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

Case No. 2024 NY Slip Op 03519
Regular Panel Decision
Jun 27, 2024

Matter of Reyes Bonilla v. XL Specialty Ins.

Claimants Jose Reyes Bonilla and Marvin Reyes Bonilla, carpenters, were involved in a motor vehicle accident while commuting to a job site in Greenpoint, Brooklyn, in an employer-provided van. They filed workers' compensation claims, which were established against XL Specialty Insurance by a Workers' Compensation Law Judge (WCLJ). XL Specialty appealed, arguing its policy did not cover commuting injuries and that it was not the proper carrier. The Workers' Compensation Board affirmed the WCLJ's decisions, finding XL Specialty failed to preserve its challenge to being the carrier and that the employer's responsibility for transportation made the injuries compensable. The Appellate Division, Third Department, affirmed, agreeing that the issue was unpreserved and that the injuries arose out of and in the course of employment due to the employer's control over the conveyance.

Workers' CompensationMotor Vehicle AccidentEmployment InjuriesCommuting AccidentEmployer Provided TransportationWrap-up PolicyInsurance Coverage DisputeCarrier LiabilityIssue PreservationAppellate Review
References
16
Case No. ADJ3419685 (GRO 0029797)
Regular
Dec 10, 2000

MARLENA MOORE vs. ALBERTSONS, SPECIALTY RISK SERVICES

This case involves a Petition for Removal filed by Marlena Moore against Albertsons and Specialty Risk Services. The Workers' Compensation Appeals Board (WCAB) has reviewed the petition and the report from the workers' compensation administrative law judge. Consequently, the WCAB has denied the Petition for Removal. The decision incorporates the reasoning provided in the WCJ's report.

WORKERS' COMPENSATION APPEALS BOARDMARLENA MOOREALBERTSONSSPECIALTY RISK SERVICESPetition for RemovalWCJ reportdenial of removaladministrative law judgeADJ3419685GRO 0029797
References
0
Case No. ADJ3288082 (LBO 0384974)
Regular
May 09, 2013

ANDRES CRUZ vs. ALLSTATE/KOOKLANCAR PEYMAN, SPECIALTY RISK/SEDGWICK

This case, *Andres Cruz v. Allstate/Kooklancar Peyman; Specialty Risk/Sedgwick*, concerns a workers' compensation claim. The Workers' Compensation Appeals Board (WCAB) granted reconsideration of the Administrative Law Judge's (ALJ) prior decision. The WCAB rescinded the ALJ's decision and remanded the case back for further proceedings and a new decision at the trial level. This order is not a final determination on the merits of the claim.

Workers Compensation Appeals BoardReconsiderationAdministrative Law JudgeRescinded DecisionFurther ProceedingsTrial LevelFinal DecisionMeritsDental Trauma CenterSpeciality Risk
References
0
Case No. ADJ793678 (OAK 0338326)
Regular
Sep 07, 2010

ARMENDO CASAS vs. LOS ANGELES CHEMICAL and EXCESS SPECIALTY INSURANCE, GAB ROBINS, BRENNTAG and EXCESS SPECIALTY INSURANCE, SPECIALTY RISK SERVICES

This case involves a petition for reconsideration by Excess Specialty Insurance regarding a workers' compensation award. The original award found the applicant sustained a cumulative trauma injury ending November 2, 2006, but deferred key issues like sleep disorder, permanent disability, and liens. The Board granted reconsideration, rescinded the original award, and returned the case for a new decision at the trial level. The Board believes piecemeal adjudication should be avoided and all issues should be decided concurrently after further development of the record.

Cumulative traumaThoracic spineLumbar spinePsycheSleep disorderGastrointestinal disorderSexual dysfunctionPermanent disabilityEmployment Development Department lienPetition for Increase in Compensation
References
0
Case No. MISSING
Regular Panel Decision

Claim of Smith v. Specialty Services, Inc.

Claimant, a construction foreman for Specialty Services, Inc., was injured while performing work for a church in Pennsylvania. Although Specialty filed a work-related accident report and its carrier began paying benefits, the carrier filed a notice of controversy over seven months after the Workers' Compensation Board indexed the case, exceeding the 25-day limit. The carrier argued that the late filing was due to surprise, mistake, and newly discovered evidence regarding the church's involvement, which claimant and Specialty allegedly failed to disclose. The Workers' Compensation Board refused to excuse the late filing, finding the carrier failed to demonstrate good cause. The appellate court affirmed the Board's decision, noting that the carrier had ample time to investigate and that belatedly obtained evidence is not a sufficient ground to excuse a late filing.

Workers' CompensationLate Notice of ControversyTimely FilingEmployer-Employee RelationshipInsurance CarrierGood CausePleading BarAppellate ReviewBoard DecisionStatutory Interpretation
References
2
Case No. ADJ752333
Regular
Jul 25, 2011

RICARDO RIVERA vs. COLOR SPOT NURSERIES, INC., CHARITIS, SPECIALTY RISK SERVICES

This case concerns applicant's petition for reconsideration and removal of an administrative law judge's (WCJ) order denying his objection to a replacement orthopedic QME panel. The WCJ allowed the orthopedic panel after finding the defendant had substantially complied with regulations for requesting a specialty change. The Workers' Compensation Appeals Board (WCAB) dismissed the reconsideration petition as the order was interlocutory and denied removal, finding no irreparable harm or prejudice to the applicant. The WCAB upheld the WCJ's decision, deeming the change in specialty appropriate and the defendant's compliance sufficient under the circumstances.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalQualified Medical Evaluator (QME)Medical DirectorOrthopedicsChiropracticLabor CodeIndustrial InjuryLeft Knee
References
12
Case No. ADJ1885105
Regular
Dec 16, 2010

SCOTT SIMONS vs. SUPERHEAT SERVICES, INC., SPECIALTY RISK PLEASANTON

The Appeals Board denied the applicant's petition for reconsideration regarding penalties and attorney fees, finding no evidence of unreasonable delay by the defendant. The Board granted the defendant's petition in part, reversing the order for a medical-legal examination by Dr. Sadoff for left knee surgery due to an underdeveloped record. However, the Board affirmed the WCJ's award of significant medical treatments, including home care, a motorized wheelchair, and neurological treatment for dementia, finding the treating physician's opinions more persuasive than utilization review denials. Finally, the Board clarified that transportation expenses are only for medical and medical-legal appointments, not legal ones.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardFurther Medical TreatmentDr. DeSallesDr. SadoffHome CareMotorized WheelchairTilt-Table TestENG Study
References
12
Case No. ADJ579864 (SAC 0353253)
Regular
Oct 01, 2010

Marcia Pratt vs. WELLS FARGO BANK, SPECIALTY RISK PLEASANTON

This case involves a dispute over attorney's fees awarded in a workers' compensation settlement. The applicant's attorney sought reconsideration of a $15,000 fee award, arguing it was insufficient given the case's complexity and the settlement's value. The Board granted reconsideration, determining that the Medicare Set-Aside (MSA) funding should be excluded from the fee calculation. Ultimately, the attorney was awarded $21,752, representing 15% of the "new money" received by the applicant after excluding MSA costs.

Workers' Compensation Appeals BoardJoint Fee Finding and OrderCompromise and Release Agreementattorney's feelien claimantstipulated awardpermanent disabilitylife pensionMediCare Set-aside AccountMSA
References
1
Case No. MISSING
Regular Panel Decision

GuideOne Specialty Insurance v. Admiral Insurance

This case involves an insurance coverage dispute where Weingarten Custom Homes (WCH) contracted with Torah Academy for construction, designating Torah Academy as an additional insured under WCH's liability policy with Admiral Insurance Company. The Admiral policy had lower coverage limits ($1,000,000) than required by the contract ($2,000,000/$5,000,000), with GuideOne Specialty Insurance Company providing secondary and excess coverage to Torah Academy. After a construction worker's injury led to a $1,225,000 settlement, Admiral paid $1,000,000, and GuideOne paid $225,000. GuideOne then sued Admiral to recover its payment, arguing that a letter signed by Admiral's claims superintendent effectively modified Admiral's policy to higher limits. The appellate court reversed the Supreme Court's decision, ruling that the letter did not constitute a valid policy endorsement and that the policy's unambiguous terms could not be altered by extrinsic evidence, thereby granting Admiral's motion to dismiss GuideOne's complaint.

Insurance Policy DisputeContract InterpretationLiability InsuranceAdditional InsuredPolicy LimitsMotion to DismissAppellate ReversalDocumentary EvidenceExtrinsic Evidence RulePolicy Amendment
References
12
Case No. MISSING
Regular Panel Decision

Commercial Risk Reinsurance Co. v. Security Insurance

Petitioners Commercial Risk Reinsurance Company Limited and Commercial Risk Re-Insurance Company (collectively “Commercial Risk”) initiated an action to vacate an arbitration award obtained by respondent Security Insurance Company of Hartford (“Security”). Security subsequently cross-moved to confirm the Award. The District Court denied Commercial Risk’s motion to vacate and granted Security’s motion to confirm the Award, finding that Commercial Risk failed to establish sufficient grounds for misconduct by the arbitrators. Commercial Risk then sought reconsideration of this order, arguing improper exclusion of a witness and documents related to damages. The Court denied the motion for reconsideration, reaffirming its original decision and emphasizing the broad discretion granted to arbitrators in procedural matters, particularly given the "Honorable Engagement" clause in the parties' agreement.

ArbitrationReinsurance ContractsVacatur of Arbitration AwardConfirmation of Arbitration AwardMotion for ReconsiderationFederal Arbitration ActInternational ArbitrationEvidentiary RulingsJudicial ReviewArbitrator Discretion
References
27
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