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

Case No. ADJ7091667
Regular
Jan 31, 2013

THOMAS HERRERA vs. AMERI-COLD LOGISTICS, LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board reconsidered a decision allowing the applicant to treat outside the defendant's Medical Provider Network (MPN). The Board found the employer failed to notify the applicant of his right to predesignate a personal physician as required by law. However, the remedy for this failure is limited to treatment with that specific personal physician, not any physician outside the MPN. Therefore, the original order was rescinded, and the applicant is now entitled to treatment from his identified personal physician, Dr. Aceves, provided he meets the statutory criteria, and not outside the MPN otherwise.

ADJ7091667Americo LogisticsLiberty Mutual InsuranceMedical Provider Network (MPN)Petition for Reconsiderationcumulative injurypsyche injuryinternal injuryheadachessleep disorder
References
2
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. 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. 533089
Regular Panel Decision
Oct 07, 2021

Matter of Barden v. General Physicians PC

Claimant, a patient services representative, sought to amend her workers' compensation claim to include left shoulder aggravation after a work-related injury to her right shoulder. The Workers' Compensation Board disallowed this request, finding that claimant failed to provide sufficient credible medical evidence to establish a causal relationship between her employment and the left shoulder condition. The Appellate Division, Third Department, affirmed the Board's decision. The court noted that the claimant's treating physician opined the left shoulder pathology was largely preexisting and unrelated to the work injury, and other medical opinions either lacked sufficient weight or were based on inaccurate information, providing no basis to disturb the Board's finding.

Workers' CompensationShoulder InjuryCausationMedical EvidencePreexisting ConditionAppellate ReviewBoard DecisionClaim AmendmentPatient Services Representative
References
10
Case No. MISSING
Regular Panel Decision
Apr 07, 1988

De Coste v. Champlain Valley Physicians Hospital

Decedent, Darwin A. De Coste, experienced chest pain and elevated blood pressure, leading him to Champlain Valley Physicians Hospital where he was seen by Dr. William Amsterlaw. Amsterlaw diagnosed reflux esophagitis despite an abnormal electrocardiogram, discharging De Coste, who subsequently suffered a fatal cardiopulmonary arrest 12 hours later. The administrator of De Coste's estate filed a wrongful death action, alleging medical malpractice and that the misdiagnosis was the proximate cause of death. A jury awarded pecuniary damages and funeral expenses, which the defendants appealed. The appellate court affirmed the verdict, finding rational support for the jury's malpractice finding and rejecting the defendants' argument to reduce the award by Social Security benefits due to the effective date of CPLR 4545 (c).

Medical MalpracticeWrongful DeathProximate CauseCollateral Source RuleCPLR 4545Jury VerdictEmergency Room CareMisdiagnosisArteriosclerosisMyocardial Infarction
References
3
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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