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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
Jan 05, 2009

Glew v. Cigna Group Insurance

Plaintiff George Glew, a volunteer EMT, contracted hepatitis C and other illnesses after a needle stick injury in March 1994 while on duty. He filed a claim with CIGNA, the insurer, under an accident and sickness policy. CIGNA denied the claim, asserting the policy was 'accident only' or that notice was not timely. Glew sued to recover disability payments. The court found that CIGNA's 1994 accident and sickness policy, though lost, had terms similar to a 1995 VFIS policy, providing indefinite coverage for infectious diseases. The court ruled that Glew proved his total and permanent disability was caused by the needle stick and that he complied with the policy's notice provisions, thus entitling him to total disability benefits from CIGNA.

Insurance CoverageDisability BenefitsInfectious DiseaseNeedle Stick InjuryHepatitis CEMT WorkerVolunteer Ambulance WorkerLost PolicySecondary EvidenceBurden of Proof
References
26
Case No. MISSING
Regular Panel Decision

Unsecured Claims Estate Representative of Teligent, Inc. v. Cigna Healthcare, Inc. (In Re Teligent Inc.)

This case is an appeal by Savage & Associates, P.C., acting as the Unsecured Claims Estate Representative for Teligent, Inc., against Cigna Healthcare. The Representative challenged the Bankruptcy Court's summary judgment ruling, which determined that Teligent had assumed a group insurance contract with Cigna. The central issue on appeal was whether the original insurance policy terminated due to periodic rate renewals, thereby giving rise to new contracts and allowing the recovery of preference payments made to Cigna. The Bankruptcy Court concluded that the insurance contract was a single, continuous agreement, with re-ratings merely adjustments rather than terminations. The District Court affirmed this decision, holding that the policy lacked a fixed term and continued indefinitely, and that rate renewals did not constitute new contracts.

BankruptcyInsurance ContractExecutory ContractContract AssumptionSummary JudgmentAppealPreference PaymentsRate RenewalContract InterpretationDelaware Law
References
36
Case No. MISSING
Regular Panel Decision

Straehle v. INA Life Ins. Co. of New York

Plaintiff Julie Straehle sued CIGNA Life Insurance Company under ERISA for wrongfully denying her long-term disability benefits claim after she allegedly injured her back and shoulder at work. The court reviewed CIGNA's two-step denial process, including the administrative appeal and additional evidence presented at a bench trial. The court applied a de novo standard of review, discounting Straehle's subjective complaints of pain and her treating physician's conclusory opinions due to inconsistencies with objective medical evidence and observed behaviors. Ultimately, the court found that Straehle failed to demonstrate her inability to perform the material duties of her sedentary occupation within the policy's terms. Therefore, judgment was granted for the defendant, CIGNA's denial of benefits was affirmed, and the complaint was dismissed.

ERISALong-Term Disability BenefitsDisability DenialDe Novo ReviewSubjective PainObjective Medical EvidenceTreating Physician RuleFunctional Capacity AssessmentRotator Cuff InjuryCervical Sprain
References
6
Case No. BAK 128071
Regular
Apr 07, 2008

COURTNEY PENEBAKER vs. CIGNA HEALTHCARE and CIGNA PROPERTY & CASUALTY COMPANY / ACE USA

The Appeals Board denied the defendant's petition for reconsideration, upholding the administrative law judge's decision that the applicant could continue treatment with her chosen surgeon outside the defendant's Medical Provider Network (MPN). The defendant failed to provide proper notice of the MPN and applicant's rights, thus unreasonably refusing to authorize treatment and travel expenses. This failure to comply with MPN notification requirements meant the defendant remained liable for reasonable medical treatment self-procured by the applicant.

Medical Provider NetworkMPNReconsiderationFindings Order and AwardIndustrial InjuryBilateral Upper ExtremitiesCumulative TraumaPermanent DisabilityPenaltiesAttorneys Fees
References
4
Case No. MISSING
Regular Panel Decision
Mar 19, 1998

Conciatori v. Longworth

The plaintiff appealed two orders from the Supreme Court, Queens County. The first order, entered December 19, 1997, granted summary judgment to defendants Peter Longworth, Foley, Smit, O’Boyle and Weisman, CIGNA Companies Insurance Company of North America, and Janice Bogner, dismissing the defamation complaint against them, and denied the plaintiff's cross-motion to amend. The second, a judgment entered March 19, 1998, dismissed the complaint. The appellate court dismissed the appeal from the intermediate order as the right of direct appeal ended with the judgment entry. The court affirmed the judgment, concluding that statements made by attorney Peter Longworth at a Workers' Compensation Board hearing were absolutely privileged as they related to the hearing's subject. Furthermore, statements by Janice Bogner, acting within Cigna's employment and related to the Workers' Compensation Board matter, were qualifiedly privileged; the plaintiff failed to show malice. Claims for prima facie tort and tortious interference with contractual relations were also properly dismissed due to lack of specificity regarding special damages and failure to prove intentional procurement of contract breach, respectively.

Summary JudgmentDefamationAbsolute PrivilegeQualified PrivilegeWorkers' Compensation BoardPrima Facie TortTortious InterferenceAppellate ProcedureNew York LawAttorneys
References
14
Case No. MISSING
Regular Panel Decision
Mar 02, 1994

Robinson v. CIGNA

The defendant appealed an order from the Supreme Court, Nassau County (McCabe, J.), which denied its motion for partial summary judgment to dismiss the first through fourth causes of action in a breach of contract action. The appellate court reversed the lower court's order and granted the defendant's motion for partial summary judgment. The court determined that the respondents failed to present triable issues of fact concerning their claim for annual cost-of-living increases under the Longshore and Harbor Workers’ Compensation Act. The appellate panel noted that qualification for such relief under 33 USC § 910 (f) requires a "permanent total disability," whereas the Workers’ Compensation Board had previously found the respondents suffered only a "partial permanent disability."

Breach of ContractPartial Summary JudgmentAppellate ReviewCost-of-Living AdjustmentLongshore and Harbor Workers' Compensation ActPermanent Total DisabilityPartial Permanent DisabilityWorkers' Compensation BoardStatutory InterpretationNassau County
References
2
Case No. SAC 0332085
Regular
Aug 04, 2008

ROCKY GRIMES vs. ENVIROCON, CIGNA

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, affirming the finding that the applicant sustained an industrial injury due to Valley Fever, as the defendant failed to timely deny the claim and did not present sufficient evidence to rebut the presumption of injury. The Board also dismissed the applicant's petition for reconsideration, stating that the applicant was not aggrieved by a final order, as the WCJ ruled in their favor regarding the industrial injury. The defendant was admonished for attempting to introduce new evidence after discovery had closed without proper acknowledgment.

Workers Compensation Appeals BoardIndustrial InjuryValley FeverCoccidioidomycosisLungsProstateTesticlesBrainHipsKnees
References
0
Case No. MISSING
Regular Panel Decision
Sep 22, 2003

Cigna Property & Casualty v. Liberty Mutual Insurance

The Supreme Court, New York County, affirmed a judgment vacating an arbitration award. The court determined that the arbitrator's conclusion, which granted priority of payment to a workers' compensation carrier solely because a claim was paid, lacked necessary evidentiary support. Citing Insurance Law § 5105 (a), the decision emphasized that any request for reimbursement must be predicated on an allocation of loss. As the record failed to provide evidence of such an allocation, the court found the award was properly vacated.

ArbitrationWorkers' CompensationVacatur of AwardEvidentiary SupportAllocation of LossInsurance LawCPLRReimbursementPriority of PaymentAppellate Decision
References
1
Case No. ADJ13109382
Regular
Nov 23, 2020

TERESA CERASIA vs. CIGNA, ACE AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration of the original award. The Board rescinded the prior decision and returned the case to the trial judge for further proceedings due to insufficient substantial evidence. Specifically, the Board found the record needed development regarding the applicant's claim of temporary total disability, the admissibility of a physician's report, and the applicant's resignation circumstances. The issue of ongoing temporary disability benefits also requires further development of the record.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact & AwardTemporary Total DisabilityPrimary Treating PhysicianMedical ReportsAdmissibility of EvidenceForm 5021PR-2 formAD Rule 9785
References
0
Case No. VNO 0276776 VNO 0466575
Regular
May 13, 2008

LUCY ARRIETA vs. BORDEN FOOD SERVICE, CIGNA INSURANCE COMPANY (ESIS)

The Workers' Compensation Appeals Board (WCAB) granted reconsideration, striking the sanctions imposed on the defendant. The WCAB found that Labor Code section 5813, which authorizes sanctions, was inapplicable as both the injury and the application filing predated its effective date. The WCAB otherwise affirmed the WCJ's findings regarding new and further disability and entitlement to benefits.

Petition for ReconsiderationFindings and AwardPetition to ReopenOrder Imposing SanctionsLabor Code § 5813compensable consequence injuriesnew and further disabilitycredibilityapplicant's responseReport of Workers' Compensation Judge
References
2
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