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

Case No. 2022 NY Slip Op 00289
Regular Panel Decision
Jan 18, 2022

Matter of Personal-Touch Home Care of N.Y., Inc. v. City of N.Y. Human Resources Admin.

The Appellate Division affirmed the Supreme Court's judgment, which denied a petition to overturn a decision by the Office of Administrative Trials and Hearings Contract Dispute Resolution Board (CDRB). The CDRB had found that Personal-Touch Home Care's claim to use unspent Medicaid funds for fiscal year 2007 to offset workers' compensation assessment expenses from 2009-2010 was foreclosed. The court agreed that the State Department of Health (DOH) rationally interpreted its regulations, concluding that these retroactive assessments, levied due to financial mismanagement of a self-insurance trust, were not

Workers' CompensationMedicaid FundsSelf-Insurance TrustFiscal YearRetroactive AssessmentAdministrative LawAgency DeferenceContract DisputeHealth Care AgenciesFinancial Mismanagement
References
4
Case No. 2020 NY Slip Op 00653 [179 AD3d 1412]
Regular Panel Decision
Jan 30, 2020

Matter of James v. Home Comfort Assistance, Inc.

Claimant Christina James sought workers' compensation benefits after sustaining a work-related ankle injury. The Workers' Compensation Law Judge established an employer-employee relationship and awarded benefits. Home Comfort Assistance, Inc. appealed this decision to the Workers' Compensation Board, but their application for review was denied due to incompleteness; specifically, referring to attached pages for the "Basis for Appeal" instead of providing the information directly on the form RB-89. Home Comfort then appealed the Board's denial to the Appellate Division, Third Department. The Appellate Division affirmed the Board's decision, ruling that the Board acted within its discretion by refusing to consider an application that did not fully comply with 12 NYCRR 300.13 (b) (1).

Workers' CompensationAppellate ReviewIncomplete ApplicationForm RB-89Administrative ReviewDiscretionary AuthorityProcedural ComplianceThird DepartmentEmployer-Employee RelationshipJurisdictional Defect
References
8
Case No. ADJ10864843
Regular
Nov 15, 2018

YOLANDA PLASCENCIA vs. HYUNDAI CAPITAL AMERICA, SOMPO AMERICA INSURANCE COMPANY

This case involves an applicant who sustained injuries after falling into a pothole on her employer's premises during a break. The applicant was in the process of switching vehicles with her daughter when the incident occurred. The defendant argued the injury was not AOE/COE, as the personal vehicle exchange served no employer benefit and the personal comfort doctrine did not apply. The Board denied reconsideration, adopting the WCJ's report which found the injury compensable under the personal comfort doctrine. The Board reasoned that it's reasonably contemplated for employees to access the employer's parking lot during breaks, and moving a personal car is a personal convenience incidental to employment.

AOE/COEPersonal Comfort DoctrineIndustrial InjuryCourse of EmploymentWorkers' Compensation Appeals BoardPetition for ReconsiderationFindings of FactWCJEmployer's PremisesPaid Break
References
2
Case No. 526722
Regular Panel Decision
Apr 11, 2019

Matter of Persons v. Halmar Intl., LLC

Claimant Matthew Persons appealed a Workers' Compensation Board decision that found he violated Workers' Compensation Law § 114-a by exaggerating his condition and failing to disclose volunteer firefighter activities, leading to disqualification from future wage replacement benefits. The Appellate Division, Third Department, found the Board's decision was not supported by substantial evidence, as it was based on speculation, surmise, and mischaracterizations of claimant's activities and medical records. The court noted that claimant was forthcoming about his volunteer work and that video surveillance did not conclusively contradict his reported injuries. Consequently, the decision was reversed, and the matter was remitted to the Board for further proceedings.

Workers' Compensation LawFraudExaggerated ConditionVolunteer Firefighter ActivitiesWage Replacement BenefitsSubstantial EvidenceMedical TestimonyPsychiatric DisabilityVideo SurveillanceRemittal
References
6
Case No. ADJ8550333
Regular
May 15, 2015

STEPHEN MARTIN BLOXHAM vs. LITHIA FORD MAZDA SUZUKI, HARTFORD ACCIDENT & INDEMNITY, ESIS

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration. The Board affirmed the finding that a car salesman's injuries from a car accident while purchasing cigarettes on a paid, employer-authorized break arose out of and occurred in the course of employment. This falls under the personal comfort doctrine, an exception to the going and coming rule, and the employer's encouragement of "prospecting" at the store further supported coverage. The Board rejected the defendant's argument that smoking's health detriments should disqualify it from the personal comfort doctrine.

Petition for ReconsiderationFindings of FactOrderOpinion on DecisionAOE/COEgoing and coming rulepersonal comfort doctrinepaid breakemployer's permissionprospecting
References
1
Case No. MISSING
Regular Panel Decision
May 25, 2012

Ali v. State

The claimant appeals from a judgment of the Court of Claims that dismissed their claim for personal injuries. The incident occurred on February 24, 2009, at the New York State Workers’ Compensation Board office when a security guard, reacting to news of his grandmother's death, punched a wooden bench causing it to fall on the claimant. The claimant subsequently filed a personal injury claim against the State of New York. The Court of Claims granted the defendant's application to dismiss the claim, determining that the security guard was acting solely for personal motives unrelated to his employment, and his conduct was not reasonably foreseeable by the defendant, thus precluding vicarious liability under the doctrine of respondeat superior.

Personal InjuryRespondeat SuperiorVicarious LiabilityScope of EmploymentForeseeabilityEmployee MisconductClaim DismissalCourt of Claims DecisionAppellate ReviewNegligence
References
7
Case No. MISSING
Regular Panel Decision

Vullo v. Sheets (In Re Sheets)

The debtors, James and Irene Sheets, filed a Chapter 7 bankruptcy petition and exempted their two pre-petition personal injury actions under New York State law. After the lawsuits settled post-petition, the trustee initiated an adversary proceeding to claim the proceeds as property of the bankruptcy estate. The court determined that because the personal injury actions were validly exempted from the estate at the commencement of the case, their proceeds did not subsequently become estate property. Citing legal precedent, the decision emphasized that exempted property and its resulting proceeds revert to the debtors' control, not the trustee's. Consequently, the trustee's application for a turnover order seeking these personal injury recoveries was denied.

Bankruptcy LawChapter 7 BankruptcyProperty ExemptionsPersonal Injury ProceedsBankruptcy EstateAdversary ProceedingTurnover OrderNew York Exemption LawDebtor RightsPost-Petition Settlements
References
5
Case No. MISSING
Regular Panel Decision

Boles v. Dormer Giant, Inc.

This case addresses whether Workers’ Compensation Law § 11 shields an employer from third-party liability for contribution or indemnity when the employer failed to secure workers' compensation for an injured employee. Plaintiff Douglas Boles was injured in a scaffolding collapse while working for Personal Touch Home Improvements, Inc., a subcontractor of Dormer Giant, Inc. Boles sued Dormer Giant, which then brought a third-party action against Personal Touch. The lower courts dismissed Dormer Giant's third-party complaint, concluding Personal Touch was protected by Section 11. The Court of Appeals reversed, holding that an employer must comply with Workers’ Compensation Law § 10 by securing compensation for employees to benefit from the protections of Workers’ Compensation Law § 11 against third-party liability, reinforcing the legislative intent behind the 1996 Omnibus Workers’ Compensation Reform Act.

Workers’ Compensation Law § 11Employer LiabilityThird-Party ContributionThird-Party IndemnityGrave InjuryFailure to Secure Workers' CompensationLabor Law § 240(1)Scaffolding AccidentSubcontractor LiabilityStatutory Interpretation
References
6
Case No. MISSING
Regular Panel Decision
Nov 13, 1985

National Union Fire Insurance v. Ideal Mutual Insurance

This case involves an appeal concerning personal jurisdiction over Parthenon Insurance Company. The plaintiff appealed an order denying its motion to reargue and renew opposition to Parthenon's motion to dismiss for lack of personal jurisdiction. The Appellate Division reversed the lower court's decision, granting the plaintiff's motion to reargue and renew, and subsequently denying Parthenon's motion to dismiss without prejudice, allowing for limited discovery on the jurisdictional issue. The central legal question is whether Parthenon, a 'captive' insurer for Hospital Corporation of America (HCA) and its subsidiaries, which conduct business in New York, is subject to personal jurisdiction in New York State. The court found that enough evidence was presented to warrant discovery to establish jurisdiction.

Personal JurisdictionCorporate VeilSubsidiary LiabilityParent CompanyInsurance CoverageMotion to DismissDiscoveryAppellate ReviewCPLRCaptive Insurer
References
4
Case No. Appeal Nos. 1, 2, and 3
Regular Panel Decision

Testerman v. Zielinski

The case involves three consolidated appeals stemming from a personal injury action and a wrongful death action after a pickup truck collided with another vehicle. Robert C. Testerman, a passenger in the pickup truck, commenced a personal injury action. Daniel D. Bigelow initiated a wrongful death action as executor of the estates of Tenny Bigelow and Douglas L. Bigelow, the occupants of the other vehicle. The collision occurred when Rachel L. Zielinski, operating a pickup owned by her employer Pisa Electrical Construction & Manufacturing, Inc., drove through a stop sign. In Appeal No. 2, the court affirmed the dismissal of Testerman's personal injury claim against Pisa, citing Workers' Compensation Law's exclusive remedy provision. However, in Appeal No. 1, the court reversed the summary judgment dismissing Testerman's claim against Daniel Bigelow, finding insufficient evidence that Tenny Bigelow used reasonable care. Similarly, in Appeal No. 3, the court reversed the partial summary judgment on liability granted to Daniel Bigelow in the wrongful death action, for the same reasons as Appeal No. 1.

Personal InjuryWrongful DeathSummary JudgmentWorkers' Compensation LawVehicle and Traffic LawAutomobile AccidentExclusive RemedyEmployer LiabilityVicarious LiabilityAppellate Review
References
7
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