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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
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 The Board rescinded the liability transfer to the Special Fund, without prejudice, pending further evidence.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. MISSING
Regular Panel Decision

Employers' Liability Assur. Corp. v. Williams

J. H. Williams, an employee, sustained an injury in September 1924 while working for American Construction Company, an insured employer under the Texas Employers’ Liability Act. He initially received weekly compensation payments from Employers’ Liability Assurance Corporation, Limited. After payments ceased, Williams sought a lump sum award from the Industrial Accident Board, which was granted in June 1925. The assurance corporation subsequently sued in the district court of Galveston county to set aside this award. Williams cross-petitioned for total and permanent disability and a lump sum payment due to manifest hardship. A jury found Williams totally and permanently disabled, and the court sided with Williams, awarding him and his attorneys, Morris, Sewell & Morris, a lump sum of $6,032.15. The assurance corporation appealed this judgment, contesting the finding of total permanent disability and the lump sum award. The appellate court affirmed the lower court's decision, finding sufficient evidence to support the jury's findings and noting the appellant's failure to follow legal procedures regarding a surgical operation demand.

Workers' CompensationTotal Permanent DisabilityLump Sum SettlementIndustrial Accident BoardAppellate ReviewMedical Expert TestimonyJury FindingsEmployer LiabilitySurgical InterventionManifest Hardship
References
6
Case No. MISSING
Regular Panel Decision
Jul 11, 1990

Claim of Marino v. K.L.M. Royal Dutch Airlines

In 1979, the claimant filed for compensation due to an occupational lung disease. Atlantic Mutual Insurance Company, the carrier, sought reimbursement from the Special Disability Fund under Workers’ Compensation Law § 15 (8) (d), alleging the claimant’s pre-existing diabetes materially increased his disability. Although a Workers’ Compensation Law Judge initially approved the claim, the Board rescinded it and referred it to an impartial physician. Despite a stipulation between the carrier and the Fund acknowledging liability, the Board disregarded it, concluding that the disability stemmed solely from the lung condition based on medical evidence. The carrier appealed, but the appellate court affirmed the Board’s decision, upholding the Board’s prerogative to disregard stipulations and resolve conflicting medical evidence.

Occupational Lung DiseaseSpecial Disability FundWorkers' Compensation LawPre-existing DiabetesStipulation DisregardMedical Evidence ConflictBoard DiscretionAppellate ReviewReimbursement ClaimCarrier Liability
References
4
Case No. ADJ2497883 (SFO 0450940) ADJ3261393 (SFO 0504693)
Regular
Apr 30, 2010

JANETTE HARDIN vs. COUNTY OF ALAMEDA, SEDGWICK CLAIMS MANAGEMENT SERVICES, CHARTIS INSURANCE, TRISTAR RISK MANAGEMENT

This case involves Chartis Insurance seeking reconsideration of an arbitrator's decision setting the date of cumulative trauma injury for Janette Hardin's breast cancer as May 28, 1997, not the previously stipulated date of May 16, 2001. Chartis argued the stipulated date was res judicata and could not be altered, especially in a contribution proceeding. The Workers' Compensation Appeals Board denied the petition, affirming that contribution proceedings allow for a relitigation of liability and the determination of the true date of injury based on facts, not prior stipulations between the applicant and one defendant. The Board reasoned that findings of liability in the primary case are not binding in supplemental contribution proceedings.

Cumulative traumaDate of injuryContribution proceedingsRes judicataStipulated awardLabor Code section 5500.5Apportionment of liabilityCase-in-chiefSupplemental proceedingsGreenwald v. Carey Distribution Company
References
2
Case No. MISSING
Regular Panel Decision

Anzaldua v. American Guarantee & Liability Insurance Co.

This worker's compensation case involves an appeal by Esther Anzaldua against American Guarantee & Liability Insurance Company, the compensation carrier. Anzaldua was injured on the job and sued after rejecting an award from the Texas Industrial Accident Board. A jury awarded her damages for partial incapacity and medical expenses, but Anzaldua appealed, alleging the medical award was insufficient, that certain medical reports were improperly admitted due to hearsay, and that a supplemental jury charge was coercive. The court affirmed the lower court's judgment, finding the jury's verdict supported by evidence, the medical reports properly admitted, and the supplemental charge not coercive.

Workers' CompensationMedical ExpensesJury VerdictEvidence AdmissibilitySupplemental Jury ChargeCoercionIncapacityAppealTexas LawInsurance
References
7
Case No. MISSING
Regular Panel Decision

Loblaw, Inc. v. Employers' Liability Assurance Corp.

Loblaw, Inc., a self-insured retail chain, sued its excess insurer, Employers’ Liability Assurance Corporation, for reimbursement under a workers’ compensation policy. The dispute centered on whether Loblaw timely notified Employers’ of an employee's escalating injury claim. Loblaw initially believed the claim would not exceed its $25,000 self-retention, delaying notice until June 1972, despite warnings from its agent and mounting costs. The Supreme Court, Erie County, initially sided with Loblaw, but the Appellate Division reversed, ruling Loblaw had an ongoing obligation to notify the insurer and was derelict by May 1969. This court affirmed the Appellate Division's dismissal of Loblaw's complaint, holding that the notice given in June 1972 was too late as a matter of law, given the claim had exceeded $21,000 by December 1970.

Insurance policy interpretationWorkers' compensationExcess insuranceNotice provisionSelf-insurerTimely noticeAppellate reviewContract constructionObjective standardSubjective judgment
References
22
Case No. MISSING
Regular Panel Decision

Electric Mutual Liability Insurance Co. v. White

Electric Mutual Liability Insurance Company appealed a worker’s compensation judgment concerning Ira Gillis White, who sustained a back injury. A jury found White totally incapacitated for three months and permanently partially incapacitated thereafter, establishing his weekly earning capacity at $150 during the partial incapacity period. Electric Mutual contended that the trial court erred in excluding evidence of White’s pre-injury wages and that the jury’s finding on earning capacity was unsupported or against the evidence. The appellate court affirmed the trial court’s decision, explaining that worker’s compensation aims to compensate for loss of earning capacity, not just actual wages, and that post-injury earnings do not conclusively prove capacity. The court found sufficient evidence to support the jury's assessment of White's diminished earning capacity, considering his pain and physical limitations despite continued employment.

Worker's CompensationIncapacityEarning CapacityBack InjuryHerniated DiscMedical EvidenceWage ExclusionJury FindingsAppellate ReviewTexas Law
References
7
Case No. MISSING
Regular Panel Decision
Jul 21, 1990

Fullenwider v. American Guarantee & Liability Insurance Co.

This is an appeal in a worker's compensation case. The plaintiff, Lucille Fullenwider, alleged she developed industrial asthma while working for Motorola, Inc., leading to total and permanent incapacity. The jury found she did not suffer an occupational injury, and the trial court rendered judgment in favor of the defendant, American Guarantee & Liability Insurance Company. The sole issue on appeal was whether the trial court erred in permitting two undisclosed expert witnesses to testify when interrogatories requesting their names were not supplemented thirty days prior to trial. The appellate court concluded that while the trial court abused its discretion in admitting the testimony without a finding of good cause, the error was harmless as the plaintiff was not prejudiced, and affirmed the trial court's judgment.

Expert Witness TestimonyDiscovery RulesGood Cause ExceptionTrial Court DiscretionAbuse of DiscretionHarmful ErrorWorker's CompensationIndustrial AsthmaOccupational InjuryUndisclosed Witnesses
References
17
Case No. MISSING
Regular Panel Decision

Capps v. American Mutual Liability Insurance Co.

Archie Capps appealed a take-nothing judgment, arguing that American Mutual Liability Insurance Company improperly deducted both worker's compensation and social security benefits from his disability insurance payments. Capps, disabled in 1972, received disability policy payments from 1973 and a lump-sum worker's compensation settlement in 1974, which included attorney's fees. He also received monthly social security benefits. The court affirmed the judgment, holding that the insurance policy's anti-duplication clause permitted the deduction of both worker's compensation and social security payments. Furthermore, the court found that attorney's fees awarded in the worker's compensation case were part of the total amounts payable and were properly deducted, and that the calculation of payments was correct.

AppealDisability InsuranceWorker's CompensationSocial Security BenefitsAnti-duplication ClauseAttorney's FeesLump-sum SettlementBenefit DeductionsPolicy InterpretationInsurance Law
References
2
Case No. MISSING
Regular Panel Decision

American Mutual Liability Insurance Co. v. Bradshaw

This case focuses on determining the average weekly wage for plaintiff Gene Bradshaw to calculate workmen's compensation benefits. Bradshaw, an independent contractor for Champion International Corporation, was required to pay for workmen's compensation coverage through defendant American Mutual Liability Insurance Company, with premiums deducted from his pulpwood earnings. The core dispute arose from American Mutual's attempt to reduce Bradshaw's gross earnings by various expenses (labor, equipment, etc.) to calculate his average weekly wage, a method Bradshaw contested. The trial court and subsequently the appellate court affirmed that Bradshaw was entitled to maximum benefits, emphasizing that the insurance premiums were based on gross earnings and the statute did not differentiate between gross and net earnings for wage computation, thereby rejecting the proposed deductions. The court found that where it's impracticable to compute average weekly wages, it should consider what a person in similar employment in the same district would earn.

Workmen's CompensationAverage Weekly WageIndependent ContractorGross EarningsNet EarningsInsurance PremiumsStatutory InterpretationLiberal ConstructionTimber IndustryPulpwood Harvesting
References
2
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