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

Case No. ADJ6639764
Regular
Sep 23, 2010

DENNIS MUSKRAT vs. CALIFORNIA MEN'S COLONY, SCIF STATE EMPLOYEES OXNARD

The Workers' Compensation Appeals Board granted reconsideration to eliminate a 25% penalty previously awarded. The penalty was based on the employer's denial of medial branch blocks, but the Board found the employer's request for clarification from the Agreed Medical Evaluator was reasonable. The AME had failed to cite evidence supporting the treatment recommendation, and the employer's inquiry was justified given this lack of basis. Therefore, the penalty was rescinded, and the employer was ordered to provide the necessary medical treatment.

Workers' Compensation Appeals BoardIndustrial InjuryLumbar SpineTemporary DisabilityMedical Branch BlocksUtilization ReviewAgreed Medical Evaluator (AME)Labor Code Section 5814PenaltyUnreasonable Delay
References
3
Case No. ADJ8115084
Regular
Jun 02, 2014

MARY HAYWORTH vs. KCI HOLDINGS USA, INC., FIDELITY AND GUARANTY INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, rescinding a prior finding that the applicant failed to establish a plainly erroneous fact in an Independent Medical Review (IMR) determination. The Board found the IMR decision was based on a plainly erroneous mistake of fact because it evaluated a request for dorsal medial branch block injections as though it were a request for facet injections, which are different procedures. Consequently, the medical treatment dispute is remanded to the Administrative Director for review by a different independent review organization or reviewer.

Workers' Compensation Appeals BoardIndependent Medical ReviewLabor Code Section 4610.5Plainly Erroneous Finding of FactMedical Treatment DisputeUtilization ReviewAdministrative DirectorDorsal Medial Branch BlockFacet InjectionsMTUS Guidelines
References
2
Case No. MISSING
Regular Panel Decision

Claim of Zobel v. Chemung County

Claimant, a correction officer, sustained a torn medial meniscus in his right knee when turning to enter an elevator while completing his shift. He applied for workers’ compensation benefits, which the employer controverted, arguing the injury was idiopathic. A Workers’ Compensation Law Judge and the Board found the injury work-related, awarding benefits. The Appellate Division affirmed this decision, citing substantial evidence. They noted the claimant’s testimony, corroborated by an independent medical examiner, supported the finding that the injury resulted from a workplace accident.

Work-Related InjuryMedial Meniscus TearCorrection OfficerCourse of EmploymentIdiopathic DefenseSubstantial EvidenceAppellate AffirmationMedical Examiner ReportKnee InjuryElevator Accident
References
6
Case No. ADJ3582743 (STK 0215397)
Regular
Apr 11, 2014

KERI LARSEN vs. MODESTO IRRIGATION DISTRICT

This case concerns defendant Modesto Irrigation District's petition for reconsideration of a workers' compensation award. The Workers' Compensation Appeals Board granted reconsideration, finding the administrative law judge erred in using an incorrect impairment number for calculating permanent disability. The Board amended the award to reflect an 18% permanent disability rating, based on the agreed medical evaluator's opinion regarding lateral epicondylitis and decreased grip, not nerve entrapment. The Board also corrected the finding for future medical treatment to the right arm and elbow, aligning with the amended disability rating.

Workers' Compensation Appeals BoardModesto Irrigation DistrictKerri Larsenpermanent disability ratingAMA GuidesAlmarez-Guzmanstraight ratingReport And Recommendation On Petition For ReconsiderationAgreed Medical EvaluatorAME
References
5
Case No. MISSING
Regular Panel Decision

Clanton v. Salon Visentin, Inc.

Claimant, a former shampooer and full-time receptionist, developed bilateral carpal tunnel syndrome and right epicondylitis. She sought workers' compensation benefits, claiming her injuries were an occupational disease due to strenuous repetitive movements associated with her employment. A Workers’ Compensation Law Judge and subsequently the Workers’ Compensation Board denied her claim, finding insufficient evidence of a recognizable link between her condition and a distinctive feature of her occupation. The appellate court affirmed the Board's determination, concluding that the record supported the finding that there was insufficient evidence of a specific repetitive movement suggesting a link between her job and injuries.

Occupational diseaseCarpal Tunnel SyndromeEpicondylitisRepetitive motion injuryWorkers' compensation benefitsCausal relationshipMedical evidenceSufficiency of evidenceAppellate reviewBoard decision
References
3
Case No. 2021 NY Slip Op 04940 [197 AD3d 1379]
Regular Panel Decision
Sep 02, 2021

Matter of Bigdoski v. Bausch & Lomb

Barbara Bigdoski, a customer service representative, developed bilateral shoulder impingement and right lateral epicondylitis, which she attributed to extensive typing. A Workers' Compensation Law Judge found her condition to be a causally-related occupational disease with a disablement date of June 20, 2019, a decision affirmed by the Workers' Compensation Board. The employer and its carrier appealed, contending the condition was related to her workspace configuration rather than repetitive motion. The Appellate Division, Third Department, affirmed the Board's finding, citing competent medical evidence establishing a link between Bigdoski's work and her condition, and rejected the carrier's arguments.

Workers' CompensationOccupational DiseaseShoulder ImpingementEpicondylitisRepetitive MotionCausally RelatedMedical EvidenceSubstantial EvidenceAppellate ReviewJudicial Review
References
7
Case No. MISSING
Regular Panel Decision

Claim of Thompson v. New York Telephone Co.

A chauffeur's helper sustained a knee injury while descending stairs to exit her employer's premises after changing clothes. She was diagnosed with a torn medial meniscus. The Workers’ Compensation Board ruled the injury compensable as an accident arising out of and in the course of employment. The employer appealed, arguing the injury was not compensable because the claimant was not engaged in actual labor and the injury lacked a direct employment connection. The court affirmed the Board's decision, citing that the course of employment includes a reasonable amount of time for an employee to leave the premises after work. Furthermore, accidents occurring in the course of employment are presumed to arise out of employment, a presumption the employer failed to rebut with substantial evidence.

Knee InjuryCompensable InjuryCourse of EmploymentArising Out of EmploymentPresumptionAffirmationAppellate DivisionWorkers' Compensation BoardChauffeur's HelperPremises Liability
References
2
Case No. MISSING
Regular Panel Decision

Liebman v. New Jersey Manufacturers Insurance

A physician, acting as plaintiff, brought a jury trial action against an insurance company, the defendant, under the New York State No-Fault Law to recover fees for surgical procedures and subsequent hospital visits, as well as attorneys' fees. The core dispute revolved around whether certain surgical procedures (arthroscopy, arthrotomy, excision of torn medial meniscus) were separate and distinct for billing purposes, and if post-operative hospital visits constituted reimbursable care or included follow-up care under the Workers’ Compensation Board medical fee schedule. The jury found arthroscopy and arthrotomy to be separate procedures, but arthrotomy and excision were not. They also determined the hospital visits were follow-up care. The court, finding the issues novel and unique, awarded the plaintiff $4,425 plus interest in attorneys' fees, exceeding the statutory maximum.

No-Fault LawInsurance ClaimMedical Billing DisputeAttorneys' FeesJury TrialSurgical ProceduresWorkers' Compensation ScheduleNovel and Unique IssuesOrthopedic SurgeryArthroscopy
References
7
Case No. 534152
Regular Panel Decision
Jun 02, 2022

In the Matter of the Claim of Maurice Blue

Claimant Maurice Blue sustained a right leg injury in 2016, leading to a workers' compensation claim for his right knee. His physician diagnosed a medial meniscus tear and chondromalacia patella, initially recommending a 50% schedule loss of use (SLU) but later limiting it to 10% based on the 2018 Workers' Compensation Guidelines for Determining Impairment. The Workers' Compensation Law Judge (WCLJ) awarded 50% SLU, but the Workers' Compensation Board modified this to 10%, strictly applying a special consideration for chondromalacia patella and disregarding the meniscal tear. The Appellate Division found the Board's interpretation irrational, stating it leads to inequitable outcomes where greater injury results in lesser compensation. Consequently, the court modified the Board's decision, reversing the restrictive interpretation of the guidelines and remitting the matter for a proper assessment of the evidence.

Schedule Loss of UseKnee InjuryChondromalacia PatellaMeniscus TearMedical Impairment GuidelinesAppellate ReviewStatutory InterpretationEquity in CompensationRange of Motion DeficitsWorkers' Compensation Law
References
33
Case No. 2022 NY Slip Op 03565
Regular Panel Decision
Jun 02, 2022

Matter of Blue v. New York State Off. of Children & Family Servs.

Claimant Maurice Blue sustained a work-related right leg injury in December 2016, with his claim for workers' compensation benefits established for a right knee injury including a medial meniscus tear and chondromalacia patella. His physician initially assessed a 50% schedule loss of use (SLU) based on range of motion deficits but, applying a special consideration in the 2018 Workers' Compensation Guidelines for chondromalacia patella, limited his opinion to 10% SLU. The Workers' Compensation Board (WCB) adopted this 10% SLU, reversing a Workers' Compensation Law Judge's (WCLJ) award of 50%. On appeal, the Appellate Division, Third Department, found the WCB's interpretation of the guidelines irrational and inconsistent with the Workers' Compensation Law, as it resulted in claimants with more severe injuries receiving lesser compensation. The court reversed the WCB's decision regarding the preclusion of additional SLU for other knee impairments and remitted the matter for a proper assessment.

Workers' CompensationSchedule Loss of UseKnee InjuryChondromalacia PatellaMeniscus TearMedical Impairment GuidelinesAppellate ReviewStatutory InterpretationEquitable ApplicationJudicial Precedent
References
35
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