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Case Law Database

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

Case No. MISSING
Regular Panel Decision

Claim of Arena v. Crown Asphalt Co.

Thomas Arena (decedent) sustained a work-related foot injury in 1980, leading to workers' compensation benefits and subsequent renal failure. Decedent and his wife (claimant) filed a third-party medical malpractice action against treating physicians and the hospital, which was settled in 1988 through a structured settlement. A stipulation between the carrier and decedent outlined the carrier's offset credit against decedent's workers' compensation claim and reserved rights against future death benefits claims, but claimant was not a signatory. After decedent's death in 1993, claimant filed for death benefits, prompting the carrier to seek an offset credit from the third-party settlement proceeds. The Workers’ Compensation Board initially found the carrier entitled to a credit, but later reversed itself, ruling against any credit. The appeals court determined that the carrier sufficiently preserved its offset rights through a general release signed by both claimant and decedent. However, it found no clear agreement on the specific offset amount in the stipulation or settlement that applied to claimant's death benefits. Consequently, the Board's decision of zero credit was reversed, and the matter was remitted for a factual determination of the precise credit amount.

Offset CreditThird-Party SettlementDeath Benefits ClaimRenal FailureMedical MalpracticeStipulation AgreementGeneral ReleaseWaiver of RightsStructured SettlementApportionment of Damages
References
12
Case No. MISSING
Regular Panel Decision

Jeffries v. Pension Trust Fund of the Pension, Hospitalization & Benefit Plan of the Electrical Industry

Plaintiff Claude Jeffries, a retired electrician, sued the Pension Trust Fund of the Electrical Industry under ERISA, seeking to include pension credits from 1969-1975 in his current benefits. He alleged the Plan should have declared a partial termination during a 1975-1979 New York recession, which would have vested his benefits. The defendant moved to dismiss the complaint, arguing lack of standing and statute of limitations, while plaintiff moved for class certification for similarly affected members. The court denied the defendant's motion to dismiss the claim for benefits, finding it timely, but granted dismissal for the breach of fiduciary duty claim as time-barred. The plaintiff's motion for class certification was denied due to insufficient evidence for numerosity, with leave to refile after discovery.

ERISAPension BenefitsClass CertificationMotion to DismissStatute of LimitationsFiduciary DutyPartial TerminationBenefit ForfeitureUnemploymentLabor Union
References
15
Case No. MISSING
Regular Panel Decision

Jamal v. Gohel

This case involves an appeal by the New York State Insurance Fund (SIF) from an order of the Supreme Court, Dutchess County. The Supreme Court had granted the plaintiff's motion to extinguish SIF's right to claim a credit or offset against Workers' Compensation death benefits and to compel reinstatement and retroactive payment of these benefits. The plaintiff had initially received death benefits from SIF after her husband's work-related death, and also won a jury award in a wrongful death action against a third party. SIF later asserted a right to a credit or offset against the death benefits for the jury award proceeds, suspending payments, which the plaintiff challenged. The appellate court reversed the Supreme Court's order, ruling that primary jurisdiction for determining the applicability of Workers' Compensation Law, particularly regarding an insurer's right to claim a credit or offset, rests with the Workers’ Compensation Board, not the Supreme Court.

Wrongful DeathWorkers' Compensation BenefitsInsurance FundCredit or OffsetPrimary JurisdictionWorkers' Compensation BoardAppellate ReviewDutchess CountyStatutory RightsDeath Benefits
References
7
Case No. 2019-01-0630
Regular Panel Decision
Oct 28, 2020

Ferguson, Anne Michelle v. Amazon.com, Inc.

Anne Michelle Ferguson, an Amazon employee, sought permanent total disability and medical benefits for complex regional pain syndrome (CRPS) after injuring her left foot at work in October 2017. Amazon contended that benefits should be limited to a foot contusion and sought a credit for overpayment of temporary partial disability benefits. The Court weighed competing medical expert opinions, ultimately giving greater weight to Dr. Dreskin's diagnosis of compensable CRPS. Consequently, the Court awarded Ms. Ferguson permanent partial disability benefits of $8,858.13 and ongoing medical benefits, including access to a panel of CRPS specialists. However, her claim for permanent total disability was denied as she was deemed capable of sedentary work, and Amazon received a credit for previously overpaid temporary benefits.

Workers' CompensationPermanent Partial DisabilityComplex Regional Pain Syndrome (CRPS)Medical BenefitsVocational DisabilityMaximum Medical Improvement (MMI)Temporary Partial DisabilityPain ManagementMedical Expert TestimonyFoot Injury
References
5
Case No. MISSING
Regular Panel Decision

Claim of Beth V. v. New York State Office of Children & Family Services

Claimant, a youth division aide, suffered severe injuries including physical assault, rape, and kidnapping during work, leading to established workers' compensation benefits and a classification of permanent partial disability. She subsequently reached a $650,000 settlement in a federal civil rights action against her employer and co-employees for the same injuries. The workers' compensation carrier waived its lien for past benefits but asserted a right to a credit for future payments against the settlement under Workers’ Compensation Law § 29. The Workers’ Compensation Board reversed a Workers’ Compensation Law Judge’s decision, ruling in favor of the carrier's credit, finding the settlement covered the same injuries for which workers' compensation benefits were awarded. The appellate court affirmed the Board's decision, confirming the carrier's entitlement to a credit against the third-party settlement recovery.

Workers' CompensationThird-Party SettlementCredit Against RecoveryLienFuture BenefitsPermanent Partial DisabilityPTSDRapeCivil Rights ClaimFederal Lawsuit
References
4
Case No. 2016-07-0074
Regular Panel Decision
Jul 17, 2017

Latch, Terry v. A&A Express

Terry Latch, a truck driver, sought medical and temporary disability benefits for a neck injury sustained at A&A Express. The employer contested causation and Mr. Latch's refusal of light duty. The Workers' Compensation Judge, crediting the treating neurosurgeon Dr. Parsioon over an IME, found the neck injury compensable, thus granting medical benefits, including approval for a proposed spinal fusion surgery. However, the court denied temporary disability benefits, ruling that Mr. Latch unreasonably refused the employer's offer of a light-duty desk position. The decision emphasizes the presumption of correctness afforded to treating physicians' opinions over one-time IME evaluations.

Workers' CompensationNeck InjurySpinal FusionLight Duty RefusalTemporary DisabilityMedical BenefitsCausation DisputeTreating PhysicianIndependent Medical ExaminationHerniated Disc
References
9
Case No. MISSING
Regular Panel Decision
Jun 16, 2006

Fortis Benefits v. Cantu

Vanessa Cantu suffered severe injuries in a car accident and sued multiple parties. Her medical insurer, Fortis Benefits, intervened, seeking subrogation for medical benefits paid under the policy. After Cantu settled with the defendants, Fortis pursued recovery from Cantu. Cantu argued that the equitable "made whole" doctrine barred Fortis's claim because her total losses exceeded the settlement amount plus the benefits Fortis paid. The trial court and court of appeals sided with Cantu. The Texas Supreme Court reversed, holding that the "made whole" doctrine does not override an insurer's clear contractual subrogation rights. The Court affirmed the dismissal of Fortis's claims against Ford due to a pretrial agreement.

Insurance SubrogationMade Whole DoctrineContractual SubrogationEquitable SubrogationERISATexas LawInsurance Policy InterpretationPersonal InjuryAutomobile AccidentSettlement Proceeds
References
28
Case No. MISSING
Regular Panel Decision

Travelers Indemnity Co. of Rhode Island v. Starkey

The Travelers Indemnity Company of Rhode Island appealed a trial court's judgment that awarded death benefits to Lynn Edward Starkey and Hazel Dean Starkey under the Texas Workers’ Compensation Act. The case stemmed from Jonathan Starkey's work-related injuries in 1984, for which Travelers paid indemnity benefits until his death in 2001. His parents subsequently sought death benefits, which Travelers disputed, asserting a right to deduct previously paid benefits. The trial court found that Travelers had waived this credit in a third-party settlement agreement. The appellate court affirmed, concluding that the contractual language constituted a waiver of Travelers' rights to an offset and upheld the award of benefits, attorneys' fees, interest, and costs to the Starkeys.

Workers' CompensationDeath BenefitsIndemnity BenefitsThird-Party SettlementContractual WaiverCredit OffsetWage Rate DisputeAppellate CourtTexas LawEvidentiary Sufficiency
References
22
Case No. 2018-01-0224
Regular Panel Decision
Aug 23, 2019

Yearby, Reginald v. Armstrong Relocation

This expedited hearing addressed whether the employee, Reginald Yearby, was entitled to temporary disability benefits at the maximum compensation rate of $992.20, and if the employer, Armstrong Relocation, was due a credit for overpayment. The Court found Mr. Yearby's actual taxable earnings were significantly less than initially stated, derived from his 2016 and 2017 tax returns, even though he was treated as an employee for workers' compensation purposes despite being an independent contractor. Citing Tennessee Code Annotated, the Court determined Mr. Yearby's correct average weekly wage was $552.50, leading to a compensation rate of $368.35. Consequently, his request for maximum benefits was denied, and Armstrong Relocation was granted a credit for past overpayments.

Temporary disability benefitsWorkers' CompensationAverage weekly wageOverpaymentExpedited hearingIndependent contractorEarningsBusiness expensesCompensation rateMedical treatment
References
2
Case No. ADJ4465666 (OAK 0286384) ADJ2738204 (OAK 0277457)
Regular
Jun 22, 2012

NAQUISHA HENSLEY vs. A.C. TRANSIT DISTRICT, SUBSEQUENT INJURIES BENEFITS TRUST FUND

The Appeals Board granted reconsideration, rescinding the WCJ's decision that denied the employer reimbursement for a $10,200 mistaken payment. The Board found the applicant should have known the payment was an error, given its identical amount to a previous settlement check from the Subsequent Injuries Benefits Trust Fund. While the employer's adjuster was negligent, the Board exercised its discretion to allow the employer a credit of $10,200 against future workers' compensation benefits rather than ordering direct reimbursement due to the time lapse and applicant's spending of the funds. This credit includes future medical treatment, acknowledging the employer's fault in the overpayment.

Workers' Compensation Appeals BoardA.C. Transit DistrictSubsequent Injuries Benefits Trust FundPetition for ReconsiderationFindings And OrdersErroneous PaymentReimbursementCreditStipulated AwardsCompromise and Release
References
9
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