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Case Law Database

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

Case No. ADJ8455911
Regular
Nov 20, 2013

SANDRA VACA vs. CAPISTRANO UNIFIED SCHOOL DIST.,, SCHOOL DIST.,, CORVEL CORP.

This case concerns a dispute over the correct temporary disability indemnity rate for an applicant who worked as both a substitute teacher and a self-employed realtor. The applicant's net income as a realtor, after expenses, was used for the calculation, not her gross receipts. The Board rescinded the original award and found the applicant entitled to $395.93 per week in temporary disability, affirming the use of net income and earnings up to her last day of work. The issue of attorney's fees was deferred.

Workers' Compensation Appeals BoardTemporary Disability RateAverage Weekly EarningsSelf-Employed IncomeGross ReceiptsNet IncomeEarning CapacitySubstitute TeacherIndustrial InjuryGross Income
References
3
Case No. MISSING
Regular Panel Decision

Cianciulli v. Perales

This case concerns a petitioner's challenge under CPLR article 78 against determinations by the New York State Commissioner of Social Services. The Commissioner affirmed a local agency's decision to discontinue the petitioner's Aid to Families with Dependent Children (AFDC) grant due to receiving a lump-sum income exceeding household needs. The Commissioner also affirmed that a $2,600 loan repayment was not a life-threatening circumstance, thus not deductible from the lump-sum income for AFDC reapplication. The court confirmed both determinations, finding the petitioner's arguments lacked merit. It rejected claims that regulation 18 NYCRR 352.29 [h] violates constitutional duties or statutory mandates, or creates an invalid conclusive presumption of income availability. The court upheld the Commissioner's interpretation that life-threatening situations occur after lump-sum receipt, not for prior debts, even if those debts were for life-threatening circumstances at the time they were incurred.

AFDCLump-sum incomePublic assistanceSocial Services LawLife-threatening circumstanceLoan repaymentAdministrative reviewConstitutional lawStatutory interpretationEligibility criteria
References
7
Case No. ADJ2969875
Regular
Nov 16, 2012

ROBERTA FRANCINE YOUNG vs. COUNTY OF MONTEREY, LIBERTY MUTUAL INSURANCE GROUP

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding the WCJ's denial of her petition for commutation. The WCJ found that commuting benefits to allow the applicant to purchase a home would result in a net monthly loss of income, based on projected expenses exceeding her reduced income. Applicant argued the WCJ failed to consider future income increases and the stabilization benefits of homeownership. The Board agreed with the WCJ's findings and suggested a new petition could be filed in the future, addressing cognitive disability and financial assistance resources.

Petition for CommutationFindings and OrderWCJ ReportMonthly ExpensesRent PaymentsStorage UnitPG&EHomeowners InsuranceProperty TaxesWorkers' Compensation Payments
References
0
Case No. ADJ6649763
Regular
Oct 30, 2009

LESLIE ADAM MACK vs. ATLAS VAN LINES, ZURICH AMERICAN INSURANCE, GALLAGHER BASSETT

Reconsideration granted; temporary disability indemnity rate to be calculated based on net income, not gross income.

Average weekly earningsTemporary disability indemnityGross incomeNet incomeIndependent contractorSpecial expensesRemunerationLabor Code section 4454Hupp v. Workers' Compensation Appeals BoardSelf-employment earnings
References
5
Case No. Dkt. # 6, Dkt. # 7
Regular Panel Decision
Feb 05, 2013

Crayton v. Astrue

Plaintiff appeals the denial of supplemental security income benefits by the Commissioner of Social Security. Plaintiff filed an application for Supplemental Security Income benefits in 2009, alleging inability to work due to various medical conditions. An Administrative Law Judge (ALJ) denied the application, and the Appeals Council denied review, making the ALJ's decision final. The District Court reviews the Commissioner's decision, finding that while the ALJ's assessment of exertional limitations was supported by substantial evidence, the ALJ failed to apply the Psychiatric Review Technique (PRT) in analyzing non-exertional limitations. Consequently, the court remands the matter for further proceedings consistent with its opinion, specifically for proper application of the PRT.

Supplemental Security IncomeSocial Security ActDisability BenefitsAdministrative Law JudgePsychiatric Review TechniqueRFCExertional LimitationsNon-exertional LimitationsDepressionAnxiety
References
15
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. MISSING
Regular Panel Decision

Psaty & Fuhrman, Inc. v. New York State Tax Commission

Petitioner, a general contracting firm involved in the construction of the Nelson A. Rockefeller Empire State Plaza, faced a personal income tax assessment for additional payments made to 16 employees. These payments, characterized as per diem living and travel allowances, did not have New York State income taxes withheld. The State Tax Commission, after an audit and hearing, ruled these were supplemental wages subject to withholding tax, not reimbursements. Petitioner initiated a CPLR article 78 proceeding, bearing the burden of proof, to challenge this determination. The court, noting the payments lacked a fixed formula and some recipients lived locally, found the respondent acted reasonably. The determination was confirmed, and the petition dismissed.

Personal Income TaxWithholding TaxSupplemental WagesPer Diem PaymentsTravel AllowanceLodging AllowanceCPLR Article 78Burden of ProofTax DeficiencyState Tax Commission
References
1
Case No. ADJ8139465
Regular
Apr 18, 2013

Robert Scharfe vs. VI-TEL, LUMBERMANS UNDERWRITING ALLIANCE

This case concerns applicant Robert Scharfe's petition for reconsideration of a workers' compensation award. Scharfe argued the administrative law judge erred in calculating his average weekly earnings, claiming the judge disregarded significant self-employment income. The Board denied reconsideration, affirming the judge's decision that Scharfe failed to provide substantial evidence of his self-employment earnings, as his tax returns showed a net loss. Additionally, the Board found no error in the admission of income declarations from Scharfe's child support cases, which contradicted his claimed earnings.

Robert ScharfeVi-TelLumbermans Underwriting AllianceADJ8139465Opinion and Order Denying Reconsiderationtemporary disability indemnityaverage weekly earningsself-employment incomechild support casesLos Angeles County Superior Court
References
1
Case No. MISSING
Regular Panel Decision
Dec 03, 2010

Claim of Gardner v. Triple R Transport, Inc.

The claimant, a truck driver, was injured in 1999 while working for the employer. The employer's workers' compensation carrier contested the existence of an employer-employee relationship and, subsequently, the calculation of the claimant's average weekly wage. The Workers' Compensation Board determined there was an employer-employee relationship and set the average weekly wage based on the claimant's gross income. The employer and carrier appealed, arguing the wage should be based on net income after employment-related tax deductions. The court reversed the Board's decision, finding that the Board failed to review the claimant's tax deductions or explain its deviation from prior precedent regarding necessary expenses. The case was remitted to the Board for further proceedings consistent with the court's decision.

Workers' CompensationAverage Weekly WageGross IncomeNet IncomeTax DeductionsEmployer-Employee RelationshipRemittalFactual DeterminationPrecedentTruck Driver
References
5
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