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

Case No. ADJ1543435
Regular
Feb 04, 2013

Sergio Cordero vs. Michael Bernier dba Pacific Services, Stellrecht Company, State Compensation Insurance Fund, Uninsured Employers Benefit Trust Fund

The Workers' Compensation Appeals Board denied reconsideration, upholding the finding that the applicant was injured in the course and scope of employment with an unlicensed contractor, Michael Bernier. The Board gave great weight to the Workers' Compensation Judge's credibility determination regarding the employer's testimony. The applicant's injury occurred while he was directed by Bernier to remove solar panels from a property owned by Stellrecht Company. The Board clarified the distinction between "course of employment" and "scope of employment" in workers' compensation law to affirm the decision.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ credibilitycourse and scope of employmentunlicensed contractoruninsured contractorgeneral-special relationshipLabor Code §2750.5B&P §7125.2Blew v. Horner
References
5
Case No. MISSING
Regular Panel Decision

Claim of Foti-Crawford v. Buffalo General Hospital

A registered nurse sustained a back injury in July 1991 while concurrently employed by Buffalo General Hospital and Supplemental Health Care, leading to permanent partial disability. The Workers’ Compensation Board awarded benefits of $153.36 per week and ruled that the Special Disability Fund should reimburse the hospital's carrier for most of these benefits under Workers’ Compensation Law § 14 (6). The Fund appealed, contending that reimbursement was unwarranted as the benefits did not exceed the maximum amount the hospital would have paid without concurrent employment. The court affirmed the Board's decision, finding its interpretation rational, especially given the claimant returned to work for the primary employer.

Workers' CompensationConcurrent EmploymentSpecial Disability FundReimbursementPermanent Partial DisabilityAverage Weekly WageAppellate ReviewBack InjuryNurseWorkers' Compensation Law
References
2
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
May 11, 2004

Claim of Frank v. New York City Transit Authority

This case involves an appeal from a Workers' Compensation Board decision that found a causal relationship between a decedent's death and his employment. The employer engaged in prolonged retaliatory and harassing conduct, including unjustifiably withholding differential pay, threatening to revoke medical benefits, refusing to reimburse pharmacy expenses, denying vacation leave, and filing a false claim of absence without leave. This behavior, alongside repeated failures to substantiate claims regarding benefit overpayments, led to prolonged hearings. Following one such hearing, the decedent suffered a fatal myocardial infarction. A Workers' Compensation Law Judge and the Board subsequently found a causal connection between the employer's conduct and the decedent's death. The Appellate Court affirmed the Board's determination, concluding that substantial evidence supported the finding that the death resulted from the employer's "prolonged pattern of intimidation, deceit, and unlawful coercion, the wrongful withholding of benefits to which decedent was entitled, and generally disgraceful conduct towards the decedent." The employer's claims regarding witness preclusion were dismissed as not properly before the court.

Workers' CompensationCausationEmployer RetaliationStress-Related DeathMyocardial InfarctionBenefits WithholdingAppellate ReviewSubstantial EvidenceProcedural IssuesUnjustified Conduct
References
6
Case No. MISSING
Regular Panel Decision

Claim of Hope v. Warren County Board of Elections

This case involves an appeal by a workers' compensation carrier regarding the calculation of a claimant's average weekly wage based on concurrent employment. The claimant, injured on November 3, 2009, had employment as a polling inspector and concurrently with a retail store. A Workers’ Compensation Law Judge (WCLJ) and subsequently the Workers’ Compensation Board calculated the claimant's average weekly wage based on both employments, totaling $80.69, and directed the carrier to continue awards. The carrier appealed, arguing that awards should only be based on the primary employment wage of $3.56 due to the inability to seek reimbursement from the Special Disability Fund for concurrent employment amounts following 2007 amendments to Workers’ Compensation Law § 14 (6). The Appellate Court affirmed the Board's decision, interpreting the statutory language to mean that primary employers are liable for benefits calculated on combined average weekly wages, and the 2007 amendments did not intend to reduce benefits for injured workers.

Concurrent Employment BenefitsAverage Weekly Wage CalculationSpecial Disability Fund ClosureWorkers' Compensation Law § 14(6)Statutory Amendment ImpactEmployer Liability LimitsTemporary Total DisabilityTemporary Partial DisabilityAppellate Review of WCABLegislative Purpose Analysis
References
5
Case No. MISSING
Regular Panel Decision

Claim of Rondon v. Manhattan & Bronx Surface Transit Operating Authority

Claimant, a bus driver, was injured in 2007 and subsequently received workers' compensation benefits for an eight-month period. The self-insured employer challenged these benefits under Workers' Compensation Law § 114-a, alleging the claimant worked during the disqualification period and attempted to introduce video evidence. The Workers' Compensation Law Judge (WCLJ) refused to admit the video due to lack of authentication by the investigator who filmed it, eventually closing the record when the employer failed to produce all necessary investigators. While the Workers' Compensation Board ruled that the investigator's testimony wasn't strictly necessary for authentication, it upheld the WCLJ's closure of the record because the employer hadn't appealed the initial authentication ruling and failed to present all investigators. Consequently, the Board remitted the case for a determination on claimant's disqualification, a decision which the employer appealed, but the appellate court dismissed the appeal as an interlocutory order that did not resolve all substantive issues.

Appeal DismissalInterlocutory OrderEvidence AuthenticationVideo FootageClaimant BenefitsEmployer LiabilityAdministrative ReviewRecord ClosureAppellate ProcedureWorkers' Compensation Law § 114-a
References
2
Case No. ADJ387954 (OXN 0145858) ADJ2973719 (OXN 0145147)
Regular
Oct 27, 2017

FRANCISCO PRIETO vs. O.C. CONTRACTING, INC., AMERICAN INTERNATIONAL GROUP, INC., UNINSURED EMPLOYERS BENEFITS TRUST FUND

This case concerns a Petition for Reimbursement filed by Granite State Insurance Company against the Uninsured Employers Benefits Trust Fund (UEBTF). Granite State mistakenly paid workers' compensation benefits to an employee injured while working for an uninsured employer. The Workers' Compensation Appeals Board (WCAB) rescinded a prior order granting reimbursement, holding that UEBTF is not statutorily liable to reimburse insurance carriers for erroneous payments. The WCAB emphasized that UEBTF's purpose is to provide benefits to injured workers of uninsured employers, not to indemnify insurers. A dissenting opinion argued for amending the order to allow reimbursement to Granite State through applicant from funds UEBTF owes the applicant.

Uninsured Employers Benefits Trust FundGranite State Insurance CompanyPetition for ReimbursementLabor Code sections 37153716mistaken paymentillegally uninsured employerLabor Code section 4909creditdirect reimbursement
References
0
Case No. ADJ843966 (SDO 0338705)
Regular
Dec 13, 2013

Reed Thomas Kirby vs. Arthur Gonzales, STATE FARM INSURANCE COMPANY, KEITH PATRICK DONNELLY, UNINSURED EMPLOYERS BENEFITS TRUST FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to amend a prior award. The WCAB affirmed the finding that the applicant sustained an injury while employed as a tree trimmer by an uninsured employer, Keith Patrick Donnelly. However, the WCAB amended the award to reflect that liability rests solely with the uninsured employer, not the Uninsured Employers Benefits Trust Fund (UEBTF), as UEBTF's liability is derivative. The WCAB rejected arguments that the City of San Diego was also responsible and confirmed the applicant is entitled to benefits from Donnelly.

Uninsured Employers Benefits Trust FundUEBTFKeith Patrick DonnellyTarzan Tree SpecialistsArthur GonzalesState Farm Insurance Companytree trimmerderivative defendantLabor Code section 3352(h)City of San Diego
References
2
Case No. ADJ10549266
Regular
Jan 18, 2018

VICTOR QUINTANILLA (DEC'D), HEIDI QUINTANILLA vs. PRONTO EXPRESS & SERVICES, INC., ISHMAEL PATEL, UNINSURED EMPLOYERS BENEFITS TRUST FUND

In this workers' compensation death benefit claim, the defendant employer sought reconsideration of a finding that the decedent sustained injury arising out of and in the course of employment. The appeals board affirmed the decision, primarily because the employer failed to timely deny the claim within the 90-day statutory period. This untimely denial created a rebuttable presumption of compensability under Labor Code section 5402(b). The defendant's argument regarding the "going and coming" rule became moot as they failed to raise any objection to the timeliness of the denial in their petition. Therefore, the original findings and award of death benefits were affirmed.

Workers Compensation Appeals BoardReconsiderationInjury Arising Out Of and In the Course Of Employment (AOE/COE)Going and Coming RuleLabor Code Section 5402(b)Presumption of CompensabilityUninsured Employers Benefits Trust FundTimely DenialRebuttal of PresumptionReasonable Diligence
References
6
Case No. MISSING
Regular Panel Decision

In re the Claim of Cale

Claimant, a Canadian national, worked as a social worker at New York University Medical Center under a TN visa. After her inpatient position was eliminated, she applied for partial unemployment insurance benefits. The Unemployment Insurance Appeal Board ruled that she was ineligible to receive them because she was not available for employment. The court affirmed this decision, noting that a non-United States citizen must have valid work authorization from the Immigration and Naturalization Service. Her TN visa restricted her to working for a specific employer, NYUMC, and she was not authorized to seek employment elsewhere, thereby rendering her unavailable for work and ineligible for benefits.

Unemployment InsuranceVisa RestrictionsWork AuthorizationImmigration StatusTN VisaEligibility for BenefitsAvailability for EmploymentAppellate DecisionNew York LawSocial Worker
References
3
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