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Case Law Database

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

Case No. ADJ362898 (STK 0200921)

Regular

Apr 23, 2012

SAVINDER LAL vs. US AIRWAYS GROUP, INC. dba AMERICA WEST AIRLINES, AMERICAN HOME ASSURANCE

The Appeals Board denied the defendant's Petition for Removal, which sought to prevent the issuance of a psychiatric QME panel. The Board found the defendant's argument that Labor Code § 3208.3(d) prohibits payment for psychiatric QMEs due to short employment duration was misplaced, as QME costs are medical-legal expenses, not compensation. The Board dismissed the defendant's Petition for Reconsideration, deeming it moot and improperly filed as it relied on a mistaken belief that the removal petition was automatically denied. Therefore, the order for the psychiatric QME panel stands.

Workers' Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationQualified Medical EvaluationPsychiatryLabor Code Section 3208.3(d)Medical-Legal ExpenseApplicant Employment DurationSudden and Extraordinary Employment ConditionWCJ Report and Recommendation

References

Case No. ADJ4155359 (OXN 0143340)

Regular

May 23, 2014

LISA SMITH vs. AGOURA WESTLAKE ANIMAL HOSPITAL, FIREMAN'S FUND INSURANCE COMPANY

Defendant Agoura Westlake Animal Hospital sought removal from an order continuing the case to trial on psychiatric injury and sleeplessness, arguing they should have obtained a supplemental QME report first. The Appeals Board denied this petition, agreeing with the WCJ that the psychiatric injury issue was ready for trial as both parties had QME evaluations. The Board found no abuse of discretion in the WCJ treating the hearing as a Mandatory Settlement Conference rather than a status conference. One Commissioner dissented, believing removal should be granted to allow the supplemental QME evaluation due to applicant's refusal to attend and the lack of trial readiness for psychiatric injury.

Petition for RemovalQualified Medical Evaluator (QME)Injury to PsycheSleeplessnessMandatory Settlement Conference (MSC)Declaration of Readiness to Proceed (DOR)Petition to CompelWCJ (Workers' Compensation Judge)Appeals BoardIndustrial Injury

References

Case No. ADJ803213 (FRE 0210212)

Regular

May 26, 2009

JOSE ENRIQUE RAMIREZ vs. ELKOR REALTY, ST. PAUL MERCURY INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to reverse a judge's award of increased permanent disability benefits. The original award found applicant sustained a psychiatric injury as a consequence of his orthopedic injury, relying on a QME's report. However, the Board found the psychiatric QME's report lacked substantial evidence, failing to adequately address non-industrial factors and industrial causation requirements under Labor Code section 3208.3. Consequently, the Board reversed the award, denying applicant's petition to reopen for new and further disability, including psychiatric injury.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardPetition to ReopenIndustrial InjuryPsyche InjuryOrthopedic InjuryCompensable ConsequenceQualified Medical EvaluatorSubstantial Evidence

References

Case No. ADJ94 70576

Regular

Jun 26, 2017

CARLOS CAMARGO vs. COX PETROLEUM TRANSPORT, EM OIL TRANSPORT, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted the applicant's Petition for Reconsideration, rescinded the original Finding and Order, and returned the case for further proceedings. The WCAB found that the primary medical evaluator's (QME) reports were not substantial evidence because they were based on incomplete and inaccurate history, and failed to consider the impact of industrial stress on the applicant's internal medicine conditions. Additionally, the WCAB determined that a separate evaluation by a psychology or psychiatry QME was warranted to address the applicant's psychiatric injury claim, as the internal medicine QME deferred to mental health specialists. Therefore, the record requires further development regarding both the physical and psychiatric aspects of the applicant's claimed industrial injuries.

AOE/COEQMEhypertrophic obstructive cardiomyopathyindustrial stresspsychiatric injuryDSM-IVLabor Code section 3208.3preponderance of the evidenceaggravated conditionsupplementation of the record

References

Case No. ADJ10310553, ADJ10310557

Regular

Nov 20, 2018

JOSE ESPINOSA vs. SECCOMBE HOMES, INC., dba NORTH STAR CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

The Appeals Board dismissed the applicant's petition for reconsideration of the WCJ's denial of a psychiatry QME panel, finding the order interlocutory. However, the Board granted the petition for removal, recognizing that denying a psychiatric QME panel irreparably harmed the applicant's ability to conduct necessary medical-legal discovery regarding his psyche claim. The Board amended the Joint Findings and Award to find good cause for an additional QME panel in psychiatry and granted the applicant's request. This decision allows for proper evaluation of the applicant's psychiatric complaints and potential permanent impairment rating, especially given Labor Code §4660.1's nuances for post-2013 injuries.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalJoint Findings and AwardQualified Medical Evaluator (QME)Agreed Medical Evaluator (AME)good causepsychiatric injurypermanent impairment ratingLabor Code §4660.1

References

Case No. ADJ3817836 (SJO 0250881)

Regular

May 31, 2012

ZUFAN A. REDA vs. FRY'S ELECTRONICS, INC., ZURICH NORTH AMERICAN INSURANCE

This case concerns applicant Zufan A. Reda's claim for permanent total disability due to a psychiatric injury. The Workers' Compensation Appeals Board (WCAB) is ordering the development of the record because neither the applicant's QME, Dr. Sidle, nor the defendant's QME, Dr. Keins, provided substantial evidence regarding the apportionment of psychiatric permanent disability. The WCAB found that Dr. Sidle's report incorrectly addressed causation of injury rather than apportionment of disability, and Dr. Keins' report was rejected as non-substantial due to prior rulings on industrial causation. Therefore, the WCAB has appointed Dr. Roy Curry as a "regular physician" to conduct a new evaluation on the issue of psychiatric permanent disability.

Petition for ReconsiderationDevelopment of RecordLabor Code section 5701Industrial InjuryPsychiatric InjuryCompensable ConsequenceSection 5803Section 5804Section 5410Permanent Total Disability

References

Case No. MISSING

Regular Panel Decision

Mott v. Central New York Psychiatric Center

The claimant, a guard at a state-run psychiatric center, suffered a work-related injury and received workers’ compensation benefits. During his disability, he used personal leave time for which he received full wages. The employer sought reimbursement for these advance payments, but the Workers’ Compensation Board denied reimbursement for the personal leave portion. The Appellate Division reversed this decision, differentiating personal leave from sick leave by noting that personal leave could not be accrued or converted, thus not conferring a permanent benefit to the employer or a detriment to the claimant. The court concluded that denying reimbursement would result in the claimant receiving both full wages and compensation for the same period, a disfavored outcome, and therefore, reimbursement should be granted.

ReimbursementAdvance PaymentsPersonal LeaveSick LeaveWorkers' Compensation BenefitsDisabilityEmployer ReimbursementDisproportionate ResultAppellate DivisionNew York

References

Case No. MISSING

Regular Panel Decision

Kevin M. v. South Beach Psychiatric Center

Kevin M. was arrested for stalking Grammy-winning singer Robyn Fenty (Rihanna) after sending her hundreds of delusional letters and frequently appearing near her Manhattan apartment. Found unfit to stand trial, he was civilly committed to South Beach Psychiatric Center (SBPC). During a subsequent hearing, medical experts testified to his severe psychotic disorder, continuous delusions, and assessment as a danger to himself and others. The court denied Kevin M.'s application for release, finding existing Mental Hygiene Law inadequate to protect Ms. Fenty. Exercising its general equity jurisdiction, the court issued a permanent injunction and an order of protection, prohibiting Kevin M. from any contact with Ms. Fenty or her properties, and allowing for immediate arrest if violated, addressing perceived gaps in New York law concerning dangerously mentally ill individuals with specific targets.

StalkingMental IllnessInvoluntary CommitmentOrder of ProtectionPermanent InjunctionPsychotic DisorderPublic SafetyCriminal Procedure LawMental Hygiene LawEquity Jurisdiction

References

Case No. MISSING

Regular Panel Decision

Claim of Regenbogen v. New York State Willard Psychiatric Center

The case involves an appeal regarding a workers' compensation claim for mental injury filed by a former employee of Willard Psychiatric Center, who later worked for the Workers’ Compensation Board. The claim, initially found compensable, faced jurisdictional challenges after a March 1997 amendment to Workers’ Compensation Law § 20 (2) (a) mandated neutral arbitration for Board employees' claims pending on or after its effective date. The court found that the Workers’ Compensation Board lacked jurisdiction to issue its June 1997 amended decision because the claim was still 'pending' after the amendment's effective date. Consequently, the court reversed the Board's decisions and remitted the entire matter for arbitration, emphasizing that the legislative intent was to remove any appearance of partiality in such claims.

Workers' Compensation BoardJurisdictional DisputeRetroactive Application of LawStatutory AmendmentArbitration MandateMental Stress ClaimAppellate ProcedurePending ClaimsBoard Employee ClaimsAdministrative Law

References

Case No. MISSING

Regular Panel Decision

Claim of Keser v. New York State Elmira Psychiatric Center

This case addresses whether late payment penalty provisions of Workers’ Compensation Law § 25 (3) (f) apply to reimbursements made by an employer’s compensation carrier for wages paid during an employee's disability, and if so, whether they apply when reimbursement is in a form other than monetary payment to the employee. The Court affirmed the Appellate Division's decision, answering both questions in the affirmative. A 20% penalty was upheld against the State Insurance Fund for late reimbursement to the New York State Elmira Psychiatric Center, the employer of claimant Peter Keser. The ruling emphasizes that for penalty purposes, no distinction should be made between awards payable directly to claimants and those payable to an employer as reimbursement, and the mechanics of payment (e.g., accounting credit) do not alter the need for timely compliance with award terms, promoting prompt payment of workers' compensation benefits.

Workers' CompensationLate Payment PenaltyEmployer ReimbursementDisability BenefitsStatutory InterpretationSection 25(3)(f)Compensation DefinitionCarrier LiabilityPrompt PaymentAccrued Leave

References

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Updated Daily

Case Law Database

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

Case No. ADJ362898 (STK 0200921)

Regular

Apr 23, 2012

SAVINDER LAL vs. US AIRWAYS GROUP, INC. dba AMERICA WEST AIRLINES, AMERICAN HOME ASSURANCE

References

Case No. ADJ4155359 (OXN 0143340)

Regular

May 23, 2014

LISA SMITH vs. AGOURA WESTLAKE ANIMAL HOSPITAL, FIREMAN'S FUND INSURANCE COMPANY

References

Case No. ADJ803213 (FRE 0210212)

Regular

May 26, 2009

JOSE ENRIQUE RAMIREZ vs. ELKOR REALTY, ST. PAUL MERCURY INSURANCE COMPANY

References

Case No. ADJ94 70576

Regular

Jun 26, 2017

CARLOS CAMARGO vs. COX PETROLEUM TRANSPORT, EM OIL TRANSPORT, INC., STATE COMPENSATION INSURANCE FUND

AOE/COEQMEhypertrophic obstructive cardiomyopathyindustrial stresspsychiatric injuryDSM-IVLabor Code section 3208.3preponderance of the evidenceaggravated conditionsupplementation of the record

References

Case No. ADJ10310553, ADJ10310557

Regular

Nov 20, 2018

JOSE ESPINOSA vs. SECCOMBE HOMES, INC., dba NORTH STAR CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

References

Case No. ADJ3817836 (SJO 0250881)

Regular

May 31, 2012

ZUFAN A. REDA vs. FRY'S ELECTRONICS, INC., ZURICH NORTH AMERICAN INSURANCE

Petition for ReconsiderationDevelopment of RecordLabor Code section 5701Industrial InjuryPsychiatric InjuryCompensable ConsequenceSection 5803Section 5804Section 5410Permanent Total Disability

References

Case No. MISSING

Regular Panel Decision

Mott v. Central New York Psychiatric Center

ReimbursementAdvance PaymentsPersonal LeaveSick LeaveWorkers' Compensation BenefitsDisabilityEmployer ReimbursementDisproportionate ResultAppellate DivisionNew York

References

Case No. MISSING

Regular Panel Decision

Kevin M. v. South Beach Psychiatric Center

StalkingMental IllnessInvoluntary CommitmentOrder of ProtectionPermanent InjunctionPsychotic DisorderPublic SafetyCriminal Procedure LawMental Hygiene LawEquity Jurisdiction

References

Case No. MISSING

Regular Panel Decision

Claim of Regenbogen v. New York State Willard Psychiatric Center

References

Case No. MISSING

Regular Panel Decision

Claim of Keser v. New York State Elmira Psychiatric Center

Workers' CompensationLate Payment PenaltyEmployer ReimbursementDisability BenefitsStatutory InterpretationSection 25(3)(f)Compensation DefinitionCarrier LiabilityPrompt PaymentAccrued Leave

References

Showing 1-10 of 1,718 results

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