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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. ADJ6523994
Regular
Oct 19, 2010

ROSALBA TOLOZA vs. DOLAN FOSTER ENTERPRISES, Dba TACO BELL; PENNSYLVANIA MANUFACTURERS ASSOCIATION

The employer sought reconsideration of a Workers' Compensation Appeals Board (WCAB) decision awarding total temporary disability benefits. The WCAB rescinded the prior award, finding that the applicant's termination for taking $3.65 from the cash register to pay for a taxi was for cause. However, the Board remanded the case for further proceedings to develop the record regarding the applicant's medical condition and potential total temporary disability after her termination. The WCAB clarified that an employer can be liable for temporary disability even after termination if good cause is not established.

Workers' Compensation Appeals BoardTotal Temporary DisabilityTermination for CauseModified DutyCash Handling PolicyIndustrial InjuryEmployer MisconductMedical EvidenceGood Cause for TerminationStipulated Facts
References
9
Case No. ADJ1392547 (SFO 0460414)
Regular
Aug 02, 2010

MARCO DE ANDA vs. ADECCO STAFFING AND INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA

Applicant sought reconsideration of a prior award finding back, neck, and psyche injury, compensated temporary disability, and 50% permanent disability. His petition focused on a desire for temporary total disability for a later period, but this was not an issue in the prior proceedings and was stipulated as compensated. Furthermore, the petition untimely sought review of an earlier order terminating temporary disability, for which the reconsideration period had expired. Therefore, the Board denied reconsideration of the award and dismissed the petition regarding the termination order due to lack of jurisdiction.

Workers' Compensation Appeals BoardADECCO STAFFINGMARCO DE ANDAFindings and Awardforklift operatorindustrial injuryback injuryneck injurypsyche injurytemporary total disability
References
3
Case No. MISSING
Regular Panel Decision

Smith v. New York State & Local Retirement Systems

Petitioner, a taxpayer services representative, sustained a back injury in March 1981 while lifting forms, leading to a decline in attendance and eventual termination in November 1989. She applied for accidental and ordinary disability retirement benefits, both of which were denied by the Comptroller. The accidental disability claim was denied because the incident was not deemed an 'accident' under Retirement and Security Law § 63. The ordinary disability claim was denied as untimely, having been filed approximately six months after her termination, exceeding the 90-day limit stipulated by Retirement and Social Security Law § 62. The Supreme Court dismissed the challenge to the ordinary disability denial due to untimeliness and transferred the accidental disability challenge to this Court. This Court confirmed the Comptroller's determination on both counts, rejecting the petitioner's estoppel argument regarding the untimely ordinary disability application and finding substantial evidence to support the finding that the injury did not constitute an 'accident' within the meaning of the relevant law, as it resulted from ordinary employment duties without an unexpected event.

Disability Retirement BenefitsAccidental DisabilityOrdinary DisabilityUntimely ApplicationEstoppel Against GovernmentWork-Related InjuryBack InjuryDefinition of AccidentOrdinary Employment DutiesSubstantial Evidence Review
References
16
Case No. LAO 0862183
Regular
Oct 01, 2007

ALFREDO BELTRAN vs. COCA-COLA ENTERPRISES, INC., SEDGWICK CLAIMS MANAGEMENT

The Workers' Compensation Appeals Board granted reconsideration, rescinding the prior decision that required a petition to terminate temporary disability. The Board clarified that Labor Code § 4656(c)(1) automatically limits temporary total disability to 104 weeks within two years, obviating the need for a termination petition. The case was remanded to determine the exact date temporary disability payments first commenced to properly apply this statutory limit.

Temporary total disabilityTTDPetition to TerminateLabor Code 4651.1Labor Code 4656(c)(1)104 compensable weeksTwo-year periodIndustrial injurySpineButtocks
References
1
Case No. ADJ11613276
Regular
Nov 09, 2020

MARIA SERPAS vs. GOODWILL SOUTHERN CALIFORNIA STORE AND DONATION CENTER, ADMINSURE

This case involves Maria Serpas's claim for workers' compensation temporary disability benefits following a right shoulder injury. The administrative law judge initially denied temporary disability, finding Serpas was terminated for good cause. The Appeals Board granted reconsideration, rescinded the prior decision, and returned the case for further proceedings. The Board found the evidence insufficient to determine Serpas's entitlement to temporary disability or whether her termination constituted good cause, necessitating further development of the record.

Petition for ReconsiderationTemporary Disability IndemnityGood Cause TerminationSubstantial EvidenceWork RestrictionsModified DutyInteractive ProcessJob AbandonmentVoluntary SeparationHealing Period
References
14
Case No. ADJ10570712
Regular
Dec 22, 2017

ANTHONY RUSSELL vs. TNT INDUSTRIAL CONTRACTORS, INC., TRAVELERS INSURANCE COMPANY

This case concerns an applicant seeking temporary disability indemnity after sustaining a left foot injury. The applicant was offered modified duty but was terminated from that assignment due to making inappropriate and offensive comments to colleagues. The Appeals Board granted reconsideration, rescinded the prior award of temporary disability, and ruled that the applicant was not entitled to indemnity for the period in question. This decision was based on the finding that the applicant's termination for cause relieved the employer of the obligation to pay temporary total disability, as established by case law.

Temporary Disability IndemnityModified DutyTermination for CausePetition for ReconsiderationFindings of Fact and AwardWork Status ReportTransition to WorkReEmployAbility programOffensive CommentsHarassment
References
14
Case No. ADJ11092342
Regular
Sep 16, 2019

TAMARA SPIVA vs. THE BABY CONNECTION, MID-CENTURY INSURANCE COMPANY

This case involves an applicant seeking reconsideration of a denial of additional temporary disability indemnity. The Workers' Compensation Appeals Board granted reconsideration, finding the administrative law judge applied the incorrect legal standard regarding temporary partial disability. The Board determined the focus should be on whether the applicant's conduct actually disqualified them from employment, not the employer's belief or investigation. The matter is returned for the judge to determine if the applicant engaged in misconduct leading to a justified termination, and to reassess temporary total disability entitlement regardless of the termination reason.

Temporary disability indemnityPetition for ReconsiderationFindings and OrderSonogram techCumulative injuryRight shoulderTemporary total disabilityModified dutyTermination for causeCompeting business
References
7
Case No. LAO 855766
Regular
Jul 16, 2007

JUAN L. FLORES vs. HEDENBERG, INC., dba IHOP, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration to address the defendant's petition to terminate temporary total disability indemnity. While the defendant's initial petition had procedural defects, including failing to adhere to filing deadlines and content requirements, the Board found that Labor Code section 4700 dictates no liability for temporary disability benefits exists beyond the date of the applicant's death. Consequently, the Board rescinded the prior order and issued a new order terminating the defendant's liability for temporary total disability indemnity as of February 20, 2007, the date of the applicant's death.

Workers' Compensation Appeals BoardPetition for ReconsiderationOrder Terminating LiabilityTemporary Total Disability IndemnityLabor Code Section 4700Applicant's DeathPermanent and StationaryPetition to Terminate LiabilityCalifornia Code of RegulationsRule 10462
References
2
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