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

Case No. 2018 NY Slip Op 05037 [163 AD3d 558]
Regular Panel Decision
Jul 05, 2018

Matter of Empire State Transp. Workers' Compensation Trust v. Special Funds Conservation Comm.

This case concerns a proceeding initiated by Empire State Transportation Workers' Compensation Trust for judicial approval of a settlement, nunc pro tunc, against the Special Funds Conservation Committee. The underlying issue stemmed from the Trust's failure to obtain consent from the Special Funds for a claimant's personal injury settlement, which led the Workers' Compensation Board to find a waiver of reimbursement rights. After an initial denial by the Supreme Court, the Appellate Division reversed and remitted, affirming the court's discretion in compelling such consent. Upon remittitur, the Supreme Court granted the petition, directing the Special Funds to provide nunc pro tunc consent. The Appellate Division affirmed this subsequent order, concluding that the settlement was reasonable, the delay was adequately explained, and no prejudice was demonstrated against the Special Disability Fund.

Workers' CompensationNunc Pro TuncSettlement ApprovalPersonal Injury ActionSpecial Funds Conservation CommitteeAppellate DiscretionReimbursement WaiverJudicial ReviewAppellate PracticeNassau County
References
14
Case No. 2015 NY Slip Op 01635
Regular Panel Decision
Feb 25, 2015

Empire State Transportation Workers' Compensation Trust v. Special Funds Conservation Committee

The Empire State Transportation Workers' Compensation Trust (the carrier) appealed an order denying its petition for judicial approval of a settlement nunc pro tunc. The claimant, Licinio Marrero, sustained injuries and settled a personal injury action for $100,000 without obtaining the consent of the Special Funds Conservation Committee (SFCC), which is required when SFCC liability is established prior to settlement. The Supreme Court, Nassau County, denied the carrier's request, believing it lacked discretion to compel such consent. The Appellate Division reversed this decision, clarifying that the Supreme Court does have the discretion to issue a nunc pro tunc order compelling consent if certain conditions are met: the delay was not due to the petitioner's fault, the settlement amount was reasonable, and the SFCC was not prejudiced. The case was remitted to the Supreme Court for it to exercise its discretion.

Workers' Compensation LawSpecial Disability FundNunc Pro Tunc OrderSettlement ApprovalReimbursementPersonal Injury ActionAppellate ReviewJudicial DiscretionCarrier's WaiverConsent Requirement
References
6
Case No. MISSING
Regular Panel Decision

In re the Establishment of a Supplemental Needs Trust for Kennedy

John Kennedy, a disabled person under 65, receives Social Security disability payments. His guardian, Hope Kennedy, petitioned to establish a supplemental needs trust solely funded by these payments to avoid Medicaid spend-down requirements. The court addressed the apparent conflict between New York's Social Services Law concerning spend-down (366[2][a][7]) and supplemental needs trusts (366[2][b][2][iii]), determining that such trusts serve as an exception to general Medicaid rules. Noticing parties, the Nassau County Department of Social Services and the New York State Attorney General’s Office, did not object to the trust's formation or funding source, though the Attorney General raised objections to specific provisions. The court granted the application, approving the trust under specific conditions, including provisions related to the trustee's counsel, housing investments, annual accounting with the Surrogate's Court, and ensuring state reimbursement priority upon John Kennedy's death in accordance with POMS guidelines.

Supplemental Needs TrustMedicaid EligibilitySocial Security DisabilitySpend Down ProgramPayback TrustException TrustGuardianshipRepresentative PayeeStatutory InterpretationAdministrative Deference
References
19
Case No. ADJ6743541, ADJ6769168
Regular
Nov 03, 2014

DEBORAH PRYOR vs. INSTITUTE FOR REDESIGNED LEARNING, STATE COMPENSATION INSURANCE FUND, SPECIAL NEEDS NETWORK, INC., ENDURANCE INSURANCE COMPANY

State Compensation Insurance Fund (SCIF) sought reconsideration of an arbitrator's decision denying their contribution claim against Endurance Insurance Company. The arbitrator found that the applicant did not sustain a cumulative injury during her employment with Special Needs Network, insured by Endurance, and therefore Endurance was not liable. The Workers' Compensation Appeals Board denied SCIF's petition, adopting the arbitrator's reasoning that there was insufficient evidence of injurious exposure at Special Needs to establish Endurance's liability. The Board concluded that the applicant's symptoms were due to prior cumulative trauma from employment at Institute for Redesigned Learning, not Special Needs.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for ContributionCumulative InjuryDate of InjuryLabor Code Section 5412Labor Code Section 5500.5Injurious ExposureSubstantial EvidenceCompromise and Release Agreement
References
0
Case No. MISSING
Regular Panel Decision

Cueto v. Hamilton Plaza Co.

Victor Cueto, a construction worker, was injured when a ceiling fell on him at a construction site. After settling his workers’ compensation claim against his employer, Arkay Contracting, Cueto filed a personal injury lawsuit. The defendant, Reckson Construction and Development, LLC, initiated a third-party action against Arkay for common-law indemnification and contribution. Special Trades Contracting and Construction Trust, Arkay’s workers’ compensation administrator, moved to dismiss the third-party claim, asserting that Cueto had not suffered a “grave injury” as defined by Workers’ Compensation Law § 11, which would bar such claims. The Supreme Court denied this motion, and the appellate court affirmed, finding that the third-party complaint sufficiently alleged a “grave injury” when afforded a liberal construction.

grave injuryworkers compensation lawindemnificationcontributionpersonal injuryconstruction accidentCPLR 3211(a)(7)motion to dismissthird-party actionemployer liability
References
7
Case No. 2024 NY Slip Op 24324 [86 Misc 3d 365]
Regular Panel Decision
Dec 23, 2024

Matter of Kosmo Family Trust

This case concerns the Kosmo Family Trust, where petitioners, including decedent Janet D. Kosmo's children and grandchildren, challenged the validity of trust amendments on grounds of undue influence by respondent Donna Savino. The court found that a confidential relationship existed between the decedent and respondent, characterized by the decedent's vulnerability and respondent's active involvement in the trust's modifications. The respondent, initially a healthcare worker for decedent's disabled daughter, became the primary beneficiary, receiving almost the entire estate. Ultimately, the Surrogate's Court, Albany County, voided the second and third amendments, reinstating the first amendment's beneficiaries.

Trust ValidityUndue InfluenceConfidential RelationshipEstate DisputeTestamentary CapacitySurrogate's CourtCalifornia Probate LawNew York Evidence LawDead Man's StatuteHearsay
References
82
Case No. 900983-2015
Regular Panel Decision
Mar 16, 2016

Building Exterior Servs. Trust of N.Y. v. A.W. Farrell & Son, Inc.

Plaintiff Building Exterior Services Trust of New York (BEST), a group self-insurance trust, initiated an action against former members, including A.W. Farrell & Son, Inc., for unpaid monetary assessments levied in 2013 and 2014 to address a shortfall. Defendant A.W. Farrell & Son, Inc. moved to dismiss the complaint and a cross-claim, arguing that it ceased membership in 1994, was not bound by the 2000 Trust Documents, and that assessments could only be levied against current members, with any authority expiring in 2003. The Supreme Court, Albany County, denied the motion to dismiss, finding that the Trust Documents, specifically Section 4.8 of the Indemnity Agreement and Section 10.4 of the Declaration of Trust, could authorize assessments against former members for periods of participation. The court also rejected the statute-of-limitations defense, concluding that the breach-of-contract claim accrued when the defendant refused to pay the assessments.

Workers' Compensation LawGroup Self-Insurance TrustUnpaid AssessmentsMotion to DismissStatute of LimitationsBreach of ContractDeclaration of TrustIndemnity AgreementFormer MembersTrust Solvency
References
17
Case No. MISSING
Regular Panel Decision

Iron Workers Locals 40, 361 & 417 Health Fund v. Dinnigan

The case involves a dispute between the Iron Workers Locals 40, 361, & 417 Health Fund and Robert Dinnigan, Amanda C. Dinnigan Supplemental Needs Irrevocable Trust, and their attorney regarding reimbursement of medical expenses. The Health Fund sought nearly $1.7 million paid for Amanda Dinnigan's severe injuries from a third-party tortfeasor settlement. Defendants argued against reimbursement, citing state anti-subrogation laws and the "made-whole" doctrine. The court ruled that the Health Fund was self-insured, thus preempting state law, and that the 2008 SPD, which rejected the made-whole doctrine, applied to most expenses. Ultimately, the court ordered judgment for the Plaintiff in the amount of $1,292,278, having reduced the claim by 25% to account for the Defendants' attorneys' fees and expenses in securing the original settlement.

ERISAEmployee BenefitsHealth Fund ReimbursementSubrogationEquitable ReliefSelf-Insured PlanMade-Whole DoctrinePersonal Injury SettlementSupplemental Needs TrustAttorneys' Fees
References
32
Case No. 2024 NY Slip Op 06200
Regular Panel Decision
Dec 11, 2024

Matter of NYAHSA Servs., Inc. v. Special Funds Group

This case concerns an appeal by NYAHSA Services, Inc., the workers' compensation insurance carrier for St. Patrick's Nursing Home, from an order denying its petition for judicial approval of a personal injury settlement nunc pro tunc. The underlying matter involved Karen DiNoia, who sustained injuries in 2001 during employment and settled a third-party personal injury action in 2005 for $400,000. Although NYAHSA consented, the Special Funds Group's consent was not obtained at the time, which is crucial for the carrier to be reimbursed from the Special Disability Fund. The Supreme Court dismissed the petition, citing a lack of required documentation. However, the Appellate Division, Second Department, reversed the decision, finding that the settlement was reasonable, the delay in seeking judicial relief was not the petitioner's fault, and the Special Funds Group was not prejudiced, thus granting the petition.

Nunc Pro TuncPersonal Injury SettlementJudicial ApprovalAppellate ReviewSpecial Disability FundInsurance Carrier ReimbursementSupreme Court DiscretionDelayPrejudiceReasonableness of Settlement
References
10
Case No. ADJ8164712
Regular
Sep 12, 2016

Maria Galdamez vs. The Hosseini Family Trust, LRS Realty

The Workers' Compensation Appeals Board denied Maria Galdamez's petition for reconsideration of a decision finding she did not sustain an industrial injury as a housekeeper for The Hosseini Family Trust. Galdamez argued her claim was presumed compensable under Labor Code section 5402 and that her testimony was sufficient, but the Board found no proof of claim form filing to trigger the presumption and insufficient corroboration for her testimony. The Board granted reconsideration for The Hosseini Family Trust solely to amend a finding regarding its alleged uninsured status, as that issue was not ripe for determination. The Trust's other arguments, including employment status and general/special employment, were either affirmed based on substantial evidence or waived for not being raised at trial.

Workers Compensation Appeals BoardIndustrial InjuryLabor Code Section 5402Presumption of CompensabilityPre-Trial Conference StatementPetition for ReconsiderationEmployer LiabilityUninsured EmployersGeneral-Special EmploymentJoint Employment
References
5
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