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Case Law Database

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

Case No. ADJ360205 (LBO 0384980)
Regular
Aug 05, 2010

Gurdev Malhotra vs. STATE OF CALIFORNIA, DEPARTMENT OF DEVELOPMENTAL SERVICES FAIRVIEW; Legally Uninsured, CONTRACT SERVICES

The Workers' Compensation Appeals Board granted reconsideration of a WCJ's advisory opinion concerning permanent disability rating for grip loss. Defendant argued the WCJ erred by allowing rating for grip loss when range of motion was present, and that the QME's reports did not support grip loss rating. The Board rescinded the WCJ's findings, remanding the case for further proceedings to ensure the WCJ follows the established process for issuing rating instructions based on substantial medical evidence, as clarified in *Blackledge v. Bank of America*. The ultimate determination of permanent disability requires a proper QME opinion and subsequent rating instructions from the WCJ.

Workers' Compensation Appeals BoardGurdev MalhotraState of California Department of Developmental ServicesLegally UninsuredContract ServicesPermanent Disability RatingGrip LossAMA GuidesQualified Medical EvaluatorQME
References
1
Case No. MISSING
Regular Panel Decision

Claim of Rushnek v. Ford Motor Co.

The Workers' Compensation Board ruled that Ford Motor Company was entirely responsible for a claimant's hearing loss, which began with a 13% pre-employment loss and progressed to 23.2% by retirement. Ford appealed this decision, challenging its liability for the pre-existing portion of the hearing loss, especially considering the timing of the relevant Workers' Compensation Law provisions. The court clarified that the date of disablement, in this instance, was August 1974, thus making Workers' Compensation Law § 49-ee applicable. It determined that while the last employer is generally liable for total hearing loss, an exception exists for pre-existing, occupationally caused hearing loss, allowing for reimbursement. The court reversed the Board's decision and remitted the case, instructing further proceedings to ascertain if the claimant's initial hearing loss was work-related, which would then allow Ford to seek reimbursement from prior employers.

Workers' Compensation LawOccupational hearing lossEmployer liabilityPre-existing conditionReimbursement proceduresDate of disablementAudiometric examinationAppellate reviewStatutory interpretationFord Motor Company
References
4
Case No. MISSING
Regular Panel Decision

Normile v. Allstate Insurance

Chief Judge Cooke's dissenting opinion critiques the majority's interpretation of Insurance Law section 671 (subd 2, par [b]) regarding how collateral source payments affect an insurer's aggregate $50,000 liability for basic economic loss. The dissent argues that the majority's method, which allows insurers to reduce their total liability by these payments, leads to an incomplete recovery for injured parties, particularly when total losses exceed $50,000. Cooke proposes an alternative allocation where collateral source payments are first applied to cover losses beyond the $50,000 basic economic loss threshold. This approach, he contends, ensures that insurers pay the full $50,000 in first-party benefits and only take credit for collateral sources that would otherwise result in a double recovery within the basic economic loss limit, or for amounts exceeding the $50,000 threshold. The dissenting judge asserts that the Legislature did not intend to create such an inequity, where injured individuals are left with less than full compensation while insurers avoid their primary obligation.

Insurance Law InterpretationBasic Economic LossCollateral Source PaymentsNo-Fault InsuranceWorkers' Compensation BenefitsSocial Security Disability BenefitsDissenting OpinionAggregate LiabilityFirst-Party BenefitsDouble Recovery
References
2
Case No. ADJ1793931 (OAK 0336568)
Regular
Apr 12, 2010

MICHAEL KESTEL vs. CAPITOL BUICK PONTIAC GMC, ZENITH, REPUBLIC INDEMNITY

This case concerns an appeal regarding the applicant's permanent disability rating for upper extremity injury. The defendants contended that the original $24\%$ rating was improperly calculated, specifically challenging the inclusion of grip loss as a factor. The Appeals Board found the Agreed Medical Evaluator's opinion on grip loss to be speculative and not substantial evidence under the *Almaraz II* decision. Consequently, the Board granted reconsideration, amended the award to $16\%$ permanent disability, and affirmed the remainder of the original findings.

AMEAgreed Medical EvaluatorAMA Guidespermanent disability ratingWPIwhole person impairmentgrip lossupper extremity impairmentAlmaraz IIsubstantial evidence
References
7
Case No. ADJ1728771 (LBO 0316743) ADJ1516565 (LBO 0860347)
Regular
Sep 27, 2012

Kay Rodriguez vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES, Legally Uninsured, Administered By STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of the Applicant's claim. The Board adopted the Workers' Compensation Administrative Law Judge's report, which found that the Agreed Medical Evaluator (AME) failed to adequately explain why an alternative impairment rating method (grip loss) was more accurate than the standard method (carpal tunnel syndrome) according to the AMA Guides. This lack of reasoning rendered the AME's opinion unsubstantial evidence for determining the Applicant's impairment. Therefore, the Board upheld the initial finding based on carpal tunnel syndrome, not grip loss.

Kay RodriguezLegally UninsuredState Compensation Insurance FundOrder Denying ReconsiderationAlmaraz-Guzman casesAMA GuidesWhole Person Impairment (WPI)Agreed Medical Evaluator (AME)substantial evidenceActivities of Daily Living (ADLs)
References
15
Case No. MISSING
Regular Panel Decision

Matter of Terranova v. Lehr Construction Co.

In 2009, Claimant sustained a right knee injury at work, leading to workers' compensation benefits and a 10% schedule loss of use award. Concurrently, Claimant settled a third-party action for $173,500. A dispute arose concerning the carrier's credit and the apportionment of litigation expenses from the third-party settlement, specifically whether Burns v Varriale or Matter of Kelly v State Ins. Fund applied to a schedule loss of use award. The Workers’ Compensation Board ruled that Matter of Kelly controlled, denying Claimant ongoing payments for litigation expenses. The appellate court affirmed, clarifying that for schedule loss of use awards, future benefits are ascertainable, making Matter of Kelly applicable.

Schedule Loss of UseThird-Party SettlementWorkers’ Compensation BenefitsLitigation ExpensesCarrier CreditApportionment of Counsel FeesFuture BenefitsIndependent Medical ExaminationOrthopedist ReportCourt of Appeals Precedent
References
5
Case No. MISSING
Regular Panel Decision

Claim of Grugan v. The Record

Claimant sustained a work-related injury to her left hand in 2007, leading to a dispute over whether she should receive a permanent partial disability classification or a schedule loss of use award. The Workers’ Compensation Board ultimately issued a 15% schedule loss of use award, which the claimant appealed. The Appellate Division affirmed the Board's decision, finding that substantial evidence supported the determination. The court noted that claimant had reached maximum medical improvement and her condition was stable, factors supporting a schedule loss of use award. Conflicting medical opinions from the treating orthopedist and an independent medical examiner were resolved by the Board within its discretion.

Schedule Loss of UsePermanent Partial DisabilityWorkers' Compensation BoardMedical EvidenceIndependent Medical ExaminationTreating PhysicianAppellate ReviewBoard DiscretionMaximum Medical ImprovementConflicting Medical Opinions
References
3
Case No. MISSING
Regular Panel Decision

Hyde v. North River Insurance

This case examines whether an insurance carrier, having paid no-fault benefits, can assert a lien against a judgment recovered by its insured for pain, suffering, and future economic loss. The plaintiff, an injured insured, received $50,000 in no-fault benefits from North River Insurance Company. In a subsequent tort action against the County of Rensselaer, the plaintiff secured a $1,000,000 verdict. The insurance company filed a lien against this judgment. The Special Term and appellate courts affirmed that the lien was invalid because the jury's verdict explicitly excluded basic economic loss, thereby preventing a double recovery. The decision clarifies that liens are only enforceable against recoveries that duplicate previously paid basic economic losses.

No-Fault BenefitsInsurance LienSummary Judgment AppealPersonal Injury CompensationBasic Economic LossNon-Economic LossPain and Suffering DamagesDouble Recovery PreventionStatutory LienAutomobile Accident
References
12
Case No. MISSING
Regular Panel Decision
Jun 22, 2015

Claim of Barrett v. New York City Department of Transportation

The case involves an appeal from a Workers’ Compensation Board decision regarding a claimant injured in a 2011 work-related motor vehicle accident. A WCLJ classified the claimant with a permanent partial disability and a 25% loss of wage-earning capacity, ruling that he would be entitled to 250 weeks of benefits if his full wages ceased. The Board affirmed this, leading the employer to appeal, arguing that the claimant's current full wages meant a 100% wage-earning capacity, rendering the 25% loss finding unlawful. The court affirmed the Board’s decision, distinguishing between 'loss of wage-earning capacity' (fixed, for benefit duration) and 'wage-earning capacity' (fluctuating, for weekly rates).

Workers' CompensationPermanent Partial DisabilityWage-Earning CapacityLoss of Wage-Earning CapacityBenefit DurationAppellate ReviewStatutory InterpretationMotor Vehicle AccidentNew York Workers' Compensation BoardDisability Classification
References
2
Case No. MISSING
Regular Panel Decision

Schmidt v. Falls Dodge, Inc.

The claimant was awarded a 21.43% schedule loss of use for binaural hearing loss in 2007. The Workers’ Compensation Law Judge and the Workers’ Compensation Board determined that this award was not subject to temporary disability benefits the claimant was already receiving from earlier workers' compensation cases. The employer and State Insurance Fund appealed, contending that a Court of Appeals decision overruled prior holdings regarding the overlap of schedule and nonschedule awards. The appellate court affirmed the Board's decision, distinguishing between schedule awards for future earnings loss and nonschedule awards for temporary disability during a limited time frame, concluding they do not overlap.

Workers' CompensationSchedule Loss of UseTemporary DisabilityBinaural Hearing LossAward OverlapAppellate DecisionInsurance FundEmployer LiabilityMedical BenefitsEarnings Loss
References
3
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