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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
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

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. MISSING
Regular Panel Decision

Almoravids v. Chase Manhattan Bank

The employer-respondent moved to dismiss an appeal as untimely. The Board had previously affirmed a referee's determination in June 1977, disallowing a claim. The appellant did not appeal this decision but sought reconsideration. In December 1977, the Board advised no further action was warranted. In January 1978, the appellant requested an appeal of both the June and December 1977 determinations. The appeal from the June 1977 decision was deemed untimely under Workers’ Compensation Law § 23, leading to the granting of the employer-respondent's motion to dismiss that appeal. The appellant's separate motion for an extension of time to prosecute the appeal was also denied without costs.

Appeal DismissalUntimely AppealWorkers' Compensation LawMotion GrantedMotion DeniedExtension of TimeBoard DecisionReconsideration Request
References
0
Case No. MISSING
Regular Panel Decision

Claim of Harris v. Phoenix Central School District

Claimant filed for workers' compensation benefits after an elbow injury on May 6, 2004, but notified his employer late, on June 11, 2004. A Workers' Compensation Law Judge disallowed the claim due to untimely notice and resulting prejudice to the employer, citing Workers’ Compensation Law § 18. The claimant did not appeal this decision to the Board. Over two months later, the claimant sought to reopen the case, requesting a hearing on excusing the late notice. The Board denied this request, noting the claimant's prior opportunity to litigate, his failure to seek initial Board review, and the absence of new evidence, in accordance with 12 NYCRR 300.14 [a]. This appeal challenges the Board's denial to reopen. The appellate court affirmed the Board's decision, concluding that the Board did not abuse its discretion, as its reasons were rational and supported by the record. The court further stated that the WCLJ's alleged errors were not properly before it due to the claimant's failure to seek Board review under Workers’ Compensation Law § 23.

Workers' CompensationLate NoticeEmployer PrejudiceBoard DiscretionJudicial ReviewReopening CaseAppellate AffirmationProcedural ComplianceNotice RequirementsClaim Disallowance
References
6
Case No. ADJ7324170, ADJ9797150
Regular
May 10, 2016

Beverly Bolton vs. COUNTY OF SAN BERNARDINO

The Appeals Board granted reconsideration to review the WCJ's finding that the applicant was entitled to requested medical treatment due to the employer's untimely utilization review. The employer argued the request was defective and the review was timely. The Board dismissed the employer's Petition for Removal and, after reconsideration, amended the Findings and Award. The Board affirmed the WCJ's finding that the utilization review was untimely, thus waiving objections to the request, but deferred the issue of medical necessity due to an insufficient record.

Workers Compensation Appeals BoardReconsiderationUtilization ReviewTimelinessRequest for Authorization (RFA)JurisdictionMedical NecessityRemovalAdministrative Law Judge (WCJ)Petition for Removal
References
0
Case No. ADJ11170562
Regular
Dec 02, 2019

NASIR KHAN vs. STAR STAFFING, ZURICH NORTH AMERICA, GALLAGHER BASSETT SERVICES, INC.

Defendant sought removal of a WCJ's order finding their utilization review denial of applicant's medical treatment request untimely. The WCJ determined the denial was late due to the 72-hour window for expedited requests, as the applicant's physician requested "urgent surgery." The Appeals Board denied the petition for removal, finding the defendant failed to show irreparable harm and that reconsideration would be an inadequate remedy. The Board upheld the WCJ's finding of untimely UR, allowing the Board to determine medical necessity.

Petition for RemovalUtilization ReviewExpedited Request for AuthorizationMedical Treatment Utilization StandardsTimelinessAdministrative Director RuleThreshold IssueInterlocutory IssueMedical NecessityPrimary Treating Physician
References
6
Case No. ADJ409820 ADJ1572678 ADJ3967299 ADJ349576
Regular
Dec 08, 2010

VELEDA BURTON vs. FEDERAL EXPRESS, permissibly self-insured; SEDGWICK CLAIMS SERVICES

In this workers' compensation case, the applicant, Veleda Burton, sought to disqualify the administrative law judge (WCJ) presiding over her five consolidated claims. The WCJ denied the petition, finding no stated grounds for disqualification and noting that the request was untimely as an automatic reassignment request. The Workers' Compensation Appeals Board (WCAB) adopted the WCJ's report, expressly incorporating its reasoning, and denied the petition for disqualification. The WCAB also concluded the request was untimely under California Code of Regulations, title 8, section 10453.

Petition for DisqualificationAdministrative Law JudgeReassignmentUntimely RequestCal. Code Regs. tit. 8 § 10453WCJ ReportDeniedFederal ExpressSedgwick Claims ServicesVeleda Burton
References
0
Case No. ADJ1871643 (SDO 0291759)
Regular
Oct 23, 2017

JOSE GOMEZ vs. DEPARTMENT OF CORRECTIONS, REHABILITATION PAROLE & COMMUNITY SERVICES, Legally Uninsured, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, affirming the WCJ's award of medical treatment. The defendant's Utilization Review denial was deemed untimely because their Request for Information was served more than five business days after the initial request, excluding the day after Thanksgiving. The Board clarified that the day after Thanksgiving is considered a normal business day for UR purposes under Labor Code section 4600.4. Therefore, the defendant's untimely RFI did not extend the UR deadline, and the requested medical treatment was properly authorized.

Workers' Compensation Appeals BoardUtilization ReviewRequest for AuthorizationRequest for InformationTimelinessBusiness DayLabor Code Section 4600.4Petition for ReconsiderationFindings and AwardPrimary Treating Physician
References
0
Case No. 532932
Regular Panel Decision
Jan 06, 2022

In the Matter of the Claim of Thomas Lazalee

Claimant Thomas Lazalee, a truck driver, had established work-related occupational diseases in both hands, undergoing multiple surgeries between 2018 and 2019. His treating physician, Raymond Stefanich, periodically classified him as temporarily totally disabled post-surgery, during which time the employer, Wegman's Food Markets, Inc., voluntarily paid temporary total disability benefits. At an April 2020 hearing, the employer accepted an amendment to the claim but requested to cross-examine Dr. Stefanich regarding the degree of disability following the October 2019 surgery. Both the Workers' Compensation Law Judge and the Board denied this request as untimely. The Appellate Division affirmed the Board's decision, finding that the employer's request was untimely and disingenuous, given their prior voluntary payments and the uncontroverted medical reports.

Occupational DiseaseCarpal Tunnel SyndromeTrigger ThumbTemporary Total DisabilityCross-Examination RequestUntimely RequestTreating PhysicianMedical Report AdmissibilityWorkers' Compensation Board DecisionAppellate Review
References
8
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