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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

Associated Indemnity Co. v. Hartford Accident & Indemnity Co.

Hartford Accident & Indemnity Company, a workmen's compensation insurer for a temporary labor contractor (Greene's Temporaries, Inc.), sued Associated Indemnity Company, the insurer for a customer (Frito-Lay Company), seeking subrogation for a compensation claim paid to an injured temporary employee. Hartford contended the loss was covered by Associated's policy as the employee was under Frito-Lay's control. The court reversed the trial court's decision in favor of Hartford, denying equitable subrogation. The appellate court found that Hartford had collected premiums for the temporary employees and was charged with knowledge of the contractual arrangement, thus preventing unjust enrichment if subrogation were granted.

Workmen's CompensationTemporary EmploymentSubrogationInsurance LawBorrowed Servant DoctrineRight of ControlEquitable RemediesUnjust EnrichmentInsurance PremiumsContractual Agreements
References
17
Case No. 2021 NY Slip Op 07401
Regular Panel Decision
Dec 23, 2021

Matter of Carola B.-M. v. New York State Off. of Temporary & Disability Assistance

Petitioners Carola B.-M. and Tiara M. challenged the denial of their supplemental nutrition assistance program (SNAP) benefits by the New York State Office of Temporary and Disability Assistance and the Orleans County Department of Social Services. The benefits were denied because they were deemed ineligible college students. The Appellate Division, Fourth Department, reversed this determination, holding that participation in the Adult Career and Continuing Education Services, Vocational Rehabilitation program (ACCES-VR) qualifies as a Job Training Partnership Act (JTPA) program. This status exempts the students from certain SNAP eligibility requirements. The court found that the original determination was based on an unreasonable interpretation of relevant regulations, annulled the decision, granted the petition, and remitted the case for a calculation of retroactive benefits.

SNAP benefitscollege student eligibilityJob Training Partnership ActACCES-VRvocational rehabilitationCPLR article 78regulatory interpretationpublic assistancefood stampsAppellate Division
References
28
Case No. 2015-07-0114
Regular Panel Decision
Oct 12, 2015

Miller, Torris v. TA Operating Corp.

Torris Miller, a diesel mechanic, sustained a back injury at work on November 3, 2014, while changing a tractor-trailer tire for TA Operating Corp. He filed a request for an expedited hearing seeking past medical and temporary disability benefits. The Court found that Mr. Miller provided sufficient notice of his work-related injury to the employer. Although TA Operating Corp. argued that Mr. Miller's termination for job abandonment precluded him from receiving ongoing temporary disability benefits, the Court disagreed, finding the termination improper. Consequently, the Court granted Mr. Miller temporary total disability and temporary partial disability benefits, but denied his request for payment of past medical expenses due to insufficient proof of the reasonableness of the charges.

Workers' CompensationBack InjuryTemporary DisabilityJob AbandonmentMedical ExpensesNotice RequirementEmployer LiabilityTennessee LawExpedited HearingDisability Benefits
References
13
Case No. 2017-06-1778
Regular Panel Decision
Apr 11, 2018

Demotte, Julie v. UPS

Julie Demotte sustained a workplace injury involving a broken hip and leg in November 2016 while working for UPS. UPS initially accepted the claim and provided temporary disability benefits. Dr. Jason Evans, the authorized treating physician, placed Ms. Demotte at maximum medical improvement and assigned a three-percent whole-person impairment rating. A compensation hearing was held to determine Ms. Demotte's entitlement to permanent disability, temporary disability, and future medical benefits. The Court ordered UPS to provide lifetime medical benefits for Ms. Demotte's workplace injury, but denied her claims for both temporary and permanent disability benefits. The denial of permanent disability was based on the inadmissibility of Form C-30A as proof of impairment, as Ms. Demotte failed to present admissible evidence. Additionally, the claim for further temporary disability benefits was denied due to an earlier overpayment by UPS that exceeded any subsequent amounts due.

Workplace InjuryFuture Medical BenefitsTemporary Disability BenefitsPermanent Disability BenefitsAdmissibility of Medical ReportsForm C-30AForm C-32Impairment RatingHearsayMaximum Medical Improvement
References
2
Case No. MISSING
Regular Panel Decision

Claim of Bruzzese v. Guardsman Elevator Co.

In 1994, the claimant sustained head, neck, and back injuries at work, leading to an award for permanent partial disability, which included a wage expectancy adjustment under Workers’ Compensation Law § 14 (5). Following back surgery in 1998, the case was reopened, and the claimant was found to be temporarily totally disabled. Benefits for this temporary total disability were calculated based on the claimant's average weekly wage at the time of injury, without applying the wage expectancy adjustment. The claimant appealed, arguing that since the permanent partial disability preceded the temporary total disability, the wage expectancy adjustment should also apply to the latter period. The court disagreed, affirming the Workers’ Compensation Board's decision, citing established case law that Workers’ Compensation Law § 14 (5) is applicable only to awards for permanent partial disability and not temporary disability.

Wage expectancyTemporary total disabilityPermanent partial disabilityWorkers' Compensation benefitsBack injuryAppellate reviewDisability calculationWorkers' Compensation BoardAverage weekly wage
References
1
Case No. 2015-01-0199
Regular Panel Decision
Feb 10, 2016

Tolbert, Christoper v. MPW Industrial Services at Volkswagen

This Expedited Hearing Order addresses Christopher Wade Tolbert's request for additional temporary disability benefits following a work-related injury to his head, neck, and back on June 29, 2015, while employed by MPW Industrial Services at Volkswagen. The central issues were Mr. Tolbert's entitlement to benefits and the correct weekly compensation rate. The Court found Mr. Tolbert was entitled to temporary total disability benefits from June 30, 2015, to July 9, 2015, and temporary partial disability benefits from July 10, 2015, to August 3, 2015, due to the employer's failure to provide accommodated work. Furthermore, he was awarded an additional $7.93 per week from August 4, 2015, to October 14, 2015, to correct an underpayment, and temporary partial disability benefits from November 11, 2015, onwards, based on ongoing medical restrictions from Dr. Stephen Dreskin. The Court established his correct weekly compensation rate as $261.28.

Workers' CompensationTemporary Disability BenefitsExpedited HearingWage StatementCompensation RateMedical TreatmentModified DutyEmployer AccommodationPain ManagementNeck Injury
References
7
Case No. ADJ2237816 (VNO 0533019) ADJ4364633 (VNO 0515869)
Regular
Jun 02, 2009

YOUBERT MOREH vs. LEXUS OF WESTMINSTER, CYPRESS INSURANCE COMPANY

This case involves an applicant seeking reconsideration of a denial of additional temporary disability indemnity (TDI) for two industrial injuries: a right shoulder injury in January 2005 and a back injury on March 21, 2005. The original judge denied further TDI, citing a two-year statutory limit under Labor Code section 4656(c)(1). The applicant contends the TDI for the back injury should not count towards the shoulder injury limit, as the shoulder injury was not yet claimed or accepted when TDI for the back was paid. The Appeals Board granted reconsideration, rescinded the prior order, and returned the case for further development of the record. This is to determine the precise periods of temporary disability for each injury and the extent of any overlap, which is crucial for applying the TDI limitations.

Workers' Compensation Appeals BoardTemporary Disability IndemnityLabor Code section 4656Overlapping InjuriesRight Shoulder InjuryBack InjuryAuto MechanicQualified Medical EvaluatorFindings of FactReconsideration
References
6
Case No. ADJ3658479 (MON 0326348) ADJ2546762 (MON 0325529)
Regular
Apr 29, 2009

BRAD M. WEISER vs. LAUREL SHEET METAL, EMPLOYERS COMPENSATION INSURANCE COMPANY

This case concerns an applicant seeking additional temporary disability indemnity (TDI) for a shoulder injury after already receiving two years of TDI for a back injury. The Appeals Board granted reconsideration, reversing the prior award. The Board found that because the periods of temporary disability for the back and shoulder injuries entirely overlapped, the applicant is limited to 104 weeks of TDI pursuant to Labor Code section 4656(c)(1). Therefore, the applicant is not entitled to any additional TDI beyond what has already been paid.

Labor Code section 4656(c)(1)Temporary Disability Indemnity (TDI)specific injurycumulative injuryoverlapping periods104 compensable weeksdate of commencementorthopedic surgeonregular physiciandeposition
References
3
Case No. 2015184839
Regular Panel Decision
Nov 17, 2015

Lallo, Ralph Joseph v. Marion Environmental, Inc.

Ralph Joseph Lallo, an employee, filed a motion seeking temporary disability benefits against his employer, Marion Environmental, Inc. Mr. Lallo sustained a compensable injury to his right upper extremity on April 2, 2015. The court found that Marion Environmental, Inc. did not terminate Mr. Lallo for cause, and thus, his separation would not preclude him from receiving temporary partial disability benefits. Medical evidence from Dr. Donald Huffman indicated substantial restrictions on Mr. Lallo's right arm, rendering him partially disabled. The court concluded that Mr. Lallo was entitled to temporary partial disability benefits and ordered Marion Environmental, Inc. to pay past benefits from May 1-6, 2015, and from September 28, 2015, onward at a compensation rate of $696.03 per week.

Workers' Compensation BenefitsTemporary Partial DisabilityUpper Extremity InjuryOrthopedic DiagnosisEmployment TerminationMedical Work RestrictionsWage Loss ClaimsExpedited Hearing DecisionEmployer Accommodation DisputeDr. Donald Huffman
References
9
Case No. ADJ2979319 (LAO 0864585)
Regular
Nov 21, 2008

PETRA GARCIA vs. BANKERS WEST FUNDING CORPORATION, NATIONAL LIABILITY AND FIRE INSURANCE COMPANY

This case concerns an applicant's entitlement to temporary disability indemnity (TDI) following a right upper extremity injury. The defendant sought reconsideration of an award, arguing TDI should cease earlier based on a QME's opinion and statutory limits. The Appeals Board granted reconsideration, amending the award to find TDI payable from January 3, 2006, through September 2, 2008, and continuing, while establishing the "date of commencement" for the two-year TDI limit as July 1, 2008, the date of first payment. The Board found the treating physician's opinion more persuasive than the QME's regarding the duration of temporary disability.

Workers' Compensation Appeals BoardPetra GarciaBankers West Funding CorporationNational Liability and Fire Insurance CompanyADJ2979319ReconsiderationTemporary Total DisabilityLabor Code section 4656(c)(1)Panel Qualified Medical Evaluator (QME)Ernest Washington M.D.
References
5
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