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

Case No. ADJ2590975 (STK 0190237)
Regular
Sep 12, 2011

RAFAEL DELEON vs. STATE OF CALIFORNIA, CDCR, MULE CREEK PRISON, adjusted by STATE COMPENSATION INSURANCE FUND

In this workers' compensation case, the Appeals Board affirmed a prior award granting medical treatment for applicant's diabetes. Despite the defendant's argument that diabetes treatment was for a non-industrial condition, the Board found it necessary to prevent worsening of the applicant's industrially caused heart disease. Medical evaluators concluded that controlling diabetes is an essential component of treating industrial heart conditions, making the treatment compensable. The decision hinges on the principle that treatment for non-industrial conditions is covered when essential to cure or relieve the effects of an industrial injury.

Workers' Compensation Appeals BoardIndustrial InjuryHeart ConditionDiabetesGastrointestinal DifficultiesAgreed Medical EvaluatorTreating PhysicianCardiologistMedical TreatmentLabor Code Section 4600
References
9
Case No. 03-cv-4134
Regular Panel Decision

Infantolino v. Joint Industry Board of the Electrical Industry

Anthony Infantolino sued the Joint Industry Board of the Electrical Industry (JIB) and Thomas Bush, alleging unlawful retaliation under the Americans with Disabilities Act (ADA) and New York State/City laws. JIB moved for summary judgment, arguing procedural defects and substantive failures, including that it was not Infantolino's employer. The court found JIB to be a 'joint labor-management committee' and thus a 'covered entity' under the ADA, refuting the employer argument. The court denied summary judgment regarding the retaliation claims, finding genuine issues of fact as to whether JIB's stated reasons for its actions were pretexts for impermissible retaliation. However, the motion for summary judgment was granted in part, denying punitive and compensatory damages for the ADA retaliation claim and punitive damages for the New York State Human Rights Law claim, but allowing punitive damages for the New York City Human Rights Law claim.

ADA RetaliationDisability DiscriminationSummary JudgmentBurden-Shifting FrameworkCausal ConnectionPretextPunitive DamagesCompensatory DamagesNew York City Human Rights LawNew York State Human Rights Law
References
36
Case No. 71 Civ. 2381
Regular Panel Decision
May 27, 1971

Botany Industries, Inc. v. New York Joint Board, Amalgamated Clothing Workers of America

Botany Industries, Inc., an employer, sought to vacate a labor arbitration award, while the New York Joint Board, Amalgamated Clothing Workers of America, the union, sought its confirmation and enforcement. The dispute arose from a 1966 agreement between Botany and the Joint Board, which restricted Botany from doing business with non-union manufacturers of boys', students', and junior clothing and from licensing its 'Botany' trademark under similar conditions. Botany argued these provisions constituted an illegal 'hot cargo' agreement under section 8(e) of the Labor Management Relations Act. The union contended the agreement was protected by the 'garment industry exemption' or was a 'work preservation clause.' The court, presided over by Chief Judge Edelstein, found it had jurisdiction to review the award. It determined Botany did not fall under the garment industry exemption, nor was the agreement a valid work preservation clause. Consequently, the court held the agreement void and unenforceable, thereby vacating Arbitrator Gray's award.

Labor LawArbitration AwardHot Cargo ClauseGarment Industry ExemptionCollective Bargaining AgreementJudicial ReviewUnfair Labor PracticeUnion AgreementContract EnforcementTrademark Licensing
References
40
Case No. STK 0086268 STK 0087759
Regular
Jul 10, 2007

GERALD PADGETT vs. LEPRINO FOODS COMPANY, MATRIX ABSENCE MANAGEMENT

This Workers' Compensation Appeals Board case involves a dispute over medical treatment for applicant Gerald Padgett. The defendant sought reconsideration of an order that required applicant to return to a previous QME, arguing for a separate medical-legal evaluation and alleging fraud by the applicant and his chiropractor regarding a non-industrial injury. The Board granted reconsideration, amended the order to require examination by a regular physician under Labor Code section 5701, and returned the matter to the trial level to determine if treatment needs stem from industrial or non-industrial injuries.

Petition for ReconsiderationMedical treatment disputeQualified Medical EvaluatorSupplemental reportStipulated awardFraudConcealmentMisrepresentationUnrepresented applicantRegular physician
References
3
Case No. ADJ4157637
Regular
Mar 18, 2010

BEATRICE WEISS vs. TECHNOLOGY FUNDING, LUMBERMEN'S MUTUAL CASUALTY COMPANY, BROADSPIRE, a CRAWFORD COMPANY

This case involves an applicant who sustained a spinal injury in 2000 and was awarded permanent total disability and ongoing medical treatment, including assisted living. The Workers' Compensation Appeals Board (WCAB) clarified that the applicant is entitled to full reimbursement for assisted living costs incurred after exhausting long-term care insurance, as medical treatment for industrial injuries is not apportionable, even if concurrent non-industrial conditions exist. However, the WCAB reversed an award for personal duty aides, finding insufficient evidence of their necessity due to the industrial injury, and denied claims for interest on unpaid bills and guardianship costs. The WCAB affirmed reimbursement for dental expenses necessitated by medication for the industrial injury, while excluding attorney fees for enforcing treatment denials.

Workers' Compensation Appeals BoardBeatrice WeissTechnology FundingLumbermen's Mutual Casualty CompanyBroadspireCrawford CompanyADJ4157637SFO 0445495Opinion and Decision After Reconsiderationpermanent total disability
References
5
Case No. ADJ9994879
Regular
Mar 07, 2018

LEE HOLMES vs. FIRST GROUP OF AMERICA, NEW HAMPSHIRE INSURANCE CO.

The applicant, a bus driver, sought workers' compensation for injuries sustained during non-industrial eye treatment. The Board affirmed the trial judge's decision that the injury was not industrial because the employer did not require the applicant to undergo the specific medical treatment that led to the injury. The applicant's belief that maintaining vision was a condition of employment was insufficient to establish industrial causation. The Board distinguished this case from situations involving employer-directed medical treatment or off-duty recreational activities.

AOE/COEPetition for ReconsiderationFindings and OrderWCJQMEindustrial causationproximate causereasonable expectancy of employmentoff-duty recreational activityLatourette
References
4
Case No. VNO 482752, VNO 482753
Regular
Jul 10, 2007

JESUS SANJORO vs. MOTION PICTURE AND TELEVISION FUND, Permissibly Self-Insured, Adjusted By ROYAL INDEMNITY CO.

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the administrative law judge's award of 46% permanent disability. The Board found, consistent with prior precedent in *Steinkamp*, that medical treatment itself is not apportionable, even if non-industrial factors contributed to the need for that treatment. Therefore, the applicant's permanent disability resulting from knee replacement surgery was not subject to apportionment based on the underlying non-industrial arthritis.

Workers' Compensation Appeals BoardSanjoroMotion Picture and Television FundRoyal Indemnity Co.VNO 482752VNO 482753Petition for ReconsiderationFindings Award and OrderSecurity OfficerBilateral Knees
References
4
Case No. ADJ1047594 (VNO 0549852)
Regular
Dec 22, 2016

Diane De Los Reyes vs. Mediscan, Zurich American Insurance Company

In this case, the applicant, Diane De Los Reyes, sought reimbursement for self-procured medical treatment related to her work-induced Reactive Airway Disease and Anxiety Disorder. The Appeals Board found that some of the applicant's self-procured treatment was likely industrial and reversed the WCJ's finding that all such treatment was non-industrial. The Board therefore rescinded the original order and returned the matter to the WCJ for further proceedings to determine the extent of reimbursable self-procured medical treatment and associated penalties. The applicant's entitlement to reimbursement for medical mileage and penalties thereon was affirmed.

Workers' Compensation Appeals BoardReconsiderationAgreed Medical EvaluatorReactive Airway DiseaseAnxiety DisorderSelf-procured Medical TreatmentReimbursementPenaltiesMedical MileageLabor Code § 4600(a)
References
9
Case No. ADJ7037475
Regular
Oct 04, 2018

JESUS ROJAS vs. GAY AND LESBIAN COMMUNITY CENTER, INC.; STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied Jesus Rojas's petition for reconsideration, affirming the administrative law judge's award of 81% permanent disability for his admitted industrial spine injury. Rojas argued for 100% permanent disability based on an Agreed Medical Examiner's opinion of inability to return to the labor market and contended apportionment to non-industrial factors was unsubstantiated. The Board found the apportionment to pre-existing congenital stenosis was supported by medical evidence and that the *Hikida* case did not apply as Rojas's disability was not directly caused by the effects of medical treatment necessitated by both industrial and non-industrial factors. Furthermore, the Board held that Labor Code section 4662(b) does not create an independent pathway to permanent total disability.

Petition for ReconsiderationFindings of Fact and AwardPermanent DisabilityApportionmentAgreed Medical Examiner (AME)Labor Code section 4656Labor Code section 4658Labor Code section 4662(b)Hikida v. Workers' Comp. Appeals. Bd.non-industrial factors
References
2
Case No. ADJ2596798
Regular
Jul 11, 1941

MINERVA BUTLER vs. COUNTY OF RIVERSIDE

This case involves a lien claimant, Universal Psychiatric, seeking reconsideration after their claim for medical treatment costs was denied. The claimant asserted industrial injury to Minerva Butler's psyche and internals, but the Administrative Law Judge found the lien claimant failed to meet its burden of proof. Medical evaluations, including those by Dr. Reichwald and Dr. Soltz, presented conflicting histories and failed to establish an industrial causation for the psychiatric treatment, with significant non-industrial factors and pre-existing conditions noted. The Workers' Compensation Appeals Board adopted the judge's report and denied the petition for reconsideration.

WCABReconsiderationLien ClaimACOEM GuidelinesAOE/COECompromise and ReleaseMedical-Legal EvaluationPrimary Treating PhysicianMedical Provider NetworkAgreed Medical Examiner
References
0
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