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Case Law Database

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

Case No. ADJ10268949
Regular
Nov 23, 2016

ELOY DELA TORRE FERNANDEZ vs. MERCHANT'S LANDSCAPE SERVICES, INC.

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior decision that barred the applicant's claim due to a post-termination filing defense. The applicant claimed exceptions to this defense, arguing he received pre-termination treatment and that his date of injury, under Labor Code § 5412, occurred after his termination. The WCAB found insufficient evidence to decide the pre-termination treatment exception and remanded the case to clarify the applicant's date of injury under § 5412, as this date's post-termination status would be an exception to the defense. The prior order was rescinded and the case returned for further proceedings.

Workers Compensation Appeals BoardPetition for ReconsiderationFindings and OrderLabor Code Section 3600(a)(10)Post-termination DefenseCumulative InjuryDate of InjurySection 5412Compensable DisabilityTrier of Fact
References
3
Case No. MISSING
Regular Panel Decision
Apr 13, 1973

Vic's Auto Body & Repair v. Granito

This case concerns an Article 78 proceeding challenging the denial of a special exception permit for an automobile body and fender repair shop. Initially, the Supreme Court, Nassau County, annulled the denial and directed the issuance of the permit. However, the appellate court reversed this judgment, reinstating the appellants' original determination and dismissing the petition. The appellate court found that the appellants' denial was supported by evidence of potential noise, fumes, visual blight from wrecked cars, the residential nature of the vicinity, and the severe negative impact on a neighboring medical practice. The court concluded that the proposed use failed to meet the standards for a special exception permit.

Special Exception PermitZoning DenialAutomobile Repair ShopNuisanceResidential CharacterMedical Practice ImpactCPLR Article 78Abuse of Discretion ReviewProperty ValueAppellate Review
References
1
Case No. MISSING
Regular Panel Decision
Jan 22, 2004

Mete v. New York State Office of Mental Retardation

This class action alleged age discrimination in employment against the New York State Office of Mental Retardation and Development Disabilities (OMRDD). Plaintiffs, former Chiefs of Developmental Center Treatment Services, claimed disparate treatment and disparate impact arising from a 1989 reduction in force (RIF) that eliminated their positions. All 46 Chiefs, who were over 40, were either demoted or retired, and statistical evidence showed a disproportionate impact on employees over 40. The Supreme Court granted defendants’ motion for summary judgment, dismissing all causes of action. The appellate court affirmed, finding that while plaintiffs established a prima facie case, OMRDD provided a legitimate, nondiscriminatory reason for the RIF (economic conditions and long-standing concerns about the position's utility), which plaintiffs failed to adequately prove was a pretext for discrimination.

Age DiscriminationClass ActionSummary JudgmentDisparate TreatmentDisparate ImpactReduction in ForceEmployment LawPretextPrima Facie CaseStatistical Evidence
References
11
Case No. MISSING
Regular Panel Decision

Claim of Evevsky v. Liberty Mutual Group

This case involves an appeal from a Workers’ Compensation Board decision regarding a claimant's unauthorized medical treatment. The claimant, who sustained neck and shoulder injuries in 1993, had her case reopened in 2001 after the employer's carrier objected to her request for authorized massage therapy. Both the Workers’ Compensation Law Judge and the Board determined that the treatment was not authorized under Workers’ Compensation Law § 13-b, as the massage therapist was not Board-authorized nor supervised by an authorized physician. The appellate court reviewed the Board's decision, affirming that there was no legal basis to overturn the finding. The court also considered and dismissed the claimant's constitutional arguments as being without merit.

Workers' CompensationMedical TreatmentMassage TherapyAuthorizationBoard DecisionAppellate ReviewStatutory InterpretationPhysician SupervisionConstitutionalityPermanent Partial Disability
References
3
Case No. ADJ9267193 (MF) ADJ9267135
Regular
Apr 20, 2020

KAREN HARTMAN vs. COUNTY OF SANTA BARBARA

The Workers' Compensation Appeals Board (WCAB) granted applicant Karen Hartman's petition for removal and approved a partial compromise and release agreement. This agreement resolves all claims except future medical treatment in exchange for $813,777, less credits and attorney fees. The WCAB rescinded a prior order for a neurology QME panel, finding the settlement fair and in the applicant's best interest. The award includes continued liability for necessary medical treatment.

Petition for RemovalPartial Compromise and ReleaseQualified Medical EvaluatorsNeurologyWorkers' Compensation Appeals BoardAdministrative Law JudgeLabor Code section 5001Labor Code section 5002WCAB Rule 10700Decision After Removal
References
0
Case No. LAO 0795696
Regular
Jul 09, 2007

DULCE MONTES vs. NATIONWIDE PAGING, INC., PREFERRED EMPLOYERS INSURANCE COMPANY

The applicant sought reconsideration of a decision mandating transfer into the defendant's Medical Provider Network (MPN) for treatment. The Workers' Compensation Appeals Board denied reconsideration, affirming that MPNs, as established by SB 899, allow for transfer of care regardless of prior treatment relationships or awards. The Board found no evidence applicant met exceptions to MPN transfer rules and rejected arguments based on pre-SB 899 law or MPN rule unconstitutionality.

MPNMedical Provider NetworkPrimary Treating PhysicianReconsiderationFindings of FactLabor Code Section 4616Appeals Board Rule 9767.9Transfer of CareSB 899Babbitt v. Ow Jing
References
7
Case No. ADJ8211340 (MF), ADJ1594154 (LBO 0389043), ADJ562819 (LBO 0391438)
Regular
Sep 14, 2018

CAROLYN DAVIS vs. LONG BEACH TRANSIT, ATHENS ADMINISTRATORS

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior award to applicant Carolyn Davis concerning cumulative and specific injuries sustained as a bus driver. Applicant contended the WCJ erred in apportioning permanent disability. The parties subsequently entered a partial compromise and release agreement, where applicant released all claims except future medical treatment for $49,743.25, after credits and attorney fees. The WCAB approved the settlement as adequate and in applicant's best interest, modifying the prior award to reflect only the ongoing liability for further medical treatment.

Workers' Compensation Appeals BoardReconsiderationJoint Findings and AwardAdministrative Law JudgeLumbar SpinePsyche InjuryCumulative PeriodPermanent Partial DisabilityApportionmentFurther Medical Treatment
References
0
Case No. ADJ10369582
Regular
Nov 05, 2018

Barbara Riggs vs. Sears Holdings Corporation, ACE American Insurance Company

This case involves an applicant seeking workers' compensation benefits who claims she cannot find a physician within the defendant's Medical Provider Network (MPN) due to her deafness and past negative experiences. The Administrative Law Judge initially allowed out-of-network treatment based on "exceptional circumstances." However, the Appeals Board granted reconsideration to develop the record, finding that the primary issue is whether the defendant neglected or refused to provide reasonably necessary treatment within its MPN. The Board rescinded the prior order and returned the case for further proceedings to determine if the MPN physician can accommodate the applicant's needs and if the defendant's prior actions constituted neglect or refusal.

Workers' Compensation Appeals BoardSears Holdings CorporationACE American Insurance CompanyESISPetition for ReconsiderationFindings and OrdersMedical Provider Network (MPN)exceptional circumstancesself-procure medical treatmentLabor Code section 4600
References
3
Case No. ADJ7264010, ADJ7498085
Regular
Mar 16, 2017

SANDRA CATLIN vs. J.C. PENNEY, INC., AMERICAN HOME ASSURANCE CO.

This case involves a defendant's petition for removal of a WCJ's order requiring the applicant to undergo a treatment consultation with an Agreed Medical Evaluator (AME) under Labor Code § 4050 and directing the defendant to provide a nurse case manager. The defendant argued that § 4050 grants them the right to select a physician for examination and that the AME consultation order was improper, as was the indefinite appointment of a nurse case manager. The Appeals Board granted the petition for removal, affirming the WCJ's orders except for the AME re-evaluation, which was deferred due to a lack of statutory basis and evidence presented. The Board found that § 4050 has been largely subsumed by more specific statutes governing medical evaluations and treatment disputes.

Petition for RemovalAgreed Medical Evaluator (AME)Labor Code § 4050Nurse Case ManagerMedical TreatmentUtilization Review (UR)Compromise and Release (C&R)Declarations of Readiness to Proceed to Expedited Hearing (DOR)Medical ExaminationQualified Medical Examination
References
7
Case No. ADJ8155759
Regular
Jan 16, 2014

Steven Casciano vs. Kelly Services, Inc.

In *Casciano v. Kelly Services, Inc.*, the Workers' Compensation Appeals Board (WCAB) denied the employer's petition for reconsideration. The employer argued the applicant's back injury claim was a post-termination claim barred by Labor Code § 3600(a)(10). However, the WCAB found the exception under § 3600(a)(10)(B) applied. This exception is triggered when there is evidence of injury in pre-termination medical records, regardless of explicit industrial causation. The Kaweah Delta Emergency Room report showing the applicant sought treatment for back pain prior to termination satisfied this requirement. Therefore, the WCAB affirmed the finding that the applicant sustained an injury arising out of and in the course of employment.

Labor Code § 3600(a)(10)AOE/COEPost-termination claimException to defenseEvidence of injuryIndustrial causationPre-termination treatmentWCJ findingsPetition for ReconsiderationKaweah Delta Emergency Department
References
2
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