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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

Claim of Simpson v. Glen Aubrey Fire Co.

A volunteer fireman suffered an acute lumbosacral strain requiring frequent hospital and doctor visits. He sought reimbursement for 290 miles of travel expenses. The Workers' Compensation Board approved reimbursement at 20 cents per mile, leading to this appeal. The court examined whether travel expenses for medical treatment are reimbursable under the Volunteer Firemen’s Benefit Law and Workers’ Compensation Law. It concluded that access to medical treatment implies the financial means to obtain it, upholding the humanitarian goals of the legislation.

Volunteer FiremanLumbosacral StrainMileage ReimbursementTravel ExpensesMedical TreatmentWorkers' Compensation LawVolunteer Firemen's Benefit LawStatutory InterpretationRemedial LawLiberal Construction
References
2
Case No. ADJ1938020 (LAO 0877660)
Regular
Jul 21, 2010

FRANCISCO PEREZ vs. KING TACO RESTAURANTS, INC., AMERICAN CASUALTY

This case involves an applicant seeking reimbursement for travel expenses incurred to attend a Qualified Medical Evaluator (QME) appointment. The applicant relocated out of state after sustaining an industrial knee injury. The defendant initially disputed medical findings, triggering the QME process, and later refused to reimburse travel expenses to the out-of-state QME. The Workers' Compensation Appeals Board ruled that the applicant was entitled to travel expenses, citing relevant Labor Code sections and precedent. Sanctions were denied, and penalty issues were deferred.

ADJ1938020LAO 0877660King Taco RestaurantsInc.American CasualtyQualified Medical EvaluatorQME panelLabor Code Section 4062.2Labor Code Section 4061Labor Code Section 4600
References
3
Case No. ADJ3344826 (SAL 0075781)
Regular
Jun 08, 2011

Ronald Fryer vs. CORNUCOPIA COMMUNITY MARKET, TRAVELERS INSURANCE

The Workers' Compensation Appeals Board reviewed Travelers Insurance's petition for reconsideration of a $10,000 sanction order. The Board affirmed that Travelers engaged in sanctionable conduct by violating a prior order to allow applicant treatment outside their Medical Provider Network and by failing to pay authorized medical bills. However, the Board reduced the total sanction amount to $2,500, finding the initial imposition excessive given the circumstances. Applicant's separate claims for reimbursement of expenses were not addressed in this decision but may be pursued in future proceedings.

Workers' Compensation Appeals BoardTravelers InsuranceFindings and OrdersanctionsMedical Provider NetworkMPNprimary treating physicianDr. Nicodemusself-procured medical treatmentcontinuity of care
References
2
Case No. MISSING
Regular Panel Decision
May 03, 1985

Wolf v. Wolf

In two support proceedings, the petitioner mother appealed two orders. The first order, entered September 7, 1984, denied her petition for an upward modification of child support. The second order, entered May 3, 1985, denied her full reimbursement for certain child counseling expenses. The Family Court's decisions were affirmed on appeal. The court properly denied a general increase in the father's child support obligation and directed the mother to seek payment for counseling expenses through the father's medical insurance coverage.

child supportupward modificationcounseling expensesparental obligationsFamily Lawappellate reviewOrange County
References
0
Case No. MISSING
Regular Panel Decision

Salazar-Martinez v. Fowler Brothers, Inc.

Plaintiff Eustacio Salazar-Martinez sued Fowler Brothers, Inc., alleging violations of the FLSA and New York Labor Laws for failing to reimburse pre-employment travel, visa, and recruitment expenses, which allegedly reduced his first-week wages below minimum wage. Defendants sought summary judgment and dismissal of various claims. The court denied summary judgment, finding that pre-employment travel and visa expenses are primarily for the employer's benefit and must be reimbursed to avoid minimum wage violations, and that factual issues regarding recruitment fees remained. The court also denied dismissal for declaratory relief and for claims from 2006, 2007, and 2010, but granted dismissal for claims from 2003-2005. The case was referred for further pretrial matters, including class certification.

H-2A visa programFLSANew York Labor LawMinimum WageWage and HourReimbursementPre-employment expensesTravel expensesVisa costsRecruitment fees
References
23
Case No. MISSING
Regular Panel Decision

In re Relativity Fashion, LLC

This Memorandum Opinion addresses a motion for attorneys' fees and expenses filed by Relativity Media, LLC (and its affiliates RML Distribution Domestic, LLC, Armored Car Productions, LLC, and DR Productions, LLC, collectively 'Relativity') and Mr. Ryan Kavanaugh against Netflix, Inc. The dispute arose from Netflix's refusal to execute 'Date Extension Amendments' related to a License Agreement, prompting Relativity to seek relief under Section 1142 of the Bankruptcy Code. The Court previously ruled that Netflix was barred by res judicata and judicial estoppel from asserting its claimed contractual rights to distribute films before theatrical release. In this opinion, the Court determined that Relativity was the 'prevailing party' under California Civil Code Section 1717 and the License Agreement's fee provision. Consequently, Relativity is entitled to reimbursement for its own reasonable attorneys' fees and litigation expenses. However, the Court denied Mr. Kavanaugh's request for reimbursement of his counsel's fees and expenses, concluding that he was not a party to the License Agreement and did not meet the exceptions for non-signatories to recover fees. The Court awarded Relativity $818,547.48, comprising $795,732.50 in attorneys’ fees and $22,814.98 in litigation expenses, against Netflix.

Attorneys FeesLitigation ExpensesContract LawCalifornia Civil Code Section 1717Bankruptcy Code Section 1142Prevailing PartyLodestar MethodHourly RatesJudicial EstoppelRes Judicata
References
85
Case No. ADJ165588 (SAL 0108801)
Regular
Mar 09, 2009

STEVEN G. CARR vs. COUNTY OF SANTA CRUZ, Permissibly Self-Insured, Adjusted By SEDGWICK CLAIMS MANAGEMENT SERVICES

The Board granted reconsideration and amended a prior award, clarifying which expenses are compensable for the applicant's industrial injury. The applicant, a deputy sheriff, was awarded expenses for his gym membership and associated travel, totaling $10,241.76. However, the Board disallowed most pharmaceutical expenses, only allowing those for Celebrex, Nabumetone, and Avapro, along with travel mileage for these prescriptions. The issue of medical mileage reimbursement for treatment of family members was remanded for further adjustment or adjudication.

DeputysheriffIndustrialinjuryHypertensionGymmembershipPharmaceuticalexpensesMileageexpenseMedicaltreatmentPetitionforreconsiderationWCJFindingsofFact
References
1
Case No. MISSING
Regular Panel Decision

Cephalon, Inc. v. Travelers Companies, Inc.

Plaintiff Cephalon, Inc. initiated a declaratory judgment action against The Travelers Companies, Inc. and its four subsidiaries in the Southern District of New York. Cephalon sought a declaration that its off-label promotion of the drug Actiq did not violate the FDCA and caused no injury to Travelers. This suit was filed after Travelers, a workers' compensation insurer, sent pre-suit settlement demands to Cephalon, accusing it of causing damages through off-label drug promotion. Travelers moved to dismiss or transfer the case. The court granted Travelers' motion to dismiss, ruling that Cephalon's declaratory action was improperly anticipatory, having been filed in direct response to Travelers' specific threat of litigation and impending deadlines.

Declaratory JudgmentImproperly AnticipatoryFirst-Filed RuleMotion to DismissFederal Rule of Civil Procedure 12(b)(6)Off-Label Drug PromotionFood, Drug and Cosmetics ActInsurance DisputeWorkers' CompensationForum Selection
References
19
Case No. MISSING
Regular Panel Decision

Travelers Insurance v. Nory Construction Co.

Plaintiff Travelers Insurance Company initiated a subrogation action against Nory Construction Co., Inc. to recover over $3.5 million paid to satisfy a judgment against its insured, the State of New York, following a construction accident. Travelers sought common-law indemnification, arguing Nory was entirely at fault, including amounts paid beyond its policy limits. Nory countered that Travelers could not recover voluntary payments, and the claim was barred by the antisubrogation rule and untimely disclaimer. The court denied Travelers' motion for summary judgment due to insufficient evidence regarding Nory's sole fault. Ultimately, the court granted Nory's motion for summary judgment, concluding that Travelers' overpayment, made without legal compulsion or Nory's request, constituted a voluntary payment and was therefore not recoverable under equitable subrogation principles.

SubrogationIndemnificationInsurance Policy LimitsAntisubrogation RuleVoluntary Payment DoctrineSummary Judgment MotionConstruction LawWorkers' Compensation InsuranceCommercial General LiabilityUmbrella Policy
References
48
Case No. MISSING
Regular Panel Decision

Pecker Iron Works of New York, Inc. v. Traveler's Insurance

This case involves a dispute between Pecker Iron Works and Travelers Indemnity Company of Connecticut concerning the primary versus excess coverage obligations of two liability insurance carriers. Pecker, designated as an 'additional insured' under Upfront Enterprises' policy with Travelers, sought primary coverage after an Upfront worker was injured on a construction site. Travelers contended its policy provided only excess coverage for additional insureds unless explicitly designated as primary in a written contract. The Supreme Court initially agreed with Travelers, but the Appellate Division reversed, holding that coverage for additional insureds is presumed primary unless unambiguously stated otherwise. The Court of Appeals affirmed the Appellate Division's decision, concluding that Pecker was entitled to primary coverage.

Insurance CoverageAdditional InsuredPrimary CoverageExcess CoverageSubcontractor AgreementDeclaratory JudgmentContract InterpretationLiability InsuranceConstruction ProjectAppellate Review
References
4
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