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

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. 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. ADJ6626529
Regular
Nov 05, 2015

NICOLAS WALKER vs. LOS ANGELES UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to further study the issues in this case. The WCAB rescinded the prior Findings of Fact & Award, denied the defendant's motion to be relieved of stipulation regarding the thoracic spine, and found that the applicant sustained industrial injury to his cervical spine, shoulders, and thoracic spine. The WCAB deferred issues of permanent disability, apportionment, and attorney's fees, returning the matter to the WCJ for further record development.

Workers' Compensation Appeals BoardNicolas WalkerLos Angeles Unified School DistrictSedgewick Claims Management ServicesInc.ADJ6626529Opinion and Decision After ReconsiderationFindings of Fact & AwardWCJcervical spine
References
5
Case No. ADJ203727 (SRO 0140512)
Regular
Jan 29, 2013

CONRADO HERNANDEZ vs. JOHNNY FRANKLIN MUFFLER, BERKSHIRE HATHAWAY/REDWOOD FIRE AND CASUALTY COMPANY

In this workers' compensation case, the applicant sustained an industrial injury resulting in multiple impairments. Initially awarded 60% permanent disability, the applicant sought reconsideration, arguing the rating omitted the thoracic spine and advocating for total disability based on vocational expert testimony. The WCJ amended the rating to 63% after including the thoracic spine, finding no substantial evidence for total disability. The Appeals Board adopted the WCJ's recommendation, affirming the amended 63% permanent disability award and adjusting the attorney's fee.

Petition for ReconsiderationDecision After Reconsiderationindustrial injurycognitive impairmentpsycheconsciousness disorderpermanent disabilityapportionmentvocational expertamended rating
References
0
Case No. ADJ9709726
Regular
Jun 25, 2015

LAURA NUNEZ vs. SUTTER PACIFIC MEDICAL FOUNDATION, SUTTER HEALTH

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant challenged the finding of industrial injury AOE/COE for thoracic outlet syndrome, arguing it wasn't an issue for trial and the medical evidence was insufficient. The Board found that thoracic spine injury was an issue and that Dr. Avery's opinion provided substantial medical evidence to support the thoracic outlet syndrome finding. Any potential defects in the original WCJ opinion were cured by the WCJ's subsequent report.

Thoracic outlet syndromeAOE/COEPetition for Reconsiderationsubstantial medical evidenceG. James Avery M.D.Steven Bratman M.D.industrial injuryapportionmentWCJlabor code 5313
References
1
Case No. ADJ9841969
Regular
Jul 23, 2019

MARIA ALBERTO vs. GUARDIAN HOME CARE, ZURICH AMERICAN INSURANCE COMPANY

This case involves a workers' compensation applicant who sustained injuries to her left elbow, left upper extremity, lumbar spine, and right knee. The WCAB granted reconsideration of an administrative law judge's decision to re-evaluate specific injuries and permanent disability. The Board found that further development of the medical record was necessary concerning alleged injuries to the right wrist, thoracic spine, and cervical spine. Consequently, the decision defers these issues and the determination of permanent disability pending further medical evidence.

WCABReconsiderationPanel Qualified Medical EvaluatorAdministrative Law JudgePermanent DisabilityIndustrial InjuryCervical SpineThoracic SpineRight WristMedical Opinion
References
3
Case No. ADJ790852
Regular
Apr 05, 2016

LAURA BREITIGAN vs. COUNTY OF RIVERSIDE

The Workers' Compensation Appeals Board granted the applicant's petition for reconsideration, amending the award to include attorney fees on accrued unpaid permanent disability benefits and correcting clerical errors. The Board denied the defendant's petition for reconsideration, upholding the finding of 100% permanent disability and injury to the lumbar spine. The defendant was also admonished for filing a document exceeding the page limit without prior permission. The applicant, a nurse, sustained industrial injuries to her thoracic spine, lumbar spine, and psyche.

Workers' Compensation Appeals BoardLaura BreitiganCounty of RiversideFindings and Awardindustrial injurythoracic spinelumbar spinepsychepermanent disabilityapportionment
References
0
Case No. ADJ10954606
Regular
Mar 09, 2020

DORIT DAVIDOFF vs. UCLA MEDICAL CENTER, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board granted reconsideration to clarify findings of fact regarding industrial injury AOE/COE. The Board rescinded the previous decision and substituted a new Findings and Award to specifically address the stipulated injury to the lumbar spine, ensuring the award of permanent disability benefits was properly supported. The Board clarified that stipulations agreed upon by the parties should be treated as findings of fact to meet statutory requirements. The decision confirms permanent disability for the left ankle, thoracic spine, and lumbar spine, denies claims for neck and knee injuries, and orders further medical treatment and attorney fees.

Petition for ReconsiderationFindings and AwardIndustrial InjuryLumbar SpineThoracic SpineLeft AnkleAOE/COEStipulationJurisdictional FactsFindings of Fact
References
1
Case No. ADJ12582828
Regular
Jan 03, 2023

TERRY KELLY vs. SAFEWAY

This case involves a workers' compensation claim where the defendant sought reconsideration of an award finding injury AOE/COE to multiple body parts. The primary dispute centers on the applicant's occupational group number, with the applicant claiming "butcher" (420) and the defendant arguing "meat cutter" (322), impacting permanent disability ratings. The Board granted reconsideration, finding insufficient evidence to determine the occupational group number and therefore deferring permanent disability for all affected body parts pending further development of the record. The finding of injury AOE/COE to the applicant's cervical spine, thoracic spine, lumbar spine, bilateral knees, bilateral elbows, and bilateral wrists was upheld.

Occupational Group NumberMeat CutterButcherCumulative TraumaPermanent DisabilityQualified Medical EvaluatorSubstantial EvidenceFurther DevelopmentBody PartsWPI Ratings
References
11
Case No. ADJ9791003
Regular
Feb 21, 2020

FRANKLIN LOPEZ DE LA CRUZ vs. BARRETT BUSINESS SERVICES, INC.

This case concerns a lien claimant, Optimal Health, seeking reimbursement for medical treatment provided to an applicant injured on July 1, 2014. The applicant's employer accepted a lumbar spine injury but denied claims for thoracic spine, cervical spine, and leg injuries. The initial WCJ disallowed Optimal Health's lien, ruling treatment outside the approved Medical Provider Network (MPN) was improper. The Appeals Board granted reconsideration, finding the applicant may self-procure treatment for denied body parts. The Board remanded the case for further proceedings to determine if the applicant sustained injury to denied body parts, if treatment was reasonable and necessary, and if fees were appropriate.

Medical Provider NetworkMPNdenied body partsself-procured treatmentlien claimantburden of proofindustrial injuryreasonable and necessary treatmentMedical Treatment Utilization ScheduleMTUS
References
2
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