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Case Law Database

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

Case No. ADJ2155279 (RIV 0040729)
Regular
Nov 28, 2012

JACK RAMSEY vs. CALIFORNIA PAVEMENT MAINTENANCE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, Sedgwick CMS, LEGION INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) amended a previous award to defer the issue of attorney fees for enforcing an award of Labor Code section 5710 fees. The WCAB affirmed the remainder of the award, including a $100 penalty for unreasonable delay in authorizing medical treatment, finding the 100-day delay in authorizing treatment with the applicant's chosen physician was unreasonable. The Board also affirmed the award of attorney fees under Labor Code section 5814.5 for enforcing the medical treatment award. The case was returned to the trial level for further proceedings regarding the amount of section 5814.5 fees, with a dissenting opinion arguing for further proceedings on the unreasonable delay issue due to insufficient evidence.

Workers' Compensation Appeals BoardCIGALegion Insurance CompanySedgwick CMSJack RamseyLabor Code section 5814Labor Code section 5814.5Labor Code section 5710Medical Provider NetworkMPN
References
2
Case No. MISSING
Regular Panel Decision
Oct 12, 2007

Salvador-Pajaro v. Port Authority

This case involves a Port Authority police officer who sued the Port Authority for personal injuries, alleging an unsafe workplace in New Jersey. The Port Authority's motion for summary judgment dismissing the complaint was initially denied by the Supreme Court, New York County. However, the appellate court unanimously reversed this decision, granting the motion and dismissing the complaint. The court ruled that New York's Labor Law § 27-a, which was the basis for the General Municipal Law § 205-e claim, does not apply to the Port Authority as an Interstate Compact agency, particularly without concurring legislation from New Jersey. Additionally, New York Labor Law provisions concerning workplace safety do not apply to workplaces located outside of New York, even if both the injured worker and the employer are New York domiciliaries.

Interstate Compact AgencyWorkplace SafetyJurisdictionExtraterritorial ApplicationLabor LawGeneral Municipal LawSummary JudgmentPersonal InjuryPort AuthorityEmployer-Employee Relations
References
5
Case No. 2015 NY Slip Op 00461 [124 AD3d 475]
Regular Panel Decision
Jan 15, 2015

Port Authority of New York & New Jersey v. Port Authority Police Lieutenants Benevolent Ass'n

The Appellate Division, First Department, affirmed a judgment confirming an arbitration award that found the Port Authority of New York and New Jersey violated a collective bargaining agreement by ending free E-Z Pass privileges for retired police sergeants. The court ruled that the arbitrator did not exceed his authority and that his interpretation, which vested retired members with a lifetime interest in these privileges, was not irrational. The decision also clarified that a contractual phrase regarding 'applicable law' pertains to the award's binding nature, not a ground for vacating the award due to a mistake of law.

Arbitration AwardCollective Bargaining AgreementE-Z Pass PrivilegesRetired EmployeesArbitrator's AuthorityAppellate ReviewContractual InterpretationLifetime BenefitsJudicial ReviewPublic Authority
References
5
Case No. ADJ3262542 (GRO 27301) ADJ437058 (GRO 28637)
Regular
Jan 25, 2010

Herman Dennler vs. TIMEC CO., INC., ST. PAUL TRAVELERS, OPEN WAVES SYSTEMS, LUMBERMAN'S MUTUAL CASUALTY COMPANY, BROADSPIRE

The Workers' Compensation Appeals Board denied St. Paul Travelers' petition for reconsideration regarding a Findings and Award. The WCJ found the applicant needed surgery as recommended by Dr. Khoo and that Travelers unreasonably delayed its authorization. The Board affirmed the WCJ's findings, citing Labor Code § 4062(b) which mandates employer authorization of surgery when a second opinion evaluator recommends it. Travelers' failure to authorize the recommended revision surgery, despite a second opinion report, constituted an unreasonable delay warranting increased compensation and attorney fees.

Labor Code § 4062(b)Petition for ReconsiderationFindings and AwardPetition for ReconsiderationOpinion and OrderWCJLabor Code § 5814Labor Code § 5814.5Industrial InjuryLumbar Spine
References
1
Case No. MISSING
Regular Panel Decision
May 18, 2001

Lamuraglia v. New York City Transit Authority

Vincenzo Lamuraglia, a construction worker, was injured after being struck by a New York City Transit Authority bus while working. He and his wife, Rosa Lamuraglia, sued the Transit Authority entities, which then initiated a third-party action against Vincenzo's employer, Premium Landscaping, Inc. A jury found the Transit Authority 65% at fault and Premium 35% at fault, awarding damages for lost earnings, pain and suffering, and loss of services. The Supreme Court reduced some of these awards. On appeal, the judgment was modified, granting a new trial on damages unless the plaintiffs agree to further reductions in their awards for pain and suffering and loss of services. The appellate court also rejected the Transit Authority's arguments regarding jury instructions on pedestrian duty of care and the emergency doctrine.

Personal InjuryNegligenceDamagesJury VerdictAppellate ReviewThird-Party LiabilityComparative FaultWorkplace AccidentBus AccidentDuty of Care
References
14
Case No. ADJ6973825
Regular
May 21, 2012

MONICA BENARD vs. JENNY CRAIG, SEDGWICK CMS

This case concerns a penalty imposed on Jenny Craig for unreasonably delaying authorization for applicant Monica Benard's chiropractic treatment. The WCJ found a 25% penalty for the delay, which Jenny Craig appealed, arguing the delay was due to the applicant's choice of a chiropractor outside their Medical Provider Network (MPN). The Appeals Board affirmed the unreasonable delay finding but reduced the penalty to 20% of the delayed treatment's value, citing a failure in case management rather than intentional disregard. Jurisdiction was reserved for the parties to adjust the penalty amount.

Workers Compensation Appeals BoardMonica BenardJenny CraigSedgwick CMSADJ6973825ReconsiderationFindings and AwardLabor Code section 5814Medical Provider Network (MPN)chiropractic treatment
References
9
Case No. ADJ3641089
Regular
Jan 25, 2018

JOHN SIGLER vs. GENERAL DYNAMICS, INC., CHARTIS INSURANCE COMPANY, BROADSPIRE CLAIMS SERVICES

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding the WCJ's decision that he failed to meet his burden of proof for penalties and sanctions. The applicant claimed unreasonable delay and bad faith regarding authorization for Synvisc injections. The Board found the Utilization Review process was timely and, even if it had been delayed by one day, it was not unreasonable, especially since the employer ultimately authorized the treatment. Additionally, the Board affirmed the WCJ's decision to strike an undisclosed exhibit that lacked probative value and was irrelevant to the current claim.

Workers' Compensation Appeals BoardPenalties and SanctionsUnreasonable DelayTreatment AuthorizationUtilization ReviewSynvisc InjectionsPrimary Treating PhysicianRequest for AuthorizationLabor Code Section 5814Labor Code Section 4610
References
7
Case No. ADJ8920582 (LBO 0029109)
Regular
Oct 10, 2013

DAVID SMITH vs. RMD REBAR, SEABRIGHT INSURANCE COMPANY

This case involves an applicant's claim for workers' compensation medical treatment, specifically facet blocks and a spinal cord stimulator. The Appeals Board affirmed an arbitrator's July 31, 2012 decision, as amended, finding no unreasonable delay in authorizing this treatment after prior related decisions. The Board also affirmed a June 14, 2013 decision by another arbitrator, which imposed a penalty and awarded attorney's fees for defendant's unreasonable delay in authorizing separate treatment (radio frequency ablation). The Appeals Board emphasized the importance of attorney fees to ensure injured workers have recourse for denied medical treatment, even without a monetary award.

Workers' Compensation Appeals BoardReconsiderationAttorney's FeesMedical TreatmentArbitratorFindings and OrderSan FranciscoSeabright Insurance CompanyRMD RebarDavid Smith
References
6
Case No. MISSING
Regular Panel Decision

Samuelsen v. New York City Transit Authority

The case concerns a dispute between Local 100, Transport Workers Union of Greater New York (the Union) and the New York City Transit Authority (TA) and Manhattan and Bronx Surface Transit Authority (MaBSTOA). The Union challenged a Memorandum of Understanding (MOU) and a consolidation agreement that aimed to merge MaBSTOA and TA surface transit operations, arguing that these agreements violated Public Authorities Law § 1203-a (3) (b). This law prohibits MaBSTOA employees from becoming, 'for any purpose,' employees of the TA, acquiring civil service status, or becoming members of NYCERS. The Union contended that the agreements effectively made MaBSTOA employees into TA employees, thereby violating the statute. The defendants moved to dismiss the complaint, asserting the validity of the agreements and procedural defenses. The motion court initially dismissed the complaint, but the appellate court reversed this decision, agreeing with the Union's interpretation of the statute and finding that the complaint sufficiently alleged a cause of action.

Workers' RightsCollective BargainingStatutory InterpretationPublic Authorities LawCivil ServiceEmployment LawUnion DisputeConsolidation AgreementEmployer LiabilityDismissal Reversal
References
3
Case No. MISSING
Regular Panel Decision

Saltares v. Bowen

The plaintiff, Mr. Saltares, sought interim disability insurance benefits and Supplemental Security Income under the Social Security Act after his case was remanded to the Secretary of Health and Human Services for further proceedings. Magistrate Naomi Reice Buchwald recommended denying the request, arguing that courts generally lack the authority to award interim benefits in "original entitlement" cases. Plaintiff objected, citing anticipated delays on remand due to the Administrative Law Judge's initial inadequate processing of his claim. District Judge Kram acknowledged the court's remedial power to grant interim benefits in instances of unreasonable delay caused by the Secretary. However, the Court ultimately denied the application, finding that despite the plaintiff's financial hardship and the reasons for remand, the delays in this particular case did not meet the threshold of "unreasonable delay" established by precedent.

Disability benefitsSocial Security ActInterim benefitsRemandUnreasonable delayJudicial reviewAdministrative Law JudgeOriginal entitlement casesSouthern District of New YorkDistrict Court Decision
References
10
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