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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

Claim of Keselman v. New York City Transit Authority

Claimant, injured in 1986, initially established a right shoulder injury. The Workers’ Compensation Board affirmed this but denied a causally related neck injury in 1996. After another application in 1998 alleging a worsened neck condition, the Workers’ Compensation Law Judge found a causally related neck injury and permanent partial disability, awarding benefits from February 5, 1998, which the Board affirmed. Separately, the Board also ruled the employer was entitled to credit schedule payments against disability payments made after February 5, 1998. The court affirmed both decisions, finding substantial evidence supported the deterioration of the neck injury post-1996 and that schedule awards are independent of actual disability periods, thus allowing the employer's credit.

Workers' CompensationPermanent Partial DisabilitySchedule AwardDisability PaymentsNeck InjuryRight Shoulder InjuryCausally Related InjuryReopening CaseMedical EvidenceMRI
References
7
Case No. 05-CV-1573
Regular Panel Decision

Magin v. Cellco Partnership

This action was brought under ERISA by David Magin against Verizon Wireless entities and MetLife Corporation after his short-term disability benefits were denied. Plaintiff also implicitly sought long-term disability benefits. The court considered cross-motions for summary judgment. Applying an arbitrary and capricious standard of review, the court found MetLife's denial of short-term disability benefits was not an abuse of discretion, citing a lack of material medical evidence. The claim for long-term disability benefits was dismissed as it was never properly filed. Consequently, the defendants' motion for summary judgment was granted, and the plaintiff's complaint was dismissed.

ERISADisability BenefitsShort Term DisabilityLong Term DisabilitySummary JudgmentAbuse of DiscretionDe Novo ReviewFiduciary DutyClaims DenialMedical Evidence
References
38
Case No. ADJ91 04682
Regular
Mar 15, 2016

NOEL CERVANTES vs. UCLA MEDICAL CENTER, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and awarded lien claimant Liberty Life Assurance reimbursement for $3,940.85 in short-term disability payments. The WCAB found that the lien claimant provided sufficient notice of its payments to UCLA Medical Center before UCLA paid overlapping temporary disability benefits. Legibility of a reimbursement agreement was deemed irrelevant when the parties stipulated to the payments made. Therefore, UCLA Medical Center was ordered to reimburse Liberty Life Assurance for these benefits under Labor Code section 4903.1.

Labor Code section 4903.1(a)Lien claimantPetition for ReconsiderationGroup disability policyReimbursement AgreementOverlapping disability paymentsNotice of lienTemporary disability benefitsShort-term disability paymentsCompromise and Release Agreement
References
1
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. MISSING
Regular Panel Decision

Lampo v. Eastman Kodak Co.

The claimant appealed three decisions by the Workers' Compensation Board that denied additional disability benefits and rejected an application for reconsideration of a discrimination claim. The court found substantial evidence in Dr. David Smith's testimony, which indicated normal visual performance, supporting the Board's conclusion that the claimant had no loss of visual acuity. It was also noted that the claimant received 26 weeks of disability payments, and the employer's long-term disability plan, which exceeds state requirements, is governed solely by ERISA. The Board's decision to deny reconsideration of the discrimination claim was deemed neither an abuse of discretion nor arbitrary, as no new evidence was presented. Consequently, the court affirmed the Board's decisions.

Workers' Compensation BoardDisability BenefitsVisual AcuityERISADiscrimination ClaimReconsideration DenialSubstantial EvidenceCredibility IssueAppellate ReviewAffirmed Decision
References
3
Case No. MISSING
Regular Panel Decision

Rector v. Sylvania

Plaintiff Sylvia Rector sued her former employer, Osram Sylvania, alleging disability discrimination under the Americans with Disabilities Act (ADA) after her termination. Rector suffered a shoulder injury requiring surgery and received short-term and long-term disability benefits. She was eventually cleared to return to work without restrictions, but Sylvania was undergoing a reduction in force and had no available position. The court granted Sylvania's motion for summary judgment, concluding that Rector's temporary shoulder injury did not constitute a disability under the ADA as it lacked the required permanent or long-term impact on a major life activity.

ADADisability DiscriminationSummary JudgmentEmployment LawShoulder InjuryTendonitisImpingement SyndromeTemporary DisabilityMajor Life ActivityReduction in Force
References
15
Case No. 12 Civ. 5645(KPF)
Regular Panel Decision
Feb 18, 2015

Wedge v. Shawmut Design & Construction Group Long Term Disability Insurance Plan

This case involves Plaintiff William Wedge's challenge under ERISA against the Shawmut Plan and Reliance Standard Life Insurance Company (RSLI) for the termination of his long-term disability benefits. Wedge, a former Senior Project Manager, suffered from Central Serous Chorioretinopathy (CSCR) and had his benefits denied by RSLI, which determined he was not "Totally Disabled" under the "Any Occupation" clause. The court applied an arbitrary and capricious standard of review, considering RSLI's structural conflict of interest but finding it warranted minimal weight. Ultimately, the court concluded that RSLI's decision, supported by comprehensive medical and vocational evidence, including an Independent Medical Examination, was reasonable and not arbitrary or capricious. Therefore, Plaintiff's motion for summary judgment was denied, and Defendants' motion was granted.

ERISA LitigationLong Term DisabilityBenefits DenialArbitrary and Capricious ReviewSummary Judgment MotionDiscretionary AuthorityConflict of InterestCentral Serous ChorioretinopathyMedical EvidenceVocational Assessment
References
46
Case No. ADJ2759696 (VNO 0492027)
Regular
Oct 11, 2010

WOON YOUNG PARK vs. FILM PAYMENT SERVICES, INC., CHARTIS INSURANCE

The Board granted reconsideration, rescinding the WCJ's decision on the defendant's credit for overpaid temporary disability. The defendant is allowed credit for temporary disability payments made from March 26, 2009, to June 3, 2009, at the temporary disability rate. Further credit is granted for payments made from June 4, 2009, to December 7, 2009, at the permanent disability rate of $185.00 per week. The Board denied further credit due to insufficient evidence regarding post-AME report overpayments.

Petition for ReconsiderationPermanent DisabilityTemporary DisabilityCreditStipulated AwardAgreed Medical ExaminationPermanent and StationarySection 4909Abuse of DiscretionDue Process
References
0
Case No. MISSING
Regular Panel Decision

Cook v. City of Binghamton

Plaintiffs, disabled firemen receiving benefits under former section 207-a of the General Municipal Law, initiated this action to challenge the constitutionality of Chapter 965 of the Laws of 1977. This amendment altered their benefits by limiting full salary payments until retirement age, requiring the acceptance of accidental disability retirement allowances, and potentially mandating light duty or forfeiture for outside employment. Special Term initially deemed Chapter 965 unconstitutional for firemen disabled prior to its effective date regarding benefit reduction. However, the appellate court reversed this aspect of the ruling, asserting that Chapter 965, as a remedial statute, legitimately altered the terms and conditions of employment without impairing vested rights. The court declared Chapter 965 constitutional, thereby upholding the legislative power to modify such employment terms.

Disabled Firemen BenefitsGeneral Municipal Law Section 207-aChapter 965 Laws of 1977Statutory ConstitutionalityVested RightsRetirement and Social Security LawWorkers' Compensation LawLegislative AuthorityRetroactive ApplicationPublic Employee Benefits
References
6
Case No. MISSING
Regular Panel Decision

In re Settlement Capital Corp.

Settlement Capital Corporation (SCC) sought court approval, under New York's Structured Settlement Protection Act (SSPA), to acquire $125,000 of a $225,000 annuity payment due to Richard C. Ballos on October 1, 2010. Ballos, a totally disabled father of two, agreed to transfer these rights for a net advance of $36,500, reflecting a 15.591% annual discount rate. The court, presided over by Justice Patricia E. Satterfield, denied the petition after a hearing on April 23, 2003. The decision hinged on a two-pronged test: whether the transfer was in Ballos's 'best interest' and if the transaction terms were 'fair and reasonable.' The court found that Ballos did not demonstrate 'true hardship' given his other income sources and previous transfer of structured settlement payments, concluding it was not in his or his dependents' best interest. Furthermore, the court deemed the 15.591% discount rate, resulting in Ballos receiving only 29% of the transferred amount, unconscionable and not 'fair and reasonable.'

Structured SettlementStructured Settlement Protection Act (SSPA)Annuity TransferDiscount RateBest Interest StandardFair and Reasonable StandardPayee ProtectionFinancial HardshipCourt ApprovalGeneral Obligations Law
References
12
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