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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

Claim of Lewis v. Stewart's Marketing Corp.

A claimant sustained serious injuries in 1997 and was awarded workers' compensation benefits. In 2008, a dispute arose regarding the permanency and degree of disability, with conflicting medical reports submitted by the claimant (permanent total disability) and the employer (moderate partial disability). The Workers' Compensation Law Judge denied the employer's request to cross-examine the claimant and his physician, subsequently ruling that the claimant had a permanent total disability. Upon appeal, the Workers’ Compensation Board affirmed this decision. The appellate court reversed the Board's decision, emphasizing that denying the employer's timely request for cross-examination was improper, especially given the conflicting medical evidence, and remitted the matter for further proceedings.

Workers’ CompensationDisability AssessmentPermanent Total DisabilityIndependent Medical ExaminationCross-Examination RightsProcedural Due ProcessConflicting Medical EvidenceRemittalAppellate ReviewBoard Decision Reversal
References
3
Case No. MISSING
Regular Panel Decision
May 17, 2004

Claim of Patterson v. Empire Blue Cross & Blue Shield

The claimant sustained physical and psychological injuries on September 11, 2001, during the evacuation of her workplace at World Trade Center Tower One in Manhattan. In March 2003, the employer moved to discontinue benefits, arguing that claimant no longer had a work-related disability. A Workers’ Compensation Law Judge (WCLJ) ordered depositions of medical experts. Claimant’s attorney failed to appear for the deposition of the employer’s orthopedic expert. Consequently, the WCLJ ruled that the claimant waived her right to cross-examine the expert and found no further work-related disability after May 12, 2003. The Workers’ Compensation Board affirmed this decision, which the claimant subsequently appealed. The Appellate Division affirmed the Board’s determination, citing substantial evidence supporting the finding of no further disability and concluding that the WCLJ did not abuse its discretion in denying an adjournment for cross-examination.

Workers' CompensationDisabilityMedical Expert TestimonyWaiver of Cross-ExaminationAdjournmentAppellate ReviewSeptember 11World Trade CenterNew York StateWorkers' Compensation Board
References
7
Case No. MISSING
Regular Panel Decision
Apr 15, 1983

American White Cross Laboratories, Inc. v. North River Insurance

Vincent Yeager, an employee of American White Cross Laboratories, Inc. (American), was injured during employment, leading to a lawsuit against a machine manufacturer, who then brought a third-party action against American for indemnification. American was covered by both a workers’ compensation policy from the State Insurance Fund and a general liability policy from North River Insurance Co. North River disclaimed liability, citing exclusions for workers’ compensation obligations and bodily injury to employees. American then initiated a fourth-party action against North River for contribution. The Supreme Court initially denied American's summary judgment motion and granted North River's cross-motion to dismiss, with leave to replead for indemnification. This court reversed, holding that North River's exclusions do not insulate it from American’s claims because the employer's liability to a third-party tort-feasor for an employee's injury arises from equitable apportionment, not directly from workers' compensation law, thus granting American's motion for summary judgment and denying North River's cross-motion.

Insurance coverage disputeGeneral liability policyWorkers' compensation exclusionContribution between tort-feasorsIndemnificationSummary judgmentFourth-party actionDole-Dow doctrineEquitable apportionmentEmployer liability
References
2
Case No. 2024 NY Slip Op 00844 [224 AD3d 1079]
Regular Panel Decision
Feb 15, 2024

Matter of Cross v. New York State Dept. of Corr. & Community Supervision

Brenda Cross, the claimant, established a workers' compensation claim for knee and ankle injuries from a 2020 work accident. The employer's carrier required her to use contracted providers for diagnostic testing. After an approved MRI for her right ankle was performed by a non-contracted provider, the carrier objected to payment. The WCLJ and Workers' Compensation Board sided with the carrier but found claimant not responsible for the bill. Cross appealed, but the Appellate Division, Third Department, dismissed the appeal, ruling that Cross lacked standing as she was not aggrieved, since she was not responsible for the medical bill and any dispute over reimbursement rates was between the provider and the carrier.

Workers' Compensation ClaimMedical Bill DisputeDiagnostic TestingContracted ProvidersStanding (Law)Aggrieved PartyAppeal DismissedWorkers' Compensation Board DecisionAppellate DivisionMedical Reimbursement
References
2
Case No. MISSING
Regular Panel Decision

Schairer v. Schairer

The wife filed a motion to disqualify the law firm of Sari Friedman, P.C. from representing her husband in their ongoing divorce proceedings, citing a conflict of interest. This conflict stemmed from Ms. Friedman's prior representation of the court-appointed custody forensic expert in his own divorce case in 1995. The husband cross-moved to disqualify the same forensic expert, alleging potential bias against police officers and Ms. Friedman's previous representation of the expert. The court found a clear appearance of a conflict of interest, as Ms. Friedman could not effectively cross-examine her former client, the expert, without potentially using privileged confidential information. Consequently, the court granted the wife's motion to disqualify Sari Friedman, P.C. and denied the husband's cross-motion, determining that any claims of bias against the expert could be addressed during trial.

DivorceAttorney DisqualificationConflict of InterestForensic ExpertCustodySpousal DisputeProfessional EthicsConfidentialityLegal RepresentationJudicial Opinion
References
10
Case No. MISSING
Regular Panel Decision
Oct 04, 2006

Claim of McKenzie v. UJA-FED

Claimant, employed in data entry, developed bilateral carpal tunnel syndrome and sought workers' compensation benefits. The Workers' Compensation Law Judge initially dismissed the claim, but the Workers' Compensation Board reversed, finding the condition to be an occupational disease causally related to employment, based on agreement between the treating physician and an independent medical examiner, and the carrier's failure to request cross-examination. The carrier appealed, arguing the Board erred in its finding regarding cross-examination and mischaracterized medical evidence. The appellate court affirmed the Board's decision, ruling that the carrier waived its right to cross-examination by not making a timely request and finding no basis to disturb the Board's assessment of the medical evidence.

Occupational DiseaseCarpal Tunnel SyndromeWorkers' CompensationMedical EvidenceCross-Examination WaiverAppellate ReviewCausationEmployment-Related InjuryMedical Expert TestimonyBoard Decision Appeal
References
6
Case No. MISSING
Regular Panel Decision

Claim of Hutchins v. Callanan Industries

This case involves an appeal from a Workers’ Compensation Board decision regarding a claimant's compensable injury and benefits. The Workers’ Compensation Law Judge (WCLJ) precluded an independent medical examination (IME) report from the employer's carrier due to untimely filing and denied cross-examination of the treating physician. The Board affirmed these determinations and imposed a $250 penalty on the carrier for a frivolous appeal. The Appellate Division found no error in precluding the IME report due to the carrier's fault. However, it reversed the denial of cross-examination, stating that the Torres precedent, which justified denying cross-examination when there's no disagreement on condition, was inapplicable as the carrier did dispute the degree of disability. Consequently, the court also reversed the imposition of the $250 penalty, finding the carrier's application for review was not frivolous. The matter was remitted to the Workers’ Compensation Board for further proceedings.

Workers' Compensation AppealIME PreclusionCross-Examination DenialFrivolous Appeal PenaltyTimely FilingMedical EvidenceAdministrative ReviewAppellate ReversalRemittalWorkers' Compensation Board
References
8
Case No. MISSING
Regular Panel Decision

Dorato v. Blue Cross of Western New York, Inc.

George Dorato (plaintiff) sued Blue Cross of Western New York (defendant), also known as HealthNow, Inc., doing business as Blue Cross & Blue Shield of Western New York, after his health insurance benefits for a herniated disk were denied. Dorato's workers' compensation claim, which alleged a work-related injury, resulted in a $80,000 Section 32 settlement agreement, although his claim was officially 'disallowed' by the Workers' Compensation Board. HealthNow denied benefits citing a contract exclusion for injuries where payment is available under Workers' Compensation Law, arguing the settlement constituted such payment. Dorato moved for summary judgment, seeking a de novo review and asserting collateral estoppel, and also moved to amend his complaint to recharacterize his claims under ERISA. The court applied an 'arbitrary and capricious' standard of review to HealthNow's decision, noting the contract's discretionary authority. The court found that collateral estoppel did not apply due to lack of identical issues and HealthNow's inability to participate in the WCB proceedings. Ultimately, the court granted HealthNow's motion for summary judgment, ruling that their interpretation of the contract's exclusion was rational and not arbitrary or capricious. Dorato's motions were consequently denied as futile.

ERISAWorkers' CompensationHealth InsuranceSummary JudgmentCollateral EstoppelArbitrary and Capricious StandardDe Novo ReviewBenefit DenialContract ExclusionEmployee Welfare Benefit Plan
References
29
Case No. MISSING
Regular Panel Decision

Claim of Pugliese v. Remington Arms, Inc.

The claimant, employed by Remington Arms, Inc. for over three decades, sought workers' compensation benefits, citing severe depression and anxiety stemming from alleged harassment and falsification of attendance records by a supervisor. Initially, a Workers' Compensation Law Judge denied further adjournments for an independent medical examination (IME) report and cross-examination of the treating psychologist, determining the depression to be an occupational disease. The Workers' Compensation Board subsequently modified this, reclassifying it as a compensable accidental injury. The employer and its carrier appealed, challenging the use of hearsay evidence, the preclusion of their IME report, and the denial of their right to cross-examine the claimant's treating psychologist. The appellate court found sufficient corroboration for the hearsay evidence and upheld the IME report's preclusion due to the carrier's delays. However, the court reversed the denial of cross-examination, stating that the absence of the IME report did not negate the carrier's right, especially given their dispute on causal relationship. Consequently, the case was reversed and remitted to the Workers' Compensation Board for further proceedings.

DepressionAnxietyWorkplace HarassmentAttendance Records FalsificationIndependent Medical ExaminationIME Report PreclusionRight to Cross-ExaminationHearsay EvidenceCorroborating EvidenceOccupational Disease
References
11
Case No. ADJ1880658
Regular
Feb 09, 2011

CLAIRE COATS vs. STATE COMPENSATION INSURANCE FUND

The applicant sought reconsideration of a WCJ's decision that denied her motion to strike a permanent disability rating and denied her request for cross-examination of the rater. The Appeals Board granted reconsideration, finding that the applicant was improperly denied her due process right to cross-examine the rater. The Board rescinded the WCJ's decision and returned the case to the trial level for a new WCJ to conduct further proceedings and issue a new decision, allowing consideration of the applicant's other contentions. This procedural error regarding the cross-examination right necessitated the remand.

Workers' Compensation Appeals BoardClaire CoatsState Compensation Insurance FundFindings and Award and OrderSenior Claims AdjusterIndustrial InjuryPermanent DisabilityMotion to StrikeCross-examinationRater
References
1
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