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

Case No. ADJ869605
Regular
Nov 19, 2012

MILES GRAY vs. AT&T, permissibly self-insured, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves an applicant who sustained a severe right lower extremity injury, leading to multiple surgeries, significant leg length discrepancy, and fused ankle/foot, requiring constant mobility aids. The Agreed Medical Evaluator (AME) provided opinions on impairment, and vocational experts testified regarding the applicant's ability to return to work. The Workers' Compensation Appeals Board denied reconsideration of the prior award, finding substantial evidence supporting the applicant's unsuitability for rehabilitation. Defendant's supplemental reply did not alter this decision.

Agreed Medical EvaluatorVocational ExpertPetition for ReconsiderationDeniedRight Lower Extremity InjuryMultiple FracturesLeg Length DiscrepancyShoe LiftAnkle FusionGait Derangement
References
1
Case No. 529417
Regular Panel Decision
Feb 06, 2020

Matter of Johnson v. City of New York

Thomas Johnson, a patient care technician, sustained work-related knee injuries in a February 2006 fall. He subsequently sustained additional work-related injuries in November 2009 to his neck, back, shoulder, and hips, for which he received schedule loss of use (SLU) awards for his right arm, left leg, and right leg. The Workers' Compensation Board later ruled on the permanency of his 2006 injuries, finding an 80% SLU for his left leg and a 40% SLU for his right leg. However, the Board reduced these new awards by his previously received SLU awards for the 2009 injuries, resulting in a final 30% SLU for his left leg and a 0% SLU for his right leg. The Appellate Division affirmed the Board's decision, confirming that SLU awards for the knee and hip are encompassed within leg awards, and prior leg SLU awards must be deducted from subsequent leg SLU awards.

Schedule Loss of UseKnee InjuriesHip InjuriesLeg ImpairmentPrior SLU Award DeductionAppellate Division ReviewIndependent Medical ExaminationTreating Physician ReportPermanent Impairment GuidelinesWork-related Accident
References
9
Case No. MISSING
Regular Panel Decision

United States v. Jafari

This Decision and Order addresses the government's motion for a preliminary order of forfeiture against Defendant Nina Jafari, a licensed clinical social worker convicted of health care fraud. Jafari was found guilty on four counts of defrauding BlueCross BlueShield of Western New York by billing for psychotherapy sessions using an inflated CPT code, often misrepresenting session lengths or billing individual sessions for group therapy. The Court, presided over by District Judge Elizabeth A. Wolford, granted the government's motion, ordering the forfeiture of $125,000. This decision considered both uncharged and acquitted conduct related to Jafari's broader fraudulent scheme, finding the amount reasonable based on a preponderance of the evidence, despite discrepancies in the calculation methodologies.

health care fraudforfeitureCPT code 90808criminal forfeituresentencingpreponderance of evidenceacquitted conductuncharged conductmoney judgmentfraudulent billing
References
38
Case No. 2022-08-1209
Regular Panel Decision
Mar 05, 2024

Dunbar, Tanya v. Kelly Services, Inc.

Tanya Dunbar, an employee, filed an interlocutory appeal after a trial court denied her request for temporary disability and additional medical benefits for alleged right leg, right foot, and bilateral hip injuries sustained at work. The employer, Kelly Services, Inc., disputed timely notice of the incident. The Appeals Board found that the trial court erred in concluding there was insufficient expert medical proof for causation, given Dr. Cooper's questionnaire statements. Dr. Cooper's deposition testimony, while noting a change in his opinion on the mechanism of injury, did not adequately refute his causation opinions. The Appeals Board affirmed the trial court's evidentiary rulings but reversed the denial of benefits and remanded the case to address the employer's notice defense and discrepancies regarding temporary disability dates.

Workers' CompensationInterlocutory AppealMedical CausationTemporary Disability BenefitsMedical BenefitsTarsal Tunnel SyndromePosterior Tibial TendonitisNotice DefenseExpert Medical TestimonyMedical Records Admissibility
References
8
Case No. MISSING
Regular Panel Decision

In re the Claim of Trickel

In this case, the claimant appealed a decision by the Workers’ Compensation Board regarding a consequential injury claim. The claimant sustained a fractured right tibia and fibula in 1988 during employment, for which workers’ compensation benefits were granted. In 1991, the claimant suffered a lower back injury and contended it was a consequence of the 1988 leg injury and subsequent leg shortening. The Workers’ Compensation Board denied this claim, ruling the 1991 accident was new and unrelated, and apportioned disability with 50% attributed to the noncompensable 1991 incident, 25% to the 1988 leg injury, and 25% to a prior noncompensable leg injury. The court affirmed the Board's decision, stating that whether a disability is consequentially related is a factual question for the Board and that the Board was free to credit the carrier’s expert testimony which found no causal relationship.

Workers' CompensationAppealCausally Related InjuryBack InjuryLeg FracturePermanent DisabilityApportionmentMedical Expert TestimonySubstantial EvidenceNew Accident
References
3
Case No. MISSING
Regular Panel Decision

Reagan v. Tennessee Municipal League

The employer and its insurance carrier appealed a permanent partial disability award to an employee in a worker’s compensation case. Appellants argued that the employee's injuries were confined to a scheduled member (right leg and foot) and therefore, the disability rating should be based on statutory schedules, not apportioned to the body as a whole. The court found that the employee sustained a severe fracture to the right leg and ankle, rated by an orthopedic surgeon as 50% permanent partial disability to the foot/ankle, or 35% to the leg, or 14% to the whole person per medical guidelines. However, the appellate court ruled that statutory schedules for scheduled member injuries must control over medical impairment ratings that translate to a body as a whole disability. Consequently, the trial court's judgment was reversed, and the case remanded for a redetermination of the disability rating based solely on the injury to the right leg as a scheduled member.

Permanent Partial DisabilityScheduled Member InjuryBody as a WholeStatutory SchedulesMedical Impairment RatingRemandLeg InjuryFoot InjuryAnkle InjuryTennessee Law
References
2
Case No. MISSING
Regular Panel Decision
Dec 13, 1979

In re the Claim of D'Amore v. Town of Hempstead

A claimant appealed a decision from the Workers’ Compensation Board regarding injuries sustained during employment. The claimant was injured by a falling heater, striking his head, right big toe, and leg, leading to subsequent ulceration, gangrene, and amputations of the toe and leg. Although initial medical reports only noted a head injury, later testimony from the claimant and medical experts, Dr. Grauer and Dr. Ahmad, established the link between the workplace accident and the toe and leg injuries. The Board found the injuries causally related. The Appellate Division affirmed the Board's determination, concluding that substantial evidence supported the findings.

AmputationGangreneUlcerationToe injuryLeg injuryHead injuryWorkplace accidentCredibilitySubstantial evidenceWorkers' Compensation
References
1
Case No. 2018-06-2210
Regular Panel Decision
Nov 12, 2019

Reazkallah, Maikel v. Imperial Guard & Detective Service, Inc.

Maikel Reazkallah, an employee of Imperial Guard & Detective Service, Inc., sustained injuries during an assault while working as a security guard on April 21, 2018. He sought treatment for his legs and temporary partial disability benefits. The Court held an expedited hearing on November 7, 2019, where Mr. Reazkallah claimed injuries to both legs, despite initial reports and previous testimony focusing on his left knee and right hand. The Court found insufficient evidence to support a right-leg injury or a reduction in wages to justify temporary partial disability benefits. Consequently, the Court denied the requested relief.

Workers' CompensationExpedited HearingTemporary Partial DisabilityMedical BenefitsBurden of ProofEmployment InjurySecurity GuardAssault InjuryWage ReductionMedical Records
References
2
Case No. ADJ2505068
Regular
May 28, 2013

MARIA FREITAS vs. SAVEMART SUPERMARKETS

The Workers' Compensation Appeals Board denied SaveMart Supermarkets' petition for reconsideration of an award finding the applicant's right leg injury to be a compensable consequence of her industrial back injury. The WCAB adopted the judge's report, which found the applicant's testimony credible, supported by medical opinions noting prior leg weakness and difficulty walking. The judge found that a contemporaneous surgeon's report, which stated the applicant missed a step, was less persuasive than the applicant's consistent testimony and supporting medical evidence. The WCAB upheld the judge's credibility determination and the finding that the leg injury was causally related to the admitted back injury.

Compensable Consequence InjuryCredibility FindingWCJ Report AdoptionTibia FractureCumulative Back InjuryMechanism of InjuryLower Extremity WeaknessAntalgic GaitSworn TestimonyMedical Opinion
References
1
Case No. 2024 NY Slip Op 04848 [231 AD3d 1213]
Regular Panel Decision
Oct 03, 2024

Matter of DiPippo v. Accurate Signs & Awnings

Michael DiPippo sustained work-related injuries in an August 2006 fall, leading to an established claim later amended to include consequential right leg deep vein thrombosis and obesity. He underwent amputations of both legs in 2014 and 2018. DiPippo sought to amend his claim to include the consequential amputation of his right leg, arguing it was caused by conditions linked to his initial injury. The Workers' Compensation Board disallowed the amendment, finding insufficient medical proof of a causal connection. The Appellate Division affirmed the Board's decision, ruling that DiPippo did not qualify as a medical expert and his independent analysis or generalized statements of possibility were inadequate to establish the required causal nexus.

Workers' CompensationAmputationCausal NexusMedical EvidenceExpert TestimonyBoard DecisionAppellate ReviewSubstantial EvidenceWork-Related InjuryClaimant Burden of Proof
References
12
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