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

Case No. ADJ10033983 ADJ11112700
Regular
Jul 08, 2019

PABLO PEREZ vs. TAYLOR FARMS, ZURICH NORTH AMERICA INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted applicant Pablo Perez's Petition for Removal, rescinding the prior finding that a Functional Capacity Evaluation (FCE) was not a reasonable and necessary medical-legal expense. The WCAB found that an FCE, recommended by Panel Qualified Medical Evaluator Dr. Ali Soozani to assess permanent impairment, provides crucial objective data not fully captured by subjective complaints or a standard physical examination. The Board reasoned that while a physical therapist conducts the FCE, this is permissible under Labor Code section 3209.5 for medical treatment and does not violate Labor Code section 4628 when viewed as a distinct diagnostic tool supporting the QME's overall evaluation. Consequently, the WCAB issued a new Finding of Fact and Order deeming the FCE reasonable and necessary.

Functional Capacity EvaluationMedical-Legal ExpensePanel Qualified Medical EvaluatorPermanent ImpairmentActivities of Daily LivingSubstantial EvidenceAlmaraz/GuzmanLabor Code Section 4628Diagnostic ToolMedical Opinion
References
4
Case No. ADJ9201223
Regular
Feb 06, 2020

JOHN INMAN vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration of a decision finding the applicant permanently and totally disabled. The defendant challenged the vocational expert's opinion, arguing it was based on an inconsistent Residual Functional Capacity Evaluation (FCE) by the Agreed Medical Examiner. The Board rescinded the award, finding the FCE results were a "rough estimate" and ordered a new, accurate FCE to clarify the applicant's permanent disability.

Workers' Compensation Appeals BoardPermanent Total DisabilityResidual Functional Capacity EvaluationAgreed Medical ExaminerVocational ExpertScheduled RatingOgilvie v. Workers' Comp. Appeals Bd.LeBoeuf v. Workers' Comp. Appeals Bd.Gainful EmploymentLabor Market Access
References
2
Case No. ADJ2973393 (LAO 0883929)
Regular
Mar 27, 2014

CLEVETTE THOMAS vs. WELLPOINT, INC.; ZURICH NORTH AMERICA

The Workers' Compensation Appeals Board granted reconsideration to a lien claimant seeking reimbursement for a Functional Capacity Evaluation (FCE). The Board found sufficient evidence that the FCE was requested by the applicant's primary treating physician, Dr. Mays, despite the lack of formal designation. The Board also noted the defendant's failure to respond to the authorization request for the FCE. Ultimately, the Board rescinded the judge's denial and ordered reimbursement for the lien claimant's services.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationFindings and OrdersAdministrative Law JudgeFunctional Capacity Examination (FCE)Primary Treating PhysicianReimbursementCompromise and Release AgreementCumulative Trauma Injury
References
0
Case No. MISSING
Regular Panel Decision

O'HALLORAN v. Barnhart

The plaintiff, Kathleen O’Halloran, sought judicial review of a final determination by the Commissioner of Social Security denying her Disability Insurance Benefits. The District Court found that the Administrative Law Judge (ALJ) made several legal errors in assessing O’Halloran’s disability claim. These errors included failing to properly evaluate her mental impairments and functional limitations, not fully developing the record with "other source" evidence from treating therapists, nurses, and family, and misapplying standards regarding her residual functional capacity and ability to perform past work. The court also noted the ALJ's incorrect evaluation of the materiality of O'Halloran's alcohol abuse. Consequently, the court reversed the Commissioner's decision and remanded the case for further proceedings consistent with its order.

Social Security ActDisability Insurance BenefitsMental ImpairmentParanoid SchizophreniaAlcohol AbuseAdministrative Law JudgeResidual Functional CapacitySequential Evaluation ProcessMental Impairments EvaluationPast Relevant Work
References
12
Case No. 2019 NY Slip Op 05361 [174 AD3d 1001]
Regular Panel Decision
Jul 03, 2019

Matter of Swiech v. City of Lackawanna

Claimant David T. Swiech appealed two decisions by the Workers' Compensation Board. The Board found that Swiech violated Workers' Compensation Law § 114-a by knowingly making false statements regarding his physical abilities, based on inconsistencies between his reported limitations during a functional capacity evaluation (FCE) and surveillance video. Consequently, the Board imposed a mandatory penalty and permanently disqualified him from receiving future wage replacement benefits. Swiech also appealed the denial of his application for full Board review, which was rejected for non-compliance with regulatory requirements (12 NYCRR 300.13). The Appellate Division, Third Department, affirmed both decisions, concluding that the Board's finding of a § 114-a violation was supported by substantial evidence and that the denial of full Board review was not an abuse of discretion.

Workers' Compensation LawFraudMisrepresentationWage Replacement BenefitsPermanent DisqualificationFunctional Capacity EvaluationSurveillance VideoAppellate ReviewProcedural ComplianceSubstantial Evidence
References
12
Case No. MISSING
Regular Panel Decision

Medlin v. Rome Strip Steel Co., Inc.

Plaintiff Alexander Medlin sued Rome Strip Steel Co., Inc. (RSS) and several individuals for disability discrimination under the ADA and New York State Human Rights Law, and for improper disclosure of confidential medical information. Medlin, a Hot Roll Slitter Operator, suffered a non-work-related back injury and requested light duty or accommodations upon his return, which RSS denied after a functional capacity evaluation (FCE). The EEOC found probable discrimination by RSS regarding accommodation denial and confidentiality breaches. Defendants moved for summary judgment, contesting Medlin's disability status, RSS's duty to provide light duty, and the impropriety of medical information disclosure. The court denied RSS's motion for summary judgment on the ADA claims, citing unresolved factual disputes concerning Medlin's perceived disability, RSS's failure in the interactive accommodation process, and the alleged improper disclosure. However, the ADA claims against individual defendants Kirk Hinman, Roger Pratt, and Walter Race were dismissed, as were claims against Impact and Cindy Bush, along with Title VII and ADEA claims.

Disability DiscriminationAmericans with Disabilities ActReasonable AccommodationFunctional Capacity EvaluationConfidential Medical InformationSummary JudgmentEmployment LawPerceived DisabilityInteractive ProcessNew York State Human Rights Law
References
44
Case No. ADJ10336191
Regular
Jan 18, 2023

JEFFERY BLUM vs. STATE OF CALIFORNIA, CALIFORNIA HIGHWAY PATROL, STATE COMPENSATION INSURANCE FUND, STATE CONTRACT SERVICES

This case involves an employer's petition for reconsideration of a workers' compensation award. The Appeals Board denied the petition, affirming the finding that the applicant sustained new and further permanent disability to his knees. The employer's arguments regarding apportionment for the lumbar spine and bias of the medical evaluator were rejected, as the lumbar spine issue was settled by prior stipulation and bias was not raised timely. The Board found the medical evaluator's opinions on knee impairment constituted substantial evidence, despite a functional capacity evaluation.

New and further disabilityPermanent disabilityApportionmentStipulations with Request for AwardQualified Medical Evaluator (QME)Lumbar spineBilateral knee impairmentSubstantial evidencePetition for ReconsiderationWorkers' Compensation Appeals Board (WCAB)
References
12
Case No. MISSING
Regular Panel Decision

Main Evaluations, Inc. v. State

The claimant, Main Medical Evaluations, entered into contracts with the New York State Office of Temporary and Disability Assistance (OTDA) to perform consultative medical evaluations. OTDA terminated these contracts, alleging the claimant failed to disclose professional disciplinary proceedings against its chief medical officer, Arvinder Sachdev, and submitted false information during the bidding process. Following the dismissal of its claim in the Court of Claims, the claimant appealed. The appellate court affirmed the lower court's judgment, concluding that OTDA had legitimate grounds for termination due to the claimant's misrepresentations and failure to report substantial contract-related issues concerning Sachdev's integral role. Additionally, the court rejected the claimant's equal protection argument, finding no evidence of selective enforcement based on impermissible considerations.

Contract TerminationProfessional MisconductFalse RepresentationEqual ProtectionGovernment ContractsAppellate ReviewBreach of ContractMedical LicensingAdministrative ProceedingsDue Diligence
References
5
Case No. 524528
Regular Panel Decision
May 17, 2018

Matter of Bloomingdale v. Reale Constr. Co. Inc.

Claimant, who suffered multiple work-related injuries in 1992 and 2011, appealed a Workers' Compensation Board decision classifying him with a 33% loss of wage-earning capacity and suspending awards due to a lack of labor market attachment. The Appellate Division, Third Department, affirmed the Board's determination regarding claimant's attachment to the labor market, finding it supported by substantial evidence of minimal job search efforts. However, the Court reversed the Board's assessment of a 33% loss of wage-earning capacity. It concluded that the medical evidence, extensive functional limitations, and limited vocational skills of the 55-year-old claimant did not support such a low impairment rating, necessitating a re-evaluation. The matter was remitted to the Workers' Compensation Board for further proceedings to correctly ascertain claimant's loss of wage-earning capacity.

Workers' Compensation LawPermanent Partial DisabilityLoss of Wage-Earning CapacityLabor Market AttachmentMedical ImpairmentVocational FactorsAppellate Division Third DepartmentRemittalBack InjuryNeck Injury
References
19
Case No. MISSING
Regular Panel Decision

Matejka v. Barnhart

Plaintiff, Ms. Matejka, alleging disability since March 31, 2000, applied for Disability Insurance Benefits, which was denied by an Administrative Law Judge (ALJ). The plaintiff sought review in District Court, arguing the ALJ's decision lacked sufficient inquiry into past relevant work, a reasoned finding on credibility, a proper residual functional capacity assessment, and a correct determination of the severity of her depression. The District Court found the ALJ's conclusions not supported by substantial evidence due to these deficiencies, particularly regarding the exertional requirements of past work, the evaluation of the plaintiff's credibility, the lack of a function-by-function RFC analysis, and the failure to adequately assess the severity of her depression, especially in light of uncontradicted medical opinions. Consequently, the Court reversed the Commissioner's decision and remanded the case for a new hearing consistent with its findings.

Disability Insurance BenefitsAdministrative Law JudgeResidual Functional CapacityCredibility AssessmentMedical EvidencePsychological AssessmentSpinal StenosisChronic Back PainDepressionRemand
References
24
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