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

Case No. 534273
Regular Panel Decision
Jan 12, 2023

In the Matter of the Claim of Amber Bakerian

Claimant Amber Bakerian appealed a decision by the Workers' Compensation Board. The Board had denied her request for a hearing concerning future wage expectancy under Workers' Compensation Law § 14 (5) and an award for protracted healing periods. The Appellate Division affirmed the Board's denial of the wage expectancy issue, upholding the application of the laches doctrine due to the significant delay in raising the claim. However, the Court reversed the Board's decision regarding the protracted healing period, finding it erred in deeming the issue moot. Consequently, the case was remitted to the Workers' Compensation Board for further proceedings consistent with the Court's decision on the protracted healing period.

Workers' CompensationWage ExpectancyLachesSchedule Loss of UseTemporary Total DisabilityProtracted Healing PeriodAppellate ReviewRemittalPrejudiceMedical Opinions
References
7
Case No. ADJ7803069
Regular
Mar 22, 2016

EDILBERTO CERNA ROMERO vs. STONES AND TRADITIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and reversed the judge's finding regarding a September 14, 2015 utilization review (UR) decision. The Board found this second UR decision, which sought further information on some treatments, to be timely for all requested modalities. Consequently, the Board ruled that the UR decision of September 14, 2015, was timely, and the WCJ lacked jurisdiction to review the medical necessity of the denied treatments. The Board did not disturb the WCJ's finding that the August 12, 2015 UR decision was untimely.

Utilization ReviewTimelinessLabor Code Section 4610Request for AuthorizationDWC Form RFAIndependent Medical ReviewMedical NecessityProspective ReviewConcurrent ReviewAppeals Board
References
1
Case No. ADJ2904305 (GOL 0095697) ADJ1827151 (GOL 0095698)
Regular
Aug 02, 2010

GUADALUPE CARRILLO vs. SAN ANTONIO VILLAGE HOA, STATE FARM INSURANCE COMPANIES

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration regarding a disallowed lien balance of $9,349.46. The claimant, a doctor, failed to obtain required written authorization for work hardening services billed under CPT Code 97545. Despite a claim of verbal authorization and a general request for multiple modalities, the Board found the lack of specific written authorization for the disputed services to be determinative. Therefore, the administrative law judge's disallowance of the lien balance was upheld.

Workers' Compensation Appeals BoardLien claimantPetition for ReconsiderationCompromise and ReleaseWork hardeningWork conditioningCPT Code 97545Prior authorizationVerbal authorizationWritten authorization
References
0
Case No. ADJ10332854
Regular
Jun 19, 2017

RALPH SWASEY vs. EL DORADO UNION HIGH SCHOOL DISTRICT

This case involves a worker's compensation claim for industrial injury to the left elbow and shoulder. The Appeals Board granted reconsideration, affirming the chosen occupational group but increasing the permanent disability award from 21% to 23%. This increase occurred because the Qualified Medical Evaluator's apportionment of 10% to non-industrial factors was not supported by substantial medical evidence. Specifically, the doctor's reasoning for attributing disability to diabetes and arthritis was conclusory and did not adequately explain how these factors contributed to permanent disability rather than just healing time.

Petition for ReconsiderationOccupational Group Number 390ApportionmentMedical TreatmentPermanent DisabilityQualified Medical EvaluatorSubstantial Medical EvidenceLabor Code 4663Labor Code 4664Industrial Injury
References
4
Case No. ADJ10082337
Regular
Feb 13, 2017

RUPERTO HERNANDEZ vs. OC HOME BUILDERS, STATE COMPENSATION INSURANCE FUND

This case involved a construction worker who sustained an industrial injury to his left forearm but not his cervical spine, as initially determined by the administrative law judge. The Workers' Compensation Appeals Board granted reconsideration, amending the decision to award temporary disability benefits from the date of injury to October 8, 2015. The Board clarified that temporary partial disability payments are wage-loss based even if the applicant worked during their healing period. The finding of no industrial injury to the cervical spine was affirmed based on a lack of consistent medical reporting of neck complaints.

Petition for ReconsiderationIndustrial InjuryLeft Forearm InjuryCervical Spine InjuryTemporary DisabilityPermanent DisabilityAgreed Medical EvaluatorPrimary Treating PhysicianSubstantial EvidenceWage Loss
References
3
Case No. MISSING
Regular Panel Decision

Claim of Cozzy v. Movers, Inc.

Claimant, a driver and helper for a moving company, sustained a compensable arm and shoulder injury in July 1985. His doctor cleared him for work in May 1986, but before he could return, his employer's president terminated his employment. The claimant subsequently filed a workers' compensation discrimination complaint. Both the Workers’ Compensation Law Judge and the Workers’ Compensation Board found discrimination, a decision the employer then appealed. The appellate court found substantial evidence to support the Board's conclusion that the termination was discriminatory, stemming from the injury's healing time, internal company politics, and insurance carrier issues. Consequently, the Board's determination was affirmed.

Workers' CompensationDiscriminationTerminationWork InjuryRetaliationEmployer LiabilityAppellate ReviewSubstantial EvidenceInjury LeaveEmployer Appeal
References
1
Case No. 2020-09171, N-349-18, N-8740-18, N-8741-18, N-8742-18, N-8743-18, N-8744-18, N-8745-18, N-8746-18, N-8747-18, N-8748-18, N-8749-18, N-8750-18, N-8751-18, N-8752-18, N-8753-18, N-345-19
Regular Panel Decision
Nov 30, 2022

Matter of Amaris A. A. (Jasmine R.)

This case details an appeal by Jasmine R., the mother, from a Family Court order in Suffolk County. The Family Court had found that the mother abused her child, Amaris A. A., and derivatively neglected her seven other children, based on evidence of abusive head trauma and multiple healing rib fractures. The Suffolk County Department of Social Services presented expert testimony from a pediatric radiologist confirming non-accidental trauma. The mother failed to rebut the prima facie case of child abuse. The Appellate Division affirmed the Family Court's findings, concluding that DSS established abuse and derivative neglect by a preponderance of the evidence.

Family LawChild AbuseChild NeglectDerivative NeglectAbusive Head TraumaRib FracturesFamily Court Act Article 10Preponderance of EvidencePrima Facie CaseAppellate Review
References
5
Case No. MISSING
Regular Panel Decision

Naughright v. Weiss

Plaintiff Jamie A. Naughright sued Donna Karan Weiss, Urban Zen, LLC, and Stephen M. Robbins for negligent misrepresentation, negligence, fraud, medical malpractice, battery, and failure to obtain consent. Naughright alleged she suffered severe injuries from "healing services" provided by Robbins, an unlicensed practitioner, whom the Karan Defendants had promoted as a qualified physician. The court granted the motion to dismiss the negligent misrepresentation claim against the Karan Defendants and dismissed part of the fraud claim against Robbins due to insufficient pleading of time and place. However, the claims for negligence, medical malpractice, battery, and failure to obtain consent against Robbins were allowed to proceed.

Motion to DismissNegligent MisrepresentationNegligenceFraudMedical MalpracticeBatteryLack of Informed ConsentFederal Rules of Civil ProcedurePersonal InjuryUnlicensed Practitioner
References
63
Case No. ADJ10307625; ADJ10307786
Regular
Aug 20, 2018

RENEE SKELTON vs. DEPARTMENT OF MOTOR VEHICLES, STATE COMPENSATION INSURANCE FUND

This case involves an applicant seeking reconsideration of a denial for temporary disability indemnity for time lost attending medical appointments. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, amending the original decision. The WCAB found the applicant is entitled to temporary disability indemnity for wage loss incurred while attending medical-legal examinations, as per Labor Code section 4600(e)(1). However, the WCAB affirmed the denial of temporary disability for time lost attending treatment appointments after returning to work. A dissenting opinion argued for entitlement to temporary disability for attending treatment appointments during the healing period, even after returning to work.

Workers' Compensation Appeals BoardTemporary Disability IndemnityPetition for ReconsiderationFindings and OrderIndustrial InjuryReturn-to-WorkMedical Treatment AppointmentsMedical-Legal ExaminationsPanel QMEWage Loss
References
3
Case No. 2020 NY Slip Op 07640 [189 AD3d 1855]
Regular Panel Decision
Dec 17, 2020

Matter of Downer v. New York City Dept. of Corr.

Patrick Downer, a correction officer, sustained work-related shoulder injuries in January 2015, leading to multiple surgeries and a workers' compensation claim. A Workers' Compensation Law Judge (WCLJ) awarded benefits, including for a protracted healing period (PHP), which the Workers' Compensation Board subsequently modified, reducing the PHP weeks. Downer's application for reconsideration and/or full Board review was denied. The Appellate Division affirmed the Board's decision, ruling that its review was limited to whether the Board abused its discretion or acted arbitrarily, and found that Downer had not met the burden to demonstrate newly discovered evidence, a material change in condition, or that the Board improperly failed to consider issues.

Workers' CompensationSchedule Loss of UseProtracted Healing PeriodBoard ReviewAppellate ReviewAbuse of DiscretionArbitrary and CapriciousNewly Discovered EvidenceMaterial Change in ConditionAdministrative Law
References
6
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