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

Case No. ADJ2623515 (SJO 0244721) ADJ1776322 (SJO 0250018)
Regular
Feb 10, 2010

THU-HA TRAN vs. THERMO LASER SCIENCE, ST. PAUL TRAVELERS, MATRIX ABSENCE MANAGEMENT

This case concerns Matrix Absence Management's petition for reconsideration of a workers' compensation decision regarding cost reimbursement for applicant Thu-Ha Tran's lumbar spine treatment. The arbitrator previously found insufficient evidence to compel reimbursement between Matrix and St. Paul Travelers. Matrix's petition lacked verification, a requirement under Labor Code section 5902. The Board dismissed the petition because Matrix failed to cure this defect despite notice. Even if verified, the Board would have denied the petition based on the original arbitrator's reasoning.

Workers' Compensation Appeals BoardPetition for ReconsiderationDismissalVerificationLabor Code Section 5902Lucena v. Diablo Auto BodyFindings and OrderReimbursementLumbar SpineMatrix Absence Management
References
1
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. ADJ2317869
Regular
Aug 04, 2009

ALLEN BONET vs. HONDA OF OAKLAND, MATRIX ABSENCE MANAGEMENT

This case involves a Petition for Removal filed by Honda of Oakland and Matrix Absence Management. The Workers' Compensation Appeals Board denied the petition because the defendants failed to demonstrate substantial prejudice or irreparable harm, which are the strict requirements for removal. The Administrative Law Judge recommended denial, citing significant issues with the medical records and the applicant's inconsistent testimony regarding his date of injury. The ALJ had taken the matter out of submission to further develop the record, specifically to determine the correct date of injury, which is crucial for evaluating the defendants' post-termination and statute of limitations defenses.

Petition for RemovalWorkers' Compensation Appeals BoardADJ2317869Allen BonetHonda of OaklandMatrix Absence ManagementOrder Denying Petition for RemovalSubstantial PrejudiceIrreparable InjuryAOE/COE
References
4
Case No. MISSING
Regular Panel Decision

57th Street Management Corp. v. Zurich Insurance

The plaintiff, 57th Street Management Corp., sought a judgment declaring that Zurich Insurance Company, the defendant, had a duty to defend and indemnify it in an underlying negligence action initiated by an injured employee, Isaac Wilner, and a subsequent third-party action by Bade Cab Corp. Wilner was injured in 1984, received workers' compensation benefits from a policy issued by Zurich, and later sued 57th Street Management Corp. and Bade Cab Corp. The action against 57th Street Management Corp. was dismissed due to Workers' Compensation Law § 11. Bade Cab Corp. then served a third-party summons on the plaintiff. The Appellate Division reversed the Supreme Court's order, granting Zurich's cross motion for summary judgment. The court found that the plaintiff failed to provide timely notice to Zurich of the personal injury action, vitiating coverage, and that notice of the workers' compensation claim did not serve as notice for subsequent actions.

Insurance CoverageDuty to DefendDuty to IndemnifySummary Judgment AppealTimely Notice RequirementWorkers' Compensation ExclusivityThird-Party LiabilityNew York Appellate LawEmployer's Liability InsuranceVitiation of Coverage
References
5
Case No. ADJ8094646
Regular
Jan 17, 2014

ALEJANDRINA BARRETO vs. OUT OF THE SHELL, SOUTHERN INSURANCE COMPANY, REPUBLIC INDEMNITY COMPANY, PHARMAFINANCE, LLC, HEALTHCARE FINANCE MANAGEMENT, LLC

This case involves lien claimants PharmaFinance and Healthcare Finance Management, and their representatives Landmark Medical Management and Brian Hall, who sought reconsideration of a decision disallowing their liens for medical treatment. The Appeals Board granted reconsideration solely to notice its intention to impose sanctions of up to $2,500 against the lien claimants and their representatives. This action is due to a pattern of allegedly filing petitions containing false statements about not receiving notices, which violates the Board's Rules of Practice and Procedure and Labor Code Section 5813. The Board found these claims not persuasive and indicative of a tactic to avoid responsibility.

Workers' Compensation Appeals BoardPetition for ReconsiderationSanctionsLien ClaimantsHearing RepresentativesIndustrial InjuryFindings and OrderCompromise and ReleaseNotice of IntentionLabor Code section 5813
References
0
Case No. 2020 NY Slip Op 06000 [187 AD3d 1395]
Regular Panel Decision
Oct 22, 2020

Matter of Capraro v. Matrix Absence Mgt.

Claimant, a home-based claims examiner, was injured while moving unassembled new office furniture to his home office after his employer declined to cover the expense. He applied for workers' compensation benefits, but both a Workers' Compensation Law Judge (WCLJ) and the Workers' Compensation Board denied his claim, ruling that the injury did not arise out of and in the course of his employment. The Board had applied a novel, rigid standard for at-home employees, limiting compensability to injuries during regular work hours and active work duties. The Appellate Division, Third Department, found this new standard unsupported by precedent and inconsistent with the remedial nature of the Workers' Compensation Law, emphasizing that a regular pattern of work at home makes the residence a place of employment. The court reversed the Board's decision and remitted the matter, instructing the Board to apply the long-established standard to determine if the activity was "purely personal" or "reasonable and sufficiently work related."

Workers' CompensationArising out of employmentCourse of employmentWork-from-home injuryOffice furniturePersonal activity vs. work-relatedAppellate reviewRemittalBoard decision reversalHome as workplace
References
20
Case No. MISSING
Regular Panel Decision
Nov 24, 1987

Langdon v. WEN Management Co.

The plaintiff, widow of Joseph Langdon, appealed an order of the Supreme Court, Queens County, which granted the defendants' motion for summary judgment dismissing her complaint for personal injuries. Joseph Langdon died 17 days after sustaining severe head injuries from a fall at his workplace, Astoria Gardens. The Workers’ Compensation Board initially found Elizabeth and Gregory Associates to be the decedent's employer, but later determined that a 'general/special' employment relationship existed between WEN Management Company and Associates, making both equally liable for benefits. The Supreme Court granted summary judgment to the defendants, concluding that the Board's determination of the decedent’s employer had collateral estoppel effect. The appellate court affirmed, agreeing that the doctrine of collateral estoppel applies to bar the plaintiff's cause of action against the defendants, as the issue of the decedent’s employer was necessarily decided by the Board after the plaintiff had a full and fair opportunity to contest it.

Collateral EstoppelIssue PreclusionSummary JudgmentWorkers' Compensation LawEmployer LiabilityGeneral/Special EmploymentPersonal InjuryWrongful DeathAppellate ReviewAdministrative Agency Determination
References
4
Case No. ADJ3434154
Regular
Mar 28, 2011

GARY ZIMMERMAN vs. LEPRINO FOODS, INC., MATRIX ABSENCE MANAGEMENT COMPANY

The Workers' Compensation Appeals Board granted reconsideration, finding that Leprino Foods violated Labor Code section 132a by failing to place the applicant on a required union leave of absence. While the Board affirmed the WCJ's decision that the applicant's termination was lawful based on a doctor's work restrictions, they awarded a 50% increase in compensation up to $10,000, plus costs, due to the Section 132a violation. However, the Board denied back pay, agreeing with the WCJ that lost wages were not caused by the employer's contract violation but by the lawful termination and the applicant's insufficient mitigation efforts. A dissenting commissioner argued for back pay, citing the discriminatory nature of the termination during the mandated leave and the lack of evidence for the WCJ's findings on misleading doctors and failed mitigation.

Labor Code section 132aLeprino FoodsMatrix Absence Management CompanyGary ZimmermanBrian Belanger D.C.permanent and stationary reportunion grievanceArbitratorback payreinstatement
References
3
Case No. 2014 NYSlipOp 06892 [121 AD3d 481]
Regular Panel Decision
Oct 14, 2014

Matter of Emerald Claims Mgt. for Ullico Cas. Ins. Co. v. A. Cent. Ins. Co.

Petitioner, Emerald Claims Management for Ullico Casualty Insurance Company, as subrogee of Randolph Meyers, sought "loss transfer" reimbursement from A. Central Insurance Company, an adverse insurer, under Insurance Law § 5105. Petitioner had paid workers' compensation benefits to its insured after a motor vehicle accident and sought reimbursement for no-fault benefits. Respondent asserted a disclaimer of coverage due to noncooperation. The Supreme Court confirmed two arbitration awards in favor of the petitioner, and the Appellate Division unanimously affirmed this judgment. The arbitrators' decision was upheld as rational, construing Insurance Law § 5105 (a) to provide a direct right to reimbursement regardless of the respondent's disclaimer of coverage. The Appellate Division also found that the respondent waived any jurisdictional arguments by fully participating in the arbitration.

Insurance LawWorkers' CompensationSubrogationLoss TransferCompulsory ArbitrationDisclaimer of CoverageNoncooperationAppellate ReviewJudgment AffirmationInsurance Policy
References
6
Case No. ADJ2555047 (SRO 0120485) ADJ2388195 (SRO 0132795)
Regular
Nov 24, 2008

VIRGINIA GOPAR vs. ADVANCED FIBRE COMMUNICATION, SAFETY NATIONAL CASUALTY, MATRIX ABSENCE MANAGEMENT, CIGA, BROADSPIRE, LEGION INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration, rescinding the prior decision and returning the matter for further proceedings. The WCAB determined that collateral estoppel bars relitigating the cumulative trauma injury date of November 5, 2004, which was previously adjudicated. This established date means CIGA, as the insurer for Legion Insurance Company, is entitled to seek reimbursement from Safety National Casualty, which provided coverage during a portion of the injury period. The WCAB instructed the arbitrator to consider the effect of prior case law regarding contribution and reimbursement in light of the established injury date.

CIGALegion InsuranceSafety National Casualtycumulative traumacollateral estoppeldate of injuryapportionmentcontributionincurred lossesloss adjustment expenses
References
8
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