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Case Law Database

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

Case No. G107 435
Regular Panel Decision
Jun 02, 2023

Matter of Marku v. ABM Industries

This case concerns the claim of Denise Perry under the Workers' Compensation Law. The Workers' Compensation Law Judge (WCLJ) previously found that the employer, Adventist Home Care, established a violation of Workers' Compensation Law § 114-a by the claimant for willfully making false statements to obtain benefits. Consequently, the WCLJ disallowed indemnity benefits and imposed both mandatory and discretionary penalties. A Board Panel decision filed on February 17, 2022, affirmed the WCLJ's findings. The claimant subsequently filed an application for reconsideration on March 18, 2022, which the Board Panel reviewed. After considering the claimant’s arguments, the Board Panel determined that the application did not raise new issues or present new material evidence, nor did it demonstrate an erroneous statement of material fact or law in the prior decision. Therefore, the Board Panel, by a majority vote, affirmed its prior decision.

Workers' Compensation FraudFalse RepresentationIndemnity Benefits DisallowanceWCL § 114-a PenaltyApplication for Reconsideration DeniedBoard Panel AffirmationWillful MisrepresentationWorkers' Compensation Law Judge DecisionEmployer Established Violation
References
0
Case No. MISSING
Regular Panel Decision

Claim of Mulligan v. Workers' Compensation Board

The claimant, a former workers' compensation law judge, appealed the denial of reduced earning benefits, which stemmed from his claim that stress from his job caused him to voluntarily withdraw from the labor market. He had previously received benefits for a 1995 angina attack. An arbitrator and subsequent arbitration panel concluded that he voluntarily withdrew from the labor market, a determination the claimant contested, asserting his retirement was due to work-related stress. The court, led by Judge Carpinello, found substantial evidence supported the panel's decision, noting the claimant never complained of stress to supervisors, sought accommodations, or applied for disability retirement. The court affirmed the arbitration panel's decision, denying the claimant's appeal.

Voluntary Withdrawal from Labor MarketReduced Earning BenefitsWorkers Compensation BenefitsArbitration Panel DecisionSubstantial EvidenceDisability RetirementJob-Related StressAppellate ReviewLabor Market WithdrawalClaim Denial
References
8
Case No. WCB No. G076 2707
Regular Panel Decision
Dec 09, 2021

Matter of Duncan v. John Wiley & Sons, Inc.

This Board Panel Decision concerns an appeal by the applicant, Joseph Lafayette, regarding a Workers' Compensation Law Judge's (WCLJ) finding on the causal relationship of his back injury. The applicant sustained injuries to his back, neck, and shoulder during his employment. The WCLJ had previously established a causal relationship for the neck and shoulder injuries but disallowed the claim for the back injury. Upon review, the Board Panel determined that the medical evidence in the record supports a causal relationship between the claimant's employment and his lower back injury. As a result, the Panel modified the WCLJ's decision to establish a causal relationship for the back injury, while affirming the other aspects of the original decision.

Workers' CompensationBack InjuryNeck InjuryShoulder InjuryCausal RelationshipMedical EvidencePanel ReviewWCLJ DecisionModificationAppeal
References
2
Case No. G0699450
Regular Panel Decision
Aug 10, 2023

Matter of Von Maack v. Wyckoff Heights Medical Center

The claimant, Yvette Robles, sustained a work-related injury to her left knee. The Workers' Compensation Law Judge (WCLJ) initially established accident, notice, and causal relationship. However, the employer and carrier appealed, contending the claim was untimely filed. A Board Panel modified the WCLJ's decision, determining that the claim was barred by Workers' Compensation Law § 28 due to untimely filing. The Full Board subsequently affirmed the Board Panel's decision, upholding the bar to the claim.

Timeliness of ClaimWCL § 28Board Panel ReviewAccident, Notice, and Causal RelationshipLeft Knee InjuryEmployer AppealFull Board ReviewClaim BarredStatute of LimitationsWork-Related Injury
References
0
Case No. ADJ3845272 (SRO 0103733) ADJ1335789 (SRO 0121654)
Regular
Jun 22, 2012

ROBERT VIALE vs. LOCKHEED MARTIN CORPORATION

This case involves a dispute over an attorney's fee where the applicant's attorney sought $90,000 from a $638,982 settlement. The WCJ initially limited the fee, excluding amounts used for Medicare Set Aside (MSA) funding from the calculation based on a prior panel decision. The Appeals Board granted reconsideration, rescinded the WCJ's order, and awarded the full $90,000 fee. The Board found the WCJ gave undue weight to a non-binding panel decision and insufficient weight to Labor Code and WCAB rules mandating consideration of responsibility, care, time, and results obtained. They concluded the full fee was reasonable given the successful settlement for the applicant, who gained control of their treatment and significant cash compensation.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationFindings and OrderWCJCompromise and ReleaseMedicare Set Aside AccountAnnuityAttorney FeeLabor Code Section 4903(a)
References
1
Case No. MISSING
Regular Panel Decision

Matter of Burns v. New York State Workers' Compensation Board

Claimant sought workers' compensation benefits due to injuries from an automobile accident. As an employee of the Workers’ Compensation Board, his claim was processed through a neutral outside arbitration process. An arbitrator established his claim and average weekly wage. Claimant appealed, arguing his average weekly wage should have been calculated differently due to a recent promotion, as per Workers’ Compensation Law § 14 (2). An arbitration panel declined to address this argument because it was not raised before the arbitrator. The appellate court affirmed the panel's decision, citing that the panel could decline review of issues not previously raised, consistent with 12 NYCRR 300.13 [e] [1] [iii].

ArbitrationAverage Weekly WageWorkers' CompensationAppellate ReviewIssue PreservationAdministrative LawProcedural Due ProcessStatutory InterpretationWorkers’ Compensation Board
References
2
Case No. ADJ10389861
Regular
Feb 05, 2020

TERESA GARCIA vs. WAL-MART ASSOCIATES, INC., ACE AMERICAN INSURANCE

The Workers' Compensation Appeals Board granted reconsideration to amend an order regarding a Qualified Medical Evaluator (QME) panel in urology. While the WCJ's decision addressed a threshold issue (injury arising out of and in the course of employment), making it a final order subject to reconsideration, the defendant's challenge focused on an interlocutory issue. The Board affirmed the WCJ's decision, but clarified that if parties cannot agree on an Agreed Medical Evaluator (AME) urologist, the Medical Unit must issue a QME panel for the applicant's zip code. The Board found no basis for removal, as no significant prejudice or irreparable harm was demonstrated.

Workers' Compensation Appeals BoardPetition for ReconsiderationThreshold IssueInjury AOE/COELumbar SpineInterlocutory DecisionRemoval StandardIrreparable HarmQualified Medical Evaluator (QME)Urology
References
3
Case No. MISSING
Regular Panel Decision
Aug 14, 1981

Claim of Schiffman v. Fugazy Continental Corp.

Claimant, a limousine driver, filed for workers' compensation benefits after sustaining an injury. Initially, a referee found an employer-employee relationship, but a board panel reversed this decision. Subsequently, the full 13-member Workers’ Compensation Board rescinded the panel’s prior decision and referred the case back for reconsideration. The panel then found an employment relationship, aligning with other similar cases involving the same employer. The employer and its insurance carrier challenged the board's action, but the court affirmed the decision, asserting the board's plenary authority to modify or rescind prior decisions to resolve inconsistencies.

Employer-Employee RelationshipBoard ReviewPlenary AuthorityInconsistent FindingsAppellate ReviewLimousine DriverInjury ClaimBoard DecisionRescissionJudicial Affirmation
References
2
Case No. ADJ9332041
Regular
Mar 08, 2019

ANA VILLANUEVA vs. TEVA FOODS, TRAVELERS INSURANCE COMPANY

This case concerns whether lien claimant Firstline Health, Inc.'s lien should be subject to a stay under Labor Code section 4615 due to alleged control by criminally charged providers. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, finding the applicant's due process rights were violated. The WCAB rescinded the previous order and returned the case for further proceedings, specifically to allow Firstline an opportunity to rebut evidence of Dr. Uwaydah's de facto control. This decision emphasizes the need for fair hearing and timely notice before imposing a stay on a lien claimant's claim.

Workers' Compensation Appeals BoardLabor Code section 4615Labor Code section 139.21criminally charged providerslien claimantde facto ownershipde facto controlfraudulent documentsconspiracyinsurance fraud
References
23
Case No. MISSING
Regular Panel Decision
Mar 21, 2003

Claim of Robinson v. New Venture Gear

Claimant was injured when his left arm was caught in a machine, leading to a workers’ compensation claim. Conflicting medical reports from examining physicians Walter Wawro, Mark Goodman, and W. David Ferraraccio provided different schedule loss of use percentages for his left arm. Wawro's report was precluded due to his unavailability for deposition. The Workers’ Compensation Law Judge initially credited Ferraraccio's report, finding a 27.5% schedule loss of use. However, a Workers’ Compensation Board panel ultimately found that the medical evidence supported the 15% schedule loss of use as determined by Goodman. The claimant appealed this decision, but the Appellate Division affirmed the Board panel's decision, upholding the 15% schedule loss of use.

Workers’ CompensationSchedule Loss of UseLeft Arm InjuryMedical EvidenceConflicting Medical OpinionsIndependent Medical ExaminationDepositionPreclusion of EvidenceAppellate ReviewSubstantial Evidence
References
2
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