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

Case No. 2024 NY Slip Op 05011 [231 AD3d 1262]
Regular Panel Decision
Oct 10, 2024

Matter of Lebeau v. Meet Caregivers Inc.

Claimant Okina Lebeau, a certified nurse assistant, filed for workers' compensation benefits alleging injuries to her right leg and knee from an assault by a coworker. A Workers' Compensation Law Judge initially established the claim, but the Workers' Compensation Board reversed, finding the injury did not arise out of employment. Claimant's subsequent application for reconsideration was denied. The Appellate Division, Third Department, affirmed the Board's decision, crediting the coworker's and manager's testimonies over claimant's. The Board determined that no physical altercation occurred and that the claimant's injury did not arise out of and in the course of her employment, a finding supported by substantial evidence.

Employment InjuryAssault ClaimCredibility AssessmentSubstantial EvidenceAppellate ReviewWorkers' Compensation BoardWorkplace IncidentClaimant TestimonyEmployer InvestigationFactual Determination
References
8
Case No. ADJ7505520
Regular
Jul 01, 2014

ALBERT LOBO vs. COUNTY OF SAN BERNADINO

In this case, the Workers' Compensation Appeals Board amended a prior award concerning applicant Albert Lobo's industrial injury. The Board clarified that applicant is entitled to home health care services, including reimbursement for caregiver Halimah Shenghur. However, specific issues regarding the commencement date of liability and reimbursement for certain other individuals are deferred for further development of the record. The Board affirmed the entitlement to services based on a physician's prescription and the caregiver's extensive documented care, while emphasizing the employer's duty to investigate and provide benefits promptly.

Industrial injurybilateral upper extremitiesbilateral lower extremitiesinternal systemsself-procured medical treatmentcaregiver serviceshome health care serviceshome modificationsNeri Hernandezprescription requirement
References
1
Case No. ADJ8074524
Regular
Jan 17, 2013

Geoconda Acevedo vs. Reliable Caregivers, PEGASUS RISK MANAGEMENT

The Appeals Board dismissed the defendant's petition for reconsideration because the selection of a Qualified Medical Evaluator (QME) is not a final order. However, the Board granted removal to address issues with defective QME panels. The Board rescinded the prior award and ordered the WCJ to appoint a regular physician if the parties cannot agree on an Agreed Medical Examiner. This action aims to resolve the ongoing delays and procedural defects in selecting a QME for the applicant's evaluation.

QME panelremovalagreed medical examinerpanel qualified medical evaluatorWCJ authoritylabor code section 5701substantive right or liabilityprimary treating physicianindustrial injuryreconsideration
References
6
Case No. ADJ7476556
Regular
Nov 09, 2010

MAXIMA ANDRES vs. MATCHED CAREGIVERS, INC., HEALTH CARE INDUSTRY SELF INSURANCE, PRIVATE ADJUSTING RANCHO CUCAMONGA

This case involves a petition for reconsideration filed by the defendant after an Order Approving Compromise and Release (OACR). However, the Workers' Compensation Appeals Board (WCAB) dismissed the petition as moot. This is because the Administrative Law Judge (ALJ) had already rescinded the OACR on October 21, 2010, prior to the defendant's petition. Therefore, the action sought by the defendant's petition had already been taken.

Workers' Compensation Appeals BoardPetition for ReconsiderationOrder Approving Compromise and ReleaseOrder RescindingWCJMootDismissalMatched CaregiversInc.Health Care Industry Self Insurance
References
0
Case No. CV-23-0964
Regular Panel Decision
Oct 10, 2024

In the Matter of the Claim of Okina Lebeau

Claimant Okina Lebeau appealed decisions by the Workers' Compensation Board that denied her claim for benefits related to an alleged workplace assault. Lebeau, a certified nurse assistant, claimed a coworker injured her right leg and knee by hitting her with a chair in November 2021. The Board reversed a Workers' Compensation Law Judge's decision, concluding that the injury did not arise out of and in the course of employment, primarily by crediting the coworker's and manager's testimonies over Lebeau's regarding the alleged physical altercation. The Appellate Division, Third Judicial Department, affirmed the Board's decisions, finding its factual and credibility determinations were supported by substantial evidence. Consequently, the denial of workers' compensation benefits was upheld.

Workers' CompensationAssaultCredibilitySubstantial EvidenceArising Out Of EmploymentCourse Of EmploymentFactual DeterminationsNurse AssistantInjury ClaimBoard Review
References
9
Case No. ADJ10324875
Regular
Sep 19, 2016

YU QIN ZHU vs. DEPARTMENT OF SOCIAL SERVICES IHSS, YORK RISK SERVICES GROUP, INC.

The Workers' Compensation Appeals Board granted reconsideration and rescinded the WCJ's decision. The Board found that the applicant, a caregiver for IHSS, did not sustain an injury arising out of and occurring in the course of employment when she was hit by a car while cycling between clients. The Board determined that her commute between clients did not fall under an exception to the "going and coming" rule as she chose her clients, work hours, and method of transportation for her own convenience. Therefore, the Board substituted its own finding that the injury was not compensable.

Workers' Compensation Appeals BoardIHSSYork Risk Services GroupInc.ADJ10324875Petition for ReconsiderationOpinion and OrderFindings of FactWorkers' Compensation Judge (WCJ)Labor Code Section 3351.5
References
8
Case No. ADJ9290124
Regular
Aug 01, 2014

TONIE RUIZ vs. STATE OF CALIFORNIA DEPARTMENT OF SOCIAL SERVICES IHSS, Legally Uninsured, Administered By YORK RISK SERVICES GROUP, INC.

The defendant sought reconsideration of an award of temporary disability benefits for an IHSS caregiver injured in 2012. The Appeals Board granted reconsideration, affirming the award of temporary disability benefits. However, the Board clarified that benefits are limited to 104 weeks under Labor Code section 4656(c)(2). The Board also ruled that placing the applicant on a registry did not constitute a valid offer of modified work, as no actual offer was made.

Workers' Compensation Appeals BoardIn-Home Supportive ServicesIHSSDual EmploymentTemporary DisabilityLabor Code 4656(c)(2)Permanent and StationaryPanel Qualified Medical EvaluatorPQMEAgreed Medical Examiner
References
3
Case No. AD 6745689
Regular
Aug 30, 2010

JORGE PEREZ vs. TK SYSTEMS, INC., INSURANCE COMPANY OF THE WEST

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior award, and remanded the case for further proceedings. The Board found that while family providing attendant care is compensable, crucial medical evidence was lacking to determine the appropriate rate for the services. Specifically, there was no medical evidence establishing the necessity of medication administration by the caregiver. The matter is returned to the trial level for development of the record on applicant's home care needs and the cost of such services.

attendant carereasonable valueindustrial injury24 hour caremedication administrationmedical evidencehome care needsLVNregistered nurselive-in caregiver
References
3
Case No. ADJ17825300
Regular
Sep 22, 2025

BARBARA CRATER vs. CRATE & BARREL HOLDINGS INC, PROPERTY & CASUALTY COMPANY OF HARTFORD

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant challenged the WCJ's findings that they failed to prove an enforceable Medical Provider Network (MPN) for ancillary services and that the applicant had the right to select a family member for home care. The Board affirmed the WCJ's decision, concluding that the defendant did not establish the existence of an enforceable MPN and therefore could not control the selection of the home caregiver, allowing the applicant to choose her daughter.

Medical Provider NetworkAncillary ServicesHome Care ProviderFamily Member SelectionLabor Code Section 5813Petition for ReconsiderationFindings of FactWorkers' Compensation Administrative Law JudgeBurden of ProofUtilization Review
References
8
Case No. ADJ10873991
Regular
Dec 24, 2018

CARLA AGUILAR vs. UNITED CEREBRAL PALSY/SPASTIC CHILDREN’S FOUNDATION OF LOS ANGELES AND VENTURA COUNTIES

The Workers' Compensation Appeals Board granted reconsideration and affirmed the WCJ's decision, with minor amendments. The Board gave great weight to the WCJ's credibility determinations, finding no substantial evidence to overturn them. Applicant Carla Aguilar sustained an injury to her right shoulder, elbow, and wrist on March 27, 2017, while employed as a caregiver. The employer was United Cerebral Palsy/Spastic Children's Foundation, permissibly self-insured and administered by York Risk Services, Inc.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJcredibility determinationsGarza v. Workmen's Comp. Appeals Bd.self-insuredadministeredinjurycaregiverdirect support staff
References
1
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