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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
Feb 22, 1984

Barnhardt v. Hudson Valley District Council of Carpenters Benefit Funds

The plaintiff, injured in May 1978 during maintenance work, was denied workers' compensation due to the absence of an employer-employee relationship. Subsequently, he sought reimbursement for medical expenses from the Hudson Valley District Council of Carpenters Benefit Funds (Benefit Funds) through a union insurance policy. Continental Assurance Company (Continental), Benefit Funds' insurer, rejected the claim, citing an employment-related injury exclusion in the policy. The plaintiff then initiated an action against Benefit Funds, which in turn filed a third-party action against Continental seeking indemnification. Continental's motion for summary judgment, asserting the exclusion, was denied by the County Court. The appellate court affirmed this denial, ruling that the exclusionary language was ambiguous and applied only in cases where a clear employer-employee relationship existed, a fact still to be determined.

Insurance Policy InterpretationEmployment StatusWorkers' Compensation ExclusionSummary Judgment MotionContractual AmbiguityGroup Health InsuranceMedical Expense ReimbursementThird-Party ActionAppellate ReviewEmployer-Employee Relationship
References
10
Case No. MISSING
Regular Panel Decision

Cook v. Pension Benefit Guarantee Corp.

The Trustees of the Local 852 General Warehouseman’s Union Pension Fund sued the Pension Benefit Guarantee Corporation (PBGC) seeking reimbursement for pension benefits paid to retirees of two closed warehouses. The Fund argued for recovery based on equitable estoppel, asserting detrimental reliance on an initial PBGC determination that it would guarantee these benefits. The PBGC moved for summary judgment, contending that estoppel against a federal agency requires a showing of affirmative misconduct or manifest injustice. The Court found no evidence of affirmative misconduct by the PBGC and concluded that its change in determination, made to conform with Congressional intent, did not constitute manifest injustice. Consequently, the Court granted the PBGC's motion for summary judgment, ruling that equitable estoppel was inapplicable.

Equitable EstoppelFederal Agency EstoppelSummary JudgmentERISAPension BenefitsMulti-employer PlanPension Benefit Guarantee Corporation (PBGC)Affirmative MisconductManifest InjusticeDetrimental Reliance
References
10
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. ADJ4025440 (VNO 0557895)
Regular
Mar 12, 2012

CHARLES B. HANLON vs. WYLE HOLDINGS, INC., AIG adjusted by CHARTIS CLAIMS, INC.

The Workers' Compensation Appeals Board granted reconsideration to clarify an ambiguous award for temporary disability benefits. The applicant sustained a cumulative injury resulting in temporary and permanent disability. The defendant argued the award was unclear regarding the coordination of temporary disability payments with benefits already paid by the Employment Development Department (EDD). The Board clarified that the applicant is to be compensated for temporary disability, less amounts paid by EDD, with adjustments potentially needed to match the agreed-upon temporary disability rate. Furthermore, the Board clarified that EDD's overpayments of unemployment benefits made after the applicant's permanent and stationary date are to be reimbursed from the applicant's permanent disability benefits.

Cumulative industrial injuryTemporary disability indemnityPermanent disability benefitsPetition for ReconsiderationFindings and AwardAmbiguous awardEDD benefitsLabor Code §4904Agreed Medical ExaminerTemporary total disability
References
0
Case No. MISSING
Regular Panel Decision
Jan 15, 1988

Pension Benefit Guaranty Corp. v. LTV Corp.

David H. Miller and William W. Shaffer ("Miller and Shaffer") moved to intervene individually and as representatives of participants in the Jones & Laughlin Retirement Plan in an action filed by the Pension Benefit Guaranty Corporation (PBGC) against LTV Corporation and LTV Steel Company ("LTV"). LTV did not object to individual intervention but opposed class action intervention, arguing it would delay the PBGC action. The court granted the motion, allowing Miller and Shaffer to intervene both individually and as class representatives. The decision emphasized that Miller and Shaffer met the minimal burden of showing that PBGC's representation might be inadequate, as their interests, seeking full plan benefits, could diverge from PBGC's role as plan administrator. This opinion allows the class action to proceed under Rule 23(e), preventing dismissal or compromise without court approval.

InterventionERISAPension PlansBankruptcyClass ActionRule 24Rule 23(e)Adequate RepresentationPlan TerminationRestoration
References
6
Case No. ADJ8860181
Regular
Jul 16, 2015

GARY GATSON vs. BIMBO BAKERIES USA, INC., ACE AMERICAN INSURANCE COMPANY

This case involves a dispute over the Employment Development Department's (EDD) lien for temporary disability benefits paid to the applicant. The original award found the applicant sustained a cumulative trauma injury and awarded temporary disability benefits, but only allowed partial reimbursement to EDD. Both EDD and the employer sought reconsideration, with EDD arguing for full reimbursement and the employer challenging the EDD lien finding. The Appeals Board granted EDD's petition, denied the employer's, and will allow further proceedings to determine the correct amount of EDD's lien and temporary disability award.

WCABcumulative traumaAchilles tendonpermanent disabilitytemporary disabilityEDD lienreconsiderationsubstantial evidencestandingLabor Code section 4904
References
0
Case No. ADJ9103955
Regular
Aug 25, 2014

EMMANUEL BRISENO vs. CALTRANS, Permissibly Self-Insured, Adjusted By STATE COMPENSATION INSURANCE FUND

This case concerns a workers' compensation appeal where the defendant, Caltrans, sought reconsideration of an award of temporary disability benefits. Caltrans argued the award should credit benefits already paid by the Employment Development Department (EDD) to prevent double recovery. The Appeals Board granted reconsideration, agreeing that the award needed adjustment for the EDD's potential lien. Consequently, the Board amended the award to require the parties to adjust the benefit amount, taking into account the EDD's potential lien interest.

Workers' Compensation Appeals BoardADJ9103955Emmanuel BrisenoCALTRANSPermissibly Self-InsuredState Compensation Insurance FundTemporary Disability IndemnityEmployment Development Department (EDD)EDD LienDouble Recovery
References
0
Case No. 2021 NY Slip Op 04070
Regular Panel Decision
Jun 24, 2021

Matter of Cisnero v. Independent Livery Driver Benefit Fund

Claimant Jeffrey Cisnero, an independent livery driver, sustained injuries when he was shot during a dispatch. He filed a claim for workers' compensation benefits, which was initially disallowed by a WCLJ but later reversed by the Workers' Compensation Board, finding coverage through the Independent Livery Driver Benefit Fund (ILDBF). The carrier appealed, arguing misinterpretation of the relevant statutes, particularly Executive Law § 160-ddd (1). The Appellate Division, Third Department, affirmed the Board's decision, determining that Cisnero's injuries arose out of and in the course of providing covered services as an independent livery driver dispatched by an ILDBF member. The court found that the vehicle's attenuated affiliation with the New York Black Car Operators' Injury Compensation Fund, Inc. did not alter ILDBF's liability.

Workers' CompensationLivery DriverIndependent ContractorBenefit FundAccidental InjuryCourse of EmploymentStatutory InterpretationExecutive LawWorkers' Compensation LawAppellate Review
References
3
Case No. ADJ2902670 (VNO 0344530)
Regular
Sep 16, 2016

IRMA LARIOS vs. AREA TRADE BINDERY, GALLAGHER BASSETT

The Workers' Compensation Appeals Board granted reconsideration to address the lien claim of the Employment Development Department (EDD). The original award failed to account for EDD's lien for state disability benefits paid to the applicant. The Board found that the defendant is obligated to withhold EDD's lien amount from temporary disability payments once notified. Therefore, the case was returned to the trial level for recalculation of temporary disability benefits, including proper credit for the EDD's lien.

Lien claimantPetition for ReconsiderationFindings and AwardEmployment Development Department (EDD)Temporary disability benefitsIndustrial injuryCervical spineHypertensive heart diseaseGastrointestinalPsyche
References
3
Case No. ADJ12260655
Regular
Nov 30, 2020

MONICA TELLEZ vs. GARFIELD BEACH CVS, LLC, XL INSURANCE COMPANY

The Appeals Board denied the Employment Development Department's (EDD) petition for reconsideration regarding its lien claim. The EDD sought reimbursement for unemployment benefits paid to the applicant, arguing they overlapped with permanent disability indemnity awarded. However, the WCJ correctly determined the EDD failed to establish it paid benefits for the same days as the permanent disability indemnity awarded, which commenced on the applicant's permanent and stationary date of October 15, 2019. Therefore, the EDD's lien was not allowed under Labor Code section 4904(b).

WCABPetition for ReconsiderationLienEmployment Development DepartmentPQMETemporary DisabilityPermanent and Stationary DatePermanent Disability IndemnityUnemployment Insurance CodeSection 4904(b)
References
0
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