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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

Tri-State Employment Services, Inc. v. Mountbatten Surety Co.

The United States Court of Appeals for the Second Circuit certified a question to the New York Court of Appeals regarding whether a professional employer organization (PEO) may be a proper claimant under a labor and materials surety bond. Plaintiff Tri-State Employment Services, Inc., a PEO, provided employee leasing services to Team Star Contractors, Inc. for a construction project, covering payroll, taxes, and insurance. When Team Star failed to pay, Tri-State filed a claim with the surety, Mountbatten Surety Company, Inc., which was dismissed by the District Court. The New York Court of Appeals determined that a PEO's primary role as an administrative services provider and payroll financier creates a presumption that it does not provide labor for the purpose of a payment bond claim. The Court found that Tri-State failed to overcome this presumption by demonstrating sufficient direction and control over the workers. Consequently, the Court answered the certified question in the negative, ruling that Tri-State Employment Services, Inc. is not a proper claimant under the surety bond in the circumstances presented.

Professional Employer OrganizationSurety BondLabor and Materials BondClaimant StatusEmployee LeasingPayroll ServicesAdministrative ServicesConstruction ContractCertified QuestionNew York Law
References
16
Case No. MISSING
Regular Panel Decision

Weiss v. Tri-State Consumer Insurance

This case involves an appeal concerning the amount of supplementary uninsured/underinsured motorist (SUM) coverage available under an insurance policy issued by Tri-State Consumer Insurance Company. The plaintiffs, daughters and administrators of the estates of Rifka and Anton Goldenberg who died in a car accident, sought $400,000 in SUM coverage. Tri-State contended the coverage was limited to $145,000, arguing that payments from the tortfeasor's insurer ($100,000) and a Dram Shop recovery ($255,000) reduced the $500,000 policy limit. The Supreme Court initially granted the plaintiffs' motion for $400,000 in coverage and denied Tri-State's cross-motion. However, the appellate court reversed this decision, ruling that the Dram Shop recovery, as damages from sources other than motor vehicle liability insurance, correctly reduced the SUM endorsement, thus limiting the available coverage to $145,000.

Supplementary Uninsured/Underinsured MotoristSUM CoverageInsurance Policy InterpretationDram Shop ActWrongful DeathSummary JudgmentAppellate ReviewInsurance LawContract LawAutomobile Insurance
References
8
Case No. 2013-1427 K C
Regular Panel Decision
Jun 03, 2016

Harvard Med., P.C. v. Tri State Consumers Ins. Co.

This is an appeal by Harvard Medical, P.C., as assignee of Lenford Carty, against Tri State Consumers Ins. Co. The appeal is from an order of the Civil Court of the City of New York, Kings County, entered April 12, 2013, which granted the defendant's motion for summary judgment. The defendant argued that it had fully paid the plaintiff in accordance with the workers' compensation fee schedule for first-party no-fault benefits. The Appellate Term, Second Department, affirmed the Civil Court's order, citing a related case, Renelique, as Assignee of Yvon Delgado v Tri State Consumers Ins. Co.

No-fault benefitsSummary JudgmentAppellate ReviewWorkers' Compensation Fee ScheduleAssignee
References
1
Case No. 2011-192 K C
Regular Panel Decision
Dec 19, 2017

Jamaica Dedicated Med. Care, P.C. v. Tri State Consumer Ins. Co.

This case concerns an appeal from an order of the Civil Court of the City of New York, Kings County, which denied defendant Tri State Consumer Ins. Co.'s cross motion for summary judgment. Jamaica Dedicated Medical Care, P.C., as assignee, sought first-party no-fault benefits. Tri State Consumer Ins. Co. contended that it had either properly reimbursed services according to the workers' compensation fee schedule or timely denied others due to lack of medical necessity. The Appellate Term found a triable issue of fact regarding medical necessity and that the defendant failed to establish its workers' compensation fee schedule defense as a matter of law. Consequently, the order denying summary judgment was affirmed.

No-fault benefitsSummary judgmentMedical necessityWorkers' compensation fee scheduleAppellate reviewAssigneeInsurance claimCivil CourtAppellate TermKings County
References
2
Case No. ADJ9193730
Regular
Apr 04, 2016

KENT CAMPBELL vs. TRI-VALLEY GROWERS, AIG CLAIMS

This Workers' Compensation Appeals Board order dismisses a Petition for Removal concerning case ADJ9193730. The petitioner voluntarily withdrew their petition. Consequently, the Board has dismissed the removal proceedings.

Petition for RemovalWithdrawn PetitionWorkers' Compensation Appeals BoardDismissal OrderTri-Valley GrowersAIG ClaimsGallagher Bassett ServicesADJ9193730Long Beach District OfficeService List
References
0
Case No. MISSING
Regular Panel Decision

Winn v. Hudson Valley Equine Center

A claimant, an equine veterinarian, appealed a Workers’ Compensation Board decision regarding an occupational disease affecting his right shoulder and wrist. The claimant developed these conditions from strenuous work at Hudson Valley Equine Center between 1982 and 1988, leading to surgery and a workers' compensation claim in 1988. The Workers’ Compensation Law Judge (WCLJ) found an occupational disease with a disability date of March 23, 1988, ruling the claim timely and estopping the carrier, Insurance Company of North America/CIGNA, from denying coverage. The Workers’ Compensation Board affirmed the WCLJ's findings. The employer and carrier appealed, contending the finding of an occupational disease lacked support and that the claim was time-barred. The appellate court affirmed the Board's decision, citing substantial medical evidence connecting the conditions to the claimant's occupation and upholding the Board's determination of the date of disablement and the carrier's estoppel.

Occupational DiseaseEquine VeterinarianShoulder InjuryWrist InjuryCarpal Tunnel SyndromeWorkers' Compensation LawDate of DisablementTimeliness of ClaimEstoppelInsurance Coverage
References
9
Case No. ADJ4529427 (STK 0161706) ADJ2447284 (STK 0166992)
Regular
Nov 17, 2008

ROBERT SHAW vs. TRI-VALLEY GROWERS, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA

The Workers' Compensation Appeals Board granted reconsideration of a prior award, rescinding the original decision. The Board returned the case to the WCJ for further proceedings and a new decision. This action was based on the WCJ's acknowledgment of partial merit in the defendant's arguments regarding permanent disability apportionment and temporary disability entitlement.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardPermanent DisabilityCumulative TraumaApportionmentPrior InjuryObesityTemporary Disability IndemnityPermanent and Stationary
References
0
Case No. MISSING
Regular Panel Decision
Dec 01, 2017

Musante v. Mohawk Valley Community College

Robert Musante, a former faculty member, filed a civil rights lawsuit against Mohawk Valley Community College (MVCC) alleging age and gender discrimination, retaliation, and defamation following his termination. MVCC terminated Musante after an investigation into student complaints of classroom misconduct, including sexually explicit stories and inappropriate language. Musante disputes the allegations, claiming the complaints were from disgruntled students and that the investigation was biased, driven by an HR director's disapproval of his teaching style and perceived animus against older male professors. He also claims retaliation for lodging a discrimination complaint and for defamatory statements made by an MVCC employee that hindered his job search. The court denied MVCC's motion for summary judgment, finding genuine disputes of material fact regarding discrimination, retaliation, and defamation, and ordered the claims to proceed to trial.

Age DiscriminationGender DiscriminationRetaliation ClaimDefamation ClaimSummary Judgment MotionFaculty TerminationClassroom MisconductStudent ComplaintsEmployment DiscriminationCivil Rights Litigation
References
28
Case No. STK 100401, STK 102758, STK 151721
Regular
May 01, 2007

JACK LITTLE vs. TRI-VALLEY GROWERS, NATIONAL UNION FIRE INSURANCE COMPANY

Applicant Jack Little sustained admitted industrial injuries to his knees and back, resulting in permanent disability and a need for ongoing medical treatment, including for his hypertension. The Appeals Board denied reconsideration of the finding that applicant's erectile dysfunction is not a compensable consequence of the industrial injuries, as both medical evaluators concluded it was not caused by the work injuries. However, a dissenting commissioner argued for reconsideration to further develop the record regarding whether the industrially-caused hypertension and its medications contribute to the erectile dysfunction.

Workers' Compensation Appeals BoardTri-Valley GrowersNational Union Fire Insurance CompanyJack Littleindustrial injurieskneesbackmaintenance mechanicpermanent disabilitymedical treatment
References
3
Case No. MISSING
Regular Panel Decision

Claim of Serafin v. Pleasant Valley Wine Co.

This case is an appeal from a Workers’ Compensation Board decision, filed October 19, 1982, which denied benefits to a claimant widow and two dependent children. The claim stemmed from the death of the decedent, an assistant sales manager for Pleasant Valley Wine Company, who died of a myocardial infarction on November 2, 1976, allegedly after carrying wine cases for work. The carrier contested the claim due to untimely filing and lack of employer notification under section 18 of the Workers’ Compensation Law. Conflicting medical opinions were presented regarding the causal connection between the decedent's work activity and his death. The Board concluded that the application was untimely filed, prejudicing the employer, and found no credible evidence of an accident arising from employment, nor any advance payment of compensation. The court affirmed the Board's decision, citing substantial evidence supporting the Board's findings and its power to resolve conflicting medical opinions, as well as the prejudice to the employer from the untimely claim.

Untimely ClaimWorkers CompensationMyocardial InfarctionCausal ConnectionEmployer NotificationConflicting Medical OpinionsPrejudiceScope of EmploymentAccidentDependent Benefits
References
5
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