Home Assurance CompanyAIG Claim ServicesMON 328728MON 328729ReconsiderationJoint Findings and AwardWCJ
References
9
Case No. MON 0328875
Regular
Apr 29, 2008

LUIS I. MORA vs. COUNTY OF LOS ANGELES, CAMBRIDGE INTEGRATED SERVICES (Adjusting Agent)

The Workers' Compensation Appeals Board granted reconsideration to allow the defendant credit for temporary disability overpayments against permanent disability indemnity. The Board found that the overpayment resulted from a delayed medical report, not employer fault, and the credit was not significantly detrimental to the applicant. Consequently, the defendant is now entitled to offset the temporary disability overpayment from the permanent disability award.

Temporary disability overpaymentPermanent disability indemnityCredit for overpaymentLabor Code Section 4909Substantial evidenceMaximum recoveryResidual impairmentWage replacementEquitable estoppelAgreed Medical Evaluator
References
13
Case No. AHM 0093986 AHM 0116200
Regular
Jan 15, 2008

Dawn Keep vs. CHINO VALLEY MEDICAL CENTER, BROADSPIRE INSURANCE COMPANIES, STATE COMPENSATION INSURANCE FUND

The applicant sought reconsideration of a workers' compensation award, primarily challenging the permanent disability rating and the employer's credit for temporary disability overpayments. The Board affirmed the permanent disability findings but rescinded the overpayment credit, deferring that issue to allow for determination of the applicant's permanent and stationary date and clarification of overlapping cumulative trauma and temporary disability periods. This action requires the WCJ to first establish these dates before ruling on any potential overpayment credit.

Cumulative traumaPermanent disability ratingApportionmentAgreed Medical Examiner (AME)Escobedo v. Workers' Comp. Appeals Bd.Temporary disability overpaymentPermanent and stationary dateZurich AmericaState Compensation Insurance Fund (SCIF)WCJ Report and Recommendation
References
1
Case No. ADJ6474657
Regular
May 22, 2014

SANDRA VASQUEZ vs. THE EASTRIDGE GROUP, NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA, TRISTAR RISK MANAGEMENT

This case concerns an applicant seeking reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The applicant argued for additional temporary disability benefits and disputed a credit for overpayment. The WCAB agreed, amending the original award to grant further temporary disability from December 9, 2010, to May 5, 2011, based on treating physician opinions. Furthermore, the WCAB denied the defendant's requested credit for temporary disability overpayments, finding it would significantly disrupt the applicant's benefits and was inequitable. The WCAB otherwise affirmed the original findings regarding industrial injuries and permanent disability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardAdministrative Law JudgeIndustrial InjuryPermanent DisabilityTemporary Disability IndemnityLabor Code Section 4656Two-Year CapFive-Year Cap
References
9
Case No. ADJ1315206 (SDO 0327261)
Regular
Jun 25, 2010

Marvin Nelson vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES

This case concerns Marvin Nelson's workers' compensation claim for an industrial injury to his back. The WCAB granted reconsideration to amend the findings regarding temporary disability overpayment. While upholding the denial of a neck injury claim due to insufficient medical evidence contemporaneous with the injury, the Board found no overpayment of temporary disability between August 16-24, 2004. The determination of permanent disability, apportionment, and further overpayments remains deferred pending further medical development.

Workers Compensation Appeals BoardMarvin NelsonState of California Department of Social ServicesIndustrial InjuryBack InjuryNeck InjuryTemporary DisabilityPermanent DisabilityOverpaymentDr. Carl Maguire
References
4
Case No. ADJ4025440 (VNO 0557895)
Regular
Mar 12, 2012

CHARLES B. HANLON vs. WYLE HOLDINGS, INC., AIG adjusted by CHARTIS CLAIMS, INC.

The Workers' Compensation Appeals Board granted reconsideration to clarify an ambiguous award for temporary disability benefits. The applicant sustained a cumulative injury resulting in temporary and permanent disability. The defendant argued the award was unclear regarding the coordination of temporary disability payments with benefits already paid by the Employment Development Department (EDD). The Board clarified that the applicant is to be compensated for temporary disability, less amounts paid by EDD, with adjustments potentially needed to match the agreed-upon temporary disability rate. Furthermore, the Board clarified that EDD's overpayments of unemployment benefits made after the applicant's permanent and stationary date are to be reimbursed from the applicant's permanent disability benefits.

Cumulative industrial injuryTemporary disability indemnityPermanent disability benefitsPetition for ReconsiderationFindings and AwardAmbiguous awardEDD benefitsLabor Code §4904Agreed Medical ExaminerTemporary total disability
References
0
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