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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
Dec 27, 2001

MacRo v. Independent Health Ass'n, Inc.

Plaintiffs Cheryl Macro and Kim Zastrow, insured under a group health contract with Independent Health through the Tonawanda City School District, initiated a class action in state court to challenge Independent Health's modification of infertility treatment coverage. Defendant Independent Health removed the case to federal court, asserting ERISA preemption. Plaintiffs moved to remand, arguing that their claims fell under New York Insurance Law, which is exempt from ERISA preemption by the saving clause, and that their health plan qualified as a 'governmental plan' also exempt from ERISA. The District Court granted the plaintiffs' motion, concluding that the claims were indeed saved from ERISA preemption and that the plan was exempt, thus rendering federal subject matter jurisdiction absent. The court accordingly remanded the case back to New York State Supreme Court.

Infertility CoverageHealth Insurance DisputesERISA PreemptionSaving ClauseGovernmental PlansRemoval to Federal CourtSubject Matter JurisdictionNew York Insurance LawClass Action LitigationEmployee Benefits Plan
References
31
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. MISSING
Regular Panel Decision

Main Evaluations, Inc. v. State

The claimant, Main Medical Evaluations, entered into contracts with the New York State Office of Temporary and Disability Assistance (OTDA) to perform consultative medical evaluations. OTDA terminated these contracts, alleging the claimant failed to disclose professional disciplinary proceedings against its chief medical officer, Arvinder Sachdev, and submitted false information during the bidding process. Following the dismissal of its claim in the Court of Claims, the claimant appealed. The appellate court affirmed the lower court's judgment, concluding that OTDA had legitimate grounds for termination due to the claimant's misrepresentations and failure to report substantial contract-related issues concerning Sachdev's integral role. Additionally, the court rejected the claimant's equal protection argument, finding no evidence of selective enforcement based on impermissible considerations.

Contract TerminationProfessional MisconductFalse RepresentationEqual ProtectionGovernment ContractsAppellate ReviewBreach of ContractMedical LicensingAdministrative ProceedingsDue Diligence
References
5
Case No. ADJ7899375
Regular
Apr 06, 2020

AMANDA CULVER vs. INITIATIVE FOODS, UNITED STATES FIRE INSURANCE COMPANY, CRUM AND FORSTER

This case involves Amanda Culver's claim for permanent total disability due to a 2010 industrial injury resulting in a fall down stairs. The defendant, Initiative Foods, contested the finding of 100% permanent disability, arguing the Administrative Law Judge (ALJ) improperly relied on an Independent Vocational Evaluator (IVE) and overlooked their own vocational expert. The Workers' Compensation Appeals Board affirmed the ALJ's decision, finding the IVE's report constituted substantial evidence supporting the applicant's permanent total disability. The Board found the defendant's arguments regarding the IVE's methodology and reliance on medical reports unconvincing.

Independent Vocational Evaluatorvocational rehabilitationpermanent total disabilityorthopedic injurypsychiatric injuryapportionmentAgreed Medical Examinerwork restrictionsvocational testingsubstantial evidence
References
3
Case No. ADJ7679237
Regular
Oct 27, 2017

VALERIE TRUJILLO vs. COLTON JOINT UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board granted reconsideration and amended a previous award. The Board found that the administrative law judge erred by failing to address the applicant's vocational expert evidence concerning permanent total disability. The Board also directed the judge to incorporate an agreed medical evaluator's opinion on right ankle impairment if the vocational evidence is rejected. Jurisdiction was reserved on the issue of permanent disability, allowing for further evaluation of the vocational evidence.

WCABPetition for ReconsiderationFindings and AwardSpecial Education AideLumbar SpineRight AnklePsychePermanent DisabilityAgreed Medical EvaluatorAMA Guides
References
8
Case No. ADJ7944187
Regular
Feb 19, 2014

LISA MENDOZA vs. RITE AID CORPORATION, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The defendant, Rite Aid Corporation, petitioned for removal after the WCJ quashed a deposition and set an unreasonably short deadline for a vocational evaluation. The Appeals Board granted the petition, finding merit in the defendant's arguments regarding discovery limitations. The Board amended the prior orders, keeping discovery open for the vocational evaluator's report and depositions of qualified medical evaluators. This allows the defendant to fully pursue its discovery related to impairment, apportionment, and recent sub rosa video evidence.

Petition for RemovalVocational Rehabilitation AssessmentQuashed DepositionPermanent ImpairmentApportionmentSub Rosa VideoQualified Medical EvaluatorsIra CohenDiscoveryWorkers' Compensation Appeals Board
References
0
Case No. ADJ7399938 ADJ7068967
Regular
Jun 23, 2015

OLENA GARCIA vs. RESIDENCE INN, NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PENNSYLVANIA

The Appeals Board granted reconsideration, rescinded the prior award, and returned the case for further development of the record. The initial award found permanent total disability based on a vocational expert's opinion, but the Board found this opinion lacked substantial medical evidence. Specifically, the medical expert's supplemental report was not based on a current evaluation, and the vocational expert's conclusions, relying on that report, were therefore also flawed. The matter is remanded to allow for a current medical evaluation and reassessment of vocational rehabilitation and diminished earning capacity.

Workers' Compensation Appeals BoardPermanent Total DisabilityJoint Findings and AwardVocational ExpertSubstantial EvidenceScheduled RatingFunctional Capacity EvaluationAgreed Medical ExaminerApportionmentModified Work
References
0
Case No. MISSING
Regular Panel Decision

Ficken v. Vocational Education & Extension Board of Suffolk

The petitioner sought review of her employment termination as a secretary by the Vocational Education and Extension Board of the County of Suffolk (VEEB) and requested reinstatement with back pay. She argued that she was discharged without the procedural protections afforded to civil servants under Civil Service Law § 75. VEEB contended that the petitioner was not covered by these protections. The Supreme Court ruled in favor of the petitioner, directing her reinstatement and back pay. The appellate court affirmed this decision, holding that the petitioner's position, though designated 'unclassified' by Suffolk County, did not fit any category under Civil Service Law § 35, thus classifying it as 'classified' and entitling her to § 75 protections. The court emphasized that the petitioner could not be denied these rights until a proper classification was established.

Civil Service LawEmployment TerminationReinstatementBack PayUnclassified ServiceClassified ServiceCivil Servant RightsDue ProcessArticle 78 ProceedingSuffolk County
References
5
Case No. MISSING
Regular Panel Decision

Swift Independent Packing Co. v. District Union Local One

This case involves a dispute between Swift Independent Packing Company and District Union Local One over a labor arbitration award. Swift sought to vacate the award, which was issued by Arbitrator Mario A. Procopio and favored the Union regarding work schedules and overtime pay under a collective bargaining agreement. Swift raised several objections, including alleged arbitrator bias, reliance on facts not in evidence, the award lacking essence from the agreement, and refusal to hear testimony. The District Court, emphasizing its limited scope of review over arbitration awards, denied Swift's motion for summary judgment to vacate the award and granted the Union's motion to confirm it, concluding that no grounds for vacatur existed and that Swift had waived its right to object to the alleged bias.

Labor ArbitrationCollective Bargaining AgreementArbitration AwardVacatur of AwardConfirmation of AwardArbitrator BiasJudicial ReviewWaiver DoctrineOvertime PayWork Schedules
References
19
Case No. MISSING
Regular Panel Decision

In re the Arbitration between Rochester Independent Workers & General Dynamics/Electronics Division

This case involves a motion by the Rochester Independent Workers, Local No. 1 (Union) to compel arbitration against General Dynamics/Electronics Division (Company). The grievance concerned a reduction in force, lay-offs, and the transfer of work out of the bargaining unit. The Union claimed violations of the Recognition and Management Rights articles of their collective bargaining agreement. The Company argued that its right to subcontract and assign work was an exclusive management prerogative explicitly excluded from arbitration by the agreement. The court, referencing Federal precedents, determined that the agreement's language clearly excluded such matters from arbitration and, therefore, denied the Union's motion to compel arbitration.

arbitrationlabor disputecollective bargaining agreementsubcontractingmanagement rightsgrievance procedurelay-offunionfederal court decisionscontract interpretation
References
10
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