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Case Law Database

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

Case No. 2017 NY Slip Op 04184 [150 AD3d 1589]
Regular Panel Decision
May 25, 2017

New York State Workers' Compensation Board v. Program Risk Management, Inc.

The New York State Workers' Compensation Board, acting as administrator and successor to the Community Residence Insurance Savings Plan, initiated legal action against various entities and individuals after the trust became severely underfunded. Defendants include Program Risk Management, Inc. (administrator), PRM Claims Services, Inc. (claims administrator), individual officers of PRM, the Board of Trustees, and Thomas Gosdeck (trust counsel). The plaintiff sought damages for claims such as breach of contract, breach of fiduciary duty, and legal malpractice. The Supreme Court's order partially dismissed some claims and denied others. On cross-appeal, the Appellate Division, Third Department, modified the Supreme Court's order, notably reversing the dismissal of several breach of fiduciary duty claims and common-law indemnification against PRMCS, while affirming denials of motions to dismiss breach of contract, legal malpractice, and unjust enrichment claims. The court's decision was influenced by recent rulings in State of N.Y. Workers' Compensation Bd. v Wang.

Workers' Compensation LawGroup Self-Insured TrustBreach of ContractBreach of Fiduciary DutyLegal MalpracticeUnjust EnrichmentStatute of LimitationsEquitable EstoppelAlter Ego LiabilityCommon-Law Indemnification
References
20
Case No. SBR 0320298
Regular
Jun 13, 2008

DANILO DeGUZMAN vs. LOMA LINDA UNIVERSITY MEDICAL CLINIC, LOMA LINDA RISK MANAGEMENT

This case concerns a dispute over the reasonable value of medical services provided by West Coast Spine Restoration Center. The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior decision, finding that the defendant properly paid the lien claimant's fees according to the Official Medical Fee Schedule. The Board determined that the lien claimant failed to meet its burden of proof to justify charges exceeding the OMFS for work hardening and functional capacity evaluations.

Workers' Compensation Appeals BoardLoma Linda University Medical CenterLoma Linda Risk ManagementDanilo DeGuzmanIndustrial InjuryRegistered NurseWork HardeningFunctional Capacity EvaluationOfficial Medical Fee ScheduleOMFS
References
1
Case No. WCK 0068998
Regular
Jan 22, 2008

LINDA FONTENOT vs. BARRETT BUSINESS SERVICES INC., PINNACLE RISK MANAGEMENT SERVICES

The Workers' Compensation Appeals Board (WCAB) rescinded sanctions imposed against Barrett Business Services Inc. (represented by Pinnacle Risk Management Services) and its adjustor, Chamber Medical Collections, Inc. (CMC), for failing to appear at a hearing. The WCAB found that CMC provided a reasonable excuse for its non-appearance, supported by a doctor's note, and deemed the sanctions disproportionate. The matter was returned to the trial level for further proceedings on other sanctions and the underlying lien claim.

Workers Compensation Appeals BoardReconsiderationSanction OrdersLien ClaimantFailure to AppearWCJPetition for ReconsiderationTimelinessReasonable ExcuseDoctor's Statement
References
0
Case No. 2019 NY Slip Op 05656 [174 AD3d 704]
Regular Panel Decision
Jul 17, 2019

Matter of Linda H.A. (Belluci)

In this case, Linda H.A. appealed a Supreme Court judgment that appointed an independent guardian for her person and property under Mental Hygiene Law article 81. The proceeding was initiated by the Executive Director of North Shore University Hospital, alleging Linda H.A. was an incapacitated person requiring a guardian. Following a hearing, the Supreme Court, Nassau County, granted the petition. On appeal, the Appellate Division, Second Department, affirmed the judgment, finding clear and convincing evidence of Linda H.A.'s incapacity. The court based its decision on testimony revealing her inability to provide for personal needs and property management, delusional beliefs, a history of eviction, and refusal of medical and housing assistance.

GuardianshipIncapacitationMental Hygiene Law Article 81Appellate ReviewPersonal Needs ManagementProperty ManagementClear and Convincing EvidenceDelusional BeliefsEviction HistoryRefusal of Care
References
7
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
Jul 26, 2000

AIU Insurance v. Unicover Managers, Inc.

This case involves plaintiff insurance companies, AIG, seeking a declaration that defendant ReliaStar Life Insurance Company was bound to reinsure AIG for certain workers' compensation risks based on reinsurance slips signed by Unicover Managers, Inc., ReliaStar's managing general underwriter. The Supreme Court, New York County, dismissed AIG's complaint against ReliaStar and Unicover, and ReliaStar's third-party complaint against E.W. Blanch Company. The appellate court affirmed the dismissal, finding that the parties' correspondence and conduct established that reinsurance would only be bound upon ReliaStar's own signature, negating any actual or apparent authority of Unicover or ratification by ReliaStar. Estoppel and misrepresentation claims against both defendants were also dismissed. The judgment was modified to explicitly dismiss all remaining cross claims and counterclaims, and the initial dismissal was otherwise affirmed.

Reinsurance AgreementSummary JudgmentContract InterpretationAgency AuthorityApparent AuthorityRatificationEstoppelMisrepresentationWorkers' Compensation RisksCross Claims
References
3
Case No. ADJ158605 (RIV 0028842)
Regular
Nov 14, 2008

CHARLES WEBSTER vs. COUNTY OF RIVERSIDE RISK MANAGEMENT

The Workers' Compensation Appeals Board denied Charles Webster's petition for reconsideration in his case against County of Riverside Risk Management. The Board adopted the findings and reasoning of the workers' compensation administrative law judge in their decision. This order formally denies Webster's request to have the case reconsidered.

Workers' Compensation Appeals BoardOrder Denying ReconsiderationWCJ ReportPetition for ReconsiderationTapia v. Skill Masters StaffingAppeals Board en bancADJ158605RIV 0028842County of Riverside Risk ManagementCharles Webster
References
1
Case No. ADJ8107354
Regular
Aug 29, 2014

STACY SAUNDERS vs. LOMA LINDA UNIVERSITY MEDICAL GROUP

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration in the case of *Saunders v. Loma Linda University Medical Group*. This decision was made to allow for further study of the factual and legal issues presented. Consequently, all future communications regarding this case must be submitted in writing directly to the Office of the Commissioners of the WCAB, not to any district office or via e-filing.

Petition for ReconsiderationWorkers' Compensation Appeals BoardLoma Linda University Medical GroupSan Bernardino District OfficeStatutory Time ConstraintsFactual and Legal IssuesJust and Reasoned DecisionOffice of the CommissionersElectronic Adjudication Management SystemDecision After Reconsideration
References
0
Case No. ADJ3968337 (LAO 0844136) ADJ4336885 (LAO 0805868) ADJ672008 (LAO 0805870)
Regular
Sep 24, 2015

ARMIDA BELTRAN vs. MCDONALD'S, HAZELRIGG RISK MANAGEMENT SERVICES

This case involves a petition for reconsideration by McDonald's and Hazelrigg Risk Management Services regarding deposition attorney fees. The Workers' Compensation Appeals Board (WCAB) is dismissing the petition because the petitioner has withdrawn it. This withdrawal is consistent with a prior WCJ order rescinding the attorney fee orders, allowing for further discovery on deposition attorney fee payments. Consequently, the petition for reconsideration is dismissed.

Petition for ReconsiderationWCJrescindeddeposition attorney fee ordersCIGAOrder of Rescissioncrossed in the mailwithdrawn petitionfurther discoveryprior payment
References
0
Case No. 2016 NY Slip Op 00302 [135 AD3d 572]
Regular Panel Decision
Jan 19, 2016

Domaszowec v. Residential Management Group LLC

Plaintiff Tracy Domaszowec's decedent died from a fall while cleaning a window on the 13th floor of an apartment building. The Appellate Division, First Department, modified a Supreme Court order, granting plaintiff's motion for partial summary judgment on her Labor Law § 240 (1) claim against Residential Management Group LLC and 40 Fifth Avenue Corporation (40 Fifth defendants), the building owner and manager. The court found the decedent was engaged in "commercial window washing," thereby making Labor Law § 240 (1) applicable. The court affirmed the dismissal of Labor Law § 202 against Veronica Bulgari and Stephen Haimo due to lack of exclusive control, and common-law negligence claims against T&L Contracting of N.Y., Inc. and Greenpoint Woodworking Inc. due to the lack of an exception to the contractual obligation rule. Issues of fact precluded summary judgment on negligence claims against Panorama Windows, Ltd., and the doctrine of res ipsa loquitur was deemed inapplicable to certain defendants.

Window cleaner fatalityScaffold LawSummary judgment appealAppellate Division First DepartmentCommercial vs. routine window washingLabor Law applicabilityContractual tort liabilityRes ipsa loquitur in negligencePunitive damages dismissalExpert witness evidence
References
8
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