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

Case No. 01-42217-REG
Regular Panel Decision

Ames Department Stores, Inc. v. Lumbermens Mutual Casualty Co. (In re Ames Department Stores, Inc.)

This document is a report and recommendation from Judge Robert E. Gerber concerning Ames Department Stores, Inc.'s motion to confirm exclusive jurisdiction in an adversary proceeding against Lumbermens Mutual Casualty Company. The proceeding, occurring under Ames' Chapter 11 bankruptcy, addresses the ownership of an $8 million trust account and alleged interference with the debtor's property. Judge Gerber recommends that the court possesses subject matter jurisdiction over all claims, asserting exclusive jurisdiction over specific claims involving automatic stay violations, marshaling, and equitable subordination. Furthermore, he advises that the McCarran-Ferguson Act does not mandate deferral to an Illinois state court for these issues, and the First Assuming Jurisdiction Doctrine is applicable to certain in rem claims.

Bankruptcy LawJurisdictional DisputeExclusive JurisdictionAutomatic Stay ViolationMcCarran-Ferguson ActIn Rem JurisdictionAdversary ProceedingChapter 11 BankruptcySurety BondsCash Collateral
References
65
Case No. MISSING
Regular Panel Decision

In re Paragon Process Service, Inc.

Paragon Process Service, Inc. appealed a decision by the Unemployment Insurance Appeal Board, which held the company responsible for unemployment insurance contributions for its process servers from 1978 to 1980. Paragon contended that these process servers were independent contractors, not employees, over whom it exercised no control beyond legal requirements. The court, referencing precedents like *Matter of 12 Cornelia St. (Ross)*, determined that the Board lacked a rational basis for classifying the process servers as employees. Consequently, the court reversed the Board's decision. The matter was then remitted to the Unemployment Insurance Appeal Board for further proceedings consistent with this new finding.

Unemployment insuranceIndependent contractorProcess serversEmployer liabilityEmployee classificationAppellate reviewAdministrative decisionRational basis reviewLabor lawNew York law
References
2
Case No. ADJ9527444
Regular
May 23, 2018

, REYES P. HERNANDEZ, vs. , QUALI RUN RANCH; STATE COMPENSATION INSURANCE FUND; OMA OJAI PACIFIC; ZENITH INSURANCE COMPANY; ACE USA INSURANCE COMPANY, Administered By ESIS; MICHAEL AND JODY CROMER, Homeowners; STATE FARM INSURANCE,

The Workers' Compensation Appeals Board granted ESIS's Petition for Removal because the WCJ's order denying ESIS a panel Qualified Medical Evaluator (PQME) evaluation was found to cause significant prejudice and irreparable harm. ESIS was not a party to the original Agreed Medical Examiner (AME) agreement between the applicant and SCIF, and the WCJ's decision unfairly bound ESIS to the AME's findings and effectively closed ESIS's discovery rights. The Board rescinded the WCJ's decision and ordered a PQME evaluation for ESIS, recognizing the denial violated ESIS's due process rights.

Petition for RemovalQualified Medical EvaluatorAgreed Medical ExaminerDue ProcessSignificant PrejudiceIrreparable HarmDiscoveryFindings and OrderWorkers' Compensation Appeals BoardCumulative Trauma
References
6
Case No. MISSING
Regular Panel Decision

Ames v. Norstar Building Corp.

This dissenting opinion concerns the Labor Law § 240 (1) claim brought by plaintiff Leigh Ames, a construction worker who suffered injuries from a fall at an elevated work site. Justices Gorski and Lawton argue against the majority's decision to grant defendants' motion for summary judgment, asserting that defendants failed to demonstrate a prima facie showing for dismissal. The dissent contends that Ames's accident, involving a fall while attempting to access an elevated work area, falls under the protections of Labor Law § 240 (1), challenging the majority's conclusion that a doorway threshold is not an elevated work site. Citing numerous precedents, the dissenting justices maintain that the lack of appropriate safety devices for elevated access constitutes a violation of the Labor Law. Therefore, they advocate for denying summary judgment to the defendants and modifying the existing order.

Construction accidentElevated work siteSummary judgmentLabor Law violationDissenting opinionLadder safetyAccess to work sitePrima facie caseWorker protectionPersonal injury
References
15
Case No. ADJ8343056
Regular
Nov 05, 1972

MYRNA MEDINA vs. COUNTY OF LOS ANGELES

The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration, upholding the WCJ's award for applicant Myrna Medina's cumulative industrial injury. The defendant argued it was denied due process by not being allowed to use the AME/PQME process, but the WCJ found this issue was never raised at trial. Furthermore, the defendant failed to properly raise these arguments or support them with evidence in their petition. The Board also noted potential sanctions for knowingly false statements within the petition.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and Awardindustrial cumulative injuryEligibility Worker IItemporary disabilitypermanent disabilitymedical treatmentAME/PQME processLabor Code sections 4060
References
0
Case No. ADJ6872612
Regular
Oct 22, 2013

AIDA LOPEZ vs. C&S WHOLESALE GROCERIES

The Workers' Compensation Appeals Board (WCAB) rescinded a prior order reinstating findings that applicant sustained an industrial psychiatric injury and ordered a new psychiatric PQME due to alleged ex-parte communication. The WCAB found that crucial evidence regarding the communication, specifically letters between the defendant and the PQME, was not admitted into the record. Therefore, the case is returned to the trial level for clarification of the evidence and a new decision, while also cautioning against gamesmanship and suggesting an Agreed Medical Examination (AME) to expedite the process.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationOrder Reinstating Findings and OrderPanel Qualified Medical Examiner (PQME)Labor Code section 4062.3(e)Ex-parte communicationDiscoveryAgreed Medical Examination (AME)Writ of ReviewPanel striking
References
2
Case No. ADJ6593388
Regular
Oct 21, 2014

JENNIFER GARRETT vs. HIGH DESERT MEMORIAL HOSPITAL DISTRICT, ALPHA FUND

The Workers' Compensation Appeals Board vacated its prior order granting reconsideration and dismissed the applicant's Petition for Reconsideration because it was filed against a non-final, procedural order directing an AME to issue a supplemental report. The Board also denied the applicant's Petition for Removal, finding no substantial prejudice or irreparable harm, as removal is an extraordinary remedy. The applicant's contention that she had a due process right to a new PQME was based on mere speculation about the AME's report. The Board admonished the applicant's counsel for filing the inappropriate petition.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalAgreed Medical EvaluatorSupplemental ReportQualified Medical Evaluator PanelInterlocutory OrderFinal OrderSubstantive RightIrreparable Harm
References
11
Case No. ADJ4133886 (AHM 0150741)
Regular
Jan 18, 2011

HUGO ABADIA vs. QUICKSILVER, INC., ACE USA

This case involves a dispute over an applicant's entitlement to spinal surgery following an admitted industrial injury. The defendant seeks reconsideration of a decision awarding surgery, arguing the utilization review denial was timely and the applicant waived timeliness objections by agreeing to an Agreed Medical Examiner (AME) process. The Appeals Board granted reconsideration, finding the applicant waived their right to object to the timeliness of the utilization review by participating in the AME process. Consequently, the Board rescinded the award and remanded the case for further proceedings to address the medical necessity of the surgery, including the AME's reports.

Workers' Compensation Appeals BoardUtilization ReviewAgreed Medical ExaminerReconsiderationExpedited HearingFindings and AwardSpinal SurgeryLow Back InjuryWaiverTimeliness
References
2
Case No. MISSING
Regular Panel Decision

Ames v. Group Health Inc.

Plaintiffs, including trustees John Ames and Michael Pantony of the United Welfare Fund-Welfare Division (UWF) and participant Fred Tremarcke, sued Group Health Incorporated (GHI) under ERISA and HIPAA. They alleged GHI illegally discriminated against Tremarcke by denying his health coverage after he went on disability leave, arguing it violated HIPAA's anti-discrimination provisions and breached the insurance policy. Tremarcke's employer, Classic Chevrolet, continued making health contributions on his behalf, and a 'Side Letter of Understanding' with his union attempted to maintain his 'active employee' status. The court ultimately ruled in favor of GHI, finding that Tremarcke did not meet the eligibility requirements of the UWF-GHI plan, which required working over 20 hours per week, and that the 'Side Letter' could not unilaterally alter GHI's contractual obligations. Consequently, the plaintiffs' motion for partial summary judgment was denied, and the defendant's motion for partial summary judgment was granted, dismissing the second and third causes of action.

ERISAHIPAACOBRAHealth InsuranceDisability BenefitsSummary JudgmentFiduciary DutyBreach of ContractMulti-employer FundCollective Bargaining Agreement
References
6
Case No. MISSING
Regular Panel Decision

Steuben Foods, Inc. v. GEA Process Engineering, Inc.

Plaintiff Steuben Foods, Inc. initiated a patent infringement lawsuit against Defendants GEA Process Engineering and GEA Procomac S.p.A., alleging infringement of United States Patent No. 6,209,591. The case involved motions for summary judgment filed by the Defendants, which were subject to reports and recommendations by a Magistrate Judge. Following Plaintiff's objections to the Magistrate Judge's second Report and Recommendation, the District Court reviewed the matter de novo. The Court ultimately denied Plaintiff's objections and adopted the Magistrate Judge's recommendation, granting Defendants' amended motion for summary judgment. The decision hinged on the proper construction of the patent claim term "into," which the Court found to imply the possibility of contact with the contents of a region, a condition not met by the accused product.

Patent InfringementSummary JudgmentClaim ConstructionFederal Rules of Civil ProcedureMagistrate JudgeReport and RecommendationObjectionsSterile RegionsValve Activation MechanismAseptic Processing
References
12
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