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

Case No. ADJ2934117 (STK 0214084)
Regular
Jun 06, 2011

BENNIE MADAVE vs. STOCKTON UNIFIED SCHOOL DISTRICT

This case involves an applicant seeking workers' compensation for a right shoulder rotator cuff repair surgery denied by a WCJ. The WCJ ruled the need for surgery stemmed from a subsequent non-industrial accident, not the initial industrial injury. The Appeals Board granted reconsideration, rescinded the original order, and returned the case for further medical record development. This is because the medical evidence failed to definitively determine if the surgery was necessary to cure or relieve the effects of the industrial injury, even if the tear itself wasn't solely industrially caused.

Rotator cuff repairIndustrial injuryNon-industrial accidentUtilization reviewPanel Qualified Medical EvaluatorPQMEApportionmentPermanent disabilityInextricably linkedFurther development of medical record
References
1
Case No. ADJ1313860
Regular
Mar 07, 2017

Kevin Voelker vs. D. Frey Plastering Co., State Compensation Insurance Fund

This case involves a workers' compensation applicant challenging an Independent Medical Review (IMR) determination that denied authorization for shoulder surgery. The applicant argued the IMR incorrectly applied guidelines for acromioplasty/impingement syndrome instead of guidelines for a rotator cuff tear, which was the actual condition for which surgery was requested. The Appeals Board granted reconsideration, finding the IMR's determination was based on a plainly erroneous mistake of fact readily apparent from the submitted records, not requiring expert opinion. Consequently, the Board rescinded the IMR determination and remanded the matter for a new IMR process.

Workers' Compensation Appeals BoardIndependent Medical ReviewPetition for ReconsiderationFindings and OrderPlainly Erroneous Finding of FactMedical Treatment Utilization ScheduleRequest for AuthorizationRotator Cuff TearAcromioplastyImpingement Syndrome
References
3
Case No. MISSING
Regular Panel Decision

Claim of Anderson v. New York City Department of Design & Construction

Claimant appealed a Workers' Compensation Board decision from April 25, 2013, which denied his application to include a partial right rotator cuff tear under his existing 2002 work-related injury claim. The Board found that claimant failed to establish a causal link between the 2002 automobile accident and the 2009 rotator cuff tear, despite the opinion of his orthopedist. The orthopedist acknowledged that age-related degeneration could cause such tears independently of trauma. The Appellate Division affirmed the Board's decision, concluding there was substantial evidence to support the finding that the orthopedist's testimony did not convincingly prove a causal relationship.

Rotator cuff tearCausal relationshipWorkers' CompensationMedical evidenceDisabilityWork-related injuryAutomobile accidentShoulder painOrthopedist opinionSubstantial evidence
References
4
Case No. MISSING
Regular Panel Decision
Jun 02, 2008

Claim of Laezzo v. New York State Thruway Authority

The claimant suffered a work-related slip and fall in 2002, leading to injuries including his head, neck, back, and knees. His morbid obesity contributed to his back and knee issues, prompting him to seek authorization for gastric bypass surgery. The Workers’ Compensation Law Judge approved the surgery, a decision affirmed by the Workers’ Compensation Board, which found the surgery causally related to the compensable injuries. The employer and its carrier appealed, challenging the causal link. The court affirmed the Board's decision, noting substantial evidence that the claimant's weight gain was a result of the sedentary lifestyle imposed by his injuries, and that the surgery would aid in his recovery.

Workers' CompensationConsequential InjuryGastric Bypass SurgeryMorbid ObesityMedical Treatment AuthorizationCausationKnee InjuryBack InjurySedentary LifestyleBoard Decision Appeal
References
2
Case No. 518426
Regular Panel Decision
Oct 02, 2014

MatterofAndersonvNewYorkCityDepartmentofDesign&Construction

Donald Anderson, the claimant, sought workers' compensation benefits for injuries sustained in a 2002 work-related automobile accident. Initially, his claim was established for neck and back injuries, but in 2005, the Workers' Compensation Board determined he had no continuing disability, noting he was magnifying symptoms. In 2009, Anderson was diagnosed with a partial right rotator cuff tear, which he sought to include under his existing claim, alleging a causal link to the 2002 accident. The Board denied this application, finding a lack of established causal relationship. The Appellate Division affirmed the Board's decision, concluding that Anderson failed to present convincing evidence from his orthopedist or any other proof to establish the necessary causal connection between the 2002 accident and his right rotator cuff tear.

Workers' CompensationCausally Related InjuryRotator Cuff TearAutomobile AccidentMedical EvidenceDisability BenefitsAppellate ReviewShoulder InjurySubstantial EvidenceCausation
References
4
Case No. MISSING
Regular Panel Decision
Apr 05, 2004

Elescano v. Eighth-19th Co.

A construction worker sued for personal injuries, including a ruptured rotator cuff requiring extensive physical therapy and surgery. The Supreme Court, New York County, awarded $100,000 for past pain and suffering and $50,000 for future pain and suffering. On appeal, the award for future pain and suffering was deemed materially deviating from reasonable compensation. The judgment was unanimously modified to vacate the future pain and suffering award and direct a new trial on that issue, unless the third-party defendant stipulates to increase the award to $200,000, and otherwise affirmed, without costs.

Personal InjuryConstruction AccidentRotator Cuff InjuryPain and Suffering AwardFuture DamagesDamages AssessmentAppellate ReviewJudgment ModificationNew Trial OrderedConditional Affirmance
References
1
Case No. MISSING
Regular Panel Decision
Jun 08, 2011

Guallpa v. Key Fat Corp.

The defendant appealed a judgment from the Supreme Court, Queens County, entered June 8, 2011, which awarded the plaintiff substantial damages for personal injuries. The plaintiff, a construction worker, sustained an ankle fracture, herniated disc, and rotator cuff injury after falling from a ladder in 2006, requiring multiple surgeries. The Supreme Court had granted the plaintiff summary judgment on liability, and a jury determined the damages. The appellate court affirmed the judgment, finding the jury's awards for past/future pain and suffering, lost earnings, and future medical expenses to be reasonable and not speculative, thus rejecting the defendant's challenges.

Personal InjuryConstruction Site AccidentFall from HeightLadder InjuryDamages AssessmentJury AwardAppellate AffirmationSummary Judgment LiabilityPain and Suffering DamagesLost Earnings Damages
References
11
Case No. ADJ3149661 (SDO 0271415)
Regular
Apr 27, 2012

Elsa Cervantes vs. COSTCO WHOLESALE CORPORATION, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board granted reconsideration to find that applicant Elsa Cervantes sustained an industrial injury to her left shoulder, overturning the WCJ's prior decision. The Board found substantial medical evidence supported that the rotator cuff tear arose from the April 27, 2000 incident, reversing the WCJ's reliance on Dr. Lane's opinion. Applicant is entitled to further medical treatment, including surgery, and continuing temporary disability benefits for the left shoulder injury. However, the Board affirmed the WCJ's decision regarding the defendant's right to control medical treatment through its Medical Provider Network, finding no contrary evidence of substantiality to overturn the credibility findings.

Workers Compensation Appeals BoardElas CervantesCostco Wholesale CorporationSedgwick Claims Management Servicesindustrial injuryneck injuryleft trapezius muscle injurypsyche injuryleft shoulder injuryMedical Provider Network (MPN)
References
0
Case No. MISSING
Regular Panel Decision
Dec 12, 2002

Parsons-Zieba v. Cornell University

The claimant, an administrative assistant, developed pain in her right wrist, arm, shoulder, and neck due to repetitive motions required by her job. She was diagnosed with impingement syndrome (rotator cuff tendonitis), which her physician determined was causally related to her employment duties, and her condition was alleviated by surgery. The Workers' Compensation Board ruled this constituted an accidental injury and awarded benefits, a decision subsequently appealed by the employer and carrier who disputed the "accidental injury" definition. The court affirmed the Board's ruling, citing substantial medical evidence from physicians Edward Koppel and Stephanie Roach, which established that repetitive acts could cause a debilitating injury without requiring a sudden event. Additionally, the court found the arguments regarding timely notice of the claim to be unpersuasive.

Workers' Compensation LawAccidental InjuryRepetitive Stress InjuryImpingement SyndromeRotator Cuff TendonitisAdministrative AssistantMedical EvidenceAppellate ReviewCausally Related DisabilityTimely Notice
References
5
Case No. MISSING
Regular Panel Decision
Feb 15, 2013

Claim of Storm v. Phillips Lighting Co.

The claimant, a machine operator, sustained a work-related right shoulder injury in 2002, leading to surgery in 2010 for a rotator cuff tear. An occupational physician, Michael Lax, diagnosed an occupational disease in November 2011, attributing it to repetitive arm motion. Subsequently, the claimant applied for workers\' compensation benefits in 2012. While a Workers’ Compensation Law Judge initially deemed the claim time-barred and related to the 2002 accident, the Workers’ Compensation Board reversed, establishing the claim. On appeal, the Board\'s determination was affirmed, with the court finding substantial evidence that the claim was timely filed due to the claimant\'s knowledge date in November 2011, and that the claimant suffered from a distinct occupational disease aggravated by her employment duties.

Workers\' CompensationOccupational DiseaseRepetitive Motion InjuryShoulder InjuryRotator Cuff TearTimeliness of ClaimDate of DisablementAggravationWorkers\' Compensation Board AppealAppellate Review
References
6
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