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

Case No. ADJ11756653
Regular
Apr 08, 2020

EUGENIO ABAC vs. CITISTAFF SOLUTIONS, INC.; OLD REPUBLIC c/o GALLAGHER BASSETT

This case, concerning Eugenio Abac and his employer Citistaff Solutions, Inc., has been decided by the Workers' Compensation Appeals Board (WCAB) after reconsideration. The WCAB affirmed the February 11, 2020 Findings of Fact, adopting and incorporating the reasoning of the workers' compensation administrative law judge. This means the original decision regarding Mr. Abac's workers' compensation claim remains in effect.

Workers' Compensation Appeals BoardReconsiderationOpinion and DecisionFindings of FactAdministrative Law JudgeWCJCitistaff SolutionsOld RepublicGallagher BassettADJ11756653
References
0
Case No. MISSING
Regular Panel Decision
May 17, 2011

Avrio Group Surveillance Solutions, Inc. v. Essex Insurance

Plaintiff Avrio Group Surveillance Solutions commenced a declaratory judgment action against Defendant Essex Insurance Company, seeking an order to defend and indemnify Avrio in a personal injury action. Essex filed a motion to dismiss, which was converted to a motion for summary judgment. The court addressed two main exclusions: the Completed Operations Exclusion and the Contractual Liability Exclusion. The court found a potentiality of coverage under the Completed Operations Exclusion due to ambiguities in the term "intended use" and unresolved factual issues regarding the completion of work, denying summary judgment on this ground. However, the court granted summary judgment in favor of Essex regarding the Contractual Liability Exclusion, as the subcontract did not qualify as an "insured contract" under the policy's specific definition in effect at the time of the incident, and Avrio was presumed to have agreed to these terms. The case will proceed to an evidentiary hearing on the Completed Operations Exclusion.

Insurance CoverageDeclaratory JudgmentSummary JudgmentContractual Liability ExclusionCompleted Operations ExclusionInsurance Policy InterpretationChoice of LawMaryland Contract LawFederal Civil ProcedureDuty to Defend
References
37
Case No. MISSING
Regular Panel Decision

Durant v. A.C.S. State & Local Solutions Inc.

Plaintiff Sharon Durant filed a lawsuit against A.C.S. State and Local Solutions, Inc. (ACS) alleging sexual harassment and a hostile work environment. Durant, a customer service representative, claimed she received two sexually explicit notes from a co-worker, Terri Simeon. Upon reporting the second note, ACS swiftly responded by moving Durant's workstation and disciplining Simeon, which ended the direct harassment. Despite these actions, Durant resigned, asserting constructive discharge because Simeon was not fired. The court granted summary judgment in favor of ACS, ruling that there was no quid pro quo harassment, the environment was not sufficiently hostile, no constructive discharge occurred, and her state law claims and intentional infliction of emotional distress claim also failed or were time-barred.

Sexual HarassmentHostile Work EnvironmentSummary JudgmentQuid Pro QuoConstructive DischargeEmployer LiabilityCorrective ActionCo-worker MisconductEmployment DiscriminationTitle VII
References
21
Case No. 2021 NY Slip Op 07321
Regular Panel Decision
Dec 23, 2021

Matter of Salinas v. Power Servs. Solutions LLC

The case involves a workers' compensation claim by Michel Salinas, which identified Power Services Solutions LLC as the employer and Everest National Insurance Company as the carrier. Everest's appeal to the Workers' Compensation Board was denied as untimely despite concerns about deficient notice and a potentially fraudulent certificate of insurance. The Appellate Division, Third Department, reversed the Board's decision, finding an abuse of discretion given the strong evidence of fraud and the flawed communication to Everest. The matter was remitted to the Board for further proceedings to investigate the fraud allegations. The court emphasized that the Board should not ignore legitimate evidence of fraud.

Workers' Compensation LawAppellate DivisionBoard DiscretionTimeliness of AppealFraudulent Insurance CertificateNotice RequirementsEmployer IdentificationCarrier LiabilityRemittalAbuse of Discretion
References
25
Case No. ADJ3533713
Regular
Nov 07, 2011

JUANA LOPEZ vs. THE MERCHANT OF TENNIS, HARTFORD INSURANCE

The Workers' Compensation Appeals Board (WCAB) removed this matter for the purpose of imposing sanctions. The WCAB found that the petition for reconsideration filed by SIR Practice Solutions, LLC on behalf of several lien claimants was skeletal, unintelligible, and violated multiple WCAB rules regarding evidentiary and legal support. The lien claimants and SIR Practice Solutions, LLC failed to object to the Notice of Intention to Impose Sanctions within the allotted time. Therefore, the WCAB imposed sanctions of $250.00 against each individual lien claimant and found SIR Practice Solutions, LLC jointly and severally liable for these sanctions.

Workers' Compensation Appeals BoardRemovalSanctionsLien ClaimantsSIR Practice SolutionsPetition for ReconsiderationSkeletal PetitionAppeals Board Rule 10846Labor Code Section 5813Notice of Intention to Impose Sanctions
References
6
Case No. ADJ1761179 (LBO 0351115), ADJ3800791, ADJ2478410
Regular
Mar 21, 2013

MARIA MELENDEZ vs. KELERMEYER BUILDING SERVICES, INC.; REHAB SOLUTIONS aka NORTH AMERICAN DISTRIBUTORS

This case involves a lien claimant, Rehab Solutions, whose lien was dismissed by the Workers' Compensation Appeals Board (WCAB) due to non-appearance at a lien conference and failure to respond to a Notice of Intention to Dismiss. Rehab Solutions petitioned for reconsideration, arguing they received neither notice nor an opportunity to be heard. The WCJ's report, adopted by the WCAB, found that Rehab Solutions was properly noticed for the lien conference and later received a Notice of Intention to Dismiss, but failed to appear or respond for approximately 90 days. Consequently, the WCAB denied the Petition for Reconsideration, though they admonished the lien claimant that further frivolous filings would result in sanctions.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJLien ClaimantOrder Dismissing LienDeclaration of Readiness to ProceedLien ConferenceNotice of HearingNotice of Intention to Dismiss LienProof of Service
References
0
Case No. ADJ10954204
Regular
Sep 15, 2022

MARIA FLORES vs. PINNACLE HEALTH CORP., SUMMARY OF EVIDENCE INSURANCE COMPANY OF THE WEST, AFFINITY HOME HEALTH CARE SERVICES, FALLS LAKE FIRE & CASUALTY INSURANCE, SEDGWICK CMS, HOME HEALTH CARE SOLUTIONS, INC.

The Workers' Compensation Appeals Board denied a petition for reconsideration filed by Home Health Care Solutions. The applicant, an LVN, was injured in a car accident while traveling between patients for multiple agencies. The Board adopted the WCJ's report, which found the injury arose out of and occurred in the course of employment for Home Health Care Solutions. This decision was based on the fact that the applicant was required to use her own vehicle, which extended the employer-employee relationship beyond direct service. The WCJ also found the going and coming rule did not bar the claim due to the required use of transportation between patient locations.

Workers' Compensation Appeals BoardPetition for ReconsiderationGoing and Coming RuleAOE/COELVNCar AccidentAutomobile ExceptionTransitEmployment RelationshipRequired Vehicle Use
References
6
Case No. 2024 NY Slip Op 00831 [224 AD3d 1051]
Regular Panel Decision
Feb 15, 2024

Matter of Golisano v. ABX Innovative Packaging Solutions LLC

The claimant, Jason R. Golisano, filed for workers' compensation benefits in August 2021 for injuries to his left wrist and hand. A Workers' Compensation Law Judge (WCLJ) established the claim for a left wrist injury. The employer and its carrier (appellants) sought review of this decision by the Workers' Compensation Board, but their application was filed beyond the 30-day limit. The Board denied the application as untimely, and the carrier appealed. The Appellate Division, Third Department, affirmed the Board's decision, finding no abuse of discretion in denying the untimely application, despite the carrier's arguments regarding a short delay and the COVID-19 pandemic.

Workers' CompensationTimelinessApplication for ReviewBoard DiscretionAppellate ReviewCOVID-19Procedural IssueWCLJ DecisionEmployer-Carrier AppealNew York Law
References
4
Case No. ADJ3172767
Regular
May 10, 2017

VICTOR GONZALEZ vs. CITISTAFF SOLUTIONS, STATE COMPENSATION INSURANCE FUND

The Appeals Board affirmed the WCJ's decision finding the lien claimant, Monrovia Memorial Hospital, was entitled to nothing for its services. The WCJ properly excluded the lien claimant's expert declaration as it was submitted after discovery closed. The lien claimant failed to meet its burden of proving its charges were reasonable and based on a reasonable cost basis, as required by precedent in cases exempt from the Official Medical Fee Schedule. Mere presentation of usual and customary charges, without evidence of reasonableness or comparability, is insufficient.

Workers' Compensation Appeals BoardVictor GonzalezCitistaff SolutionsState Compensation Insurance FundMonrovia Memorial Hospitallien claimantbill review expertdue processreasonableness of chargesOMFS exemption
References
2
Case No. 533217
Regular Panel Decision
Jun 23, 2022

Matter of Kromer v. UPS Supply Chain Solutions

Claimant Douglas A. Kromer established a workers' compensation claim for a work-related rotator cuff tear in his left shoulder. While a Workers' Compensation Law Judge (WCLJ) initially found a 35% schedule loss of use (SLU) of the left arm, the Workers' Compensation Board modified this to 20%, crediting the opinion of Gerald Coniglio, an orthopedic surgeon. The Board further ruled that Kromer was not entitled to a further SLU award due to prior left elbow SLU awards totaling 30%, which exceeded the current 20% award. The Appellate Division reversed the Board's decision, remitting the matter for further consideration. The court found that the Board failed to consider whether the shoulder injury resulted in an increased loss of use of the left arm beyond the prior elbow injuries and also lacked a rational basis for not adding value for a posterior extension defect in the SLU calculation, departing from its own precedent.

Workers' CompensationSchedule Loss of Use (SLU)Rotator Cuff InjuryShoulder InjuryLeft ArmPrior Injury OffsetMedical OpinionImpairment GuidelinesAppellate ReviewRemittal
References
19
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