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

Case No. Misc. No. 254
Significant
Feb 14, 2013

Workers' Compensation Appeals Board, State of California vs. Daniel Escamilla

The Workers' Compensation Appeals Board suspended the privilege of non-attorney representative Daniel Escamilla to appear before it for 90 days due to a persistent pattern of professional misconduct, including filing frivolous petitions and making material misrepresentations, which sanctions had failed to correct.

Labor Code Section 4907Nonattorney Hearing RepresentativePrivilege to AppearGood CauseSanctionsFrivolous ConductBad FaithMisrepresentation of FactsWCAB Rule 10561Continuing Violation Doctrine
References
66
Case No. 2017 NY Slip Op 27428
Regular Panel Decision
Dec 14, 2017

New York State Workers' Compensation Bd. v. Compensation Risk Mgrs., LLC

This action was brought by the New York State Workers' Compensation Board (WCB), as an assignee of former members of the Healthcare Industry Trust of New York (HITNY), against Compensation Risk Managers, LLC (CRM), HITNY trustees, and auditing firm UHY LLP. The WCB alleged mismanagement, breach of fiduciary duty, and negligent auditing, leading to the Trust's insolvency. Defendants moved to dismiss on grounds of standing, statute of limitations, and pleading particularity. The court dismissed certain derivative claims and negligent misrepresentation claims against some trustees due to standing issues and statute of limitations. All claims against UHY LLP were dismissed for lack of a near-privity relationship or prior precedent. An implied indemnity claim against the trustees was sustained. The WCB's cross-motion to consolidate related actions was denied.

Workers' Compensation LawGroup Self-Insured Trust (GSIT)Fiduciary DutyNegligenceNegligent MisrepresentationStatute of LimitationsStandingDerivative ActionImplied IndemnityAuditing Firm Liability
References
46
Case No. MISSING
Regular Panel Decision

Claim of Dingman v. Town of Lake Luzerne

The claimant sustained injuries to the left shoulder and ribs after falling approximately 20 feet from a ladder while installing a roof vent for a self-insured employer. The employer initially paid workers' compensation benefits but suspended them after a medical report opined that the claimant was released to work full duty. A Workers’ Compensation Law Judge awarded benefits at a moderate disability rate, which the Workers’ Compensation Board later modified to a mild disability rate. The Appellate Division reversed the Board's decision, finding that the medical report relied upon contained inherent contradictions and thus did not constitute substantial evidence to support the finding of a mild disability. The court also affirmed the Board's refusal to suspend benefits, noting that the claimant was not given notice that attachment to the labor market would be contested. The matter was remitted to the Workers’ Compensation Board for further proceedings.

Workers' Compensation BenefitsDisability AssessmentMedical EvidenceSubstantial EvidenceLabor Market AttachmentAppellate ReviewContradictory Medical ReportsRemittalEmployer AppealMild Disability
References
4
Case No. MISSING
Regular Panel Decision
Jul 24, 2002

In re the Claim of Miller v. North Syracuse Central School District

This case involves an appeal from a Workers' Compensation Board decision concerning overlapping workers' compensation awards. The claimant, a food services worker, filed two separate claims: one for occupational disease to her shoulders, leading to a schedule loss of use award, and another for bilateral carpal tunnel syndrome, which resulted in a temporary total disability award for the period from December 13, 1999, to February 14, 2000. The State Insurance Fund argued that the schedule loss of use award should be suspended for this period to prevent an overlap. Initially, a Workers’ Compensation Law Judge disagreed, but the Workers’ Compensation Board reversed, ruling in favor of suspending the schedule award. On appeal, the court reversed the Board's decision, clarifying that a schedule award is not allocable to a specific period of disability and therefore does not overlap with a temporary total disability award covering a limited timeframe. The court distinguished this from cases involving permanent disability awards. The matter was remitted to the Workers’ Compensation Board for recalculation of the claimant’s award.

Workers' CompensationSchedule Loss of UseTemporary Total DisabilityOverlapping AwardsEarning CapacityOccupational DiseaseCarpal Tunnel SyndromeShoulder InjuryAppellate ReviewRecalculation of Award
References
7
Case No. 2018 NY Slip Op 08227
Regular Panel Decision
Nov 29, 2018

Matter of Kelly v. New York State Workers' Compensation Bd.

In 2006, claimant Grace Kelly established a workers' compensation claim for an occupational disease. The State Insurance Fund (SIF) repeatedly sought to transfer liability to the Special Fund for Reopened Cases, which was denied by Workers' Compensation Law Judges. The Workers' Compensation Board affirmed these denials and assessed $500 penalties against both SIF and its counsel, Walsh and Hacker, for filing an application for review without reasonable grounds. Walsh and Hacker appealed the penalty imposed against them to the Appellate Division, Third Department. The Appellate Division found insufficient evidence to support the Board's finding that Walsh and Hacker's application lacked reasonable grounds, and therefore reversed the penalty against them, modifying and affirming the Board's decision.

PenaltiesAppellate ReviewSpecial Fund for Reopened CasesWorkers' Compensation Law § 25-aWorkers' Compensation Law § 114-aAttorney SanctionsAdministrative LawBoard DecisionJudiciary Law § 431
References
4
Case No. 2021 NY Slip Op 03225 [194 AD3d 1275]
Regular Panel Decision
May 20, 2021

Matter of Djukanovic v. Metropolitan Cleaning LLC

Claimant Nazlija Djukanovic established a claim for workers' compensation benefits after sustaining work-related injuries and subsequently commenced a third-party action. In May 2015, claimant signed a stipulation of discontinuance with prejudice in the third-party action without obtaining the workers' compensation carrier's consent. This led the carrier to suspend benefit payments in February 2016. The Workers' Compensation Board ultimately amended its prior decision, finding that the carrier was entitled to suspend benefit payments from the date of discontinuance and rescinded any penalties against the carrier and awards to the claimant after that date. The Appellate Division affirmed the Board's decision, holding that a claimant forfeits the right to future workers' compensation benefits by discontinuing a third-party action without the carrier's consent or a compromise order, even if no prejudice to the carrier is demonstrated.

Workers' Compensation BenefitsThird-Party ActionCarrier ConsentStipulation of DiscontinuanceForfeiture of BenefitsLien RightsBenefit OffsetPenalty RescissionAppellate DivisionBoard Decision
References
8
Case No. MISSING
Regular Panel Decision

Vandenburg v. Saratoga Harness Racing

The case involves an appeal from an amended decision by the Workers’ Compensation Board, which found the carrier in violation of 12 NYCRR 300.23 (b) and imposed a penalty. The claimant sustained a compensable knee injury in 1975, leading to ongoing medical treatments and classification as permanently partially disabled. The carrier unilaterally suspended benefit payments in February 1982, citing a physician's letter suggesting the claimant could return to normal activity. However, subsequent hearings determined continuous disability, and payments were resumed. The Board ruled the carrier violated the rule requiring proper notice and a hearing determination before suspending payments, an action affirmed by this decision, with the imposition of a penalty being mandatory under Workers’ Compensation Law § 25 (3) (c).

Workers’ Compensation LawPenalty ImpositionUnilateral Suspension of BenefitsPermanent Partial DisabilityMedical EvidenceReturn to WorkAppellate ReviewProcedural ViolationBenefit ContinuationDue Process
References
2
Case No. MISSING
Regular Panel Decision
Mar 20, 2001

Claim of Derr v. VIP Structures

The claimant, who had a work-related permanent total disability, was convicted of assault in March 1999 and subsequently incarcerated. The Workers’ Compensation Board ruled that the claimant was not entitled to benefits during his incarceration after the conviction of a crime. The claimant appealed this decision, arguing for continued benefits due to his total disability and resulting lack of earning capacity, regardless of his incarceration status. The court affirmed the Board's decision, stating that the suspension of workers’ compensation benefits during incarceration after a criminal conviction is based on public policy, and this principle applies to both partial and total disabilities. The court concluded that suspending benefits in such circumstances does not conflict with the Workers’ Compensation Law's goals.

IncarcerationWorkers' Compensation BenefitsTotal DisabilityPublic PolicyAssault ConvictionBenefit SuspensionCriminal ConductAppellate ReviewDisability Benefits
References
5
Case No. MISSING
Regular Panel Decision

Claim of Richardson v. Schenectady City School District

Claimant, a health teacher for Schenectady City School District, sustained compensable head and back injuries in February 2006. In December 2008, he submitted a letter announcing his retirement effective June 2009. Subsequently, the employer and its workers’ compensation carrier sought to suspend benefits, arguing the claimant voluntarily withdrew from the labor market. The Workers’ Compensation Board determined that the claimant had voluntarily withdrawn and denied benefits after June 24, 2009. The appellate court affirmed this decision, finding it supported by substantial evidence, including an independent medical examination report stating the claimant was capable of modified duty work and the claimant's own testimony that his retirement was not due to disabilities.

Voluntary Withdrawal from Labor MarketWorkers' Compensation BenefitsModified Duty WorkIndependent Medical ExaminationDisabilityRetirementSchenectady City School DistrictAppellate DivisionSubstantial EvidenceFactual Issue
References
4
Case No. MISSING
Regular Panel Decision

Matter of Covert v. Niagara County

Claimant, a public assistance recipient, suffered a work-related injury while assigned to Niagara County through a work experience program. A Workers’ Compensation Law Judge initially established the claim and determined an average weekly wage based on public assistance benefits. After public assistance benefits were suspended, the claimant sought lost wage benefits. The Workers’ Compensation Board affirmed a WCLJ decision, ruling that payments made under the work experience program constituted "wages" under the Workers’ Compensation Law. Niagara County and its third-party administrator appealed this decision. The appellate court dismissed the appeal, holding that the Board's decision was interlocutory and did not dispose of all substantive issues, thus precluding immediate appeal. The court noted that review could be sought if and when a final determination on wage replacement benefits is issued.

Wage DeterminationPublic Assistance BenefitsWork Experience ProgramInterlocutory AppealAppellate JurisdictionMedical Evidence SufficiencySchedule Loss of UseLost Wage ClaimWorkers' Compensation Board ReviewFinality of Decision
References
9
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