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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

Claim of Palermo v. Primo Coat Corp.

The claimant, a seamstress, sustained a work-related right knee injury in 2000 and later had her claim amended to include other ailments, though a consequential left elbow injury remained unresolved. She was permanently disqualified from lost wage benefits in 2005 due to fraudulently collecting workers' compensation benefits, but her medical expenses continued. In 2008, the employer and its carrier sought to shift liability to the Special Fund for Reopened Cases under Workers’ Compensation Law § 25-a, which the Workers' Compensation Board granted. The Special Fund appealed, arguing the case was not truly closed due to the unresolved left elbow injury. The court affirmed the Board's decision, finding that even with outstanding issues related to medical expenses, the case was considered truly closed for compensation purposes as the claimant was disqualified from lost wage benefits.

Workers' CompensationSpecial Fund for Reopened CasesLost Wage BenefitsMedical ExpensesCase ClosureFraudulent CollectionPetit LarcenyLiability ShiftWorkers' Compensation BoardAppellate Review
References
12
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. MISSING
Regular Panel Decision
Apr 26, 2013

Claim of Khomitch v. Crotched Mountain Community

Claimant was injured in 2004 and received compensation through February 2007. In 2011, she sought reimbursement for medical bills and lost wages, leading to a stipulation where the carrier paid $4,750 for medical and transportation expenses (M&T). The carrier then sought to transfer liability to the Special Fund for Reopened Cases under Workers' Compensation Law § 25-a. The Special Fund argued the M&T payment was disguised compensation to improperly trigger the liability transfer. The Board Panel, after remittal, concluded that the Special Fund has standing to litigate if the payment was an advance payment of compensation. The Board rescinded the liability transfer to the Special Fund, without prejudice, pending further evidence. The employer and carrier appealed this decision, which was ultimately affirmed.

Workers' Compensation BoardSpecial Fund for Reopened CasesTransfer of LiabilityWorkers' Compensation Law § 25-aMedical and Transportation ExpensesAdvance Payment of CompensationStanding to LitigateClosed Case ReopeningIndemnity BenefitsBoard Panel Decision
References
7
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. 518297
Regular Panel Decision
Sep 04, 2014

MatterofKhomitchvCrotchedMountainCommunity

This case involves an appeal to the New York Supreme Court, Appellate Division, Third Judicial Department, concerning a Workers' Compensation Board decision. The Board had rescinded a transfer of liability to the Special Fund for Reopened Cases under Workers' Compensation Law § 25-a, without prejudice, pending evidence on the true nature of a $4,750 payment made to the claimant, which was labeled for medical and transportation expenses (M&T). The employer and carrier appealed, challenging the Special Fund's standing to litigate whether the M&T payment was, in fact, an advance payment of compensation that would preclude the transfer of liability. The Appellate Division affirmed the Board's decision, concluding that the Special Fund does have standing to challenge the nature of such payments when it involves a claim against the Fund, and that the Board adequately distinguished its prior precedents.

Workers' Compensation LawSection 25-aSpecial Fund for Reopened CasesLiability TransferAdvance Payment of CompensationMedical and Transportation ExpensesStanding to LitigateAppellate DivisionStatutory InterpretationCase Reopening
References
6
Case No. MISSING
Regular Panel Decision

Brownv. United States Fidelity & Guaranty Co.

In this action, the plaintiffs sought to recover attorney's fees and costs from the defendant, United States Fid. and Guar. Ins. Co., incurred in defending a prior Federal court action initiated by the defendant. This Federal action was itself a consequence of the defendant's earlier breach of its duty to defend the plaintiffs in a negligence suit. Special Term denied the defendant's motion to dismiss the plaintiffs' complaint, prompting the current appeal. The appellate court affirmed Special Term's decision, reiterating that expenses incurred in defending a declaratory judgment action brought due to an insurer's breach of the duty to defend are recoverable. The court distinguished this situation from prosecuting claims to establish coverage, emphasizing that the plaintiffs were defending their interests.

Attorney's FeesDeclaratory JudgmentDuty to DefendInsurance CoverageBreach of ContractIndemnificationAppellate ReviewMotion to DismissInsurer ObligationCosts
References
5
Case No. MISSING
Regular Panel Decision

Claim of Martin v. New York Telephone

This case concerns an appeal from a Workers' Compensation Board decision regarding the liability for benefits. The claimant sustained a left knee injury in 1987 and a reinjury in 1995. A 1998 Section 32 settlement agreement released the employer from future claims for a lump sum, but required it to cover medical treatment. In 2004, the claimant developed a consequential right knee injury. The Workers' Compensation Board ultimately shifted liability for benefits to the Special Fund for Reopened Cases under Workers' Compensation Law § 25-a, citing the passage of statutory timeframes. The Special Fund appealed, challenging its statutory liability and the employer's ongoing responsibility for medical expenses per the settlement. The appellate court affirmed the Board's decision, upholding the applicability of Section 25-a and noting the employer's statutory obligation for medical treatment.

Workers' Compensation Law § 25-aSpecial Fund for Reopened CasesSection 32 Settlement AgreementConsequential InjuryMedical Treatment LiabilityStatutory LiabilitySchedule Loss of UseAppellate ReviewTimelinessBoard Review
References
4
Case No. MISSING
Regular Panel Decision

Matter of Guadagno v. RIC Steel Erectors

Claimant suffered a work-related injury in 1981, with the State Insurance Fund (SIF) paying benefits until 1989. In 2001, SIF sought to transfer liability to the Special Fund for Reopened Cases, which was approved by the Workers’ Compensation Board in 2007, effective October 23, 1999. The Special Fund subsequently reimbursed SIF $680,581.92 for medical expenses. SIF then requested $315,651.14 in interest on these reimbursements under Workers’ Compensation Law § 25 (1) (f). A Workers’ Compensation Law Judge initially awarded limited interest, but the Board reversed, finding § 25 (1) (f) inapplicable to transfers under § 25-a. This court affirmed the Board's decision, holding that § 25 (1) (f) is intended for controversies where the Board directs immediate payment pending a liability dispute, a situation not present here as SIF was obligated to pay until liability transfer.

Workers' CompensationSpecial FundReopened CasesInterest PaymentMedical ExpensesStatutory InterpretationLiability TransferAppellate ReviewReimbursementWorkers' Compensation Board
References
5
Case No. MISSING
Regular Panel Decision
Apr 16, 2013

Claim of Ercole v. New York State Police

The case involves a claimant who suffered knee injuries in 1996, with the case closed in 2000. When the claimant's condition worsened in 2011, an orthopedic surgeon requested a bilateral total knee replacement. The workers' compensation carrier failed to respond, leading to the Chair of the Workers' Compensation Board authorizing the surgery. Subsequently, the carrier sought to shift liability to the Special Fund for Reopened Cases under Workers’ Compensation Law § 25-a. A Workers’ Compensation Law Judge shifted liability to the Special Fund but held the carrier responsible for surgical costs due to its delay. The Board, however, determined the Special Fund was liable for the surgical expenses, overruling prior precedent. The Special Fund appealed this decision. The appellate court affirmed the Board's decision, emphasizing that once liability shifts to the Special Fund, the carrier has no further interest in the payment of the claim, and the statute does not permit holding the carrier liable for expenses incurred after the shift.

Workers' Compensation LawSpecial FundLiability ShiftMedical AuthorizationKnee SurgeryCarrier Non-responseBoard Precedent OverrulingStatutory InterpretationAppellate ReviewStale Claims
References
13
Case No. 2016 NY Slip Op 02965 [138 AD3d 927]
Regular Panel Decision
Apr 20, 2016

Jardin v. A Very Special Place, Inc.

Jean-Paul Jardin, injured in a construction site fall from an unsecured ladder, sued A Very Special Place, Inc. (VSP) and Kang Suk Construction, Inc. under Labor Law § 240(1). VSP sought contractual indemnification from Kang Suk and Trinity Interior Coatings, Inc. The Appellate Division affirmed the denial of Jardin's summary judgment motion due to factual disputes regarding his site authorization. However, the court modified a prior order, granting VSP conditional summary judgment for contractual indemnification against Kang Suk, finding VSP free from negligence. VSP's claim against Trinity was denied as their indemnification agreement was signed after the accident and lacked retroactive intent.

Construction Site AccidentLadder SafetyLabor Law ViolationContractual IndemnificationSummary JudgmentThird-Party LiabilitySubcontractor AgreementsRetroactive Contract ApplicationAppellate Division ReviewPersonal Injury Litigation
References
16
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