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Case Law Database

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

Case No. ADJ8334555
Regular
Apr 05, 2013

JOSE HERNANDEZ vs. BRYAN MIMAKI dba PACIFIC RIMS, PALMS; ZENITH INSURANCE COMPANY

This case concerns whether a knee injury sustained by an employee, Jose Hernandez, while playing basketball on company premises during lunch is compensable. The defendant argued the injury did not arise out of employment, as it stemmed from voluntary participation in an athletic activity not required by the employer. The Appeals Board denied reconsideration, affirming the finding that the injury was industrial. The majority found the employee's subjective belief of employer expectation was objectively reasonable, given the employer provided a court and balls and supervisors encouraged participation. Commissioner Lowe dissented, arguing the applicant failed to demonstrate an objectively reasonable belief of employer expectation, as he could opt out and faced no repercussions.

Workers' Compensation Appeals BoardIndustrial InjuryRight KneeField WorkerBasketball GameOff-Duty Recreational ActivityLabor Code Section 3600(a)(9)Reasonable Expectancy of EmploymentSubjective BeliefObjective Reasonableness
References
3
Case No. ADJ6884625
Regular
Jun 19, 2012

JASON PETERSON, KIRSTIE MCCRAINE-PETERSON vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION, STATE COMPENSATION INSURANCE FUND

This case concerns the death of Jason Peterson, a correctional officer, from a pulmonary embolism after injuring his calf in a kickboxing class. The applicant, his widow, claimed the injury and death were work-related, arguing the kickboxing class was a reasonable expectancy of employment due to a general fitness requirement and incentive program. The Workers' Compensation Appeals Board (WCAB) affirmed the WCJ's decision, finding the claim barred by Labor Code Section 3600(a)(9) because the decedent's belief that kickboxing was required was not objectively reasonable, as mere general assertions of fitness expectations are insufficient. Commissioner Brass dissented, believing the decedent's participation was both subjectively and objectively reasonable given its likely benefit to his job performance as a correctional officer.

Labor Code Section 3600(a)(9)Pulmonary EmbolismCorrectional OfficerKickboxingOff-duty Recreational ActivityReasonable Expectancy of EmploymentSubjective BeliefObjective ReasonablenessEzzy testCity of Stockton v. Workers' Comp. Appeals Bd. (Jenneiahn)
References
2
Case No. ADJ9526304
Regular
Oct 22, 2018

GLADYS MELENDEZ vs. MYS CORPORATION/KRYSTAL KLEEN, EMPLOYERS COMPENSATION INSURANCE COMPANY

The Appeals Board granted reconsideration for lien claimant Citywide Scanning Service, finding that the defendant waived their right to object to the reasonableness and necessity of charges by failing to file a timely objection. The Board rescinded the original award and returned the case to the trial level for a determination of reasonable fees for all services. This decision hinged on the interpretation of statutes regarding timely objections to medical-legal expenses. The failure to object within the statutory period precludes defendants from contesting reasonableness and necessity and may expose them to penalties.

Lien claimantPetition for ReconsiderationFindings and AwardWCJExpress Records ManagementPrime Medical ResourcesEmployers' CompensationHollywood Presbyterian Medical CenterClinical Medica San MiguelIndependent Bill Review
References
8
Case No. MISSING
Regular Panel Decision

Claim of Howe v. New York State Department of Corrections

The case involves an appeal by a claimant's employer and its workers' compensation insurance carrier challenging a $500 penalty imposed by the Workers' Compensation Board. The Board found that the carrier interposed objections to the claimant's benefits claim without just cause. The appellate court affirmed the penalty, holding that "just cause" under Workers' Compensation Law § 25 (2) (c) requires an objective rational basis and relevant, objective, and reasonable evidence to support controverting a claim. A subjective good-faith belief alone is insufficient. The court found that despite opportunities, the carrier failed to provide factual evidence to disprove the claim, relying instead on supposition and unfounded hope.

Workers' Compensation PenaltyJust CauseCarrier ObjectionsEmployer LiabilityStatutory InterpretationObjective Rational BasisGood-Faith BeliefEvidence RequirementsAppellate ReviewBoard Decision Affirmation
References
2
Case No. ADJ4225434 (LAO0864755)
Regular
Dec 10, 2008

CHING YEN vs. C & C INTERNATIONAL GROUP, STATE COMPENSATION INSURANCE FUND

This case involves an applicant injured in a car accident while traveling to a wedding with her employer. The applicant claimed her participation in the trip was a reasonable expectancy of her employment as an account assistant, which involved driving and travel. The Board denied reconsideration of the workers' compensation judge's finding that the injury was industrial, determining the applicant's subjective belief of being required to attend the trip was objectively reasonable given her job duties and her employer's direction.

Workers' Compensation Appeals BoardIndustrial InjuryReasonable ExpectancyOff-duty recreational activitySubjective beliefObjectively reasonableMotor vehicle accidentAccount assistantCommercial travelSpecial mission
References
3
Case No. ADJ7033127
Regular
Sep 15, 2010

JOSEPH KROUSHOUR vs. CITY OF OAKLAND, JT2 INTEGRATED OAKLAND

The Workers' Compensation Appeals Board (WCAB) denied reconsideration of a decision that found Joseph Kroushour's left shoulder injury compensable. The WCAB adopted the Workers' Compensation Judge's (WCJ) report, which concluded Kroushour's belief that maintaining physical fitness was an employment expectancy was both subjectively held and objectively reasonable. The judge found the police officer's weightlifting to be a reasonable part of preparing for his return to duty, supported by departmental rules and job requirements. The defendant's arguments on reconsideration, including raising a new legal theory, were deemed without merit and not supported by the record.

Workers' Compensation Appeals BoardCity of OaklandJoseph KroushourPetition for ReconsiderationOrder Denying ReconsiderationReport and RecommendationInjury AOE/COELeft Shoulder InjuryPolice OfficerPermissibly Self-Insured
References
4
Case No. MISSING
Regular Panel Decision
Dec 27, 2002

Spadola v. New York City Transit Authority

Plaintiff Terry Spadola, a Line Supervisor for the New York City Transit Authority, brought an action under Title VII of the Civil Rights Act of 1964, alleging unlawful retaliation. He claimed that successive disciplinary proceedings, which ultimately led to his dismissal, were in response to his objection to a supervisor's comment he regarded as sexual harassment. The defendants, New York City Transit Authority and Manhattan and Bronx Surface Transit Operating Authority, moved for summary judgment. The court granted the motion, concluding that Spadola failed to establish a prima facie case of unlawful retaliation under Title VII, as his belief of sexual harassment was not objectively reasonable and there was insufficient evidence of a causal connection between his protected activity and adverse employment actions.

Title VIIRetaliation ClaimSexual HarassmentSummary JudgmentEmployment DiscriminationDisciplinary ActionArbitration AwardPrima Facie CaseCausal ConnectionPretext
References
53
Case No. MISSING
Regular Panel Decision

Seemann v. Sterling Insurance

Plaintiff Seemann, while at work in New Jersey, injured a co-worker with a paintball. Four months later, advised by the co-worker's attorney, Seemann notified Sterling Insurance, his homeowner's insurer in Schoharie County. Sterling Insurance disclaimed coverage due to delayed notice. The Supreme Court found Seemann's belief of no coverage justifiable and his delay reasonable, obligating Sterling Insurance to defend and pay. The Appellate Division affirmed, concluding that Seemann's good-faith belief that his homeowner's policy did not cover an off-premises incident was reasonable, and he acted diligently upon receiving the attorney's letter, thereby providing a reasonable excuse for the delay in notice.

Homeowner's InsuranceCoverage DisputeNotice RequirementsGood-Faith BeliefOff-Premises InjuryDeclaratory JudgmentAppellate ReviewReasonableness of DelayInsurance Policy InterpretationPaintball Incident
References
3
Case No. MISSING
Regular Panel Decision

In re Robert Plan Corp.

Kenneth Kirschenbaum, the Chapter 7 Trustee for The Robert Plan Corporation and The Robert Plan of New York Corporation, sought court approval for fee awards for himself and his professionals for administering an ERISA plan. The U.S. Department of Labor (DOL) objected, asserting the court lacked jurisdiction to award fees from Plan assets and had specific objections to the reasonableness of the fees. The court affirmed its core jurisdiction over the Trustee's actions as Plan administrator and his professionals' compensation, regardless of whether payments came from Plan or estate assets, citing previous rulings. The court analyzed whether Bankruptcy Code §§ 326 and 330 conflicted with ERISA statutes concerning fiduciary compensation, concluding no substantive conflict existed and the Bankruptcy Code's specific compensation scheme governed. Ultimately, the court largely overruled DOL's objections and granted the fee applications for the Trustee, K & K, Witz, and Whitfield, deeming the requested amounts reasonable and compliant with the Bankruptcy Code. The awards are payable from the Plan's Pguy Account, with any shortfall covered by the Debtors' estate.

Bankruptcy LawERISAChapter 7 TrusteeFee ApplicationPlan AdministrationJurisdictionReasonable CompensationStatutory ConstructionDepartment of LaborFiduciary Duties
References
50
Case No. MISSING
Regular Panel Decision

G.L.G. Contracting Corp. v. Aetna Casualty & Surety Co.

Plaintiff, a general contractor, failed to notify its liability insurer (defendant) about an employee's construction accident for nearly three years. After the injured employee initiated a personal injury lawsuit against plaintiff under the Labor Law, plaintiff notified its insurer, who then disclaimed coverage citing untimely notice. Plaintiff subsequently sued for a declaratory judgment, arguing it had a reasonable belief in nonliability. Defendant moved for summary judgment, contending plaintiff's owner, an experienced contractor and insurance broker, should have known of potential liability. The Supreme Court denied defendant's motion, ruling the reasonableness of belief in nonliability is a factual issue. The appellate court affirmed this decision, reserving credibility issues for the trier of fact.

Insurance Coverage DisputeTimely Notice RequirementCondition Precedent to CoverageReasonable Belief of NonliabilitySummary Judgment DenialDeclaratory Judgment ActionAppellate AffirmationLabor Law Sections 200Labor Law Sections 240Labor Law Sections 241(6)
References
8
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