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

Case No. ADJ3623428 (MON 0334798) ADJ1196230 (MON 0334799)
Regular
Feb 08, 2010

FREDERICK DOMINGUE vs. CEDAR SINAI MEDICAL CENTER

Defendant Cedar Sinai Medical Center sought reconsideration of an approved Compromise and Release (C&R) for $99,000, settling applicant Frederick Domingue's claims for various injuries, including psyche, respiratory, and cancer. Defendant argued CMS approval was a condition precedent, applicant failed to disclose terminal brain cancer, and the WCJ abused discretion due to applicant's death post-execution but pre-approval. The Appeals Board denied reconsideration, finding no evidence CMS approval was required given the C&R's terms and CMS guidelines, and that the WCAB has discretion to approve a C&R even after an applicant's death. Furthermore, the Board found no sufficient evidence of nondisclosure of a separate terminal brain cancer condition.

Compromise and ReleasePetition for ReconsiderationOrder Approving Compromise and ReleaseMedicare Set AsideCMS approvalcondition precedentindustrial injurypsycherespiratory systemspine
References
13
Case No. ADJ8873556
Regular
Jun 03, 2016

LUIS ALVARENGA vs. SCOPE INDUSTRIES, COMMERCE & INDUSTRY INSURANCE, AIG CLAIMS

The Workers' Compensation Appeals Board granted reconsideration and rescinded an order approving a Compromise and Release (C&R). The defendant argued for rescission based on a mutual mistake regarding the necessity of CMS approval for the Medicare Set Aside (MSA) amount. While CMS approval is not mandatory, the Board found the C&R inadequate as written. Specifically, the settlement did not adequately account for the MSA amount in relation to the applicant's net recovery, and the applicant was not fully advised of potential Medicare benefit denials if CMS review was bypassed. The case is returned for further proceedings to address these adequacy issues.

Compromise and ReleaseMutual MistakeMedicare Set AsideCMS ApprovalPetition for ReconsiderationOrder Approving Compromise and ReleaseRescindGood CauseFuture Medical TreatmentAdequate Consideration
References
5
Case No. ADJ2244538 (LAO 0883304)
Regular
Jul 29, 2011

MELVIN ISAAC vs. PARAMOUNT PICTURES

This case involves the Workers' Compensation Appeals Board (WCAB) removing a matter on its own motion to review a Compromise and Release (C&R) order. The WCAB issued a Notice of Intention to approve the C&R with addenda, allowing parties 20 days to object. As no objections were received, the WCAB rescinded the WCJ's prior approval and entered a new order approving the C&R with the addenda. The cases are now returned to the trial level for further proceedings.

Workers' Compensation Appeals BoardRemovalCompromise and ReleaseAddendaWCJ OrderRescindedApprovedTrial LevelParamount PicturesMelvin Isaac
References
0
Case No. ADJ2214463 (VNO 0522433)
Regular
Feb 19, 2009

RICARDO DUARTE PONCE vs. ROSS STORES, INC., SEDGWICK CLAIMS MANAGEMENT SERVICES

The Appeals Board granted reconsideration to set aside the Order Approving Compromise and Release (OACR). The defendant sought to vacate the OACR because the parties' settlement agreement, which included a Medicare Set Aside (MSA) allocation, was contingent on approval by the Centers for Medicare Services (CMS) that was never obtained. Since the applicant was a Medicare beneficiary and the settlement exceeded $25,000, federal regulations require CMS approval of the MSA. The Board rescinded the OACR and returned the matter for further proceedings.

Medicare Set AsideMSA allocationCenters for Medicare ServicesCMS approvalCompromise and ReleaseOACRPetition for ReconsiderationRescind OrderGood CauseEquitable Grounds
References
8
Case No. MISSING
Regular Panel Decision
Jun 14, 2012

Williams v. Orange & Sullivan Excavating Corp.

This case concerns an appeal challenging the approval of a personal injury settlement nunc pro tunc under Workers' Compensation Law § 29 (5). The Supreme Court, Orange County, initially granted the petition for approval, and the appellate court affirmed this decision. The ruling reiterates that employees must obtain either carrier consent or judicial approval within three months of settlement to maintain workers' compensation benefits. However, a nunc pro tunc order can still be granted after three months if the settlement is reasonable, the delay is not due to the employee's fault, and the carrier is not prejudiced. The appellate court concluded that the Supreme Court appropriately exercised its discretion in granting the nunc pro tunc approval, aligning with established legal precedent regarding such petitions.

Workers' Compensation Law § 29 (5)Personal Injury SettlementNunc Pro TuncJudicial ApprovalWorkers' Compensation BenefitsAppellate AffirmationDelay ExcuseReasonable SettlementCarrier PrejudiceJudicial Discretion
References
9
Case No. MISSING
Regular Panel Decision

Singh v. Ross

The plaintiffs appealed an order from Queens County, dated September 26, 2003, which denied their motion for nunc pro tunc judicial approval of a settlement under Workers’ Compensation Law § 29 (5). This law requires either carrier consent or judicial approval within three months of a settlement to avoid forfeiture of future workers' compensation benefits. While judicial approval can be sought beyond the three-month period if the settlement is reasonable, the delay is not due to the party's fault, and the carrier is not prejudiced, the Supreme Court denied the motion. The court found the over one-year delay in seeking approval was attributable to the plaintiffs' own fault or neglect. The appellate court affirmed this decision.

Workers' CompensationJudicial ApprovalSettlementNunc Pro TuncDelay in ApplicationCourt DiscretionAppellate ReviewPersonal InjuryThird-Party ActionForfeiture of Benefits
References
6
Case No. MISSING
Regular Panel Decision

Cosgrove v. County of Ulster

Petitioner, injured in a work-related accident, received workers' compensation and subsequently settled a third-party tort action against the respondent for $15,000. Petitioner's counsel believed the employer's insurance carrier had approved a one-third share of the settlement but the carrier failed to provide disbursement instructions for its portion. After the carrier terminated workers' compensation benefits, petitioner sought judicial approval of the settlement nunc pro tunc. The Supreme Court granted this approval, which the carrier then appealed. The Appellate Division affirmed the Supreme Court's order, concluding that the settlement amount was reasonable, the delay in seeking judicial approval was not due to petitioner's fault, and the carrier was not prejudiced by the delay.

Workers' CompensationPersonal Injury SettlementNunc Pro Tunc ApprovalJudicial DiscretionCarrier ConsentThird-Party ActionAppellate ReviewSettlement ReasonablenessDelay ExcuseLack of Prejudice
References
12
Case No. MISSING
Regular Panel Decision

Snyder v. CNA Insurance

In January 1996, the petitioner sustained injuries in a motor vehicle accident while working and received workers’ compensation benefits from CNA Insurance Companies. She later settled a third-party negligence action for $32,500 without obtaining the required consent from CNA. The petitioner sought judicial approval, nunc pro tunc, for this settlement. The Supreme Court initially granted approval, but the appellate court reversed and remitted due to insufficient documentation. Following the submission of additional evidence, the Supreme Court again granted approval, prompting the current appeal. The appellate court reviewed the relevant factors, noting evidence suggesting difficulty in proving serious injury and that respondent CNA suffered no prejudice from the delay. Despite the normal three-month limit for such applications, the Supreme Court's exercise of broad discretion in approving the settlement was not deemed an abuse. Therefore, the order of the Supreme Court was affirmed.

Workers' CompensationPersonal InjuryMotor Vehicle AccidentThird-Party SettlementJudicial ApprovalNunc Pro TuncConsent RequirementDiscretionary AuthorityAppellate ReviewInsurance Carrier
References
4
Case No. MISSING
Regular Panel Decision

Rifenburgh v. James

Petitioner was injured in an automobile accident while en route to an employer-directed physical examination and subsequently sought workers' compensation benefits. He also commenced a third-party action, which was settled without the workers' compensation carrier's consent or timely judicial approval. The Workers' Compensation Law Judge closed the case after petitioner failed to obtain judicial approval. Petitioner later attempted to reopen the claim by seeking nunc pro tunc judicial approval, but Supreme Court denied the application due to undue delay. The Appellate Division affirmed this denial, concluding that the delay was attributable to the petitioner's own neglect, thereby barring future workers' compensation benefits.

Automobile AccidentThird-Party ActionSettlement without ConsentJudicial ApprovalNunc Pro TuncUndue DelayPetitioner NeglectWorkers' Compensation BenefitsCourse of EmploymentAppellate Review
References
4
Case No. MISSING
Regular Panel Decision
Aug 25, 1997

Harosh v. Diaz

The plaintiff appealed an order from the Supreme Court, Queens County, dated August 25, 1997, which denied his motion to renew a prior motion for judicial approval of a compromise and settlement. The plaintiff was injured in 1993 when struck by the defendants' vehicle and settled his action against them for $10,000 in 1994. He subsequently filed a Workers' Compensation claim and, in February 1996, moved for approval of the settlement under Workers' Compensation Law § 29 (5), which was initially denied without prejudice. His renewed motion in May 1997 was denied as untimely, a decision the appellate court affirmed. The court emphasized that judicial approval beyond the statutory three-month period requires demonstrating the settlement's reasonableness, lack of petitioner's fault for the delay, and no prejudice to the carrier, which the plaintiff failed to do.

Appellate DecisionWorkers' Compensation LawSettlement ApprovalTimelinessPersonal InjuryAutomobile AccidentInsurance CarrierJudicial ReviewRenew MotionQueens County
References
3
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