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Case Law Database

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

Case No. MISSING
Regular Panel Decision

Vam Check Cashing Corp. v. Federal Insurance

Vam Check Cashing Corporation (VAM) sued Federal Insurance Company after experiencing a $120,000 loss due to an elaborate fraud scheme. Imposters tricked a cashier at VAM's Pine Check Cashing location into handing over the money. Federal denied VAM's claim, asserting the incident did not meet the policy's definition of 'Robbery,' specifically concerning the terms 'overt felonious act' and 'cognizance.' The court examined the insurance policy's ambiguous language, particularly the meanings of 'overt' and 'cognizance.' It ruled that the cashier did not need to recognize the act as criminal for coverage, only that the physical act of transferring money occurred in her presence and control. The court found Federal's interpretation would defeat the policy's purpose of protecting check cashing businesses from fraud. Consequently, VAM's motion for summary judgment was granted, and Federal's motion was denied.

Insurance Policy InterpretationRobbery DefinitionSummary JudgmentContract AmbiguityFraud SchemeCheck Cashing BusinessOn Premises ClauseOvert Felonious ActCognizance RequirementNew York Law
References
13
Case No. ADJ4461663 (VNO 0501542)
Regular
Oct 01, 2014

JONATHAN TRASK, vs. BLOOMINGDALE'S, INC., permissibly selfinsured, administered by MACY'S CORPORATE SERVICES

The Workers' Compensation Appeals Board denied lien claimant Dr. Silver's petition for reconsideration. The Board found that Bloomingdale's timely paid the negotiated lien settlement by issuing a check within 30 days, and when it was not received, a stop payment was placed and a replacement check issued promptly. The Board affirmed the administrative law judge's decision to admit bank records supporting timely payment, despite procedural objections regarding disclosure. Therefore, penalties, sanctions, and costs sought by the lien claimant were denied.

Lien claimantPetition for ReconsiderationStipulation and OrderTimely PaymentPenaltiesSanctionsFeesCostsComputer screen shotsSubstantial Evidence
References
0
Case No. 04-24-00797-CV
Regular Panel Decision
Jan 14, 2026

Eunice Villanueva v. Structural Repair, LLC; Isabel Alcantara; Frederick Marshall; Francis Check; Bradley Bertelsen; Michael Ellington; And Jarrod McBride

Eunice Villanueva appealed a summary judgment favoring Structural Repair, LLC and other appellees, stemming from a dispute over foundation repair. An initial arbitration between Villanueva and Advanced Foundation Repair, L.P. resulted in an award for Villanueva on a DTPA violation, which was subsequently confirmed by the trial court. Villanueva then sued the appellees, who were related to Advanced Foundation, asserting similar claims of fraud and DTPA violations. The appellees successfully moved for summary judgment, arguing res judicata based on the prior arbitration. The appellate court affirmed, holding that the arbitration award constituted a final judgment, the appellees were in privity with Advanced Foundation, and the claims were identical to those previously litigated, thus satisfying all elements of res judicata. The court also clarified that Villanueva's attempt to pierce the corporate veil did not introduce a new substantive claim precluding summary judgment.

Summary JudgmentAppealRes JudicataArbitration AwardPrivityCorporate VeilTexas Deceptive Trade Practices ActFoundation RepairFraudCivil Procedure
References
17
Case No. MISSING
Regular Panel Decision

Claim of Jacob v. New York City Transit Authority

Claimant sustained work-related injuries in January 2000 and later sought workers’ compensation benefits alleging recurrence. An issue arose regarding the veracity of the medical history provided to the employer’s independent medical examiners, specifically concerning undisclosed prior similar injuries. A workers’ compensation law judge and subsequently the Workers’ Compensation Board found that the claimant violated Workers’ Compensation Law § 114-a, leading to disqualification from wage replacement benefits. However, the Board authorized medical treatment for the January 2000 injuries. On cross appeals, the Board’s determination was affirmed, finding substantial evidence supported the violation and the appropriateness of the penalties imposed.

Workers' Compensation Law Section 114-aMedical MisrepresentationWage Replacement Benefits DisqualificationMedical Treatment AuthorizationPrior Injuries DisclosureSubstantial Evidence ReviewIndependent Medical ExaminationWorkers' Compensation Board DecisionAppellate ReviewAffirmed Decision
References
4
Case No. MISSING
Regular Panel Decision
Jul 27, 2001

Claim of Losurdo v. Asbestos Free, Inc.

The case involves a claimant appealing a Workers’ Compensation Board decision. The Board ruled that the claimant violated Workers’ Compensation Law § 114-a by failing to disclose prior left and right knee injuries to physicians and under oath, leading to disqualification from future wage replacement benefits. Although a Workers’ Compensation Law Judge initially found no fraud, the Board reversed this determination on administrative appeal, concluding the claimant knowingly made false statements. The Appellate Division affirmed the Board's decision, finding it supported by substantial evidence, emphasizing the Board's authority as the sole arbiter of witness credibility. The court rejected the claimant's explanations of forgetting the prior incidents as not credible.

Workers' Compensation FraudMisrepresentation of Medical HistoryFalse Statements Under OathWage Replacement Benefits DisqualificationWorkers' Compensation Law Section 114-aAppellate Review of Board DecisionWitness CredibilitySubstantial EvidencePrior Knee InjuriesAdministrative Appeal
References
11
Case No. ADJ9175444 ADJ9175443 ADJ9182342 ADJ9863288
Regular
Sep 11, 2017

ALEXANDRA MOON (RAMIREZ) vs. LONG BEACH COMMUNITY ACTION PARTNERSHIP, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the State Compensation Insurance Fund's (SCIF) petition for reconsideration. SCIF sought to overturn penalties and attorney's fees awarded due to an alleged unreasonable delay in issuing settlement proceeds. The Board upheld the administrative law judge's decision, finding that SCIF failed to sufficiently prove that replacement settlement checks were mailed on the dates claimed, thus supporting the applicant's testimony of a delay. The exclusion of SCIF's exhibits for lack of authentication was also deemed proper.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings Award OrdersWCJSCIFSettlement ProceedsPenaltyInterestAttorney's FeesCompromise and Release
References
1
Case No. 2021 NY Slip Op 02582
Regular Panel Decision
Apr 29, 2021

Matter of Young v. Acranom Masonary Inc.

Claimant Timothy Young established a workers' compensation claim for a back injury and received indemnity benefits, despite his treating physician continuously diagnosing a total temporary disability. Young returned to work for a different employer on April 1, 2019, but failed to disclose this information to any party or the Workers' Compensation Board, continuing to cash compensation checks. The employer's carrier subsequently raised a fraud issue under Workers' Compensation Law § 114-a, supported by video surveillance showing Young engaged in physical activity. The Workers' Compensation Board found that Young violated § 114-a through misrepresentation and imposed both mandatory and discretionary penalties, including a lifetime bar of indemnity benefits. On appeal, the Appellate Division affirmed the finding of a § 114-a violation but reversed the discretionary penalty of permanent disqualification from future wage replacement benefits, deeming it disproportionate to the offense given mitigating circumstances.

Workers' Compensation FraudDisability BenefitsMisrepresentationMandatory PenaltyDiscretionary PenaltyIndemnity BenefitsReturn to WorkVideo SurveillanceAppellate ReviewWorkers' Compensation Board Decision
References
10
Case No. ADJ1384238 (SAC 0366460)
Regular
Oct 09, 2017

ROSA VIRGEN vs. MACY'S WEST, MACY'S CORPORATE SERVICES-RISK MANAGEMENT DEPARTMENT

The Workers' Compensation Appeals Board denied Macy's West's petition for removal, upholding the WCJ's decision not to grant a replacement Qualified Medical Evaluator (QME). The Board found that a late supplemental report alone does not mandate a replacement QME under LC 4062.5 or AD Rule 31.5(a)(12). Granting a replacement QME for untimely supplemental reporting is discretionary and requires a showing of good cause, which Macy's failed to demonstrate. The Appeals Board retains exclusive jurisdiction over the validity of replacement panels.

Workers' Compensation Appeals BoardPetition for RemovalQualified Medical EvaluationPQMEReplacement PanelMedical DirectorTimelinessSupplemental ReportGood CausePrejudice
References
4
Case No. MISSING
Regular Panel Decision

Mission Consolidated Independent School District v. Garcia

The Texas Supreme Court addressed whether a plaintiff can establish a prima facie case of age discrimination under the Texas Commission on Human Rights Act (TCHRA) when replaced by an older worker. The Court held that for a prima facie case under the McDonnell Douglas framework, a plaintiff must demonstrate replacement by someone younger. Because Gloria Garcia, who was 48 when fired, was replaced by a three-year older Mexican-American woman, she failed to meet this requirement. The Court reversed the court of appeals' judgment and dismissed Garcia's age discrimination suit, clarifying that while direct evidence of discrimination remains an option, the prima facie presumption is not available in such replacement cases.

Age DiscriminationTexas Commission on Human Rights Act (TCHRA)Prima Facie CaseMcDonnell Douglas Burden-Shifting FrameworkReplacement by Older WorkerSovereign ImmunityPlea to the JurisdictionJurisdictional FactsDirect EvidenceEmployment Law
References
27
Case No. MISSING
Regular Panel Decision

Nunez v. State

Appellant Angel Diaz Nunez was convicted by a jury for forgery and sentenced to five years' imprisonment probated for seven years and a $6,000 fine. The case originated from Nunez, an attorney, forging the endorsement of his client, Joel Hinojosa, on a $6,000 worker's compensation settlement check. Hinojosa, after not receiving payment, discovered the forged check and recorded Nunez admitting to the forgery. On appeal, Nunez argued insufficient evidence, specifically that the State failed to prove he 'made' the check as required by the jury charge. The appellate court agreed, finding that the term 'maker' in the context of a check has a particularized meaning (the drawer), and Nunez, as an endorser, was not the maker. The judgment was reversed and an acquittal ordered.

ForgeryCriminal AppealSufficiency of EvidenceLegal Definition of MakeWorker's Compensation SettlementAttorney MisconductTexas Penal CodeAppellate ReviewJudgment of AcquittalEndorsement Forgery
References
17
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