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

Case No. VNO 0467089
Regular
Jun 20, 2008

LUIS ARAGON vs. THE CHEESECAKE FACTORY, U.S. FIDELITY AND GUARANTY, GALLAGHER BASSETT SERVICES

This case concerns a medical provider's lien claim after the applicant's workers' compensation claim was settled. The lien was initially disallowed because the provider had received payment from Medi-Cal and had not yet reimbursed the program. The Appeals Board granted reconsideration, amending the award to allow the provider to pursue its lien claim, but only after proving full reimbursement to Medi-Cal as required by Welfare and Institutions Code section 14124.791. Jurisdiction is reserved for further proceedings at the trial level.

Workers' Compensation Appeals BoardLien claimantMedi-Cal reimbursementWelfare and Institutions Code § 14124.791Industrial injuryBelow the knee amputationCompromise and releasePetition for reconsiderationReport and RecommendationFindings and Award
References
3
Case No. MISSING
Regular Panel Decision
Oct 26, 2015

Matter of Newbill v. Town of Hempstead

Claimant, a sanitation crew chief, injured his right ankle and foot at work and was awarded disability benefits. His self-insured employer paid his full weekly wages during a period of disability and timely sought reimbursement for these advanced payments. A Workers’ Compensation Law Judge granted the employer's reimbursement request against a 20% schedule loss of use award for the right foot. The Board affirmed this decision, and the claimant appealed, arguing that reimbursement should not cover periods where no compensation awards were initially made. The court affirmed the Board's decision, reiterating that an employer is entitled to full reimbursement from a schedule loss of use award for advanced wages paid during disability, as schedule awards are not allocable to specific periods of lost work.

Schedule Loss of UseReimbursementAdvanced Wage PaymentsDisability BenefitsEmployer RightsAppellate ReviewWorkers’ Compensation BoardStatutory InterpretationPermanent Partial DisabilityTimely Claim
References
10
Case No. RDG 0083560 RDG 0072880
Regular
Jul 18, 2007

LOUIS LUOND vs. RON PORTER, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, TIG INSURANCE COMANY

This case concerns an appeal by TIG Insurance Company regarding its liability to reimburse CIGA for workers' compensation benefits paid to an applicant with successive knee injuries. The Appeals Board denied TIG's reconsideration, upholding its prior decision that CIGA is entitled to 100% reimbursement of benefits paid after the insolvency of Cal Comp, because TIG is a solvent insurer providing "other insurance" for the applicant's medical benefits. The Board found that the 50/50 stipulation between TIG and Cal Comp was not binding on CIGA and that Labor Code section 5500.5 was inapplicable to this successive injury claim.

Workers' Compensation Appeals BoardCIGACal CompTIG Insurancereconsiderationreimbursementmedical benefitsinsolvencyliquidationstipulation
References
2
Case No. MISSING
Regular Panel Decision

Claim of Guarascio v. Spargo Wire Co.

The claimant, a truck driver, suffered work-related back and shoulder injuries in October 1995. The employer’s workers’ compensation carrier paid benefits. In 2000, the carrier sought reimbursement from the Special Disability Fund under Workers’ Compensation Law § 15 (8) (d) for these payments. A Workers’ Compensation Law Judge (WCLJ) established the claim in 2002 and later found the claimant permanently partially disabled, ruling on apportionment but deferring the reimbursement issue. The WCLJ subsequently found the carrier’s request for reimbursement timely. The Workers’ Compensation Board affirmed this decision. This appeal concerns the Board’s ruling that the carrier’s C-250 claim for reimbursement was timely filed within the statutory 52-week period, despite the underlying claim documents being posted by the Board in 2000.

ReimbursementSpecial Disability FundTimeliness of ClaimPermanent Partial DisabilityWorkers' Compensation LawPreexisting ImpairmentWork-related InjuryC-250 ClaimStatute of LimitationsAppellate Review
References
3
Case No. MISSING
Regular Panel Decision

Claim of Simpson v. Glen Aubrey Fire Co.

A volunteer fireman suffered an acute lumbosacral strain requiring frequent hospital and doctor visits. He sought reimbursement for 290 miles of travel expenses. The Workers' Compensation Board approved reimbursement at 20 cents per mile, leading to this appeal. The court examined whether travel expenses for medical treatment are reimbursable under the Volunteer Firemen’s Benefit Law and Workers’ Compensation Law. It concluded that access to medical treatment implies the financial means to obtain it, upholding the humanitarian goals of the legislation.

Volunteer FiremanLumbosacral StrainMileage ReimbursementTravel ExpensesMedical TreatmentWorkers' Compensation LawVolunteer Firemen's Benefit LawStatutory InterpretationRemedial LawLiberal Construction
References
2
Case No. MISSING
Regular Panel Decision

Poupard v. Mohonasen Central School District

The claimant, a librarian, sustained an employment-related injury. Following her injury, she received full salary for 27 weeks under a collective bargaining agreement, and then used 23 days of accumulated sick leave. The employer sought reimbursement for these advance payments. The referee and the Workers’ Compensation Board initially granted the full reimbursement. On appeal, the court modified the decision, holding that wages paid from accumulated sick leave, acquired through a collective bargaining agreement, are compulsory payments and thus not reimbursable under Workers’ Compensation Law § 25 (subd 4, par [a]). The matter was remitted for further proceedings consistent with this ruling, with costs awarded to the claimant.

Workers' CompensationReimbursementSick LeaveCollective Bargaining AgreementAdvance PaymentsOccupational DisabilityStatutory LimitationsAppellate ReviewEmployment InjuryReferee Decision
References
5
Case No. MISSING
Regular Panel Decision

Claim of Domanico v. Woodmere Fire District

This case involves an appeal from a decision by the Workers’ Compensation Board, filed April 4, 2005, which denied an employer's request for reimbursement of wages paid to a claimant during a period of disability. The court examined whether a June 24, 2004 notice, issued by the self-insured employer, Woodmere Fire District, containing language about reimbursement, was sufficient as a request under Workers’ Compensation Law § 25 (4) (a). The court found the notice to be sufficient in form. However, a critical issue remained regarding the timeliness of this request; specifically, whether it was filed prior to the compensation award made at the January 7, 2005 hearing. Due to this unresolved issue, the court reversed the Board's decision and remitted the matter for further proceedings to determine the timeliness of the reimbursement request.

Workers' Compensation ReimbursementEmployer Wage ReimbursementDisability WagesTimeliness of Reimbursement RequestWorkers' Compensation LawBoard Decision AppealJudicial ReversalRemittal for Further ProceedingsNew York Workers' CompensationStatutory Interpretation
References
5
Case No. MISSING
Regular Panel Decision

Claim of Perrin v. Builders Resource, Inc.

The case concerns an appeal from a Workers' Compensation Board decision regarding the reimbursement rate for home health aide services provided to a claimant by their sister. Initially, the carrier denied payment but was later directed to pay. The Workers’ Compensation Law Judge set the reimbursement rate at $12 per hour for services starting in 2011, which the Board affirmed. The claimant appealed, solely challenging this rate. The court dismissed the appeal, ruling that the claimant was not an aggrieved party concerning the reimbursement rate, as the dispute was between the care provider (the sister) and the carrier. The court affirmed that the claimant received the care sought and could not raise issues on behalf of the care provider.

Workers' CompensationHome Health Aide ServicesReimbursement RateAppeal DismissalAggrieved PartyCare ProviderWorkers' Compensation BoardAppellate ProcedureNew York LawCarrier Liability
References
4
Case No. ADJ212916 (VNO 0334702)
Regular
Feb 09, 2011

PETER L. WASCHER vs. AIDS HEALTHCARE FOUNDATION INC., CIGA FOR CAL. COMP. (IN LIQUIDATION), STATE COMPENSATION INSURANCE FUND

This case involves a dispute over reimbursement for workers' compensation payments made by CIGA (California Insurance Guarantee Association) on behalf of an insolvent insurer. The arbitrator initially ordered State Compensation Insurance Fund (SCIF) to reimburse CIGA only $105,511.94, pending further proof of payment. CIGA petitioned for reconsideration, arguing it had provided sufficient evidence of payment for the full $719,238.12. The Workers' Compensation Appeals Board granted the petition, finding CIGA's payment records were reliable and unrebutted. Consequently, SCIF was ordered to reimburse CIGA the entire $719,238.12.

CIGASCIFreimbursementarbitrationreconsiderationindustrial injuryAids Healthcare FoundationCal Compmedical paymentsproof of payment
References
0
Case No. MISSING
Regular Panel Decision

Claim of Foti-Crawford v. Buffalo General Hospital

A registered nurse sustained a back injury in July 1991 while concurrently employed by Buffalo General Hospital and Supplemental Health Care, leading to permanent partial disability. The Workers’ Compensation Board awarded benefits of $153.36 per week and ruled that the Special Disability Fund should reimburse the hospital's carrier for most of these benefits under Workers’ Compensation Law § 14 (6). The Fund appealed, contending that reimbursement was unwarranted as the benefits did not exceed the maximum amount the hospital would have paid without concurrent employment. The court affirmed the Board's decision, finding its interpretation rational, especially given the claimant returned to work for the primary employer.

Workers' CompensationConcurrent EmploymentSpecial Disability FundReimbursementPermanent Partial DisabilityAverage Weekly WageAppellate ReviewBack InjuryNurseWorkers' Compensation Law
References
2
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