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

Case No. ADJ5836855
Regular
Dec 11, 2012

Malory Wheat vs. STATE OF CALIFORNIA, DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded a prior award allowing a lien for living expenses claimed by the CCPOA Benefits Trust Fund. The WCAB held that liens in workers' compensation are strictly statutory and the CCPOA's claim for reimbursement of benefits advanced did not fit within the specific provisions of Labor Code sections 4903 or 4903.1 for "living expenses" or benefits provided by a "self-insured employee welfare benefit plan." The Board clarified that liens for living expenses are intended for those who loan money or extend credit, not for contractual obligations of insurance or benefit plans.

Workers' Compensation Appeals BoardMalory WheatState Compensation Insurance FundCCPOA Benefits Trust Fundlien claimantLabor Code section 4903(c)Labor Code section 4903.1(a)(1)Labor Code section 4903.1(a)(2)Labor Code section 4903.1(a)(3)living expenses
References
9
Case No. MISSING
Regular Panel Decision

Claim of Monahan v. Remington Rand, Inc.

A self-insured employer appealed a Workmen’s Compensation Board decision granting death benefits to the widow of a deceased employee. The core issue was whether the employee's death resulted from an accident arising out of and in the course of his employment. The employee, an outside service man, was killed in a car accident on his way home after volunteering to repair a machine for his employer in Albany. The Board determined he remained an outside worker and that the accident was work-related. The appellate court affirmed, finding the Board's decision justified by the evidence, as the work performed was clearly for the employer's benefit.

Workers' CompensationDeath BenefitsOutside WorkerCourse of EmploymentArising Out of EmploymentSelf-Insured EmployerAppellate ReviewVoluntary WorkFatal AccidentBoard Decision
References
0
Case No. MISSING
Regular Panel Decision

In re the General Assignment for the Benefit of Creditors of Well Bilt Box Spring Corp.

An assignee for the benefit of creditors moved to disallow a claim for priority filed by the United Furniture Workers Insurance Fund. The fund sought $480 for unpaid group welfare insurance premiums, which accrued from September 1947 to April 1948 under a collective bargaining agreement. The assignee contended that the Debtor and Creditor Law section 21-a did not provide priority for such claims, arguing it applied to employee-contributed pension plans, not employer-paid insurance. The court referenced conflicting precedents from Matter of Seaboard Furniture Mfg. Corp. (Frey) and Matter of Hollywood Commissary, Inc. (Weintraub). Adopting the view of Justice Walsh, the court ruled that this was a contract matter between the employer and union, not a claim for wages, and noted the claim was made by the insurance carrier rather than the union or employees. Consequently, the court disallowed the claim for priority and granted the assignee's application to settle their account.

Priority ClaimAssignee for CreditorsInsurance FundCollective Bargaining AgreementWelfare InsuranceEmployer ContributionsDebtor and Creditor LawSection 21-aWage ClaimContract Dispute
References
2
Case No. MISSING
Regular Panel Decision
Apr 13, 1983

Heitner v. Government Employees Insurance

This case clarifies the method for calculating "first party benefits" in no-fault automobile insurance claims concerning lost earnings. The Appellate Division reversed a Special Term decision, holding that disability benefits, along with the 20% lost-earnings deduction, should be subtracted from the claimant's gross lost monthly earnings, not from the statutory $1,000 lost-earnings ceiling. The court emphasized that the $1,000 limit represents the maximum recovery from the insurance carrier, and this interpretation prevents unwarranted windfalls to insurance companies while ensuring claimants receive intended benefits. This aligns with the consumer-oriented legislative intent of the no-fault provisions to compensate accident victims for economic loss without double recovery.

No-fault insurancedisability benefits deductionlost earningsinsurance lawstatutory interpretationbasic economic lossfirst-party benefitswage-loss calculationautomobile accident claimcollateral source offset
References
12
Case No. 81 Civ. 3958 (KTD)
Regular Panel Decision
Sep 16, 1982

In Re Pension Plan for Emp. of Broadway Maint.

This case involves a dispute between the Pension Benefit Guaranty Corporation (PBGC) and the bankrupt Broadway Maintenance Corporation over the termination date of Broadway's employee pension plan. The PBGC initiated the lawsuit to be appointed statutory trustee, declare the plan terminated, and sought a termination date of March 26, 1981, while Broadway argued for a retroactive date prior to December 31, 1979. Judge Kevin Thomas Duffy acknowledged the appointment of the PBGC as trustee and the plan's termination, with the sole issue being the precise termination date. After considering the interests of the participants, the PBGC, and Broadway, and applying legal precedent, the court ultimately set December 5, 1980, as the earliest valid termination date. This date was chosen because it marked when the PBGC filed its original Proofs of Claim, signaling its clear intent to terminate the plan.

ERISAPension Plan TerminationEmployee BenefitsBankruptcyPBGCStatutory TrusteeRetroactive Termination DateJudicial TerminationParticipant InterestsFinancial Distress
References
3
Case No. MISSING
Regular Panel Decision
Jul 13, 2001

A.I. Transport v. New York State Insurance Fund

The Supreme Court, New York County, denied a liability insurer’s application to stay an arbitration initiated by a workers’ compensation insurer. The workers’ compensation insurer sought to recover benefits paid to a bus passenger injured in an accident, where the bus was insured by the liability insurer. The court interpreted Insurance Law § 5105 (a) to allow a workers’ compensation provider, paying benefits in lieu of first party benefits, to recover amounts paid from the insurer of a liable party, even if one of the vehicles involved is a bus. It was determined that an exception for losses arising from the use of a motor vehicle (Insurance Law § 5103 [a] [1]) did not apply, as the respondent was a workers’ compensation insurer and not an automobile insurer. Consequently, the arbitration was allowed to proceed, and the petition to stay it was dismissed and unanimously affirmed.

Arbitration DisputeInsurance Law InterpretationNo-Fault BenefitsWorkers' Compensation SubrogationBus AccidentLiability CoverageStatutory ConstructionAppellate ReviewInsurer Recovery
References
4
Case No. ADJ4415679 (OAK 0259031) ADJ2701101 (WCK0050594)
Regular
May 10, 2010

Stanley Sanders vs. REMEDY INTELLIGENT STAFFING, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for RELIANCE NATIONAL INSURANCE COMPANY, OREGON STEEL MILLS, INC. dba NAPA PIPE

The Workers' Compensation Appeals Board reversed a judge's decision, ruling that Napa Pipe, a self-insured special employer, is liable for applicant Stanley Sanders' workers' compensation benefits. Despite an agreement between the general employer (Remedy Temp) and Napa Pipe attempting to limit liability to Remedy Temp's insurer (Reliance), Napa Pipe's joint and several liability as a special employer cannot be contractually eliminated. Because Napa Pipe's self-insurance was not excluded for special employees and constitutes "other insurance" under Insurance Code § 1063.1(c)(9), CIGA is relieved of its obligation to provide benefits following Reliance's insolvency. Therefore, Napa Pipe must now provide all workers' compensation benefits and administer the claim.

Workers' Compensation Appeals BoardStanley SandersRemedy Intelligent StaffingCalifornia Insurance Guarantee AssociationReliance National Insurance CompanyOregon Steel MillsNapa PipeADJ4415679ADJ2701101Opinion and Decision After Reconsideration
References
24
Case No. MISSING
Regular Panel Decision
Mar 13, 1978

Excavators Union Local 731 Welfare Fund v. Zurmuhlen

The Supreme Court, New York County, on March 13, 1978, granted the plaintiffs' motion for summary judgment on three claims for employee benefits. This appellate decision modifies the original judgment by reducing the welfare fund's recovery to $42,326.54 plus interest and costs, otherwise affirming the lower court's decision. The case concerns an employer's failure to contribute to an employee welfare fund as required by a labor contract, leading to an action under Labor Law § 198-c. The court analyzed the applicability of civil liability to corporate officers under this penal statute, confirming that a private right of action is implied. The defendant, as the sole stockholder and president, was held responsible for the non-payment of benefits.

Employee benefitsWage supplementsSummary judgmentCorporate officer liabilityPenal statutesCivil remedyLabor contractFringe benefitsEmployer contributionsWelfare fund
References
8
Case No. MISSING
Regular Panel Decision

Medoy v. Warnaco Employees' Long Term Disability Insurance Plan

Plaintiff, Audrey Medoy, sued Warnaco Employees’ Long Term Disability Insurance Plan and Warnaco, Inc. (Defendants) under ERISA, alleging wrongful termination of disability benefits, failure to provide requested documents, and failure to retain claims records. Medoy's disability benefits were discontinued in 1987 without notice. After years of requesting information and appealing the decision, which was hampered by the destruction of her claims file, she filed this action in 1997. Defendants moved to dismiss the complaint, arguing that the claims were untimely, that Medoy was not a 'participant' entitled to disclosure, and that ERISA § 1027 did not cover claims records. The court denied Defendants' motion to dismiss on all grounds, finding her claims timely, her status as a 'participant' colorable, and claims records subject to retention under ERISA § 1027.

ERISALong-term Disability BenefitsStatute of LimitationsFailure to DiscloseRecord RetentionFutility ExceptionAccrual of ActionPlan Administrator DutiesParticipant StatusMotion to Dismiss
References
37
Case No. ADJ122717
Regular
Dec 13, 2012

JOE MARTINEZ vs. CDC-CORCORAN STATE PRISON, STATE COMPENSATION INSURANCE FUND

Here is a summary of the case in four sentences: The Workers' Compensation Appeals Board denied a lien claim by the CCPOA Benefits Trust Fund for over $42,000 paid to applicant Joe Martinez for living expenses. The Board found no statutory authority under Labor Code sections 4903 or 4903.1 to allow reimbursement for living expenses paid by a self-insured employee welfare benefit plan. Specifically, Labor Code section 4903.1(a)(3) only permits such liens for group disability policies under specific conditions not met here. The Board affirmed the trial judge's decision disallowing the lien.

Workers' Compensation Appeals BoardLien claimLabor Code section 4903(c)Living expensesSelf-insured employee welfare benefit planStatutory authorizationReimbursementPermanent disabilityTemporary disabilityGroup disability policy
References
8
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