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

Case No. ADJ9667092
Regular
Jan 12, 2016

Virginia Fernandez vs. KMART, ACE AMERICAN INSURANCE COMPANY

Applicant Virginia Fernandez injured her knee and wrist, but her MPN physician's report was contradictory and failed to address all complaints, leading to a dispute. The defendant denied her request for a second opinion within the MPN, insisting she use the panel QME process. The Appeals Board found the applicant was entitled to a second opinion within the MPN to resolve the dispute over her treatment. However, the Board reversed the lower judge's order, ruling the defendant's refusal did not constitute a denial of medical treatment allowing her to seek care outside the MPN.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNSecond Opinion PhysicianQualified Medical EvaluatorQMEDenial of Medical TreatmentLabor Code section 4616.3Labor Code section 4616.4Independent Medical Review
References
3
Case No. MISSING
Regular Panel Decision
May 17, 2016

United States v. Nesbeth

Chevelle Nesbeth was convicted by a jury for importation of cocaine and possession with intent to distribute. Senior District Judge Block rendered a non-incarceratory sentence of one-year probation, with special conditions including six months' home confinement and 100 hours of community service. The judge wrote this opinion to emphasize the importance of considering the numerous statutory and regulatory collateral consequences facing Nesbeth as a convicted felon, such as restrictions on employment, housing, and voting. These consequences were extensively balanced against 18 U.S.C. § 3553(a) factors to determine a just punishment. The opinion advocates for legal counsel and the Probation Department to proactively address collateral consequences in all future pre-sentence reports and sentencing proceedings.

Collateral ConsequencesSentencing ReformCriminal JusticeProbationary SentenceDrug Trafficking OffensesFelony ConvictionJudicial DiscretionFederal Sentencing GuidelinesRehabilitationRecidivism
References
55
Case No. MISSING
Regular Panel Decision

Pizzo v. Barnhart

Plaintiff Kathleen Pizzo appealed the Commissioner of the Social Security Administration's final determination denying her disability insurance benefits. The District Court reviewed the ALJ's decision, which had assigned no weight to the treating physician's opinion and significant weight to a consulting physician's report. The court found that the ALJ erred by failing to give appropriate weight to the treating physician's opinion, not adequately developing the administrative record to obtain missing medical notes, and giving undue weight to the consulting physician's report which did not explicitly support the capacity for sedentary work. Consequently, the Commissioner's determination was remanded for further administrative proceedings consistent with the District Court's decision, granting the plaintiff's motion for judgment on the pleadings to the extent of the remand and denying the Commissioner's cross-motion.

Social Security ActDisability Insurance BenefitsAdministrative Law JudgeTreating Physician RuleResidual Functional CapacitySedentary WorkMedical EvidenceRemandSubstantial EvidenceRecord Development
References
23
Case No. ADJ6821851, ADJ6914728
Regular
Jun 07, 2013

ANTONIO MEJIA vs. GOTHIC GROUNDS MANAGEMENT, OLD REPUBLIC CONSTRUCTION PROGRAM GROUP

The Appeals Board granted reconsideration of the WCJ's decision finding industrial injury to the applicant's heart and cardiovascular system. The Board rescinded the award, finding the opinion of the applicant's treating physician unsubstantial due to a lack of detailed reasoning and contradictory evidence regarding work conditions. Conversely, the Board found the QME's opinion that Chagas disease was the sole cause of the cardiac arrest to be well-reasoned and substantial, leading to the denial of applicant's claims. Consequently, the Board ordered that the applicant take nothing by way of his claims.

Workers' Compensation Appeals BoardReconsiderationJoint Partial Findings of FactAwards & OrdersInjury AOE/COEHeart and Cardiovascular SystemLandscaperTemporary DisabilityPermanent DisabilityApportionment
References
0
Case No. MISSING
Regular Panel Decision

Formal Opinion No.

This opinion from the Chairman of the New York Workers' Compensation Board addresses the priority of income execution and income deduction orders, established by the 1985 Support Enforcement Act (CPLR §§ 5241, 5242), against other statutory deductions from workers' compensation awards. Historically, WCL § 33 provided broad exemptions for workers' compensation benefits. However, WCL §§ 206(2) and 25(4)(a) allow for reimbursement of disability insurers and employers for advance payments, respectively, and WCL § 24 establishes liens for attorneys' fees, traditionally enjoying highest priority. The 1985 Act amended WCL § 33 to make benefits subject to support enforcement and also stipulated that income executions and deduction orders take priority over other assignments, levies, or processes. The Board concluded that claims for attorneys' fees and reimbursements by disability insurance carriers and employers are to be deducted first from the workers' compensation award. The support enforcement remedies under CPLR §§ 5241 and 5242 then apply to the balance of the workers' compensation benefits paid to the employee. This approach ensures prompt payment to injured workers and prevents double payment issues.

Workers' CompensationSupport Enforcement ActIncome ExecutionIncome DeductionLien PriorityStatutory InterpretationDisability Benefits ReimbursementEmployer ReimbursementAttorneys' Fees PriorityCPLR 5241
References
9
Case No. ADJ10222181 (MF) ADJ10222198
Regular
Jan 30, 2019

SAM ALBOUDOOR vs. AMJES, INC. dba K&B FREIGHT SYSTEMS

This case concerns claims for hernias and spine injuries sustained by a truck driver. The Workers' Compensation Appeals Board granted reconsideration to review the finding that hernias were work-related, noting the medical evaluator's conflicting opinions on causation. The Board determined further medical development is required on the hernia issue due to contradictory expert testimony. Additionally, the issue of reimbursement for self-procured medical treatment was deferred pending the resolution of the hernia claims.

Workers' Compensation Appeals BoardAMJES INCK&B Freight SystemsSam Alboudoorherniahiatal herniainguinal hernialumbar spinethoracic spinePQME
References
0
Case No. ADJ8024184
Regular
Jan 06, 2014

GUILLERMO ECHAVARRIA vs. BATHTUB KING, EVEREST NATIONAL INSURANCE COMPANY

The Workers' Compensation Appeals Board denied reconsideration of a decision disallowing lien claims. The lien claimants failed to prove industrial causation by a preponderance of the evidence, as the primary medical opinion lacked substantial evidentiary support and was based on the applicant's contradictory statements. Furthermore, the lien claimants did not overcome the employer's post-termination defense under Labor Code section 3600(a)(10)(D). The Board also noted the failure to establish that reasonable and necessary medical treatment was provided.

Labor Code section 3600(a)(10)(D)Lien ClaimantsPetition for ReconsiderationCompromise and ReleaseSerious DisputeBona Fide DisputeCausationPost-termination DefenseBurden of ProofPreponderance of the Evidence
References
12
Case No. ADJ984347 (FRE 0202559)
Regular
Apr 01, 2014

ENRICA TORRES vs. CLOVIS UNIFIED SCHOOL DISTRICT

This Workers' Compensation Appeals Board case involves an applicant who sustained a psyche injury due to cumulative trauma from workplace sexual harassment. The defendant, Clovis Unified School District, sought reconsideration of an award for further medical treatment. The Agreed Medical Examiner's (AME) opinions on the applicant's need for ongoing treatment were contradictory, leading to ambiguity. Therefore, the Board amended the award to defer the determination of further medical treatment pending clarification, requiring a supplemental AME report or stipulation.

Enrica TorresClovis Unified School DistrictYORK RISK SERVICES GROUPINC.ADJ984347ADJ4520728WORKERS' COMPENSATION APPEALS BOARDRECONSIDERATIONPERMANENT DISABILITYFURTHER MEDICAL TREATMENT
References
0
Case No. ADJ10223818
Regular
Sep 14, 2018

Irene Malagon vs. Larsen Supply Company, Inc.; Samsung Fire and Marine Insurance Company, Administered by Broadspire

This case involves a workers' compensation applicant claiming injury to her shoulders, neck, and back. The defendant sought reconsideration of the WCJ's finding of industrial causation, arguing the medical evidence was insufficient. The Board affirmed the WCJ's decision, finding the applicant's treating physician's report to be substantial evidence despite some historical inconsistencies. The Board also found the Qualified Medical Evaluator's reports problematic, particularly regarding causation for wrist and hand injuries due to contradictory opinions and insufficient analysis. A dissenting commissioner believed both medical reports had significant flaws, necessitating further evaluation.

AOE/COEProduction workerCumulative injuryMedical opinionSubstantial evidenceTreating physicianQualified Medical Evaluator (QME)CausationReconsiderationCredibility determination
References
0
Case No. ADJ11428234
Regular
Oct 17, 2025

RAMON COLLADO vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, CENTINELA STATE PRISON

The Workers' Compensation Appeals Board granted reconsideration to study the factual and legal issues in Ramon Collado's case against the California Department of Corrections and Centinela State Prison. Collado sought reconsideration of a WCJ's Findings and Order from July 28, 2021, which concluded he failed to prove an industrially caused heart/hypertension injury between December 20, 2012, and August 14, 2018. The Board found the Qualified Medical Evaluator's opinion on whether Collado's condition was an aggravation or mere exacerbation of prior injuries was unclear and contradictory, failing to constitute substantial medical evidence. Consequently, the Board rescinded the WCJ's decision and returned the matter to the trial level for further proceedings, including the development of the medical record and a determination on the applicability of Labor Code section 3212 presumptions.

Workers Compensation Appeals BoardRamon ColladoCalifornia Department of CorrectionsCentinela State PrisonState Compensation Insurance FundOpinion and Decision After ReconsiderationFindings and Orderworkers' compensation administrative law judgeindustrially caused injuryexacerbation
References
28
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