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

Case No. MISSING
Regular Panel Decision
Dec 03, 2004

Claim of Scally v. Ravena Coeymans Selkirk Central School District

In this case, a claimant appealed a Workers’ Compensation Board decision regarding apportionment of her workers' compensation award. The claimant, who suffered a work-related left knee injury in 2002, had a pre-existing non-work-related injury to the same knee from 1986. While a WCLJ initially denied apportionment, the Board reversed, directing a 50/50 apportionment based on the premise that the prior injury would have resulted in a schedule loss of use award had it been work-related. The appellate court upheld the Board's determination, deferring to its interpretation that a non-work-related injury leading to a schedule loss of use constitutes a "disability in a compensation sense" for apportionment purposes. This decision was supported by medical expert testimony indicating a schedule loss of use from the prior surgery.

Workers' CompensationApportionmentKnee InjuryNon-work-related InjurySchedule Loss of UsePreexisting ConditionMedical Expert TestimonyBoard InterpretationJudicial ReviewAppellate Decision
References
13
Case No. MISSING
Regular Panel Decision

Rubeis v. Aqua Club, Inc.

Aldo Rubeis was injured after falling from a ladder while installing a steel cupola, sustaining a brain injury. He sued Aqua Club, Inc., who then impleaded Rubeis's employer, Venezia Iron Works, Inc., alleging a "grave injury" under Workers' Compensation Law § 11 for common-law indemnification and contribution. The Supreme Court denied Venezia Iron Works' motion to dismiss, and a jury found Rubeis sustained a grave injury. Venezia Iron Works appealed. The Appellate Division reviewed the definition of "grave injury" under Workers' Compensation Law § 11, specifically "permanent total disability" in the context of brain injury cases. The Court concluded that Rubeis's injuries, despite their severity, did not meet the "narrowly defined" standard for grave injury based on prior precedents, which focus on day-to-day functions rather than just employability. Therefore, the Appellate Division reversed the judgment, granted Venezia Iron Works' motion, and dismissed the third-party complaint.

Grave InjuryWorkers' Compensation Law § 11Permanent Total Disability DefinitionBrain Injury SeverityCommon Law IndemnificationContribution ClaimThird-Party Action DismissalAppellate Review StandardsStatutory InterpretationEmployer Liability Exemption
References
9
Case No. ADJ2719991 (VNO 0485134) ADJ1334047 (VNO 0428744)
Regular
Aug 20, 2009

Catalina Barajas vs. WELLPOINT HEALTH NETWORK, INC., ZURICH LOS ANGELES

This case involves an applicant who initially sustained a cumulative trauma injury to her upper extremities during a period covered by one insurer. After returning to work with modified duties, she experienced a recurrence and worsening of symptoms, necessitating further treatment and surgery, which the Board now recognizes as a separate cumulative trauma injury. The Workers' Compensation Appeals Board granted reconsideration, reversing the prior finding of a single cumulative trauma injury. The Board held that distinct periods of compensable temporary or permanent disability, as established by medical evidence and treatment, demarcate separate cumulative trauma injuries, aligning with the *Rodarte* precedent. Consequently, the applicant was found to have sustained two separate cumulative trauma injuries, each attributed to different insurance coverage periods.

cumulative traumaanti-merger doctrineLabor Code sections 3208.25303Rodartecompensable temporary disabilitypermanent disabilitywage lossmodified workbilateral upper extremities
References
3
Case No. ADJ10881718
Regular
Jul 19, 2019

WANDA JACKSON vs. CVS PHARMACY, INC., NEW HAMPSHIRE INSURANCE COMPANY

This case, *Jackson v. CVS Pharmacy, Inc.*, concerns the date of injury for a cumulative trauma claim under Labor Code section 5412. The Workers' Compensation Appeals Board denied reconsideration, upholding the finding that the applicant did not know her disability was work-related until receiving medical advice. The applicant's belief that her pain was caused by work activities was insufficient without knowledge that it constituted a compensable cumulative injury. Therefore, the date of injury was determined to be when she gained this medical knowledge, not when she first experienced symptoms or had a general belief about their origin.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code section 5412date of injurycumulative injuryoccupational diseasedisabilityknowledge of industrial origintemporary disabilitypermanent disability
References
2
Case No. MISSING
Regular Panel Decision
Jul 22, 2002

Claim of Ostuni v. Town of Ramapo

Claimant appealed from a decision of the Workers’ Compensation Board, filed July 22, 2002, which denied her application for reconsideration and/or full Board review of a prior decision. The prior decision had ruled that claimant did not sustain a work-related injury, citing insufficient credible evidence. The appellate court affirmed the Board's denial, finding that the Board fully considered all evidence and no new, previously unavailable evidence was offered to warrant altering its decision. Furthermore, the court found substantial evidence supported the Board’s September 2001 decision that claimant’s injuries were not compensable, as her recurring lower back pain stemmed from injuries predating or following the alleged November 1990 incident, rather than the incident itself. The court also upheld the Board's rejection of contrary testimony as not credible.

Workers' CompensationBack InjuryWork-Related InjuryReconsiderationBoard ReviewAppellate ReviewAbuse of DiscretionArbitrary and CapriciousSubstantial EvidenceMedical Testimony
References
5
Case No. ADJ1438639 (GRO0024593) ADJ3262777 (GRO0025366)
Regular
Jul 06, 2011

DENNIS TIMMONS vs. CALIFORNIA MENS COLONY, STATE COMP. INS. FUND, SUBSEQUENT INJURIES BENEFITS TRUST FUND

The Workers' Compensation Appeals Board granted reconsideration to reverse a prior award of Subsequent Injuries Benefits Trust Fund (SIBTF) benefits to the applicant, Dennis Timmons. The applicant sought SIBTF benefits based on a claimed pre-existing disability from a 1991 injury, arguing it imposed a prophylactic restriction from very heavy work that contributed to his 2000 industrial injury. However, the Board found no substantial medical evidence of a ratable pre-existing disability at the time of the 2000 injury, as prior medical reports indicated no residual disability and the applicant returned to work without restrictions. The Board concluded that a retroactive prophylactic restriction, without evidence of actual prior work limitations, is insufficient to establish SIBTF eligibility.

Subsequent Injuries Benefits Trust FundSIBTFpre-existing disabilityindustrial injurypermanent disabilityapportionmentAgreed Medical ExaminerAMEprophylactic restrictionWCJ
References
2
Case No. ADJ6585876, ADJ4285015 (POM 0167573)
Regular
Oct 12, 2015

Vicente Jackson vs. Northrop Grumman Corporation, Insurance Company of the State of Pennsylvania

This case concerns Vicente Jackson's cumulative trauma back injury claim against Northrop Grumman and its insurer. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, rescinded prior findings, and remanded the case for further development of the record. The primary issues are whether the applicant's claim was timely filed within the statute of limitations and whether his work activities constituted a new cumulative trauma injury. The WCAB found that Dr. Sanders' reports provided substantial medical evidence for a cumulative trauma injury, but the statute of limitations issue requires further factual development regarding the applicant's knowledge of the injury and the timing of medical treatment.

Workers' Compensation Appeals BoardVICENTE JACKSONNORTHROP GRUMMAN CORPORATIONINSURANCE COMPANY OF THE STATE OF PENNSYLVANIACalifornia Insurance Guarantee AssociationCIGAWCJcumulative trauma injurystatute of limitationsLabor Code section 5412
References
5
Case No. MISSING
Regular Panel Decision

Matter of Losardo v. Baxter Healthcare Corporation

Claimant, a truck driver, sought workers' compensation benefits for a back injury he alleged occurred in October 2007 while unloading a truck. A Workers’ Compensation Law Judge initially established the claim, but the Workers’ Compensation Board reversed this decision, finding insufficient credible medical evidence to support a work-related injury. The claimant subsequently appealed the Board's decision. The Appellate Division affirmed the Board's ruling, noting that medical records and testimony from treating physicians contradicted the claim of a work-related accident, instead suggesting a pre-existing condition and a non-work related injury at home. The court upheld the Board's broad authority to resolve credibility and draw inferences, concluding that its decision was supported by substantial evidence.

Back InjuryTruck DriverCompensable InjuryMedical EvidenceCredibilitySubstantial EvidenceAppellate ReviewDisability BenefitsWork-Related InjuryClaimant Testimony
References
4
Case No. 533112
Regular Panel Decision
Mar 17, 2022

Matter of Reyes v. H & L Iron Works Corp.

A claimant appealed a Workers' Compensation Board decision which found he violated Workers' Compensation Law § 114-a and permanently disqualified him from future indemnity benefits. The claimant, Leonel Reyes, sustained work-related injuries in 2016 and received benefits. However, he failed to fully disclose his disc jockey activities and the physical nature of this work to the Board, carrier, and examining physicians while collecting benefits. Surveillance videos showed him lifting heavy equipment, contradicting his testimony. The Workers' Compensation Board affirmed the WCLJ's finding of a violation and the imposition of both mandatory and discretionary penalties. The Appellate Division, Third Department, affirmed the Board's decision, concluding that substantial evidence supported the violation and that the permanent forfeiture of indemnity benefits was not a disproportionate penalty given the claimant's multiple egregious misrepresentations.

Workers' Compensation Law § 114-aFalse RepresentationIndemnity BenefitsPermanent DisqualificationUndisclosed EmploymentDisc JockeyMaterial MisrepresentationSubstantial EvidenceWitness CredibilityDiscretionary Penalty
References
7
Case No. ADJ7050517
Regular
Jun 16, 2010

Gary Tull vs. YOUNGS MARKET, Permissibly Self-Insured Administered By CANNON COCHRAN MANAGEMENT SERVICES

This case concerns an applicant claiming cumulative trauma injury to his right knee. The WCJ denied the claim, finding the Panel QME's report insufficient to establish cumulative trauma. The Appeals Board granted reconsideration, noting the PQME found an injury and work-related causation but incorrectly characterized it as a specific injury on a particular date. The Board remanded the case to develop the medical record, specifically directing a supplemental report from the PQME on the cumulative trauma aspect of the claim.

Cumulative traumaPanel Qualified Medical EvaluatorPQMEIndustrial injuryRight kneeFindings and OrderReconsiderationTake nothing orderSubstantial medical evidenceBurden of proof
References
7
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