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

Case No. 2024 NY Slip Op 00599 [224 AD3d 428]
Regular Panel Decision
Feb 06, 2024

Matter of New Millennium Pain & Spine Medicine, P.C. v. Garrison Prop. & Cas. Ins. Co.

This case involves two appeals by New Millennium Pain & Spine Medicine, P.C. against Garrison Property & Casualty Insurance Company and GEICO Casualty Company. New Millennium sought to vacate master arbitration awards that denied its claims for no-fault benefits for medical services. The Supreme Court denied these applications. The Appellate Division, First Department, affirmed the Supreme Court's decisions, stating that an arbitrator's award will not be set aside unless it is irrational. The court also addressed the argument regarding a 20% wage offset in no-fault benefits, finding it unavailing under Insurance Law § 5102 (b). Ultimately, New Millennium was not entitled to attorneys' fees as it was not the prevailing party.

No-fault benefitsarbitration awardvacaturinsurance lawwage offsetappellate reviewmedical servicesno-fault policy exhaustionattorneys' feesCPLR Article 75
References
8
Case No. MISSING
Regular Panel Decision

Claim of Steuber v. Home Properties, Inc.

Claimant applied for workers' compensation benefits after a March 2010 work fall, establishing injuries to his back, left knee, and left hip. After thoracic spine surgery in 2011, the employer and its workers' compensation carrier objected to coverage, arguing it was not causally connected to the initial claim. The Workers’ Compensation Board agreed, a decision which the appellate court affirmed. The court credited an independent medical examiner's opinion that the thoracic condition and subsequent falls were unrelated to the compensable accident, despite the claimant's orthopedic surgeon's testimony suggesting otherwise.

Workers' Compensation BenefitsCausal RelationThoracic Spine InjuryDegenerative ConditionIndependent Medical ExaminationSubsequent FallsBoard DecisionAppellate ReviewCredibility AssessmentSubstantial Evidence
References
3
Case No. ADJ7099916
Regular
Jun 20, 2014

ANGELICA SANCHEZ vs. TORRES FARM LABOR, SEABRIGHT INSURANCE COMPANY

The defendant sought reconsideration of an award finding industrial injury to the applicant's cervical spine and psyche, in addition to admitted injuries, and awarding temporary disability. The defendant argued the temporary disability award was improper as the psychologist relied upon by the judge did not review orthopedic records, and that EDD benefits should be credited. The WCJ conceded the temporary disability finding lacked substantial evidence, agreeing the psychologist's opinion was insufficient due to lack of review of the orthopedic records. The Appeals Board granted reconsideration, adopting the WCJ's recommendation to limit temporary disability to the period found by the orthopedic QME. A dissenting opinion argued that substantial evidence, including the primary treating physician's reports, supported the initial temporary disability award.

Workers' Compensation Appeals BoardPetition for ReconsiderationDecision After ReconsiderationTemporary Disability IndemnityPsychiatric InjuryOrthopedic InjurySubstantial Medical EvidenceQualified Medical EvaluatorApportionmentPermanent Disability
References
0
Case No. ADJ4129353 (VNO 0559667)
Regular
Jun 09, 2010

DONALD GRIFFIN vs. CITY OF TORRANCE, Permissibly Self-Insured

This case involves a firefighter claiming industrial injury to hypertension, cardiovascular, spine, and gastrointestinal systems. The defendant sought reconsideration, arguing the WCJ erred in denying apportionment for the applicant's hypertensive heart disease and spine injury. The Appeals Board denied reconsideration, agreeing with the WCJ that the orthopedic apportionment by the Agreed Medical Examiner was too speculative. The Board also found the WCJ correctly relied on the internal medicine AME's opinion to conclude the hypertensive heart disease resulted from a single cumulative trauma period.

WCABADJ4129353VNO 0559667firefighterhypertensioncardiovascularspine injurygastrointestinalpermanent disabilityapportionment
References
8
Case No. ADJ4136427 (VNO 0353070)
Regular
Apr 15, 2019

Gloria Novoa vs. AMEJEAN CORPORATION, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, TRISTAR RISK MANAGEMENT, SUPERIOR PACIFIC INSURANCE COMPANY

This case involves CIGA's appeal of a Workers' Compensation Appeals Board decision finding applicant sustained industrial injuries to her head, psychiatric, cervical spine, lumbar spine, and heart, resulting in 98% permanent disability. CIGA argued for greater apportionment of disability based on medical opinions and questioned the rating instructions for headaches and GI injury. The Board granted reconsideration to address a procedural error concerning the GI injury, deferring that issue for further proceedings. Otherwise, the Board affirmed the original findings, finding CIGA's arguments regarding apportionment and rating instructions lacked merit, and specifically rejecting CIGA's attempt to impose apportionment for psychiatric injury based on orthopedic opinions.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee Association (CIGA)ReconsiderationFindings and AwardWorkers' Compensation Administrative Law Judge (WCJ)Industrial InjuryPost Concussive SyndromePsychiatric InjuryCervical SpineLumbar Spine
References
6
Case No. MISSING
Regular Panel Decision
Apr 09, 1997

Claim of Krisher v. Graver Tank Manufacturing Co.

The claimant appealed a decision by the Workers' Compensation Board (WCB) that found no causally related disability during the period of April 10, 1995, to June 17, 1996. The claimant had sustained a back injury in 1990, followed by surgery in 1994, and later developed a left knee injury, leading to surgery in February 1995. A Workers' Compensation Law Judge initially awarded benefits for reduced earnings, but the WCB modified this, concluding there was no causally related disability. The appellate court affirmed the WCB's decision, citing testimony from orthopedic surgeon Roy Wert that the claimant could return to work without restrictions by April 1995. Another orthopedic surgeon, George Fuksa, opined that the knee injury was preexisting and not a result of the back surgery.

Workers' CompensationCausally Related DisabilityBack InjuryKnee InjuryMedical OpinionOrthopedic SurgeonReduced EarningsAppellate ReviewSubstantial EvidencePreexisting Injury
References
1
Case No. 528676
Regular Panel Decision
Apr 23, 2020

Matter of Wallace v. Don Sebastiani & Sons

The case involves an appeal from a Workers' Compensation Board decision denying Jerome T. Wallace's claim for reduced earnings benefits. Wallace, who suffered a lower back injury in 2011, subsequently left his full-time job as a regional sales manager in March 2017 after an orthopedic surgeon imposed work restrictions based on his subjective complaints of increased pain. He then worked part-time as an independent contractor for less compensation. Although a Workers' Compensation Law Judge initially awarded benefits, the Board rescinded them, finding Wallace's reduced earnings not causally related to his disability. The Appellate Division affirmed the Board's decision, deferring to its finding that Wallace's testimony regarding increased pain was incredible given the lack of objective medical evidence to support new work restrictions, thereby failing to establish a causal link between his disability and reduced earnings.

Workers' CompensationReduced EarningsPermanent Partial DisabilityLumbar Spinal StenosisDegenerative Disc DiseaseWork RestrictionsCausal RelationCredibilityObjective Medical EvidenceAppellate Review
References
5
Case No. MISSING
Regular Panel Decision

Fernandez v. North Shore Orthopedic Surgery & Sports Medicine, P.C.

Frank Fernandez, an x-ray technician, sued his former employer, North Shore Orthopedic Surgery & Sports Medicine, P.C., for retaliation under Title VII after filing a national origin discrimination complaint. A jury found in favor of Fernandez, awarding back pay, front pay, and punitive damages. North Shore subsequently moved for judgment as a matter of law, a new trial, and to modify the damage awards. The court denied North Shore's motions for judgment and a new trial, affirmed the jury's back pay award, but vacated and reduced the front pay award from $160,000 to $50,000, and the punitive damages award from $100,000 to $50,000.

RetaliationTitle VIIEmployment DiscriminationBack PayFront PayPunitive DamagesMitigation of DamagesFederal Rules of Civil ProcedureJudicial DiscretionEquitable Relief
References
27
Case No. ADJ9693769
Regular
Sep 26, 2022

AUGUSTO GARCIA vs. SIERRA TRAFFIC SERVICE, STATE COMPENSATION INSURANCE FUND

The Appeals Board reconsidered a decision and affirmed findings that the applicant sustained a heat stroke injury but not orthopedic injuries. The Board rescinded the award of temporary disability benefits, finding no substantial medical evidence supported disability resulting from the industrial injury. Consequently, the Employment Development Department is not entitled to reimbursement, and the lien of Spine and Ortho Center is disallowed.

Workers' Compensation Appeals BoardReconsiderationTemporary DisabilitySubstantial Medical EvidenceOrthopedic InjuryHeat StrokeDehydrationExhaustionSleep DisorderEmployment Development Department
References
4
Case No. ADJ2314821 (OAK 0262223)
Regular
Oct 01, 2015

CATHERINE SAENZ vs. YMCA of the East Bay, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The Board affirmed the WCJ's finding that the applicant, Catherine Saenz, was temporarily totally disabled. This disability was based on both orthopedic and psychiatric conditions stemming from her 2000 industrial injury. The applicant requires lumbar spine surgery and ongoing psychiatric treatment due to her pain, medication dependence, and functional impairment.

WCABPetition for ReconsiderationTemporary Total DisabilityIndustrial InjuryOrthopedicPsychiatricUtilization ReviewIndependent Medical ReviewAgreed Medical ExaminerQualified Injured Worker
References
0
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