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

Case No. ADJ7148195
Regular
Jan 03, 2020

KARIN SMITH vs. MARIN GENERAL HOSPITAL, ATHENS ADMINISTRATORS

This case concerns defendant's petition for reconsideration of an award for applicant's back surgery. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, affirmed the award, and corrected a clerical error in the case number. The WCAB found that while an initial surgery request was denied via Utilization Review (UR) and Independent Medical Review (IMR), the applicant's treating physician later submitted a new request supported by documented changes in material facts, including new neurological symptoms and an MRI showing critical stenosis and potential cauda equina syndrome. Because the second request indicated an imminent and serious threat to the applicant's health and was based on new medical evidence, the 12-month UR decision validity period did not apply.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardUtilization ReviewIndependent Medical ReviewLabor Code Section 4610(k)Documented Change in ConditionLumbar Spine SurgeryNurseCauda Equina Syndrome
References
0
Case No. MISSING
Regular Panel Decision

Claim of Lomuscio v. Metropolitan Suburban Bus Authority

Claimant, a bus driver, sustained work-related neck and back injuries in 1993 and 1994, for which she received workers' compensation benefits. She later experienced increased neck discomfort in August 1996 and, in November 1996, while operating a bus, heard a popping sound in her neck, leading to excruciating pain, with a subsequent MRI revealing disc herniations and neuroforaminal stenosis. A Workers’ Compensation Law Judge and the Workers’ Compensation Board concluded her partial disability stemmed from a "new accident" in November 1996, not an exacerbation of prior injuries, and denied continuing benefits. On appeal, the Court found insufficient evidence to solely attribute the partial disability to the November 1996 accident, noting prior medical findings consistent with degenerative changes before the November incident. Consequently, the Board's decision was reversed, and the matter was remitted for further proceedings to determine the causation of her partial disability.

Workers' CompensationPartial DisabilityWork-Related InjuryBus DriverNeck InjuryBack InjuryMRI StudyDisc HerniationNeuroforaminal StenosisOsteophyte
References
1
Case No. MISSING
Regular Panel Decision
Mar 28, 2001

Claim of Viau v. Walsh Trucking Services, LLC

Claimant, a truck driver, sustained two chest injuries in May and September 1997 while working. Later, in February 1998, he experienced neck, shoulder, and arm pain, which he sought to include in his workers' compensation claims. Although a Workers' Compensation Law Judge initially found a causal relationship for these broader injuries, the Workers' Compensation Board reversed, determining that the claimant failed to establish a causal link between the original incidents and his later head, neck, and arm issues. The appellate court affirmed the Board's decision, citing substantial evidence that included inconsistent testimony from the claimant and a lack of early documentation for head or neck injuries in C-2 reports and medical records. The court concluded that physicians' opinions regarding causality were based on later complaints and lacked initial supporting evidence.

Workers' CompensationCausal RelationshipDisability ClaimTruck Driver InjuryChest PainNeck PainShoulder PainHerniated DiscMedical EvidenceInconsistent Testimony
References
2
Case No. ADJ10393758
Regular
Jun 08, 2018

JOSE BASALDUA VALDEZ vs. NORCAL BUILDING SERVICES, INC., STATE COMPENSATION INSURANCE FUND, Rutherford Ashbury, LLC, Patrick F. Mockler

Defendants sought dismissal from a workers' compensation case after the applicant's employer's insurer accepted coverage. The WCJ initially denied this dismissal but later dismissed one defendant without prejudice. The Appeals Board denied the defendants' Petition for Removal, finding it moot due to the subsequent order. However, the Board, on its own motion, granted removal to amend the later order and dismiss the remaining defendant without prejudice, correcting a perceived clerical error.

Workers' Compensation Appeals BoardPetition for RemovalGranting RemovalDecision After RemovalOrder Denying Petition to DismissMinute OrderJoinderGeneral ContractorUninsured Employers Benefits Trust FundSCIF
References
1
Case No. ADJ9836001; ADJ9836002 ADJ9836004; ADJ9836542 ADJ10301695
Regular
Sep 28, 2016

BEATRIZ HERNANDEZ vs. RAMCO ENTERPRISES

This case concerns whether the applicant is entitled to a new Qualified Medical Evaluator (QME) for a later reported injury. The defendant argued that under *Navarro v. City of Montebello*, the same QME should evaluate all injuries reported prior to an initial evaluation. However, the Board found *Navarro* distinguishable because the applicant's fifth injury was reported *after* the initial QME evaluation, despite occurring earlier. Therefore, the applicant is entitled to a new PQME for the later reported injury, and the defendant's petition for reconsideration was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderQualified Medical Evaluator (QME)Panel QME (PQME)Navarro v. City of MontebelloLabor CodeMedical-Legal EvaluationsApplication for Adjudication of ClaimDeclaration of Readiness to Proceed
References
1
Case No. OAK 0274341
Regular
Sep 24, 2007

DAVID LAUDENBACH vs. CENTRAL WHOLESALE ELECTRIC SUPPLIES

The Appeals Board denied the defendant's petition challenging the WCJ's jurisdiction to award temporary disability benefits, finding that jurisdiction was not lost as the issue was deferred and the case remained open. The Board granted the applicant's petition, amending the award to defer the issue of temporary disability for a later period (January 19, 2005, through March 29, 2006) because a stipulated permanent and stationary date does not preclude a subsequent period of temporary disability. The matter was returned to the trial level for further proceedings to determine eligibility for this later period of temporary disability.

WCABPetition for ReconsiderationFindings and Awardtemporary disability benefitsstatute of limitationspermanent and stationary dateres judicataEmployment Development Department (EDD) lienstipulationjurisdiction
References
10
Case No. 2016 NY Slip Op 04060
Regular Panel Decision
May 25, 2016

Matter of Pinkesz v. Wertzberger

Edward Pinkesz appealed an order from the Supreme Court, Kings County, which denied his petition to confirm an arbitration award and granted Joel Wertzberger's motion to vacate it. The dispute arose from an agreement to arbitrate before a rabbinical court regarding life insurance policies, where an initial award was significantly increased in a later arbitration award. The Appellate Division affirmed the Supreme Court's decision, ruling that the rabbinical court exceeded its authority by modifying a final arbitration award. Therefore, the Supreme Court properly denied confirmation and granted the motion to vacate the later award.

ArbitrationRabbinical CourtAppellate ReviewArbitration AwardVacate AwardConfirm AwardCPLR Article 75Arbitrator AuthorityFinality of AwardJudicial Review of Arbitration
References
14
Case No. ADJ10075042
Regular
Nov 23, 2020

ANGEL FLORES vs. THE KROGER COMPANY, ADMINISTERED BY SEDGWICK CLAIMS MANAGEMENT SERVICES

Defendant Kroger Company sought reconsideration of a Workers' Compensation Appeals Board decision awarding applicant Angel Flores benefits for bilateral knee and right shoulder injuries sustained as a maintenance worker from 1995 to 2015. The defendant argued the Qualified Medical Evaluator's (QME) opinion was not substantial evidence. The Board denied the petition, finding the QME's later reports, after clarifying applicant's 20-year work history and job duties, provided substantial evidence of cumulative trauma injury. The QME's initial opinion was based on a misunderstanding of applicant's symptom onset, which he later corrected after further evaluation.

Permanent DisabilityCumulative TraumaSpecific InjuryPanel Qualified Medical EvaluatorPQMEIndustrial InjuryCausationSubstantial Medical EvidencePetition for ReconsiderationWCJ
References
1
Case No. MISSING
Regular Panel Decision
Feb 14, 2001

Tsatsakos v. Citicorp

Plaintiffs Stefanos Tsatsakos, a window washer, and his wife appealed an order granting summary judgment to the defendants. Tsatsakos was allegedly injured when a scaffold, only one foot above a setback, swung laterally and struck a window while he was inside it at the Citicorp Building. The plaintiffs claimed a violation of Labor Law § 240 (1), which imposes absolute liability for elevated risks. The court affirmed the lower court's decision, ruling that Labor Law § 240 (1) applies to risks of falling from or being hit by objects falling from elevated worksites, not lateral swings at a low height. Therefore, Tsatsakos's injury was not connected to an elevated hazard covered by the statute.

Personal InjuryLabor LawScaffold AccidentElevated Worksite HazardSummary JudgmentAppellate ReviewWorkers' RightsConstruction SafetyCiticorp BuildingWindow Washing
References
5
Case No. MISSING
Regular Panel Decision
Apr 10, 2007

Claim of Pawlewski v. Buffalo Board of Education

Claimant, a teacher, sustained a workplace injury in 2004 and received full wages from her employer under a collective bargaining agreement. The employer sought reimbursement from workers' compensation benefits for these wage payments. Initially, a Workers’ Compensation Law Judge granted reimbursement, but the Workers’ Compensation Board subsequently denied reimbursement for the 2005 summer recess. The employer and its carrier appealed this decision. The appellate court reversed the Board's finding regarding the summer recess reimbursement, concluding that denying reimbursement would improperly allow the claimant to receive both full wages and compensation for the same period. The case was modified, affirmed, and remitted to the Board for further proceedings consistent with the court's decision.

ReimbursementCollective Bargaining AgreementWage PaymentsDisability BenefitsEmployer AppealAppellate DivisionStatutory InterpretationSummer RecessBoard DecisionPanel Decision
References
9
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