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

Case No. 2016 NY Slip Op 08300 [145 AD3d 492]
Regular Panel Decision
Dec 08, 2016

Netzahuall v. All Will LLC

This case concerns an appeal regarding the denial of defendant Lime Light's cross-motion to dismiss common-law indemnification claims brought by defendant All Will LLC. The plaintiff, Gabriel Netzahuall, an employee of Lime Light, sustained injuries but not a "grave injury" as defined by Workers' Compensation Law § 11. Although the Workers' Compensation Board previously determined Lime Light to be the plaintiff's employer, the Appellate Division affirmed the lower court's finding that All Will, the premises owner, was not collaterally estopped from challenging this determination. The court reasoned that All Will was not a party to the prior Workers' Compensation proceeding and therefore did not have a full and fair opportunity to litigate the issue of plaintiff's employer.

indemnificationcollateral estoppelWorkers' Compensation Lawemployer-employee relationshipgrave injurypremises liabilityappellate practicestatutory interpretationprivity of partieslitigation opportunity
References
4
Case No. ADJ8336291
Regular
Feb 11, 2015

AIDA RAMOS vs. COUNTY OF LOS ANGELES

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration in this case. The Board adopted the findings of the Administrative Law Judge, concluding that the employer unreasonably neglected to furnish medical treatment to the applicant. This unreasonable neglect stemmed from the employer misdirecting an authorization for medical treatment by faxing it to the wrong number, resulting in a significant delay in the applicant receiving necessary orthopedic reevaluation. The Board emphasized that any consequences of such delays will be borne by the employer, not the injured employee, citing Labor Code § 4616.3(b).

Medical Provider NetworkMPNauthorizationfax numbermisdirectedunreasonable neglectfurnish medical treatmentdelayinjured employeeLabor Code § 4616.3(b)
References
0
Case No. ADJ3857516 (VNO 0505788)
Regular
Sep 20, 2013

ALBERTO ALCAZAR vs. PACTIV CORPORATION

This case involves a worker's compensation claim where the employer, Pactiv Corporation, was found to have unreasonably delayed necessary medical treatment, including transportation and home care. The Appeals Board modified a prior decision, finding the unreasonable delay occurred from December 20, 2010, to March 2, 2011, and reduced the penalty from 25% to 15% of the delayed benefits. The Board reversed the penalty for two instances of transportation failure by a hired company, deeming it not the employer's unreasonable conduct. Finally, attorney fees were reduced as some services were deemed unnecessary for the period of unreasonable delay.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of FactAward and OrderUnreasonable DelayMedical TreatmentTransportationHome Care AssistanceLabor Code section 5814Penalty
References
1
Case No. ADJ2607862 (SDO 0334155)
Regular
Feb 17, 2012

JAVIER HERNANDEZ vs. SWEETWATER UNION HIGH SCHOOL DISTRICT, Permissibly Self-Insured, Administered By CORVEL CORPORATION

This case concerns an employer's unreasonable delay in providing a new treating physician to an applicant with a psyche injury, leading to a penalty under Labor Code section 5814. The defendant argued the delay was not unreasonable and was applicant's fault, but the Board found the employer has an affirmative duty to actively provide medical care. Based on the WCJ's report, which indicated no evidence of the defendant's efforts to locate a physician, reconsideration was denied. The Board affirmed the finding of unreasonable delay and the imposition of a penalty.

Labor Code section 5814unreasonable delaymedical treatmenttreating physicianpenaltypsyche injuryhealth care technicianCORVEL CORPORATIONSWEETWATER UNION HIGH SCHOOL DISTRICTpermanent disability
References
6
Case No. ADJ3603721 (ANA 0385798) ADJ3874014 (ANA 4689669) ADJ4689669 (ANA 0388899)
Regular
Nov 07, 2014

CAROL HILL vs. UNILAB CORPORATION/QUEST DIAGNOSTICS, TRAVELERS INSURANCE COMPANY

This case involves an applicant seeking reconsideration of a WCJ's decision regarding unreasonable delays in benefit payments. The Board granted reconsideration and affirmed the finding of unreasonable delay for temporary disability indemnity, awarding a 25% penalty. However, the Board deferred the issue of permanent disability indemnity advance penalties for further analysis due to record ambiguity. The Board also found no unreasonable delay in medical treatment benefits and reversed an award of attorney's fees under LC 5814.5, but allowed fees from the temporary disability penalty recovery.

Workers' Compensation Appeals BoardUnreasonable DelayTemporary Disability IndemnityPermanent Disability Indemnity AdvancesLabor Code Section 5814 PenaltyMedical Treatment BenefitsAttorney's FeesPetition for ReconsiderationAdministrative Law JudgeJoint Findings and Award
References
1
Case No. ADJ6678537
Regular
Oct 07, 2011

DOTTIE BRANDON-LEGGET vs. SECURITAS SECURITY SERVICES, INC.

This case involves a security guard's claim for industrial injury to her shoulder and knee. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, affirming the findings of industrial injury and temporary total disability. However, the WCAB reversed the administrative law judge's (ALJ) penalty award under Labor Code §5814, finding that the defendant's delay in paying temporary disability was not unreasonable due to genuine doubt about its liability. The WCAB emphasized that a penalty under §5814 requires unreasonable delay or refusal, and here, the defendant's doubts were not unreasonable given the applicant's delayed treatment and lack of contemporaneous complaints.

Labor Code § 5814Unreasonable DelayTemporary Total DisabilityIndustrial InjuryRight ShoulderRight KneeReconsiderationWCJ FindingsGenuine DoubtMedical Treatment
References
13
Case No. ADJ6973825
Regular
May 21, 2012

MONICA BENARD vs. JENNY CRAIG, SEDGWICK CMS

This case concerns a penalty imposed on Jenny Craig for unreasonably delaying authorization for applicant Monica Benard's chiropractic treatment. The WCJ found a 25% penalty for the delay, which Jenny Craig appealed, arguing the delay was due to the applicant's choice of a chiropractor outside their Medical Provider Network (MPN). The Appeals Board affirmed the unreasonable delay finding but reduced the penalty to 20% of the delayed treatment's value, citing a failure in case management rather than intentional disregard. Jurisdiction was reserved for the parties to adjust the penalty amount.

Workers Compensation Appeals BoardMonica BenardJenny CraigSedgwick CMSADJ6973825ReconsiderationFindings and AwardLabor Code section 5814Medical Provider Network (MPN)chiropractic treatment
References
9
Case No. ADJ2155279 (RIV 0040729)
Regular
Nov 28, 2012

JACK RAMSEY vs. CALIFORNIA PAVEMENT MAINTENANCE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, Sedgwick CMS, LEGION INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) amended a previous award to defer the issue of attorney fees for enforcing an award of Labor Code section 5710 fees. The WCAB affirmed the remainder of the award, including a $100 penalty for unreasonable delay in authorizing medical treatment, finding the 100-day delay in authorizing treatment with the applicant's chosen physician was unreasonable. The Board also affirmed the award of attorney fees under Labor Code section 5814.5 for enforcing the medical treatment award. The case was returned to the trial level for further proceedings regarding the amount of section 5814.5 fees, with a dissenting opinion arguing for further proceedings on the unreasonable delay issue due to insufficient evidence.

Workers' Compensation Appeals BoardCIGALegion Insurance CompanySedgwick CMSJack RamseyLabor Code section 5814Labor Code section 5814.5Labor Code section 5710Medical Provider NetworkMPN
References
2
Case No. ADJ207630 (VNO 0423900), ADJ4689357 (VNO 0462906)
Regular
Feb 11, 2015

MANUEL PASQUIER vs. VOLUTONE DISTRIBUTING COMPANY, VIRGINIA SURETY INSURANCE COMPANY

This case concerns applicant Manuel Pasquier's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The WCAB initially found that the defendant unreasonably delayed three lump sum payments, resulting in interest, a $10,000 penalty under Labor Code § 5814, and attorney's fees. Pasquier argued for multiple penalties, citing the distinct nature of the payments, while the WCAB affirmed the single penalty, viewing the late payments as one act of unreasonable delay. The majority also upheld the WCJ's attorney's fee calculation, disagreeing with Pasquier's claim for higher fees and hours. However, one Board member dissented, arguing that the three distinct payments (disability indemnity, MSA seed money, and attorney's fees) constituted separate acts of unreasonable delay, each warranting an individual penalty, and supported the higher attorney's fee rate.

Compromise and ReleaseJoint Findings of Fact and Orderunreasonable delaylump sum paymentsLabor Code section 5814attorney's feeLabor Code section 5814.5Petition for Reconsiderationworkers' compensation administrative law judgeseparate acts
References
12
Case No. SBA 0076630
Regular
Mar 03, 2008

Janice Brackenridge-DeGraff vs. ACTMEDIA, INC., INTERCARE INSURANCE

The Workers' Compensation Appeals Board granted reconsideration, overturning a prior decision that denied penalties for delayed payment. The Board found the employer unreasonably delayed payment of the compromise and release agreement by 10 days beyond the agreed-upon 30-day deadline. Consequently, the Board awarded a 5% penalty on the delayed amount and a separate 5% penalty for the unreasonable delay in paying the legally owed interest.

Labor Code section 5814ReconsiderationCompromise and ReleasePenaltyUnreasonable DelayPaymentInterestAttorney's FeesCIGAWCJ
References
1
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