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

Case No. MISSING
Regular Panel Decision
May 17, 2002

In re the Claim of Kearse

The claimant appealed a decision from the Unemployment Insurance Appeal Board, which upheld its prior ruling that the claimant's request for a hearing was untimely. The claimant had been disqualified from receiving unemployment benefits due to misconduct and charged with an overpayment, but failed to request a review hearing for several months, mistakenly believing her workers' compensation case was related. The Board, upon reconsideration, adhered to its finding that the request was untimely. The Appellate Division affirmed the Board's decision, reiterating that a claimant typically has 30 days to request a hearing unless there is a valid excuse. The court also declined to consider the claimant's belated assertions of post-traumatic stress disorder as a justification for the delay.

Unemployment BenefitsUntimely RequestMisconduct DischargeOverpaymentWorkers' CompensationPost-Traumatic Stress DisorderAppellate ReviewHearing TimelinessAdministrative DecisionNew York Appellate Division
References
4
Case No. MISSING
Regular Panel Decision

Claim of Domanico v. Woodmere Fire District

This case involves an appeal from a decision by the Workers’ Compensation Board, filed April 4, 2005, which denied an employer's request for reimbursement of wages paid to a claimant during a period of disability. The court examined whether a June 24, 2004 notice, issued by the self-insured employer, Woodmere Fire District, containing language about reimbursement, was sufficient as a request under Workers’ Compensation Law § 25 (4) (a). The court found the notice to be sufficient in form. However, a critical issue remained regarding the timeliness of this request; specifically, whether it was filed prior to the compensation award made at the January 7, 2005 hearing. Due to this unresolved issue, the court reversed the Board's decision and remitted the matter for further proceedings to determine the timeliness of the reimbursement request.

Workers' Compensation ReimbursementEmployer Wage ReimbursementDisability WagesTimeliness of Reimbursement RequestWorkers' Compensation LawBoard Decision AppealJudicial ReversalRemittal for Further ProceedingsNew York Workers' CompensationStatutory Interpretation
References
5
Case No. MISSING
Regular Panel Decision

Bland v. Gellman

A claimant had two workers' compensation claims, one managed by the Special Fund for Reopened Cases and the other by Travelers Insurance Company, with liability equally apportioned. The claimant's treating physician requested a variance for aquatic therapy, which both carriers denied. Although a Workers' Compensation Law Judge approved the treatment, the Workers' Compensation Board reversed, asserting that the variance request form (MG-2) was not properly served on the Board and that the review request was untimely. The Appellate Division reversed the Board's decision, finding substantial evidence that the MG-2 form was timely filed with the Board, referencing both claim numbers, and that the request for review of the denial was also timely. The court concluded that the Board's determination lacked substantial evidence and remitted the matter for further proceedings.

Variance RequestAquatic TherapyClaim DenialMG-2 FormTimely FilingAdministrative LawAppellate ReviewSpecial Fund for Reopened CasesTravelers Insurance CompanySubstantial Evidence
References
3
Case No. ADJ9755370
Regular
Aug 10, 2017

BERNARDINO GARDEA vs. CITY OF PASADENA

This case concerns the City of Pasadena's request for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision regarding the applicant's occupational group number. The WCJ initially recommended dismissal of the reconsideration petition as untimely. However, the defendant has now requested leave to file a supplemental petition to address issues raised in the WCJ's report. The WCAB has granted the defendant's request to file this supplemental petition. The defendant is ordered to file the supplemental petition within 20 days, either by mail or via EAMS, to avoid rejection.

Workers' Compensation Appeals BoardSupplemental PetitionReconsiderationOccupational Group NumberAdministrative Law JudgePetition for ReconsiderationWCAB Rule 10848Electronic Adjudication Management SystemEAMSCity of Pasadena
References
0
Case No. 2016-06-2313
Regular Panel Decision
Jul 03, 2017

McGee, Tyrone vl Embassy Suites Nashville

Tyrone McGee, an employee of Embassy Suites Nashville, filed a Request for Expedited Hearing after becoming severely ill from eating enchiladas provided by his employer in the break room. He sought medical and temporary disability benefits, alleging his injury arose out of and in the course of his employment. The court denied his requested relief, finding that while he became ill during work, he failed to provide sufficient medical evidence to causally connect his condition to his employment, particularly that his employment contributed more than 50% to his need for medical treatment. The court highlighted the necessity of corroborative expert testimony for medical causation and noted its limited jurisdiction regarding certain requested damages like pain and suffering or housing losses.

Food Poisoning ClaimGastroenteritis DiagnosisCausation in Workers' CompExpedited Hearing DenialMedical Proof RequirementBurden of Proof EmployeeArising Out of EmploymentCourse and Scope of EmploymentWorkers' Compensation BenefitsEmployer's Duty to Provide Panel
References
4
Case No. 2021-06-1129
Regular Panel Decision
Dec 22, 2021

Swartsell, Timothy v. Nashville Tempered Glass Corp.

Timothy Swartsell sought additional medical benefits for a left shoulder injury sustained at work, requesting Dr. Jaron Sullivan as his authorized treating physician. The employer, Nashville Tempered Glass Corp., disputed compensability and Dr. Sullivan's authorization, arguing an intervening act of golfing broke the chain of causation. The Court found Mr. Swartsell's injury primarily work-related, rejecting the employer's compensability defense based on medical evidence. However, it denied the request for additional benefits and payment for past unauthorized treatment with Dr. Sullivan. This denial was due to Mr. Swartsell's failure to consult his employer before seeking outside medical care, thereby not satisfying his burden of proof for the requested relief.

Shoulder InjuryMedical BenefitsUnauthorized TreatmentCausationIntervening ActGolf InjuryRotator Cuff TearBiceps TendinopathyExpedited HearingDenial of Relief
References
7
Case No. 2018-06-1247
Regular Panel Decision
Oct 11, 2018

Lindsay, Courtland v. Western Express

This expedited hearing order addresses Courtland Lindsay's request for temporary disability and medical benefits following an alleged work-related knee injury on June 18, 2018. Lindsay claimed the incident aggravated a pre-existing patella injury sustained during a non-work-related jogging accident. Western Express, the employer, opposed the request, presenting a medical opinion from neurosurgeon Dr. Joseph Wieck, who concluded that Lindsay's injuries stemmed from the prior jogging accident and not the work incident. The Court found that Lindsay failed to provide sufficient expert medical proof to establish a causal link between his injury and employment, as required by Tennessee law. Consequently, the request for benefits was denied, and the matter was set for a future status conference.

Workers' CompensationKnee InjuryPatella FractureTendon TearMedical CausationExpedited HearingBenefit DenialPre-existing ConditionJogging AccidentEmployment Injury
References
1
Case No. 2014-01-0016
Regular Panel Decision

Careathers, Will v. Cardin Forest Products, LLC

Will Careathers, an employee of Cardin Forest Products, LLC, filed a Request for Expedited Hearing seeking medical and temporary disability benefits after reporting a midsection injury while lifting wood on August 11, 2014. He was referred to Dr. Charles R. Adcock, who diagnosed a small hiatal hernia. A post-accident drug test was positive for Oxycodone and Oxymorphone, leading Cardin to deny the claim. Careathers contended the medication was prescribed and that Cardin failed to provide a panel of physicians. Judge Thomas Wyatt denied Careathers' request, finding he failed to establish by medical expert opinion that his hiatal hernia arose primarily out of employment, as required by the Tennessee Workers' Compensation Act. The Court also found that Careathers accepted Dr. Adcock as his treating physician instead of waiting for a panel, thus denying his request for a new panel.

Workers' CompensationHiatal HerniaDrug TestCausationMedical BenefitsTemporary DisabilityPanel of PhysiciansExpedited HearingTennessee LawEmployer Liability
References
2
Case No. MISSING
Regular Panel Decision
May 01, 2005

In Re Balderas

This decision addresses post-confirmation attorneys' fees in Chapter 13 bankruptcy cases, using the Balderas case as a factual background. The debtors in the Balderas case sought modification of their plan due to payment defaults and requested $350 in attorney's fees for the motion. The court outlines the history of the Balderas' numerous modifications, moratoriums, and associated attorney fee awards, totaling $3,495, highlighting how these fees were paid out of plan distributions at the expense of creditors. The court analyzes sections 1326(b)(1) and 330(a)(4)(B) of the Bankruptcy Code to determine the reasonableness and payment method of such fees. Ultimately, the court establishes new rules for post-confirmation attorney fee awards in the Western District of Texas, San Antonio Division, including a $2,500 prima facie base fee, a $100 per month payment rate for additional fees, and specific guidelines for various types of motions. The current $350 fee request for the Balderas case's moratorium is approved but with caution against future similar requests.

BankruptcyChapter 13Attorneys' FeesPost-Confirmation FeesPlan ModificationCreditor DistributionsSecured ClaimsAdministrative ExpensesDebtor RepresentationFeasibility
References
26
Case No. 2018-06-0018
Regular Panel Decision
Jul 26, 2018

Coon, Gerald v. Commercial Warehouse and Cartage, Inc.

Gerald C. Coon, an employee, filed a request for temporary disability and medical benefits after an alleged back injury on September 22, 2017, due to a malfunctioning safety lanyard at Commercial Warehouse and Cartage, Inc. (CWC). Mr. Coon claimed continuous pain and denial of medical treatment by CWC. However, CWC witnesses testified Mr. Coon did not exhibit pain or request medical care until November 19, 2017. The Court found Mr. Coon's testimony not credible. Medical opinions varied, with Dr. Robert Carver, a panel physician, determining Mr. Coon's conditions (degenerative disc disease and lumbosacral radiculopathy) were not work-related. Dr. William M. Gavigan diagnosed a work-related lumbar strain but a non-work-related disc herniation. The Court credited Dr. Gavigan's opinion as most persuasive, confining the compensable injury to a lumbar strain, and found Mr. Coon unlikely to prevail on entitlement to additional medical treatment or temporary disability benefits, as no doctor took him off work for the strain. The Court, therefore, denied Mr. Coon's request for benefits.

Workers' CompensationBack InjuryLumbar StrainDegenerative Disc DiseaseLumbosacral RadiculopathyMedical CausationCredibility AssessmentExpedited HearingTemporary Disability BenefitsMedical Benefits
References
4
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