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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

State Farm Mutual Automobile Insurance Co. v. Pender

This case involves a subrogation action initiated by an unnamed plaintiff (subrogee) to recover $15,200 in additional personal injury protection (APIP) benefits paid to its subrogor, Darci Plumbing Co., Inc., for an employee, Kareem Atkins. The defendants moved to dismiss the complaint based on documentary evidence, collateral estoppel, and res judicata, arguing that a prior Workers’ Compensation Board decision from November 24, 2008, which awarded Atkins basic economic loss benefits, was determinative. The plaintiff cross-moved for sanctions. The court found that APIP benefits, defined by 11 NYCRR 65-1.3, are distinct from statutory basic economic loss benefits and that an insured's subrogation rights for APIP are equitable, existing under common law. Therefore, the workers' compensation award was not res judicata, and the plaintiff was not precluded from asserting its subrogation rights for amounts paid in addition to the statutory basic economic loss. Consequently, the defendants' motion to dismiss was denied, and the plaintiff's cross-motion for sanctions was also denied.

SubrogationAPIP BenefitsPersonal Injury ProtectionWorkers' CompensationCollateral EstoppelRes JudicataMotion to DismissSanctionsNo-Fault LawInsurance Law
References
1
Case No. MISSING
Regular Panel Decision
Oct 14, 2008

Westchester Medical Center v. Lincoln General Insurance

The plaintiff appealed an order from the Supreme Court, Nassau County, which denied its motion for summary judgment to recover no-fault medical benefits. The appellate court reversed the order, granting the plaintiff's motion. The plaintiff successfully demonstrated a prima facie case by showing that statutory billing forms were mailed and received, and the defendant failed to either pay or deny the claim within the 30-day period. The court rejected the defendant's arguments that letters advising of an investigation tolled the statutory period and that the period was tolled pending a no-fault application. Additionally, defenses related to Workers' Compensation benefits or the assignor's failure to appear at an examination under oath were found insufficient to defeat the medical provider's right to benefits.

no-fault insurancemedical benefitssummary judgmentinsurance contractstatutory periodtimely denialworkers' compensationpolicy conditionpreclusion remedyappellate review
References
19
Case No. MISSING
Regular Panel Decision
Jun 16, 2006

Fortis Benefits v. Cantu

Vanessa Cantu suffered severe injuries in a car accident and sued multiple parties. Her medical insurer, Fortis Benefits, intervened, seeking subrogation for medical benefits paid under the policy. After Cantu settled with the defendants, Fortis pursued recovery from Cantu. Cantu argued that the equitable "made whole" doctrine barred Fortis's claim because her total losses exceeded the settlement amount plus the benefits Fortis paid. The trial court and court of appeals sided with Cantu. The Texas Supreme Court reversed, holding that the "made whole" doctrine does not override an insurer's clear contractual subrogation rights. The Court affirmed the dismissal of Fortis's claims against Ford due to a pretrial agreement.

Insurance SubrogationMade Whole DoctrineContractual SubrogationEquitable SubrogationERISATexas LawInsurance Policy InterpretationPersonal InjuryAutomobile AccidentSettlement Proceeds
References
28
Case No. MISSING
Regular Panel Decision

Pension Benefit Guaranty Corp. v. Broadway Maintenance Corp.

This case involves the Pension Benefit Guaranty Corporation (PBGC) and the bankrupt Broadway Maintenance Corporation (Broadway) disputing the termination date of Broadway's non-union employee pension plan. PBGC initiated the lawsuit to become the statutory trustee and sought to establish March 26, 1981, as the termination date. Broadway argued for an earlier, retroactive date. The court, guided by ERISA and the interests of the plan participants, rejected both parties' proposed dates. The judge formulated a test for involuntary terminations and ultimately established December 5, 1980, as the official termination date, citing the date PBGC first formalized its intent to terminate the plan.

ERISAPension Plan TerminationEmployee Retirement Income Security ActInvoluntary TerminationTermination Date DisputeBankruptcyPlan Participants' InterestsStatutory TrusteeFiduciary DutyPension Benefit Guaranty Corporation
References
2
Case No. 2021-06-1167
Regular Panel Decision
May 25, 2023

Carrillo, Miguel Garcia v. Carlos Sanchez Hurtado, a/k/a Carlos Ramirez Rios, Gilberto Cavazos, Kosinski Homes, Kosinski Properties LLC, Hartford Casualty Insurance Company, and Hartford Underwriters Insurance Company

Miguel Garcia Carrillo, an employee of Carlos Sanchez Hurtado, sustained arm and leg injuries from a fall at a construction site. The court determined Gilberto Cavazos to be the statutory employer, making him and his insurer, Hartford Underwriters Insurance Company, responsible for workers' compensation benefits. They are ordered to provide a panel of orthopedists for Mr. Carrillo's medical treatment. However, requests for payment of past medical bills and temporary disability benefits were denied due to a lack of admissible evidence, though Mr. Carrillo may re-submit these claims with proper documentation. Additionally, the case is referred for investigation into potential penalties against Carlos Sanchez Hurtado, Gilberto Cavazos, and Hartford Underwriters Insurance Company for various statutory non-compliances, including failure to provide insurance and medical treatment.

Workers' CompensationConstruction AccidentStatutory EmployerUninsured EmployerMedical BenefitsTemporary DisabilityPenaltiesOrthopedists PanelAdmissible EvidenceEmployer Liability
References
10
Case No. 2017-04-0093 / 13763-2017
Regular Panel Decision
Oct 15, 2025

JEFFREY MOLANDS, Administrator, THE ESTATE OF MARSHA MOLANDS v. ACCESS PROGRAM

Marsha Molands, a home health nurse for Access Program, suffered low-back and left-shoulder injuries in 2017. She underwent two back surgeries in 2019 and 2023. Following the second surgery, she developed a wound infection, sepsis, and related complications, leading to her death in April 2024. Her husband, Jeffrey Molands, as Administrator of her estate and sole dependent, sought death benefits, additional temporary total disability (TTD) benefits, medical expenses, and funeral expenses. The Court found that Ms. Molands’s death arose primarily out of her 2017 work injury, largely based on the medical examiner’s testimony that infections from her surgeries caused a "death spiral." Consequently, the Court granted death benefits to Mr. Molands at a rate of 50% of Ms. Molands’s average weekly wage, along with reimbursement for medical and funeral expenses. However, the Court denied Mr. Molands’s request for a lump-sum payment of future death benefits, citing statutory limitations and a lack of "exceptional circumstances." It also denied additional TTD benefits from August 2020 to July 2023, determining that Ms. Molands had reached maximum medical improvement in August 2020. Attorney's fees were awarded to Mr. Molands' counsel.

Death BenefitsWorkers' CompensationMedical CausationSpinal InjurySepsisInfectionLaminectomyFusion SurgeryMaximum Medical ImprovementTemporary Total Disability
References
9
Case No. 2017-08-1205
Regular Panel Decision
Apr 27, 2018

Washington, John v. UPS Ground Freight, Inc.

John Washington, an employee of UPS Ground Freight, Inc., requested additional medical and temporary disability benefits for a September 7, 2017 work injury. UPS maintained it had paid all entitled benefits and had provided multiple panels of neurologists, which Mr. Washington largely rejected due to subjective concerns. The Court found that UPS had complied with its statutory duty to provide physicians, but Mr. Washington had not complied with his duty to choose one. The Court ordered UPS to allow Mr. Washington to choose another neurologist from the previously provided panels, warning that benefits could remain suspended if he failed to comply. The Court denied Mr. Washington's requests for payment of unauthorized emergency room bills, personal care assistant payments, additional temporary disability benefits, and adjustments to his wage rate calculation, concluding that his refusal to accept medical services justified the suspension of temporary benefits.

Workers' CompensationMedical BenefitsTemporary DisabilityExpedited HearingNeurology EvaluationPost-Concussion SyndromeWage Rate CalculationUnauthorized TreatmentPhysician PanelEmployee Non-Compliance
References
6
Case No. MISSING
Regular Panel Decision

Ceres Gulf v. Cooper

Oleaster Cooper claimed a knee injury in 1984 while working for Ceres Gulf, leading Ceres Gulf and its compensation carrier ESIS/INA to pay over $36,000 in benefits. Ceres contested the claim, and administrative proceedings, including a hearing officer's decision and a Benefits Review Board affirmation in April 1990, determined Cooper had no compensable injury. However, the administrative bodies declined to order reimbursement for the overpayments, citing a lack of statutory authority under the Longshore and Harbor Workers’ Compensation Act's recoupment provision. Ceres subsequently sued Cooper for repayment, and a default was entered against him on October 16 after he failed to appear. The District Court, presided over by Judge Hughes, ruled that the Act's limited recoupment provision was not the exclusive remedy and that allowing false claimants to retain benefits would undermine the compensation fund's integrity. Consequently, the court will enter a judgment in favor of Ceres Gulf and ESIS/INA, ordering Cooper to refund the overpaid compensation and medical benefits, plus prejudgment interest and attorney’s fees.

Overpayment RecoveryLongshore and Harbor Workers’ Compensation ActFederal JurisdictionStatutory InterpretationDefault JudgmentBenefit Review BoardAdministrative LawAttorney's FeesPrejudgment InterestEmployer Reimbursement
References
7
Case No. 2017-04-0215
Regular Panel Decision
Feb 26, 2018

Lee, Jimmy v. Servpro Holding Co., Inc.

Mr. Lee, an employee of Servpro Holding Co., Inc., sought temporary disability benefits for an alleged work-related injury from July 13, 2016. The Court held an Expedited Hearing on February 15, 2018, to determine his entitlement to benefits from September 15, 2016, until August 15, 2017. The Court found Mr. Lee failed to provide adequate statutory notice of the injury and also failed to provide sufficient medical proof to establish causation for his claimed disability benefits. Despite the employer's inability to prove prejudice from the lack of notice, Mr. Lee's request for benefits was ultimately denied due to the lack of medical evidence linking his symptoms to a work-related injury. The matter is set for a Scheduling Hearing on April 23, 2018.

Temporary Disability BenefitsWorkers' CompensationNotice RequirementMedical CausationExpedited HearingCredibility AssessmentEmployee InjuryEmployer LiabilityShoulder InjuryBack Pain
References
5
Case No. MISSING
Regular Panel Decision
Feb 22, 1984

Barnhardt v. Hudson Valley District Council of Carpenters Benefit Funds

The plaintiff, injured in May 1978 during maintenance work, was denied workers' compensation due to the absence of an employer-employee relationship. Subsequently, he sought reimbursement for medical expenses from the Hudson Valley District Council of Carpenters Benefit Funds (Benefit Funds) through a union insurance policy. Continental Assurance Company (Continental), Benefit Funds' insurer, rejected the claim, citing an employment-related injury exclusion in the policy. The plaintiff then initiated an action against Benefit Funds, which in turn filed a third-party action against Continental seeking indemnification. Continental's motion for summary judgment, asserting the exclusion, was denied by the County Court. The appellate court affirmed this denial, ruling that the exclusionary language was ambiguous and applied only in cases where a clear employer-employee relationship existed, a fact still to be determined.

Insurance Policy InterpretationEmployment StatusWorkers' Compensation ExclusionSummary Judgment MotionContractual AmbiguityGroup Health InsuranceMedical Expense ReimbursementThird-Party ActionAppellate ReviewEmployer-Employee Relationship
References
10
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