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

Case No. ADJ7992408, ADJ9642470
Regular
Mar 02, 2017

MICHAEL YOUNG vs. STATE OF CALIFORNIA, DEPARTMENT OF CORRECTIONS AND REHABILITATION, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration, rescinded the amended Findings and Award, and returned the case to the trial level. The Board found that the original decision failed to address all stipulated injuries and that the medical evidence regarding apportionment and the permanent disability rating was insufficient. Specifically, Dr. Dericks' apportionment to a prior non-industrial injury lacked adequate explanation, and the rationale for apportioning between specific and cumulative trauma injuries was also deficient. The permanent disability rating itself was not properly established as required by AMA Guides, necessitating further development of the medical record and a formal DEU rating.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPermanent DisabilityLabor Code section 4658(d)Cumulative Trauma InjuryQualified Medical EvaluatorAMA GuidesAlmaraz/Guzman analysisApportionment
References
9
Case No. ADJ4258585 (OXN 0130492) ADJ220258 (OXN 0130487)
Regular
Apr 17, 2018

ENRIQUE HERRERA vs. MAPLE LEAF FOODS, U.S. FIRE INSURANCE COMPANY, ALEA NORTH AMERICAN INSURANCE COMPANY

This notice informs parties that the Workers' Compensation Appeals Board (WCAB) intends to admit its rating instructions and a disability rater's recommended permanent disability rating into evidence. The WCAB previously granted reconsideration for further study. Parties have seven days to object to the rating instructions or the recommended rating, with specific procedures for addressing objections. If no timely objection is filed, the matters will be submitted for decision thirty days after service.

WORKERS' COMPENSATION APPEALS BOARDPermanent Disability RatingDisability Evaluation UnitRating InstructionsRecommended Permanent Disability RatingJoint RatingReconsiderationObjectionRater Cross-ExaminationRebuttal Evidence
References
0
Case No. ADJ8089208
Regular
Aug 10, 2017

Arthur Viray vs. Pacific Gas & Electric

The Workers' Compensation Appeals Board granted reconsideration to address significant concerns regarding the permanent disability rating and apportionment. The applicant appealed a 75% permanent disability award, seeking 100% and arguing the defendant failed to prove apportionment to non-industrial factors or a prior injury. The Board found issues with the WCJ's method of apportioning disability based on a "range of evidence" instead of medical evaluations and noted missing exhibits. The case is returned to the trial level for further proceedings, including a formal rating from the Disability Evaluation Unit, to correct these issues.

Workers Compensation Appeals BoardReconsiderationFindings of Fact and AwardPermanent DisabilityApportionmentCumulative TraumaCervical SpineLumbar SpinePsycheAgreed Medical Examiner
References
2
Case No. MISSING
Regular Panel Decision

United States v. Raymond & Whitcomb Co.

The United States, on behalf of the Postal Service, sued Raymond & Whitcomb Co. (R&W) for misusing non-profit mail rates, resulting in a $398,960.05 deficiency, bringing claims under the Federal Debt Collection Procedure Act, unjust enrichment, and the False Claims Act. The court found that R&W, a for-profit entity, collaborated with non-profit institutions (Metropolitan Museum of Art and Smithsonian Institution) on travel programs, and its significant financial stake in these ventures made the mailings ineligible for non-profit rates. Consequently, summary judgment was granted to the United States on the Federal Debt Collection Procedure Act and unjust enrichment claims, ordering R&W to pay the deficiency. However, the court denied both parties' motions for summary judgment on the False Claims Act count, determining that a genuine issue of material fact existed regarding R&W's knowledge of the falsity of the mailing statements—specifically, whether their actions constituted reckless disregard or mere negligence. The case will proceed to trial to resolve the scienter element of the False Claims Act claim, while the debt for the misused postage is established.

Mail fraudNon-profit mail rateFalse Claims ActFederal Debt Collection Procedure ActUnjust enrichmentSummary judgmentCooperative mailingsPostal Service regulationsScienterReckless disregard
References
32
Case No. MISSING
Regular Panel Decision

Kolari v. New York-Presbyterian Hospital

Plaintiffs, a group of uninsured and indigent patients, brought a consolidated action against New York-Presbyterian Hospital, NY-Presbyterian Health Care System, Inc., and the American Hospital Association. They argued that private non-profit hospitals are legally obligated to provide free or reduced-rate services to uninsured individuals and that the rates charged were unreasonable compared to those offered to insured patients. The plaintiffs alleged violations of federal laws, including 26 U.S.C. § 501(c)(3) (tax exemption), the Fair Debt Collection Practices Act (FDCPA), the Emergency Medical Treatment and Active Labor Act (EMTALA), and 42 U.S.C. § 1983, as well as various New York state laws, such as breach of contract, breach of charitable trust, New York General Business Law § 349, unjust enrichment, and fraud. The District Court granted the defendants' motions to dismiss all claims with prejudice, concluding that no federal or state law requires private non-profit hospitals to offer free or reduced-rate care or to charge uninsured patients the same as insured patients. The court found that plaintiffs lacked standing for several claims and failed to state a claim upon which relief could be granted for the remaining allegations.

Uninsured Patient RightsHospital PricingNon-Profit HospitalsTax Exempt StatusDebt Collection PracticesEmergency Medical TreatmentCivil Rights ClaimsCharitable Trust LawNew York Business LawUnjust Enrichment
References
82
Case No. MISSING
Regular Panel Decision

People v. Young

An attorney representing an indigent defendant in Monroe County filed an application seeking reimbursement for legal services at a rate of $200 per hour, mirroring the rate charged by the Special Prosecutor, rather than the statutory rates under County Law § 722-b. The attorney argued that the significant disparity in hourly compensation violated the defendant's right to equal protection and that his qualifications justified the requested rate. The New York State Association of Criminal Defense Lawyers supported the application as amicus curiae, while Monroe County opposed it, arguing the request was untimely and lacked extraordinary circumstances. Presiding Judge Donald J. Mark, J., acknowledged the court's authority to grant compensation in excess of statutory limits under extraordinary circumstances but ultimately denied the application. The denial was based on the court's reasoning that an analogous argument was previously rejected, that linking assigned counsel rates to prosecutor rates would render County Law § 722-b ineffective, and that extraordinary circumstances could not be demonstrated prior to the conclusion of the criminal action. The court, however, reserved the right to reconsider an increased hourly fee upon the case's termination if such circumstances are then proven.

Assigned CounselLegal Aid CompensationCounty Law Section 722-bHourly Rate DisputeSpecial Prosecutor FeesIndigent RightsJudicial DiscretionExtraordinary CircumstancesMonroe County LawEqual Protection Challenge
References
16
Case No. MISSING
Regular Panel Decision
Jun 22, 1992

Camardo v. General Motors Hourly-Rate Employees Pension Plan

Plaintiff John A. Camardo, injured in 1983, sought disability pension benefits from the General Motors Hourly-Rate Employees Pension Plan after being declared a 'voluntary quit' by General Motors Corporation. The Plan denied his application for forms, leading to a lawsuit under ERISA. Magistrate Judge Heckman recommended denying the defendant's motions for dismissal and summary judgment and awarding summary judgment to the plaintiff. District Judge Arcara adopted the Magistrate Judge's Report and Recommendation, dismissed the defendant's objections for procedural non-compliance, and ordered the Plan Administrator to provide the plaintiff with the necessary application forms for disability pension benefits.

ERISADisability PensionSummary Judgment MotionLocal Rule ViolationReport and RecommendationAdministrative RemediesStatute of LimitationsVoluntary Quit ClauseCollective BargainingEmployee Benefits
References
20
Case No. MISSING
Regular Panel Decision

MTA Bus Non-Union Employees Rank & File Committee ex rel. Simone v. Metropolitan Transportation Authority

The MTA Bus Non-Union Employees Rank and File Committee, along with fourteen individual plaintiffs, brought an action against the Metropolitan Transportation Authority (MTA) and MTA Bus Company (MTA Bus) concerning pension benefits. Plaintiffs asserted claims including violations of the Equal Protection Clauses of the United States and New York State Constitutions, two distinct breaches of contract, a violation of Section 115 of the New York Civil Services Law, and negligent misrepresentation. The court granted the defendants' motion for summary judgment on all claims and denied the plaintiffs' cross-motion for summary judgment. The court found that the pension benefit classifications had a rational basis, the contract claims were defeated by unambiguous plan documents, the Civil Services Law claim lacked jurisdictional basis, and the negligent misrepresentation claim was invalid as it was based on future promises.

Equal Protection ClauseRational Basis ReviewSummary JudgmentPension BenefitsBreach of ContractMTA Bus CompanyMetropolitan Transportation AuthorityNon-Union EmployeesNew York Civil Service LawNegligent Misrepresentation
References
24
Case No. MISSING
Regular Panel Decision

Hamilton v. General Motors Hourly-Rate Employee's Pension Plan

Plaintiff Gary Hamilton, proceeding pro se, initiated this action on June 26, 2014, under the Employee Retirement Income Security Act of 1974 (ERISA), alleging improper denial of pension benefits, breach of fiduciary duty, and equitable estoppel. He sought additional credited service for his tenure at non-foundry plants, contending that a Memorandum of Understanding (MOU) should modify his pension calculation as if his entire service had been at a designated foundry location. The defendants, General Motors Corporation Hourly-Rate Employee’s Pension Plan and General Motors, LLC, argued that the Plan's terms unambiguously require actual employment in designated foundry classifications for enhanced benefits and that the MOU's purpose was solely to facilitate employee transfers, not to alter pension benefits. The Court, applying an arbitrary and capricious standard of review, found the defendants' interpretation of both the Plan and the MOU to be reasonable. Consequently, the Court granted the defendants' motion for summary judgment and denied the plaintiff's claims in their entirety.

ERISAPension BenefitsFiduciary DutyEquitable EstoppelSummary JudgmentPlan AdministratorCredited ServiceFoundry JobsMemorandum of UnderstandingArbitrary and Capricious Standard
References
30
Case No. MISSING
Regular Panel Decision
Sep 08, 1987

Richmond Memorial Hospital & Health Center v. Axelrod

The petitioner, a hospital not a member of the League of Voluntary Hospitals, sought to increase its 1983 third-party reimbursement rates from the Commissioner of the New York State Department of Health. This application was based on a 'trend factor' applicable to League members, stemming from a collective bargaining agreement which the petitioner also adopted. The Commissioner denied the request, citing the petitioner's non-membership in the League. The Supreme Court annulled this determination, directing the use of the League trend factor. On appeal, the judgment was modified: the annulment of the Commissioner's arbitrary determination was affirmed, but the direction to use the specific trend factor was deleted, and the case was remitted for recalculation based on permissible factors.

CPLR Article 78Third-Party Reimbursement RatesTrend FactorMedicaid RatesBlue Cross RatesWorkers' Compensation RatesNo-Fault RatesPublic Health LawArbitrary and CapriciousJudicial Review
References
5
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