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Case Law Database

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

Case No. ADJ1323538 (SAC 0305102)
Regular
Jul 20, 2010

BRUCE LOCKWOOD vs. C.C. MEYERS, INC., C.C. MEYERS, AN INDIVIDUAL

This case involves an applicant seeking increased compensation due to serious and willful misconduct by his employer, C.C. Meyers, Inc. The applicant sustained significant injuries when an excavator ran over his foot, leading to its amputation. The Appeals Board overturned the Workers' Compensation Judge's denial, finding that the employer's failure to provide a spotter for the excavator constituted serious and willful misconduct. This failure to provide a spotter, coupled with the employer's knowledge of the risks and intentional disregard for safety, was determined to be a proximate cause of the applicant's injury. As a result, the applicant's compensation will be increased by one-half.

Serious and Willful MisconductEmployer LiabilityIndustrial InjuryProximate CauseSafe Place of EmploymentFailure to Provide SpotterExcavator SafetyCalOSHA Safety Order 1592ReconsiderationWorkers' Compensation Appeals Board
References
0
Case No. ADJ8331259
Regular
Dec 21, 2012

MARIELA GOMEZ vs. PROVIDENCE FARMS, LLC, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration. The Board adopted the WCJ's report, emphasizing that the defendant's failure to properly notify the applicant about changing treating physicians within the Medical Provider Network (MPN) resulted in a denial of necessary medical treatment. This failure to inform the applicant of her rights, particularly regarding physician selection and dispute resolution processes within the MPN, constituted a neglect or refusal to provide reasonable medical treatment, as established by precedent. Consequently, the applicant was permitted to continue receiving treatment outside the MPN until she could begin care with a designated physician within the network.

Workers' Compensation Appeals BoardProvidence FarmsLLCZenith Insurance CompanyMariela GomezADJ8331259Order Denying ReconsiderationPetition for ReconsiderationMedical TreatmentMedical Provider Network
References
2
Case No. MISSING
Regular Panel Decision

Yuhas v. Provident Life & Casualty Insurance

Deborah Yuhas sued Provident Life and Casualty Insurance Company under ERISA for long-term disability benefits, claiming physical disability. Yuhas, a graphic designer, initially received benefits for a mental condition, which ceased after 24 months due to policy limitations. She subsequently appealed, claiming physical disabilities from a car accident, leading to a retroactive award of benefits for a specific period (October 1991 through May 1993) but no further benefits. Provident repeatedly denied her claim for benefits beyond May 1993, citing lack of objective physical disability and the expiration of appeal periods. Yuhas filed suit in September 2000, but the court granted Provident's motion for summary judgment, ruling that her claim was barred by the three-year statute of limitations, which had accrued by December 13, 1993, at the latest.

ERISALong Term Disability BenefitsSummary JudgmentStatute of LimitationsAccrual of Cause of ActionDisability Insurance PolicyMental DisorderPhysical InjuryAppeals ProcessRepudiation of Claim
References
13
Case No. MISSING
Regular Panel Decision

Kennedy v. Pine Hill Coffee Service, Inc.

Gerald Kennedy, an employee of Sahlem’s Roofing, sustained injuries after falling from a roof while working on a building owned by defendant James DeMarco and occupied by Pine Hill Coffee Services, Inc. Plaintiffs moved for partial summary judgment, arguing a violation of Labor Law § 240 (1) due to the defendants' failure to provide adequate safety equipment. Defendants contended that a co-employee acting as a 'spotter' constituted a safety device and that Kennedy was a recalcitrant worker for continuing to work when the 'spotter' left. The court rejected the argument that a human 'spotter' is a safety device under Labor Law § 240 (1), emphasizing the requirement for physical safety devices. Finding that the absence of proper safety devices was the proximate cause of Kennedy’s injuries, the court granted the plaintiffs' motion for partial summary judgment.

Labor Lawabsolute liabilityconstruction accidentfall from heightsafety devicesrecalcitrant workerproximate causeNew York Lawsummary judgmentowner liability
References
7
Case No. ADJ10084576
Regular
Oct 06, 2016

ROSE SMITH vs. MEGGITT SENSING SYSTEMS PLC, THE HARTFORD

This case involves Rose Smith's workers' compensation claim where the defendant, Meggit Sensing Systems and its insurer, The Hartford, seek reconsideration of an order allowing Smith to obtain medical treatment outside their Medical Provider Network (MPN). The Appeals Board denied the petition, affirming the WCJ's finding that the defendant's failure to authorize a requested third medical opinion constituted a denial of care. This denial entitled the applicant to seek treatment outside the MPN at the defendant's expense. The defendant argued the request was procedurally deficient and not a request for treatment, but the Board found the failure to respond to the RFA for a third opinion, in context, was a failure to provide reasonable medical treatment.

Workers' Compensation Appeals BoardMedical Provider Network (MPN)Request for Authorization (RFA)Petition for ReconsiderationDenial of Medical TreatmentThird Medical OpinionUtilization Review (UR)Primary Treating PhysicianCumulative TraumaLoss of Control
References
3
Case No. MISSING
Regular Panel Decision

In re Samuel DD.

Respondent appealed a Family Court order from Albany County, entered April 20, 2010, which adjudicated her child, Samuel DD., neglected under Family Ct Act article 10. The neglect finding stemmed from respondent's failure to provide necessary medical treatment for the child's severe behavioral and mental health issues, including ADHD and suspected bipolar disorder, along with educational neglect and respondent’s own mental health problems. The child exhibited extreme and dangerous behaviors at school, leading to his dismissal. Despite medical recommendations for medication and psychiatric evaluation, the respondent refused to administer treatment, attend follow-up appointments, or cooperate with service plans. The appellate court affirmed the neglect finding, concluding that the record provided ample evidence of respondent's unreasonable failure to exercise a minimum degree of care in providing for the child's welfare.

Child NeglectFamily Court ActParental RightsMedical Treatment RefusalChild Mental HealthADHDBehavioral IssuesEducational NeglectAppellate ReviewParental Care Standards
References
11
Case No. MISSING
Regular Panel Decision

Claim of Dusharm v. Green Island Contracting, LLC

Claimant, a labor supervisor, allegedly sustained a work-related back injury in April 2006 but significantly delayed seeking medical treatment and applying for workers' compensation benefits. A Workers' Compensation Law Judge initially awarded benefits, but the Workers' Compensation Board reversed the decision, citing the claimant's failure to provide timely written notice to his employer as mandated by Workers' Compensation Law § 18. The Board, exercising its discretion, refused to excuse this lack of written notice, concluding that the employer was prejudiced by the delay due to inconsistencies in the claimant's statements and his extensive medical history. The Board considered factors like the delay in treatment, failure to initially mention the work injury to medical providers, a previous 20-year history of back pain, and failure to miss work for over a year. The appellate court affirmed the Board's determination, finding its exercise of discretion to be based on substantial evidence.

Workers' CompensationTimely NoticeEmployer PrejudiceBoard DiscretionOral NoticeBack InjuryAppellate ReviewSubstantial EvidenceClaimant DelayMedical Treatment
References
4
Case No. 2025 NY Slip Op 03700
Regular Panel Decision
Jun 18, 2025

Cabrera v. Provident Alpine Partners, L.P.

The plaintiffs, Luis Cabrera and his wife, appealed an order from the Supreme Court, Nassau County, concerning personal injuries Luis Cabrera sustained from falling off an A-frame ladder while performing demolition work. The Supreme Court had denied the plaintiffs' motion for summary judgment on their Labor Law § 240 (1) claim and granted the defendant's cross-motion to dismiss claims under Labor Law §§ 240 (1) and 241 (6). The Appellate Division, Second Department, modified the Supreme Court's order by denying the defendant's cross-motion to dismiss the Labor Law claims, while affirming the denial of the plaintiffs' motion for summary judgment. The court found triable issues of fact regarding whether Cabrera needed protection from gravity and if his actions were the sole proximate cause of his injuries under Labor Law § 240 (1). Additionally, it clarified the nondelegable duty under Labor Law § 241 (6) and highlighted the defendant's failure to demonstrate prima facie compliance with specific Industrial Code provisions (12 NYCRR 23-1.21 [b] [3] [iv] and [4] [ii]).

Labor LawSafe Place to WorkLadder FallSummary JudgmentAppellate DivisionPersonal InjuryConstruction AccidentIndustrial Code ViolationNondelegable DutyProximate Cause
References
19
Case No. MISSING
Regular Panel Decision

St. Vincent Medical Care, P.C. v. Country-Wide Insurance

The case concerns a provider's action to recover assigned first-party no-fault benefits from an insurer. The trial court initially granted the provider's summary judgment motion, but the appellate judgment modified the award, severing a $228.55 claim for February 22, 2006, services. This specific claim was denied summary judgment because it was timely denied by the insurer as exceeding the workers' compensation fee schedule. For the remaining claims, the appellate court affirmed summary judgment for the provider, determining that the insurer's follow-up verification requests were prematurely mailed and thus ineffective, precluding most defenses due to untimely denials. The insurer's cross-motion for summary judgment was consequently denied.

No-fault benefitsSummary judgmentVerification requestsTimely denialInsurance claimsWorkers' compensation fee scheduleAppellate reviewMedical servicesOverdue paymentsStatutory claim form
References
8
Case No. LBO 0385440
Regular
Feb 07, 2008

Catalina V. Canlas vs. Victoria Townhouse APTS., STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration, rescinded the prior award, and found applicant temporarily totally disabled from February 13, 2007, to the present, due to the employer's failure to provide proper notice regarding its Medical Provider Network (MPN). This failure entitled the applicant to self-procure medical treatment from non-MPN physicians, whose reports were subsequently admitted into evidence and supported the finding of total temporary disability. The issue of the EDD lien was deferred for further adjustment.

MPN noticeself-procured treatmenttemporary total disabilitymedical provider networkreconsiderationfindings and awardindustrial injuryleasing consultanttemporary partial disabilityLabor Code
References
1
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