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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
Mar 31, 2017

What Happened in Felix vs. Weber Metals Reconsideration?

Reddin Byrge's widow, as the plaintiff, initiated a lawsuit to enforce a 20% additional compensation on overdue black lung benefits against Premium Coal Company, Inc. Reddin Byrge had been awarded black lung benefits by an Administrative Law Judge (ALJ) in January 2013, with the order becoming effective upon filing in February 2013. Despite this, Premium Coal Company appealed the decision through various levels without obtaining a stay of payment, failing to make timely benefit payments. The Black Lung Disability Trust Fund covered interim payments during this period. The plaintiff argued that, according to 33 U.S.C. § 914(f) and 20 C.F.R. § 725.607, the defendants were liable for the 20% additional compensation and interest due to their failure to pay benefits within ten days of them becoming due. The defendants contended that the Longshore Act's penalty provision should not apply to black lung claims, arguing it was punitive, untimely, and that the Department of Labor's regulations were an unlawful departure from the statute. The Court granted the plaintiff's motion for summary judgment, concluding that the ALJ's order was effective in February 2013, creating an immediate payment obligation, and that the additional compensation and interest were automatically incurred due to the defendants' non-compliance and lack of a stay. Subsequently, the Court denied the defendants' motion to alter or amend the judgment, reaffirming its prior findings and reasoning.

Black Lung Benefits ActLongshore and Harbor Workers' Compensation ActSummary JudgmentAdditional CompensationInterest CalculationStatutory InterpretationAdministrative Law Judge DecisionBenefits Review BoardSixth Circuit Court of AppealsTimely Payment
References
35
Case No. 2020-07-0020
Regular Panel Decision
Mar 14, 2023

How Did the WCAB Rule in Hardgrove vs. Intercon Security?

Robert Bragg, an employee, claimed permanent total disability due to elbow, shoulder, and neck injuries sustained while bending steel with a vise. The employer, Premium Services, LLC, contended the neck injury was not work-related and Mr. Bragg was only entitled to permanent partial disability for his elbow and shoulder. The Court found Mr. Bragg's neck injury to be work-related, relying on Dr. Curlee's testimony regarding aggravation of a pre-existing condition and early complaints of neck pain, contrary to Dr. Parsioon's opinion. However, the Court denied permanent total disability, finding insufficient evidence, and awarded Mr. Bragg 23% permanent partial disability to the body as a whole, along with payment for past and future medical expenses related to all three injuries.

Workers' CompensationPermanent Partial DisabilityNeck InjuryElbow InjuryShoulder InjuryAggravation of Pre-existing ConditionMedical CausationAMA GuidesNeurosurgeon OpinionOrthopedic Surgeon Opinion
References
9
Case No. 91 B 10891
Regular Panel Decision

What Did the WCAB Decide in Cuadra vs. Community Home Care?

This memorandum decision addresses motions by Gibson, Dunn & Crutcher and Kramer, Levin, Nessen, Kamin & Frankel, counsel for the debtor (Financial News Network, FNN) and the equipment lessors committee respectively, seeking payment of prepetition fees in FNN's Chapter 11 bankruptcy case. Gibson, Dunn sought payment through the assumption of an employment agreement at a premium rate, while Kramer, Levin sought compensation under Section 503(b) for substantial contribution. The court denied Gibson, Dunn's motion, ruling that professional compensation is governed by Sections 327-330 of the Bankruptcy Code, not Section 365, and rejected the "doctrine of necessity" in this context. Kramer, Levin's motion for prepetition fees was also denied, without prejudice, as the court deemed the determination of "substantial contribution" premature and best addressed at the conclusion of the case.

Chapter 11Bankruptcy LawPrepetition FeesCounsel FeesExecutory ContractProfessional CompensationDoctrine of NecessitySubstantial ContributionDebtor-in-possessionBankruptcy Code Section 365
References
24
Case No. MISSING
Regular Panel Decision
Mar 17, 1983

How Were Death Benefits Handled in Bocanegra vs. Sun-Gro Commodities?

This case is an appeal from a Workers’ Compensation Board decision filed on March 17, 1983. The employer's insurance broker advised them of the premium due for a workers' compensation policy from the State Insurance Fund. After a partial payment, the employer paid the balance by October 22, 1980. However, the State Fund attempted to cancel the policy, effective November 25, 1980, for non-payment. The Board concluded that the State Fund was estopped from canceling the policy, having accepted premiums through its agent. Despite the State Fund's contention that payments were for an earlier period, the record lacked documentary proof, and a subsequent refund raised doubt about any default. The Board's decision affirming the estoppel was upheld.

Workers' CompensationInsurance Policy CancellationEstoppelPremium PaymentState Insurance FundInsurance BrokerBoard DecisionAppealCoverage LapseDocumentary Proof
References
1
Case No. 01-07-00310-CV
Regular Panel Decision
Jan 29, 2009

Can a WCJ Be Disqualified for Appearance of Bias?

The case involves a dispute between Sembera Security Systems Inc. (Sembera) and Texas Mutual Insurance Company (TMI) regarding the cancellation of Sembera’s workers’ compensation insurance coverage. Sembera sued TMI for breach of contract, alleging that TMI improperly cancelled its policy for non-payment of an "additional premium" during the policy term, leading to the termination of an agreement with En-Touch Systems, Inc. and causing Sembera lost profits. Both parties filed cross-motions for summary judgment, with the trial court initially ruling in favor of Sembera. On appeal, the Court of Appeals for the First District of Texas reversed the trial court's decision, concluding that TMI's cancellation of the policy was justified due to Sembera's failure to repay a $490 portion of the estimated initial premium after the policy's retroactive reinstatement. The appellate court held that TMI had the contractual right to cancel for non-payment of premium.

Breach of ContractWorkers' Compensation InsuranceSummary JudgmentInsurance Policy CancellationNon-payment of PremiumContract InterpretationLost Profits DamagesAppellate ReviewRetroactive ReinstatementInsurance Agent Liability
References
11
Case No. W2018-00999-WCAB-WC-CT
Regular Panel Decision
Dec 19, 2018

What Were the Key Rulings in Torrez vs. SuperShuttle?

This interlocutory appeal concerns employee Rick O. Muncy's request to return to his authorized treating physician for a low back injury sustained in a July 2016 work accident. The employer, Premium Distributors, Inc., refused to authorize the evaluation, contending the low back complaints had resolved and were not primarily work-related. Following an expedited hearing, the trial judge ordered the employer to authorize a return visit. The Appeals Board affirmed the trial judge's order, concluding that the preponderance of evidence supported the determination. The Board also found no abuse of discretion in the trial judge's rejection of the medical questionnaire's opinion on causation, deeming it ambiguous and non-determinative given the doctor's lack of recent examination. The case was remanded for further proceedings consistent with the decision.

Workers' CompensationMedical BenefitsLow Back InjuryExpedited HearingCausationMedical OpinionEvidenceStandard of ReviewAppellate ReviewTennessee
References
9
Case No. MISSING
Regular Panel Decision

Why Was Removal Denied in Rush vs. California Correctional Institution?

This motion, brought by a plaintiff insurance carrier and Flying Tigers, Inc., sought to stay payment to defendant John Johnstone. The payment was awarded by Deputy Commissioner McLellan under the Longshoremen’s and Harbor Workers’ Compensation Act for the death of James M. Johnstone. Plaintiffs argued that the Deputy Commissioner's findings on dependency and jurisdiction were erroneous and that they would suffer irreparable harm without a stay due to no provision for repayment under the Act. However, the court found the application inadequate, citing insufficient facts, rebutted dependency claims, and legally insufficient assertions of irreparable injury. Consequently, the motion for a stay of payment was denied.

Longshoremen's and Harbor Workers' Compensation ActWorkers' CompensationStay of PaymentPreliminary InjunctionIrreparable HarmDependencyJurisdictionCompensation AwardPenalty for Non-PaymentInsurance Carrier
References
8
Case No. MISSING
Regular Panel Decision
Nov 12, 2003

What Did the WCAB Clarify in Ontiveros vs. Savers Stores?

This case involves an appeal from an order of the Supreme Court, Westchester County, concerning an action to recover unpaid workers' compensation insurance premiums. The plaintiff, an insurance fund, sought premiums from the defendant for policy periods between November 1993 and December 1996. The defendant moved for summary judgment, arguing that claims for estimated premiums for the periods from November 1993 to November 1996 were barred by the six-year statute of limitations, CPLR 213 (2). The Appellate Division modified the Supreme Court's order, agreeing that the claims for unpaid estimated premiums for those specific periods were time-barred. However, the court found that claims for final audit premiums issued after July 30, 1996, were not time-barred. Additionally, the Appellate Division granted summary judgment to the plaintiff, dismissing the defendant's counterclaim, on the grounds that such counterclaims against the State Insurance Fund are only cognizable in the Court of Claims.

Workers' Compensation InsuranceUnpaid PremiumsStatute of LimitationsSummary JudgmentCounterclaimInstallment PaymentsEstimated PremiumsAudit AdjustmentAppellate DivisionNew York Law
References
2
Case No. MISSING
Regular Panel Decision

Why Was Reconsideration Denied in Gomez vs. Dorothy Stevens?

The petitioner, a paternal grandmother, sought foster care payments for three children who had been in her custody since July 30, 1988, following their placement by the Department of Social Services (DSS). DSS initially provided payments until July 29, 1988, but subsequently denied further funding, asserting that the foster care placement had automatically terminated. The court, in reviewing the Commissioner's determination, held that under the Interstate Compact on the Placement of Children (Social Services Law § 374-a), DSS, as the sending agency, retained jurisdiction and financial responsibility for the children. The court found that the voluntary 'discharge' of the children to the grandmother was an insufficient basis to terminate DSS's ongoing supervisory and financial responsibilities. Consequently, the Commissioner's determination denying foster care payments was annulled, and the petition seeking such payments was granted.

Foster careInterstate CompactSocial Services LawCPLR article 78Judicial reviewAnnulmentChild custodyFinancial responsibilityAgency responsibilityNew York law
References
4
Case No. MISSING
Regular Panel Decision

Why Was Reconsideration Dismissed in Sabino vs. Johnson Pump Company?

The claimant appealed a Workers’ Compensation Board decision regarding the method of payment for his hearing loss benefits, specifically challenging the biweekly installment plan. The claimant argued that Workers’ Compensation Law § 49-bb, which governs occupational loss of hearing claims, mandated a different payment method. The court rejected this contention, asserting that Workers’ Compensation Law § 15 (3) (m), which covers schedule awards for hearing losses generally, and § 49-cc, which directs occupational loss of hearing compensation to align with § 15 (3), govern the payment. Consequently, the court affirmed that the claimant was entitled to biweekly scheduled payments, consistent with other schedule loss awards.

Hearing lossWorkers' CompensationOccupational diseaseSchedule awardBiweekly paymentsStatutory interpretationAppealCompensation benefitsWorkers' Compensation Board
References
2
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