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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
Jun 27, 2013

Karabinas v. Colvin

Dimitrios N. Karabinas challenged the Commissioner of Social Security's denial of his Disability Insurance Benefits application, arguing the Administrative Law Judge (ALJ) committed several legal errors. The court identified flaws in the ALJ's Residual Functional Capacity (RFC) assessment, including failure to accommodate Karabinas's moderate difficulties in concentration, persistence, and pace, and an incomplete function-by-function analysis of his work abilities. Furthermore, the court found the ALJ improperly weighed medical opinions, specifically downplaying the detailed report from Karabinas's chiropractor, and based its credibility determination on a circular logic. Concluding that the ALJ's errors led to an unsupported denial of benefits, the District Court reversed the Commissioner's decision. The case was remanded for the sole purpose of calculating and providing benefits to Karabinas for the specified period.

Disability Insurance BenefitsSocial Security ActRFC AssessmentMedical OpinionCredibility AssessmentVocational ExpertCervical Disc ProblemsPain ManagementChiropractic TreatmentWork Limitations
References
34
Case No. 128
Regular Panel Decision
Dec 12, 2017

In the Matter of The Friends of P.S. 163, Inc v. Jewish Home Lifecare, Manhattan

This case involves two Article 78 proceedings challenging the New York State Department of Health's (DOH) State Environmental Quality Review Act (SEQRA) assessment for a new residential facility construction by Jewish Home Lifecare (JHL) in New York City. Petitioners, including parents of students at a nearby public school and local tenants, argued that DOH's assessment of environmental hazards, particularly lead dust and construction noise, was flawed and that mitigation measures were insufficient. The Supreme Court initially sided with petitioners, but the Appellate Division reversed, reinstating DOH's Findings Statement. The Court of Appeals affirmed the Appellate Division's decision, holding that DOH complied with its SEQRA responsibilities by taking a "hard look" at environmental concerns, assessing relevant hazards, and imposing adequate mitigation measures, rejecting petitioners' claims regarding flawed methodologies and insufficient protections.

SEQRAEnvironmental LawConstruction ProjectLead ContaminationAirborne DustNoise PollutionMitigation MeasuresPublic HealthArticle 78 ProceedingJudicial Review
References
3
Case No. MISSING
Regular Panel Decision

Torre v. Logic Technology, Inc.

The claimant, employed by a contractor for General Electric, sustained a spinal cord injury while participating in a fitness class at the G.E. Fitness Center during work hours. Both a Workers’ Compensation Law Judge and the Workers’ Compensation Board found that the injury arose from and occurred during his employment, leading to an award of workers’ compensation benefits. The employer's workers' compensation carrier appealed this decision. The appellate court affirmed the Board's determination. It concluded that the employer sponsored the activity by offering membership fee reimbursements and by encouraging participation for client development, thus establishing a work-related connection under Workers’ Compensation Law § 10 (1) despite the voluntary, off-duty nature of the activity.

Workers' CompensationCourse of EmploymentOff-Duty Athletic ActivityEmployer SponsorshipSpinal Cord InjuryFitness CenterEmployee BenefitsReimbursementClient DevelopmentSubstantial Evidence
References
7
Case No. ADJ2120886
Regular
Oct 12, 2015

KIMBERLY VAN BUREN vs. PRIMITIVE LOGIC, INC, REPUBLIC INDEMNITY

This case concerns a worker's claim for prescribed medications. The employer argued their utilization review denial was timely, precluding the WCJ's jurisdiction over medical necessity. The Appeals Board affirmed the WCJ's finding that the utilization review denial was untimely due to insufficient evidence of proper and timely communication to the physician. Therefore, the WCJ correctly determined the requested Lidoderm, Capsaicin, and Ketamine creams were reasonable and necessary.

Utilization ReviewTimelinessCommunicationMedical NecessityLabor Code section 4610Administrative Director Rule 9792.9.1Dubon v. World RestorationBodam v. San Bernardino CountyPrimary Treating PhysicianDr. Brendan Morley
References
2
Case No. ADJ7790908
Regular
May 21, 2015

ZHENNI LIANG vs. Q LOGIC CORPORATION, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board dismissed a petition for reconsideration filed by Nogales Psychological Counseling, Inc. due to its "skeletal" nature and failure to comply with procedural rules. The petitioner had stipulated to withdraw its lien claim at a hearing but later claimed a calendaring error caused their absence. The Board found the petitioner was not aggrieved by the dismissal order and had shown no good cause to be relieved from its stipulation. Furthermore, the Board admonished petitioner's counsel for improper filing format and misrepresentation of facts.

Nogales Psychological CounselingPetition for ReconsiderationStipulation and Order to Dismiss Lien ClaimSkeletal PetitionCalendaring ErrorReport and RecommendationLabor Code section 5902WCAB Rule 10846Aggrieved PartyStipulation to Withdraw Lien
References
1
Case No. ADJ10276513, ADJ10276376
Regular
Aug 26, 2019

MARIA ACOSTA vs. AXIS INTEGRATIVE HEALTH CENTER, THE HARTFORD

The Workers' Compensation Appeals Board granted Maria Acosta's Petition for Removal. The Board rescinded the previous decision of May 23, 2018. The matter is now returned to the trial level for further proceedings and a new decision by the Workers' Compensation Judge. This action signifies that the initial decision was deemed insufficient or flawed, necessitating reconsideration.

Petition for RemovalDecision After RemovalWorkers' Compensation Appeals BoardWCJrescindedreturnedtrial levelfurther proceedingsopinion and orderadministrative law judge
References
0
Case No. AHM 0089837 AHM 0093898
Regular
Aug 06, 2008

LETICIA M. VASQUEZ vs. TRANSWESTERN COMMERCIAL SERVICES, ROYAL & SUN ALLIANCE INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior decision and rescinded it, returning the case to the administrative law judge (WCALJ) for further proceedings. This action indicates the WCAB found the original decision flawed or incomplete and requires further development of the record. The parties retain the right to seek reconsideration of any subsequent decision made by the WCALJ.

Petition for ReconsiderationGrant ReconsiderationRescind DecisionReturn to Trial LevelFurther ProceedingsWorkers' Compensation Appeals BoardWCJDecision After ReconsiderationAdministrative Law JudgeRoyal Sun Alliance
References
0
Case No. ADJ3288464 (LAO 0772800)
Regular
Mar 27, 2009

NACHUM SAGI vs. OLYMPIC HOLDING CORP., CIGA by its servicing facility BROADSPIRE CLAIMS SERVICES, SUPERIOR NATIONAL INSURANCE COMPANY in liquidation

The Workers' Compensation Appeals Board denied reconsideration of the applicant's petition. The denial was based on the WCJ's report, which found the applicant's testimony and reported medical history inconsistent and not credible. Specifically, the Board found that the Agreed Medical Evaluator's (AME) opinion did not constitute substantial evidence due to the flawed history provided by the applicant. Therefore, the petition for reconsideration was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationAgreed Medical EvaluatorSubstantial EvidenceVargas v. Atascadero State HospitalLabor Code section 5313CredibilityConflicting HistoriesMedical FileStipulated Award
References
2
Case No. ADJ2947144 (SAC 0288806), ADJ4018561 (SAC 0305133)
Regular
Apr 16, 2013

DAN HAGAN vs. STATE OF CALIFORNIA, DEPARTMENT OF TRANSPORTATION, STATE COMPENSATION INSURANCE FUND, K-MART and SEDGWICK

The Workers' Compensation Appeals Board (WCAB) granted a Petition for Removal regarding case numbers ADJ2947144 and ADJ4018561. Consequently, the WCAB rescinded the Workers' Compensation Judge's (WCJ) January 22, 2013 decision. The matter has been returned to the trial level for further proceedings and a new decision by the WCJ. This action indicates the WCAB found the original decision flawed and requires additional judicial review.

WCABPetition for RemovalGranting RemovalRescind DecisionReturn to Trial LevelWorkers' Compensation Administrative Law JudgeFurther ProceedingsDecision After RemovalADJ2947144ADJ4018561
References
0
Case No. VNO 483286
Regular
Jul 16, 2007

ROBERT WALKER vs. MARSHALLS, CNA CLAIM PLUS, INC.

The Appeals Board granted reconsideration and rescinded the prior award, finding that the medical evidence regarding causation and apportionment was critically flawed. Neither the applicant's treating physician nor the defendant's QME adequately addressed these issues with sufficient reasoning and complete medical histories. The case is returned to the trial level for further development of the medical record, including obtaining supplemental opinions from physicians, before a new decision is made.

Workers' Compensation Appeals BoardRobert WalkerMarshall'sCNA Claim PlusInc.Findings and AwardIndustrial InjuryBack InjuryFoot InjuryPermanent Disability
References
17
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