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

Case No. ADJ8134312
Regular
Sep 15, 2016

ERNIE GALLEGOS vs. GROTH BROTHERS CHEVROLET, AUTO DEALERS COMPENSATION OF CALIFORNIA, CORVEL

The applicant sustained a right knee injury, leading to a total knee replacement. The original award granted permanent disability without apportionment, which the defendant appealed. The Appeals Board granted reconsideration, finding that apportionment to pre-existing knee conditions was legally permissible even after total knee replacement. The case is remanded for a new award based on the Qualified Medical Evaluator's 50% apportionment to pre-existing pathology. A dissenting opinion argues the medical evidence lacked sufficient reasoning to support apportionment.

WORKERS' COMPENSATION APPEALS BOARDERNE GALLEGOSGROTH BROTHERS CHEVROLETAUTO DEALERS COMPENSATION OF CALIFORNIACORVELADJ8134312PETITION FOR RECONSIDERATIONFINDINGS AND AWARDPERMANENT DISABILITYAPPORTIONMENT
References
5
Case No. MISSING
Regular Panel Decision

Matter of Williams v. Preferred Meal Systems

Claimant, a driver, suffered injuries to his right knee and back in 2009 while making a delivery, leading to an established workers' compensation claim. The claim was later amended to include consequential adjustment disorder, and the Workers' Compensation Board ultimately found that claimant had sustained a permanent total disability from May 2012 onward. The employer, workers’ compensation carrier, and policy administrator appealed this decision, arguing that further proof was needed regarding claimant's vocational and functional capacity. The court affirmed the Board's decision, holding that extensive evidence of vocational and functional capacity is not required when medical proof demonstrates a permanent total disability and inability to engage in any gainful employment, as benefits continue for life in such cases. The court found substantial evidence in the opinions of treating and independent medical examination orthopedists to support the finding of permanent total disability.

Workers' CompensationPermanent Total DisabilityWage-Earning CapacityMedical ProofVocational CapacityFunctional CapacityAppellate ReviewNew York LawDisability BenefitsClaimant Rights
References
4
Case No. MISSING
Regular Panel Decision

Matter of Riescher v. Central Hudson Gas Electric

A claimant suffered two left knee injuries, first in 1999 and second in 2009, both while working as a lineman for a utility company. The first injury, covered by Alliance National Insurance Co., resulted in a 30% schedule loss of use for the left leg. The second injury, covered by Travelers Indemnity Company of America, led to a total bilateral knee replacement. The cost of left knee surgery was initially apportioned 80% to Alliance and 20% to Travelers. A Workers' Compensation Law Judge (WCLJ) later ruled that this apportionment applied only to the *increase* in the schedule loss of use award, not the overall award. The WCLJ found an overall 50% loss of use, representing a 20% increase, and applied the apportionment to this increase, resulting in Alliance being responsible for 46% and Travelers for 4% of the overall award. Alliance appealed, arguing for apportionment of the overall award, but the Workers’ Compensation Board affirmed the WCLJ's decision. The appellate court further affirmed the Board's decision, declining to reconsider the method of apportionment.

Workers' Compensation AppealSchedule Loss of UseKnee InjuryApportionmentInsurance Carrier LiabilityWCLJ DecisionBoard ReviewJudicial DiscretionLeft Leg InjuryLien
References
2
Case No. 2021 NY Slip Op 03882
Regular Panel Decision
Jun 17, 2021

Matter of Fiato v. New York State Dept. of Transp.

In this workers' compensation case, Daniel Fiato appealed decisions regarding his schedule loss of use (SLU) award for a left knee injury. After a 2017 total knee replacement, the Workers' Compensation Board applied the 2018 Workers' Compensation Guidelines, determining a 35% SLU, which, accounting for a prior 20% SLU, resulted in a 15% award. Fiato argued for the application of the 2012 Guidelines. The Appellate Division, Third Department, affirmed the Board's decisions, ruling that the 2018 Guidelines were correctly applied as the first evaluation of the current SLU occurred after their effective date, aligning with legislative intent to reflect medical advances.

Workers' CompensationSchedule Loss of UseKnee InjuryMedical GuidelinesAppellate ReviewJurisdictionPrior AwardImpairment RatingLegislative MandateStatutory Interpretation
References
8
Case No. MISSING
Regular Panel Decision

Claim of Gaddis v. Niagara Mohawk Power Corp.

A claimant injured her left knee in a work-related accident on January 5, 1998, and was awarded workers’ compensation disability benefits. Between 2000 and 2008, her treating physicians reported a worsening condition, leading to several authorized surgeries, including a total knee replacement. The carrier sought to transfer liability to the Special Fund for Reopened Cases. A WCLJ denied the application, but a Board panel modified it, shifting liability to the Special Fund. The Special Fund appealed, arguing that medical reports submitted between 2000 and 2008 constituted a request to reopen the case, thus barring liability from shifting to the Special Fund under Workers’ Compensation Law § 25-a.

Workers' CompensationSpecial Fund for Reopened CasesLiability ShiftMedical ReportsApplication to ReopenStatutory InterpretationAppellate ReviewKnee InjuryDisability BenefitsWork-Related Accident
References
7
Case No. MISSING
Regular Panel Decision

Claim of O'Rourke v. Consolidated Edison Co.

Claimant, a mechanic, sustained a work-related knee injury in January 2006, leading to total knee replacement surgery and eventual permanent restriction from his position. After failing a job training program and losing his budgeted position, claimant took regular retirement. A Workers’ Compensation Law Judge initially found an involuntary withdrawal from the labor market and awarded benefits, but the Workers’ Compensation Board reversed, determining a voluntary withdrawal. The claimant appealed this reversal. The appellate court affirmed the Board's decision, citing medical evidence that claimant could perform light duty or sedentary work despite his disability as a mechanic, and his admission of not seeking employment post-retirement.

Workers' CompensationVoluntary Removal from Labor MarketLight Duty WorkSedentary WorkPermanent RestrictionDisabilityJob Training ProgramRetirementConsequential InjuryAppellate Review
References
8
Case No. 525196
Regular Panel Decision
Apr 26, 2018

Matter of Derouchie v. Massena W. Wc Smelter

Claimant Gerry J. Derouchie sustained injuries on February 18, 2015, including to his right knee and left hip, after stepping into a pothole on his employer's premises. He filed for workers' compensation benefits, and his case was established for multiple injuries. Having prior injuries and surgeries, claimant sought authorization for total right knee and left hip replacement surgeries, which the employer and carrier denied. A Workers' Compensation Law Judge (WCLJ) granted the authorization, and the Workers' Compensation Board affirmed, finding a causal relationship between the February 2015 accident and the need for surgeries. The Appellate Division, Third Department, affirmed the Board's decision, citing substantial evidence and deference to the Board's assessment of medical witness credibility.

Workers' Compensation BenefitsCausal RelationshipKnee Replacement SurgeryHip Replacement SurgeryPreexisting ConditionsAggravation of InjuryMedical AuthorizationSubstantial EvidenceCredibility AssessmentAppellate Review
References
10
Case No. MISSING
Regular Panel Decision

Claim of Peterson v. Faculty Student Ass'n

The claimant, a food service worker, injured her left knee in April 2005, exacerbating prior injuries from a 1992 car accident and two 1995 work-related accidents. Her treating physician requested a total left knee replacement, but the carrier argued for apportionment of costs, suggesting the 2005 injury was only 15% responsible. Both the Workers’ Compensation Law Judge and the Workers’ Compensation Board rejected the apportionment claim, holding the carrier fully responsible, aligning with the rule against apportionment for non-compensable prior conditions where the claimant was fully employed. The Court affirmed the Board's decision, emphasizing that the claimant was not disabled by the 1992 car accident at the time of the 2005 injury and that the Board's credibility determinations regarding conflicting medical opinions were entitled to deference.

ApportionmentPreexisting ConditionKnee InjuryKnee Replacement SurgeryWorkers' Compensation Board DecisionCompensable InjuryNon-compensable InjuryFull EmploymentMedical Opinion DiscrepancyEmployer Responsibility
References
6
Case No. CV-24-0652
Regular Panel Decision
May 29, 2025

Matter of Cahill v. New York State Dept. of Mental Hygiene

Claimant Lynn Cahill sustained a work-related knee injury in 1992, which led to a total knee replacement in 2012 and subsequent revision surgeries. In October 2020, she was diagnosed with a periprosthetic infection, managed with antibiotics. Her condition acutely worsened in September 2022, leading her orthopedic surgeon, Dr. Frank Lombardo, to recommend and perform immediate cement spacer surgery on October 4, 2022, due to risks of sepsis and amputation. The employer and carrier disputed liability, arguing the surgery lacked prior authorization. However, the Workers' Compensation Board, affirmed by the Appellate Division, Third Department, ruled that the surgery was performed on an emergency basis, thereby waiving the authorization requirement under Workers' Compensation Law § 13-a (5) and holding the carrier responsible for the costs.

Knee InjuryPeriprosthetic InfectionEmergency Medical CareSurgical AuthorizationAppellate DivisionWorkers' Compensation Board ReviewMedical NecessityChronic InfectionSepsisAmputation Risk
References
6
Case No. 2019 NY Slip Op 05740 [174 AD3d 1196]
Regular Panel Decision
Jul 18, 2019

Matter of Presida v. Health Quest Sys., Inc.

Claimant Oprah Presida sustained a work-related injury to her right knee, which was later amended to include a causally-related lower back injury, and a total knee replacement was authorized. The employer and its workers' compensation carrier sought review from the Workers' Compensation Board of a Workers' Compensation Law Judge's decision. The Board denied this application, finding it defective for not complying with 12 NYCRR 300.13 (b)(1), which requires applications to be completely filled out on Form RB-89 without merely referring to attached documents. The carrier appealed this denial, arguing it was arbitrary and capricious. The Appellate Division affirmed the Board's decision, concluding that the Board did not abuse its discretion in denying the application due to the carrier's failure to provide complete responses on the prescribed form.

Appellate ReviewApplication for Board ReviewProcedural ComplianceForm RB-89Administrative LawDenial of ApplicationArbitrary and Capricious StandardJudiciary Law § 431Work-Related InjuryKnee Injury
References
5
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