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Case Law Database

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

Case No. MISSING
Regular Panel Decision

Olszowy v. Norton Co.

Plaintiff Henry Olszowy, a former employee of Norton Company, retired in 1983 with a special early retirement option. His pension benefits were subsequently reduced due to a workers' compensation award from a 1973 back injury, as Norton applied an offset provision. Olszowy sued Norton, the Retirement Program, and its trustee, claiming there was no agreement for such an offset. A jury found in favor of Olszowy, leading to a judgment against the Retirement Program and its trustee. The defendants appealed, arguing the jury's verdict was unsupported by evidence, as the agreement between Norton and the union clearly provided for the offset. The appellate court reversed the judgment, finding the jury's verdict was based on plaintiff's unsupported interpretation and not on sufficient evidence.

Pension offsetWorkers' compensation benefitsEarly retirement programCollective bargaining agreementContract interpretationJury verdict reversalSufficiency of evidenceWeight of evidenceAppellate reviewEmployee benefits
References
3
Case No. MISSING
Regular Panel Decision

Solomon v. Metropolitan Life Insurnace

Tracy Solomon, a registered nurse employed by Oxford, claimed disability due to back pain and fibromyalgia. MetLife, the Plan's claims administrator and funder of benefits through a group policy, initially approved and then terminated Solomon's long-term disability (LTD) benefits multiple times, citing a lack of objective medical basis and relying on independent medical reviews and surveillance. Solomon cross-moved for summary judgment, arguing MetLife's denial was arbitrary and capricious due to a conflict of interest, unsupported by substantial evidence, and a denial of full and fair review. The court found MetLife's conflict of interest significant, its denial unsupported by substantial evidence given the nature of fibromyalgia and chronic fatigue syndrome, and a procedural violation in not allowing Solomon to respond to new medical reports. Consequently, the court denied MetLife's motion for summary judgment and granted Solomon's cross-motion for summary judgment on her claim. However, MetLife's counterclaim for overpayment reimbursement presented disputed factual issues, precluding summary judgment for either party on that claim.

ERISALong-Term Disability BenefitsSummary JudgmentAbuse of Discretion StandardConflict of InterestFibromyalgiaChronic Fatigue SyndromeSocial Security Disability IncomeMedical ReviewSurveillance Evidence
References
48
Case No. ADJ3156337 (FRE 0209931) ADJ4199467 (FRE 0209932)
Regular
Nov 20, 2008

FRANK FLORES vs. NICKEL'S PAYLESS STORES, WAUSAU INSURANCE COMPANIES, EVEREST NATIONAL INSURANCE COMPANY, AMERICAN COMMERCIAL CLAIMS ADMINSITRATORS

The Workers' Compensation Appeals Board granted reconsideration of an award for a 1999 right foot and ankle injury, specifically addressing the defendant's claims of error in permanent disability calculation without apportionment and the exclusion of medical evidence. The Board intends to admit the Agreed Medical Evaluator's reports into evidence, which the WCJ had previously excluded. This decision will allow the Board to review all relevant medical evidence before making a final determination on apportionment and the applicant's claimed injuries.

Workers Compensation Appeals BoardIndustrial InjuryPermanent Partial DisabilityApportionmentAgreed Medical EvaluatorSubstantial Medical EvidenceAdmissibility of EvidencePetition for ReconsiderationAmended Findings Award and OrderMinutes of Hearing
References
0
Case No. ADJ8518632
Regular
May 09, 2017

HORACIO MONTOYA vs. CBC FRAMING, INC., ARCH INSURANCE COMPANY, A B GALLAGHER BASSETT

The WCAB granted the defendant's Petition for Removal regarding a prior WCJ order compelling a Functional Capacity Evaluation. Removal was granted because the WCJ's order was based on a medical report that had not been formally admitted into evidence, preventing meaningful review. The Board will now admit the defendant's medical report into evidence for the limited purpose of determining the Petition for Removal. This action is an extraordinary remedy due to the prejudice caused by relying on unadmitted evidence.

RemovalFunctional Capacity EvaluationIndustrial InjuryPrejudiceIrreparable HarmAdmitted EvidenceQualified Medical EvaluationExhibit AAdministrative Law JudgePetition for Removal
References
4
Case No. MISSING
Regular Panel Decision

People v. Rodriguez

The defendant, indicted for resisting arrest and DWI, filed a motion to prevent the District Attorney from using evidence of his refusal to take a chemical test at trial. The defendant argued that admitting such evidence violates his Fifth Amendment rights against self-incrimination, despite a 1973 amendment to Vehicle and Traffic Law § 1194 that permitted it. The court analyzed precedents, distinguishing between the non-testimonial nature of the test itself and the communicative nature of a refusal. It concluded that a refusal constitutes a communication, thus falling under Fifth Amendment protection. Consequently, the court granted the defendant's motion, ruling that such evidence is inadmissible.

Fifth AmendmentSelf-incriminationChemical Test RefusalDWIAdmissibility of EvidenceConstitutional RightsTestimonial EvidenceImplied Consent LawPreclusion MotionCriminal Procedure
References
19
Case No. ADJ2839025 (STK 0210809)
Regular
Oct 07, 2010

JOSE MALDONADO vs. FCI CONSTRUCTORS, ZURICH AMERICAN INSURANCE

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant argued the $48\%$ permanent disability rating was unsupported by evidence and that the Agreed Medical Evaluator's (AME) opinion was insufficient. The Board adopted the WCJ's report, finding the AME's analysis, based on analogy within the AMA Guides for upper extremity impairment, provided substantial evidence. A dissenting opinion argued the AME failed to sufficiently explain his reasoning for deviating from standard measurements, making his opinion unsubstantiated medical evidence.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryPermanent Partial DisabilityDisability Evaluation UnitAgreed Medical EvaluatorAMA GuidesWhole Person ImpairmentAlmaraz/Guzman
References
8
Case No. ADJ14929271
Regular
Sep 23, 2022

GONZALO CERVANTES vs. VOLUNTEERS OF AMERICA OF LOS ANGELES, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

This case involves a defendant's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The defendant argued that the applicant's testimony was not substantial evidence, that the Qualified Medical Examiner's (QME) report was insufficient, and that the overall finding of industrial injury was unsupported. The WCAB denied the petition, adopting the reasoning of the Workers' Compensation Judge (WCJ). The WCJ found the applicant credible despite communication difficulties, and the QME's report substantial medical evidence, concluding there was sufficient evidence of industrial injury to the applicant's lumbar spine and left knee.

WCABPetition for ReconsiderationDeniedIndustrial InjuryLumbar SpineLeft KneeSubstantial EvidenceQME ReportCredibilitySymptom Magnification
References
8
Case No. MISSING
Regular Panel Decision

Dennis v. Colvin

Plaintiff Alicia B. Dennis challenged an Administrative Law Judge's denial of her disability benefits application under the Social Security Act. The District Court reviewed cross-motions for judgment on the pleadings. The court found that the ALJ failed to properly evaluate Plaintiff's coronary artery disease by interpreting diagnostic evidence without supporting medical opinions on functional limitations. This error rendered the ALJ's Residual Functional Capacity finding unsupported by substantial evidence. Consequently, the court granted Plaintiff's motion, denied Defendant's motion, and remanded the case for the ALJ to obtain further medical opinion evidence consistent with the decision.

Disability BenefitsSocial Security ActAdministrative Law JudgeRemandMedical EvidenceCoronary Artery DiseaseResidual Functional CapacityTreating Physician RuleALJ ErrorJudicial Review
References
26
Case No. MISSING
Regular Panel Decision

Tate v. Secretary of the Department of Health & Human Services of the United States

Plaintiff Michael Tate appealed the Secretary of Health and Human Services' denial of disability insurance benefits, marking the second time the District Court considered his case. Tate, a 41-year-old functionally illiterate former factory worker with asbestosis and intellectual impairments, presented medical evidence from several physicians, mostly concluding he was totally disabled. Despite a vocational expert's testimony, the Administrative Law Judge (ALJ) found Tate capable of sedentary work, a decision upheld by the Appeals Council. The District Court found the Secretary's decision lacked substantial evidence, citing the ALJ's unsupported medical conclusions regarding Tate's inability to walk and fatally defective hypothetical questions posed to the vocational expert. Consequently, the court remanded the case for further evidence and consistent findings.

Disability BenefitsAsbestosisIlliteracyVocational ExpertRemandSocial Security ActSubstantial EvidenceFunctional IlliteracyLung DiseaseAppeals Council
References
8
Case No. MISSING
Regular Panel Decision

Singletary v. Apfel

Plaintiff Sylvester M. Singletary appealed the Commissioner of Social Security's denial of disability insurance benefits, leading to this action under 42 U.S.C. § 405(g). The Court reviewed the final determination, including an Administrative Law Judge's decision, which the Appeals Council upheld. The central issue revolved around the ALJ's rejection of Singletary's treating physician's opinion of total disability, which the ALJ deemed unsupported by objective evidence, specifically the absence of disc herniation. The Court found that the ALJ arbitrarily substituted his lay opinion for competent medical evidence and ignored other objective findings like degenerative disc disease and disc bulging. Consequently, the Commissioner’s decision was not supported by substantial evidence, and the case was remanded solely for the calculation of benefits, with the plaintiff's motion for judgment on the pleadings granted.

Disability BenefitsSocial Security ActTreating Physician RuleSubstantial Evidence ReviewDegenerative Disc DiseaseChronic PainSpinal ImpairmentALJ ErrorRemandFederal Court Review
References
13
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