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

Case No. MISSING
Regular Panel Decision

1199seiu Nat'l Benefit Fund v. Allergan, Inc. (In re Restasis (Cyclosporine Ophthalmic Emulsion) Antitrust Litig.)

This multi-district litigation addresses defendant Allergan's alleged anticompetitive efforts to delay FDA approval of generic versions of its dry-eye medication, Restasis®. Plaintiffs, comprising Direct Purchaser Plaintiffs and End-Payor Plaintiffs, contend Allergan engaged in various unlawful strategies, including filing sham citizen petitions, defrauding the USPTO to secure "second-wave" patents, wrongfully listing these patents, initiating sham patent infringement lawsuits, and transferring patents to a Native American tribe to invoke sovereign immunity. Allergan moved to dismiss the consolidated complaints, asserting that plaintiffs failed to plausibly allege that its actions caused any delay in generic market entry. The court, however, denied Allergan's motion, concluding that the plaintiffs had adequately pleaded that Allergan's aggressive and persistent tactics could have effectively delayed competition.

AntitrustPharmaceutical IndustryGeneric DrugsFDA ApprovalPatent InfringementCitizen PetitionsHatch-Waxman ActMonopolyRestasisDry Eye Medication
References
34
Case No. 05-CV-4115
Regular Panel Decision
Sep 04, 2008

UFCW Local 1776 & Participating Employers Health & Welfare Fund v. Eli Lilly & Co.

Institutional plaintiffs, primarily third-party payors, filed a class action lawsuit against Eli Lilly and Company. They alleged that Lilly fraudulently marketed its antipsychotic drug, Zyprexa, by misrepresenting its safety and efficacy, downplaying serious side effects like weight gain and diabetes, and promoting off-label uses. The lawsuit claimed these actions led to overpayments for Zyprexa prescriptions. The court certified a class of third-party payors on federal Racketeer Influenced and Corrupt Organizations Act (RICO) claims, specifically for alleged overpricing of Zyprexa during the period of June 20, 2001, to June 20, 2005. Individual payor claims were denied class certification due to potential conflicts of interest, and state consumer protection claims were deferred. The court's decision emphasized that common questions of law and fact predominated, making a class action a superior and manageable method for adjudication.

Class ActionRICO ClaimsPharmaceutical FraudDrug MisrepresentationOff-Label MarketingZyprexa LitigationAntipsychotic DrugsThird-Party Payor ClaimsConsumer ProtectionEconomic Damages
References
82
Case No. MISSING
Regular Panel Decision

UNITED FOOD AND COMMER. WORKERS UNIONS AND FOOD EMPLOYEES BENEFIT FUND v. DeBuono

The United Food and Commercial Workers Unions and Food Employees Benefit Fund, headquartered in California, challenged New York’s Health Care Reform Act (HCRA) surcharge system. The Fund argued that the surcharges violated the Commerce and Due Process Clauses of the United States Constitution and were actionable under 42 U.S.C. § 1983. New York’s HCRA imposes surcharges on patient care, with higher rates for payors not registered with the state, a category the Fund fell into. The Fund contended that these additional costs were punitive and disproportionately affected out-of-state payors. The defendants maintained that the system was not discriminatory and offered a practical alternative. The court, acting sua sponte, assessed its subject matter jurisdiction under the Tax Injunction Act (TIA). It concluded that the HCRA surcharges constituted 'taxes' for TIA purposes and that New York State provided an adequate remedy through declaratory judgment under Civil Practice Law and Rules § 3001. Consequently, the court denied both parties' motions for summary judgment and dismissed the entire action for lack of subject matter jurisdiction.

Health Care Reform ActHCRA SurchargesTax Injunction ActSubject Matter JurisdictionCommerce ClauseDue Process ClauseERISARegulatory FeesState TaxationFederal Abstention
References
15
Case No. MISSING
Regular Panel Decision

Claim of Veach v. County of Erie

The case concerns an appeal from a disability award made to a claimant, employed as a housekeeper for Louise Swiderski, against the County of Erie, Department of Social Welfare. The Workers' Compensation Board had found that Mrs. Swiderski acted as the County's agent in employing the claimant, establishing an employer-employee relationship. The court, however, found no substantial evidence to support this finding, rejecting the arguments that the County exerted control or was the actual payor of wages through Mrs. Swiderski's welfare budget. Consequently, the court reversed the Board's decision and dismissed the claim.

employment statusaccidental injuryhousekeeperwelfare benefitsagency relationshipemployer liabilityworkers' compensationappellate reviewinsufficient evidencesocial welfare department
References
1
Case No. MISSING
Regular Panel Decision

Gerst v. Gerst

The plaintiff, Morton I. Willen, a partner in a law firm, moved to vacate an income execution served upon him due to a default in paying weekly maintenance of $125 to the defendant, plus $75 towards arrears. Willen contended that a partner's "draw" did not constitute "income" under CPLR 5241 (a) (6), as he was a partner and not an employee. The court rejected this argument, citing CPLR 5241 (a) (5) (iii) which includes partnerships as "income payors," and defining "partnership draw" as a form of compensation. Consequently, the court denied the plaintiff's motion and directed the law firm of Gerst & Pullin, Esqs. to comply with the income execution.

Income executionPartnership drawMaintenanceSpousal supportCPLR 5241Default judgmentDebtor-creditorStatutory interpretationWage garnishmentLaw firm partnership
References
7
Case No. ADJ253443 (POM 0286361)
Regular
Jan 17, 2014

JUAN MANUEL RESENDIZ vs. DANNY'S TRIMMING & BINDING CORP., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration, rescinding the WCJ's finding that it lacked jurisdiction over a lien dispute between Good Samaritan Hospital and State Fund. The Board found the contracts between State Fund, Blue Cross, and Good Samaritan potentially created an "express agreement" under Labor Code Section 5304, divesting the Board of jurisdiction. However, the Board also noted Good Samaritan failed to meet its initial burden of proof regarding the necessity of its services and that State Fund may not have provided proper notice of its payor status under the contract. The case is returned to the trial level for further evidence development on these issues.

Workers' Compensation Appeals Boardlien claimantPetition for ReconsiderationFindings of FactjurisdictionState Compensation Insurance FundOfficial Medical Fee ScheduleLabor Codeexpress agreementarbitration
References
2
Case No. MISSING
Regular Panel Decision

Claim of Fisher v. KJ Transportation

Claimant, a tractor-trailer driver for KJ Transportation (KJT), sustained a work-related back injury. KJT, facing bankruptcy, entered into an agreement with Omne Staffing, Inc. to provide workers' compensation insurance, purportedly making KJT's employees those of Omne. The Workers’ Compensation Board ruled that an employer-employee relationship still existed between the claimant and KJT, prompting KJT's appeal. The appellate court affirmed the Board's decision, finding substantial evidence that KJT maintained control over the claimant's work, provided equipment, and was listed as the payor, thus establishing the employer-employee relationship despite the agreement with Omne.

Employer-employee relationshipWorkers' Compensation InsuranceBankruptcy implicationsStaffing agreementAppellate affirmationControl test for employmentWork-related back injuryThird-party liabilityCorporate restructuringLegal precedent
References
2
Case No. MISSING
Regular Panel Decision

Ins. Co. of North America v. S. E. Senior

The case concerns an appeal by the Chairman of the Workmen’s Compensation Board from an order that annulled two assessments made against an insurance carrier. The assessments were based on the carrier's total compensation payments, but the carrier argued for a deduction of recoupment payments received from other employers for apportioned liability in occupational disease cases under Workmen's Compensation Law section 44. The Chairman contended that no such statutory deduction existed. The court determined that the term “compensation” for assessment purposes did not intend for payments to be counted twice (by both payee and payor). Consequently, the insurance carrier is entitled to deduct these recoupment payments from its total compensation payments when calculating the assessments. The order and judgment granting the carrier's petition and annulling the assessments were affirmed.

Workers' Compensation AssessmentsRecoupment DeductionOccupational Disease LiabilityStatutory ConstructionInsurance Carrier ObligationsArticle 78 AppealCompensation ApportionmentAssessment Calculation MethodologyEmployer ReimbursementFiscal Year Assessments
References
2
Case No. MISSING
Regular Panel Decision

Locher v. Unum Life Insurance Co. of America

This case involves a dispute between Marianne Locher and UNUM Life Insurance Company of America concerning disability benefits denied under an Employee Retirement Income Security Act of 1974 (ERISA)-governed employee benefit plan. Locher, claiming disability due to Chronic Fatigue Syndrome, challenges UNUM's denial of benefits. The court addressed in limine motions regarding the scope of evidence admissible at trial, specifically whether evidence beyond the administrative record should be considered. The court determined that UNUM's conflict of interest, acting as both claims administrator and payor, constituted 'good cause' to allow additional evidence. Consequently, UNUM's application to limit evidence to the administrative record was denied, and various specific evidentiary proffers were ruled upon, some granted, some denied, and others reserved for trial.

ERISAdisability benefitsChronic Fatigue Syndromede novo reviewconflict of interestadministrative recordin limine motionexpert witnessmedical evidenceemployment termination
References
11
Case No. 2017 NY Slip Op 03868 [150 AD3d 480]
Regular Panel Decision
May 11, 2017

McMahon v. Cohen Bros. Realty Corp.

The Appellate Division, First Department, unanimously affirmed a Supreme Court order granting summary judgment to Cohen Brothers Realty Corp., thereby dismissing the complaint filed by Michael McMahon et al. The core issue was whether the injured plaintiff was a special employee of Cohen Brothers Realty Corp., which would invoke the workers' compensation law's exclusivity provision as a bar to the lawsuit. Defendant presented evidence demonstrating its control over the plaintiff's hiring, supervision, and work duties, along with providing necessary equipment and materials. Despite plaintiff's attempts to counter this with evidence showing the general employer as the payor and listed employer, the court found insufficient factual dispute to overturn the special employee determination. Consequently, the appellate court upheld the dismissal, concluding that the exclusivity provision of the Workers' Compensation Law applied.

Summary JudgmentSpecial Employee DoctrineWorkers' Compensation ExclusivityAppellate ReviewEmployment Control TestProperty Management AgreementDismissal of ComplaintLabor LawEmployer-Employee Relationship
References
3
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