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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 Sutter v. Albany Capitaland Enterprises, Inc.

Claimant, a bus driver, allegedly sustained a work-related injury in September 1996. The core issue on appeal was whether First Cardinal Corporation, administrator for Empire State Transportation Workers’ Compensation Trust, validly terminated the employer's workers' compensation insurance policy as of August 18, 1996. A Workers’ Compensation Law Judge and the Workers’ Compensation Board concluded that First Cardinal failed to effect a valid termination, citing non-compliance with Workers’ Compensation Law § 50 (3-a) (3) regarding proper forms and notice period. The Appellate Division affirmed the Board's amended decision, emphasizing that public policy requires strict compliance with statutory mandates for terminating insurance contracts under the Workers’ Compensation Law.

Workers' Compensation InsurancePolicy TerminationGroup Self-Insurance PlanStatutory ComplianceNotice RequirementsAppellate ReviewEmployer LiabilityWork-Related InjuryNew York LawWorkers' Compensation Board Decision
References
1
Case No. 2018 NY Slip Op 02766 [160 AD3d 921]
Regular Panel Decision
Apr 25, 2018

Clarke v. First Student, Inc.

Ibia M. Clarke, an employee of First Student Management, LLC (FSM), sustained personal injuries due to a defective condition at FSM's premises. She subsequently filed a negligence action against First Student, Inc., the premises owner. The defendant sought summary judgment, arguing it was an alter ego of FSM, making workers' compensation her exclusive remedy under the Workers' Compensation Law. The Supreme Court, Nassau County, initially denied the defendant's motion. On appeal, the Appellate Division, Second Department, reversed the Supreme Court's order, finding that the defendant successfully demonstrated, prima facie, that it was an alter ego of the plaintiff's employer, FSM. Consequently, the defendant's motion for summary judgment dismissing the amended complaint was granted.

Personal InjuryNegligenceSummary JudgmentWorkers' Compensation LawExclusive RemedyAlter Ego DoctrineEmployer LiabilityPremises LiabilityAppellate ReviewCorporate Structure
References
9
Case No. 2017 NY Slip Op 27428
Regular Panel Decision
Dec 14, 2017

New York State Workers' Compensation Bd. v. Compensation Risk Mgrs., LLC

This action was brought by the New York State Workers' Compensation Board (WCB), as an assignee of former members of the Healthcare Industry Trust of New York (HITNY), against Compensation Risk Managers, LLC (CRM), HITNY trustees, and auditing firm UHY LLP. The WCB alleged mismanagement, breach of fiduciary duty, and negligent auditing, leading to the Trust's insolvency. Defendants moved to dismiss on grounds of standing, statute of limitations, and pleading particularity. The court dismissed certain derivative claims and negligent misrepresentation claims against some trustees due to standing issues and statute of limitations. All claims against UHY LLP were dismissed for lack of a near-privity relationship or prior precedent. An implied indemnity claim against the trustees was sustained. The WCB's cross-motion to consolidate related actions was denied.

Workers' Compensation LawGroup Self-Insured Trust (GSIT)Fiduciary DutyNegligenceNegligent MisrepresentationStatute of LimitationsStandingDerivative ActionImplied IndemnityAuditing Firm Liability
References
46
Case No. MISSING
Regular Panel Decision
Aug 01, 2002

Claim of Petitt v. Eaton & Van Winkle

The claimant was injured in a 1993 elevator accident but did not file a workers' compensation claim until 1999. The Workers' Compensation Board dismissed the claim as time-barred under Workers' Compensation Law § 28, which mandates dismissal if a claim is not filed within two years of the accident. On appeal, the claimant argued the employer and carrier waived the § 28 defense by failing to timely raise it and by making advance payments. The Board found the defense was timely raised at the first hearing and determined that the employer's one-day wage payment was sick leave, not an advance payment of compensation. The appellate court affirmed the Board's decision, concluding that the Board's findings were supported by substantial evidence.

Workers' CompensationStatute of LimitationsTime-Barred ClaimWaiver DefenseAdvance Payment of CompensationSick Leave PolicyAppellate ReviewBoard DecisionElevator Accident
References
5
Case No. ADJ837893
Regular
Jun 04, 2009

GEORGE ALBERT JUAREZ vs. BAJA ROOFING, FIRST AMERICAN STAFFING, INTERTRIBAL STRATEGIC VENTURES EMPLOYEES OCCUPATIONAL INJURY AND INDEMNITY, FIRST INTERCARE, UNINSURED EMPLOYERS FUND

This case involves a worker injured while employed by First American Staffing (First), a tribal entity, and allegedly also by Baja Roofing (Baja) as a special employer. The Tribal Appeals Court has already asserted jurisdiction over First, and the WCAB acknowledges it lacks jurisdiction over tribal entities like First due to sovereign immunity. The WCAB rescinded the prior findings and returned the case to the trial level, requiring the applicant to first pursue remedies against First in tribal court before the WCAB will consider Baja's liability. This is to determine if First secured adequate workers' compensation coverage as per their contract with Baja, which would then potentially absolve Baja of responsibility.

Workers' Compensation Appeals BoardTribal sovereign immunityGeneral and special employmentJoint and several liabilityRes judicataCollateral estoppelThird-party administratorEmployee leasing companiesTribal Appeals CourtInsured status
References
1
Case No. 2019 NY Slip Op 05820
Regular Panel Decision
Jul 25, 2019

Matter of Ellis v. First Student, Inc.

Claimant, Kevin Ellis, a school bus driver, sustained work-related injuries in November 2014 when struck by a vehicle. His initial claim for workers' compensation benefits was established for injuries to his back, left hip, and left knee. The Workers' Compensation Board later amended the claim to include causally-related injuries to his right knee and right shoulder, based on medical evidence and testimony. The employer and its carrier appealed this decision. The Appellate Division, Third Department, affirmed the Board's decision, finding substantial evidence to support the Board's determination that the injuries to the right knee and right shoulder were causally related to the work accident, crediting the testimony of orthopedist Charles Peralo over the conflicting opinion of physician Harvey Siegel.

Workers' CompensationCausally Related InjuryRight KneeRight ShoulderSchool Bus DriverSubstantial EvidenceMedical TestimonyCredibilityAppellate ReviewAmendment of Claim
References
13
Case No. MISSING
Regular Panel Decision
Apr 14, 2010

State of New York, Workers' Compensation Board v. A & T Healthcare, LLC

The New York Health Care Facilities Workers’ Compensation Trust, a group self-insured trust, became severely underfunded, leading the plaintiff, the State of N.Y. Workers’ Compensation Board, to terminate its administration in 2006. The Board then sued former Trust members, including defendant Rome Memorial Hospital, Inc., to recover their pro rata shares of a $31 million shortfall. Defendant moved for partial summary judgment, arguing that claims for deficiencies known before June 2002 were barred by the six-year statute of limitations. The Supreme Court denied this motion, and the appellate court affirmed the decision. The appellate court ruled that the statute of limitations did not apply from the time deficiencies first appeared, but rather from when an assessment was ordered and subsequently refused, which occurred in 2008, thus making the plaintiff's 2008 action timely.

Workers' Compensation TrustGroup Self-Insured TrustStatute of LimitationsPartial Summary JudgmentJoint and Several LiabilityPro Rata LiabilityUnderfundingAssessment LevyAppellate AffirmationHealthcare Industry
References
7
Case No. MISSING
Regular Panel Decision

Claim of Simmons v. St. Lawrence County CDP, Inc.

This case clarifies the application of Workers' Compensation Law § 29 regarding an insurance carrier's right to offset a claimant's net recovery from a third-party tort-feasor against future compensation benefits. The decision affirms that this offset applies to earnings lost more than three years after the date of the accident, as these are not considered 'basic economic loss' and therefore not replaced by 'first party benefits' under no-fault insurance. The court explains that the compensation carrier's lien, while no longer 'inviolable' due to Workers’ Compensation Law § 29 (1-a), still attaches to 'any recovery' in a third-party action if the benefits in question were not in lieu of first-party benefits. The claimant's argument that the recovery solely represented pain, suffering, and permanent injuries, not lost wages, was rejected.

Workers' Compensation LawLienOffsetThird-Party RecoveryNo-Fault InsuranceBasic Economic LossFirst Party BenefitsLost WagesInsurance CarrierNew York Law
References
2
Case No. MISSING
Regular Panel Decision

Estate of Moody v. Quality Structures, Inc.

Decedent, a laborer, collapsed and died on his first day of work at a construction site while pouring and raking concrete. His estate applied for workers' compensation death benefits for his children. The Workers' Compensation Board affirmed the claim, invoking the presumption of compensability under Workers’ Compensation Law § 21 (1), as the employer failed to rebut it with substantial evidence. An independent medical report by cardiologist Stephen Nash attributed death to cardiac arrhythmia and enlarged heart, with lack of sleep as a contributory factor, but did not rule out work involvement. The court affirmed the Board's decision, finding the cause of the fatal arrhythmia unexplained and the employer's evidence insufficient to overcome the presumption.

Workers' Compensation Death BenefitsCausally Related EmploymentPresumption of CompensabilityCardiac ArrhythmiaEnlarged HeartIndependent Medical ReportConstruction Laborer DeathUnexplained CollapseRebuttal of PresumptionSubstantial Evidence
References
7
Case No. MISSING
Regular Panel Decision

Claim of Cruz v. City of New York Department of Children's Services

Claimant, injured in an automobile accident while working, received workers' compensation benefits and later settled a third-party action. A Workers’ Compensation Law Judge (WCLJ) and the Workers’ Compensation Board ruled that the self-insured employer was not entitled to offset the third-party settlement against a schedule loss of use (SLU) award, even for the portion initially designated as temporary total disability. The employer appealed, arguing the offset was permissible because the weekly award exceeded statutory thresholds for basic economic loss. However, the court affirmed the Board's decision, clarifying that a schedule loss of use award is not allocable to any specific period of disability and thus is not subject to offset under Workers’ Compensation Law § 29 against first-party benefits, regardless of initial labeling or monthly rate.

Schedule Loss of Use Award OffsetThird-Party SettlementTemporary Total DisabilityPermanent Partial DisabilityBasic Economic LossNo-Fault LawInsurance LawStatutory InterpretationWorkers' Compensation Law § 29Appellate Division
References
6
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