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

Case No. 530563
Regular Panel Decision
Jan 20, 2022

In the Matter of the Claim of Luis Urena

Luis Urena, an employee of Abcal Industries, sustained injuries after falling while working on a residential renovation project in Brooklyn in July 2017 and applied for workers' compensation benefits. The Workers' Compensation Board ruled that Norguard Insurance Company, Abcal's carrier, was liable for Urena's benefits, rejecting Norguard's arguments that its policy did not cover work in New York. Norguard appealed, contending that a policy exclusion applied due to Abcal's failure to notify them of New York work within 30 days. The Supreme Court, Appellate Division, Third Judicial Department, affirmed the Board's decision, finding that Norguard failed to meet its burden of proving the exclusion applied and that the Board's interpretation of the policy language was reasonable.

Workers' Compensation InsurancePolicy ExclusionEmployer LiabilityCarrier LiabilityAppellate ReviewJurisdictionNew York Workers' Compensation LawSubcontract AgreementConstruction InjuryTimeliness
References
7
Case No. No. 13
Regular Panel Decision
Mar 26, 2020

The Matter of the Claim of Luis A. Vega v. Postmates Inc

The New York Court of Appeals addressed whether a Postmates, Inc. courier, Luis A. Vega, and similarly-situated individuals, are employees for unemployment insurance contributions. The Unemployment Insurance Appeals Board (the Board) had determined them to be employees, reversing an Administrative Law Judge's finding of independent contractor status. The Appellate Division then reversed the Board, concluding insufficient evidence of an employer-employee relationship. The Court of Appeals reversed the Appellate Division, reinstating the Board's decision, finding substantial evidence that Postmates exercised control over its couriers, rendering them employees for unemployment insurance purposes. The court highlighted Postmates' control over assignments, compensation, customer complaints, and the inability of couriers to operate as independent businesspersons.

Unemployment InsuranceGig EconomyIndependent ContractorEmployee ClassificationLabor LawApp-based DeliveryControl TestWorkers' RightsNew York Court of AppealsSubstantial Evidence
References
44
Case No. MISSING
Regular Panel Decision
Nov 13, 2002

Zurich American Insurance v. Luis Bastos Construction

Zurich American Insurance Co. initiated an action seeking a declaratory judgment that it was not obligated to defend or indemnify Luis Bastos Construction, Inc. in an underlying personal injury lawsuit filed by Hermilo Cruz. Cruz, an employee of Bastos, sustained injuries in New York while working on a job that was not related to any work being performed in New Jersey. Zurich's insurance policy provided employers' liability coverage specifically for claims arising from accidents in New Jersey or those incidental to New Jersey operations. The Supreme Court, Westchester County, granted Zurich's motion for summary judgment, ruling that Zurich had no obligation to defend or indemnify Bastos. Defendant A.E Roofing & Siding Corp. appealed this decision. The appellate court affirmed the Supreme Court's order and judgment, concluding that the terms of the policy were clear and unambiguous.

Declaratory JudgmentInsurance CoverageEmployers' LiabilityWorkers' CompensationSummary JudgmentPolicy InterpretationPersonal InjuryAppellate ReviewJurisdictionNew York Law
References
2
Case No. ADJ10259451
Regular
Sep 10, 2019

LUIS SILVA vs. CITISTAFF SOLUTIONS, OLD REPUBLIC c/o GALLAGHER BASSETT SERVICES

The Workers' Compensation Appeals Board granted reconsideration of a prior decision. They amended the decision to reflect that Old Republic, not a different insurer, is the liable party for Luis Silva's injury. The Board also admitted Defendant's Exhibit E into evidence. Otherwise, the original decision awarding temporary disability, permanent disability, future medical treatment, and attorney's fees to Luis Silva was affirmed.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ reportExhibit EOld RepublicGallagher Bassettgeneral laborerlumbar spineinternal injurytemporary disability indemnity
References
0
Case No. ADJ9409541
Regular
Aug 23, 2019

LUIS MEDINA BERNAL (Deceased), PATRICIA SOLANO VASQUEZ, MISAEL MEDINA SOLANO, LUCIA MEDINA SOLANO, XIMENA MEDINA SOLANO, I SAI MEDINA SOLANO, LUIS EMANUEL MEDINA SOLANO vs. REBECCA BAUTISTA dba REMAC TIRE SERVICES, UNINSURED EMPLOYERS BENEFITS TRUST FUND

This case involves a fatal industrial injury to Luis Medina Bernal, a tire changer. The Workers' Compensation Appeals Board (WCAB) granted reconsideration to clarify death benefit payment terms. While the WCJ correctly found petitioning applicants failed to prove partial dependency, the WCAB amended the decision. The death benefit for the widow, Patricia Solano Vasquez, is to be paid bi-weekly at $297.29 until the $250,000 total is exhausted. The attorney's fee was recalculated to $34,042.54, representing 15% of the death benefit's present value.

Workers' Compensation Appeals BoardPetition for ReconsiderationDecision After ReconsiderationFatal Industrial InjuryPartial DependencyCredibility DeterminationsNet Financial BenefitDeath BenefitPresent ValueAttorney's Fee
References
4
Case No. 2016 NY Slip Op 02734 [138 AD3d 488]
Regular Panel Decision
Apr 12, 2016

Matter of Lesli R. (Luis R.)

The Family Court's order of disposition, which found that the respondent sexually abused his stepdaughters and derivatively abused his five biological children, was unanimously affirmed. The record supported the court's determination that the respondent was legally responsible for the children and that there was a preponderance of evidence of sexual abuse. The stepdaughters' out-of-court statements were sufficiently corroborated by the respondent's own statements. The court also found that the respondent derivatively abused his own children and properly exercised its discretion in quashing a subpoena to compel one of the stepdaughters to testify due to potential psychological harm.

Child AbuseSexual AbuseDerivative AbuseFamily Court ActAppellate ReviewPreponderance of EvidenceOut-of-court StatementsCorroborationParental ObligationsSubpoena Quash
References
11
Case No. ADJ10521677 ADJ10945059
Regular
Dec 20, 2019

JOSE LUIS DURAN vs. COUNTY OF LOS ANGELES

The Workers' Compensation Appeals Board granted reconsideration for Jose Luis Duran's cases to correct clerical errors and inconsistencies in prior decisions. The Board rescinded and substituted the prior findings and awards, clarifying the permanent disability percentages and the grounds for apportionment. Specifically, Case ADJ10521677 now reflects 14% permanent disability, and Case ADJ10945059 clarifies no legal grounds for apportionment regarding heart/hypertension. The revised decisions ensure accurate payment of indemnity and attorney fees.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationPetition for ReconsiderationGrantRescindSubstituteClerical ErrorsFindings of FactAwardOrder
References
1
Case No. ADJ7332228
Regular
May 04, 2016

Luis Zapanta vs. Pacific Gas & Electric Company

The Workers' Compensation Appeals Board denied Luis Zapanta's petition for reconsideration, upholding the prior ruling that his Independent Medical Review (IMR) was timely. The Board found that the IMR process, including Maximus Federal Services' review, complied with Labor Code section 4610.6(d) and relevant regulations. Applicant's arguments regarding the timeliness of the IMR determination and whether sufficient medical records were reviewed were rejected. The Board affirmed the administrative law judge's decision based on the WCJ's report and additional supporting regulations.

Workers' Compensation Appeals BoardIndependent Medical ReviewMaximus Federal ServicesPetition for ReconsiderationFindings of Fact and OrderLabor CodeCalifornia Code of RegulationsPrimary Treating PhysicianTimelinessSupporting Documentation
References
4
Case No. MISSING
Regular Panel Decision

DeJesus v. Chater

Plaintiff Jose Luis DeJesus appealed the Commissioner of Social Security's denial of Social Security Disability Insurance Benefits. An Administrative Law Judge (ALJ) initially denied benefits, finding DeJesus capable of sedentary work despite chronic low back derangement. The Appeals Council upheld the ALJ's decision. The matter was referred to Magistrate Judge Andrew J. Peck, who recommended granting the plaintiff's motion for judgment on the pleadings and remanding for benefits calculation, finding the Commissioner's decision unsupported by substantial evidence. The District Court adopted the Magistrate Judge's recommendation, concluding there was no substantial evidence to support the Commissioner's determination that the plaintiff could perform sedentary work. The Court granted the plaintiff's motion, denied the Commissioner's cross-motion, and remanded the case for the calculation and payment of benefits.

Social Security DisabilityDisability Insurance BenefitsALJ DecisionAppeals Council ReviewSedentary Work CapacityChronic Low Back DerangementResidual Functional CapacitySubstantial Evidence ReviewMagistrate Judge ReportRemand for Benefits
References
21
Case No. MISSING
Regular Panel Decision

Zamot v. Monroe County Department of Human Services

Plaintiff Luis Zamot, acting pro se, filed a Title VII lawsuit against his former employer, the Monroe County Department of Human Services, alleging a hostile work environment based on gender. Zamot claimed he experienced harassment from female colleagues and administrative law judges, including being introduced as 'the new Barb' and facing condescending behavior. A bench trial was held in November 2009. The court found no credible evidence of gender-based harassment or discriminatory abuse. The decision concluded that any conflicts were related to Zamot's poor work performance and demeanor, not his gender, and therefore, judgment was granted in favor of the defendant.

Hostile Work EnvironmentGender DiscriminationTitle VII Civil Rights ActEmployment LawBench TrialPoor PerformanceWorkplace ConductSupervisor RelationsAdministrative LawMagistrate Judge Decision
References
14
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