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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
May 05, 2006

Capital Z Financial Services Fund II, L.P. v. Health Net, Inc.

The case concerns four limited partnerships, collectively known as Cap Z, that invested $100 million to finance Superior National Insurance Group's acquisition of workers' compensation insurers (BIG) from Health Net. Cap Z alleged that Health Net misrepresented and concealed critical information regarding BIG's inadequate loss reserves, leading to significant financial losses when both Superior and BIG became insolvent. Initially, the IAS court sustained a breach of contract claim but dismissed fraud and implied covenant claims. On appeal, the court, applying Delaware law as stipulated in the agreements, determined that Cap Z's contractual claims were derivative of Superior's and therefore lacked standing. The appellate court also found the fraud and implied covenant claims to be without merit, even under New York law, citing disclaimers and Cap Z's own due diligence. Consequently, the court dismissed the entire complaint.

Shareholder Derivative ActionBreach of ContractFraudulent InducementImplied Covenant of Good Faith and Fair DealingChoice of LawCorporate AcquisitionInsolvencyFinancial MisrepresentationInvestment LossStanding to Sue
References
12
Case No. ADJ4702604 (MON 0293583) ADJ2539407 (MON 0293581) ADJ593062 (MON 0310215)
Regular
May 03, 2010

MARLU HARRIS vs. COUNTY OF LOS ANGELES, Permissibly Self-Insured, Administered By INTERCARE INSURANCE COMPANY, HEALTH NET, AIG

This case involves two alleged cumulative industrial injuries for Marlu Harris, one with Health Net and another with the County of Los Angeles. The Workers' Compensation Appeals Board (WCAB) granted reconsideration. The WCAB agreed with the WCJ's admission of error, concluding that based on Labor Code sections 5412 and 5500.5, only one cumulative trauma date of injury applies. This decision rescinds the previous award, finding that there was no compensable disability or wage loss during the Health Net employment to establish a separate injury date. The matter is returned to the trial level for further proceedings and a revised decision.

Workers' Compensation Appeals BoardMarly HarrisCounty of Los AngelesHealth NetAIGADJ4702604ADJ2539407ADJ593062ReconsiderationJoint Findings of Fact and Award
References
1
Case No. ADJ1171761 (RDG 0076230) ADJ3401110 (RDG 0077725)
Regular
Dec 10, 2012

HAROLD HOUSTON vs. CITY OF REDDING

The Workers' Compensation Appeals Board granted the City of Redding's petition for reconsideration regarding a prior award of medical mileage reimbursement to Harold Houston. While affirming the award of medical mileage, the Board amended the Findings of Fact to clarify that no past interest is due. Interest on the medical mileage will only accrue from the date the amount becomes determined and payable, as per Labor Code section 5800. The case was returned to the trial level for further proceedings to determine the specific amount owed.

Workers' Compensation Appeals BoardCity of ReddingHarold HoustonPetition for ReconsiderationFindings Award and OrderCompromise & Releasemedical mileagefuture medical treatmentLabor Code section 5800accrued interest
References
0
Case No. ADJ8873556
Regular
Jun 03, 2016

LUIS ALVARENGA vs. SCOPE INDUSTRIES, COMMERCE & INDUSTRY INSURANCE, AIG CLAIMS

The Workers' Compensation Appeals Board granted reconsideration and rescinded an order approving a Compromise and Release (C&R). The defendant argued for rescission based on a mutual mistake regarding the necessity of CMS approval for the Medicare Set Aside (MSA) amount. While CMS approval is not mandatory, the Board found the C&R inadequate as written. Specifically, the settlement did not adequately account for the MSA amount in relation to the applicant's net recovery, and the applicant was not fully advised of potential Medicare benefit denials if CMS review was bypassed. The case is returned for further proceedings to address these adequacy issues.

Compromise and ReleaseMutual MistakeMedicare Set AsideCMS ApprovalPetition for ReconsiderationOrder Approving Compromise and ReleaseRescindGood CauseFuture Medical TreatmentAdequate Consideration
References
5
Case No. 2025 NY Slip Op 03680 [239 AD3d 1184]
Regular Panel Decision
Jun 18, 2025

Matter of Cooper v. New York City Health & Hosp. Corp.

This case addresses an appeal concerning the calculation of counsel fees in a workers' compensation claim. The claimant's attorney contended that fees should be based on the gross schedule loss of use (SLU) award, while the Workers' Compensation Board (WCB) determined fees based on the net SLU award, after deducting the employer's previous wage payments. The Appellate Division, Third Department, affirmed the WCB's decision, interpreting Workers' Compensation Law § 24 (2) (c) to mean that counsel fees for SLU awards are calculated on the compensation due 'in excess of the employer or carrier's previous payments,' which includes advance wage payments. The court also upheld the Board's discretion to make counsel fees a lien against the net SLU award payable to the claimant, preventing the employer from subsidizing legal expenses and avoiding a windfall to the claimant.

Workers' CompensationCounsel FeesSchedule Loss of UseStatutory InterpretationReimbursementAdvance PaymentsLienNet SLU AwardGross SLU AwardBoard Discretion
References
4
Case No. MISSING
Regular Panel Decision

Barnhart v. Boss Linco Lines, Inc.

The case involves an appeal from an order granting summary judgment to the defendant. Plaintiff, a truck driver injured in 1977, received workers’ compensation and no-fault benefits from his employer, the self-insured defendant. After settling a third-party action, plaintiff satisfied a workers' compensation lien for $16,565.27 and sought to be made whole for $20,479.91 in previously offset no-fault benefits. Defendant, relying on a newly effective regulation (11 NYCRR 65.6 (p) (5) (ii) eff. Jan 5, 1981), paid only the net lien amount of $16,565.27. Plaintiff argued for the application of the former regulation to recover the full offset amount. The court held that the present regulation applied as the claim for additional benefits was made after its effective date, affirming the special term's decision.

Workers' Compensation LienNo-Fault Benefits OffsetSummary Judgment AppealRegulatory InterpretationThird-Party SettlementEquitable ApportionmentInsurance Law ApplicationAppellate DivisionEmployer Self-InsuranceStatutory Construction
References
1
Case No. MISSING
Regular Panel Decision
Sep 17, 1980

Vinson v. Berkowitz

Plaintiff Willie Vinson sustained serious injuries, including an amputation, after being struck by a motor vehicle during employment and began receiving workers' compensation benefits from Hartford Insurance Company. Vinson filed a lawsuit against the tort-feasor defendants, Berkowitz, seeking to settle his claim for $25,000 (netting $16,294.54) while preserving his full workers' compensation benefits. Although Hartford Insurance Company had no lien due to recent legislative amendments, it sought to suspend future benefits until the settlement amount was exhausted. The Special Term initially ruled in favor of Vinson, denying Hartford's offset claim. However, the appellate court modified the decision, directing that the suspension of Vinson's workers' compensation benefits would only occur after the aggregate of such benefits reached $50,000, and then only until the $16,294.54 settlement amount was exhausted, otherwise affirming the original order.

Workers' Compensation BenefitsNo-Fault Automobile InsuranceTort-feasor SettlementBasic Economic LossLien SuspensionInsurance Carrier OffsetMotor Vehicle AccidentPersonal Injury ClaimAppellate DivisionStatutory Interpretation
References
2
Case No. MISSING
Regular Panel Decision

McQueen v. Downtown Athletic Club of New York City, Inc.

Plaintiff Michael McQueen was injured while using an overspray machine sold by North American Polymer Co., Inc. to his employer, U.S. Porcelain Company. Prior to trial, Michael McQueen settled claims against U.S. Porcelain Company for $238,000 and also received $21,000 in workers’ compensation benefits. A jury awarded plaintiff $325,000 in damages and assessed liability among Michael McQueen, Downtown Athletic Club, North American Polymer Co., Inc., and U.S. Porcelain Co. North American Polymer Co., Inc., which had defaulted by failing to appear at trial, moved for a post-trial order to apply New York General Obligations Law § 15-108, which reduces claims against other tortfeasors by the amount of a settlement. The court granted North American’s motion, vacating a prior judgment, finding that denying the application of the statute would result in an unjustified windfall for the plaintiff, who had already received more than the net verdict amount.

Joint tortfeasorSettlement agreementDefault judgmentWorkers' compensation benefitsComparative negligencePost-trial motionGeneral Obligations LawDamages reductionProcedural rulesFederal court jurisdiction
References
3
Case No. MISSING
Regular Panel Decision

Prentice v. Levy

Plaintiff sustained a work-related cervical spine injury in 1998 and underwent surgery by defendant Dr. Walter J. Levy in 1999. After the first surgery failed and a second surgery in 2002 to remove loosened hardware, plaintiff settled a medical malpractice action against Levy for $400,000. The self-insured employer, Tops, Inc., and its administrator, MAC Risk Management, as "the carrier," asserted a workers' compensation lien against the settlement. The Supreme Court provisionally set the lien at $22,442.91 and appointed a referee to determine the final lien and offset amounts, with the carrier bearing the costs. The appellate court affirmed the order, ruling that the interim lien was "without prejudice" and the referee's hearing scope was sufficient to conduct a comprehensive evidentiary hearing, thus causing no prejudice to the carrier.

Workers' Compensation LienMedical MalpracticeSettlement LienInterim LienWorkers' Compensation LawAppellate ReviewReferee AppointmentLien EstablishmentOffset PaymentsEvidentiary Hearing
References
2
Case No. ADJ7508584
Regular
Apr 14, 2025

CALVIN WRIGHT vs. HEALTH NET, INC.; ARCH INSURANCE CO.

The Workers' Compensation Appeals Board considered a Petition for Removal filed by the defendants (Health Net, Inc., Arch Insurance Co., and Sedgwick Management Services, Inc.) against applicant Calvin Wright. The petition challenged an order issued by WCJ Elena Jackson on March 7, 2024, which had set specific issues for trial. Citing the report of WCJ Cirina A. Rose, who identified an oversight by WCJ Jackson and factual discrepancies, the Appeals Board found that removal was warranted. Consequently, the Board granted the Petition for Removal, rescinded the WCJ's March 7, 2024 decision, and returned the matter to the trial level for further proceedings.

Petition for RemovalDecision After RemovalRescindedReturned to Trial LevelWCJ Report and RecommendationJoint Compromise & ReleaseFuture Medical OpenMPN IssueHome CarePetition for Removal Timeliness
References
4
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