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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
Jul 13, 2001

A.I. Transport v. New York State Insurance Fund

The Supreme Court, New York County, denied a liability insurer’s application to stay an arbitration initiated by a workers’ compensation insurer. The workers’ compensation insurer sought to recover benefits paid to a bus passenger injured in an accident, where the bus was insured by the liability insurer. The court interpreted Insurance Law § 5105 (a) to allow a workers’ compensation provider, paying benefits in lieu of first party benefits, to recover amounts paid from the insurer of a liable party, even if one of the vehicles involved is a bus. It was determined that an exception for losses arising from the use of a motor vehicle (Insurance Law § 5103 [a] [1]) did not apply, as the respondent was a workers’ compensation insurer and not an automobile insurer. Consequently, the arbitration was allowed to proceed, and the petition to stay it was dismissed and unanimously affirmed.

Arbitration DisputeInsurance Law InterpretationNo-Fault BenefitsWorkers' Compensation SubrogationBus AccidentLiability CoverageStatutory ConstructionAppellate ReviewInsurer Recovery
References
4
Case No. LAO 0762226, LAO 0762227
Regular
Sep 05, 2007

SHIRLEE DYERLY vs. LAWRY'S RESTAURANT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for SUPERIOR NATIONAL INSURANCE COMPANY, INTERCARE INSURANCE SERVICES, ZURICH NORTH AMERICA INSURANCE COMPANY

This case involves a dispute over insurance coverage for an applicant's neck and back injuries sustained across specific and cumulative trauma incidents. The Workers' Compensation Appeals Board (WCAB) is reconsidering an arbitrator's decision that ordered Zurich North America Insurance Company to reimburse the California Insurance Guarantee Association (CIGA) for all benefits paid by the liquidated California Compensation Insurance Company (Cal Comp). The WCAB rescinds the arbitrator's order, ruling that CIGA can only recover the amount Cal Comp would have been entitled to collect had it not been liquidated, not the full amount paid.

CIGACal CompZurichliquidationcontributionreimbursementspecific injurycumulative traumastatute of limitationsjoint findings
References
7
Case No. ADJ3196569 (POM 0282676)
Regular
Aug 28, 2009

JEANETTE DOMINGUEZ, vs. RICH PRODUCTS; ZURICH NORTH AMERICA INSURANCE

Lien claimants sought reconsideration of a WCJ's award of minimal amounts for pharmacy services, arguing they should have been paid their full billed amounts. The Workers' Compensation Appeals Board denied the petition, agreeing with the WCJ's findings that the billed amounts were not reasonable or necessary. The Board also noted the petition was procedurally deficient for lack of verification and for failing to clearly state contentions or reference the record. Therefore, the lien claimants' petition for reconsideration was denied on both substantive and procedural grounds.

Workers' Compensation Appeals BoardLien claimantsPetition for ReconsiderationFindings and AwardCompromise and ReleaseCumulative injuryProduction workerIndustrial injuryAdministrative law judgeWCJ Report
References
2
Case No. ADJ870919 (ANA 0406270) ADJ2721302 (ANA 0406269)
Regular
Jun 08, 2009

DANIEL COOPER, vs. RECORDING INDUSTRY ASSOCIATION OF AMERICA, STATE COMPENSATION INSURANCE FUND

This case involves a workers' compensation applicant who sustained a psyche injury. The defendant, State Compensation Insurance Fund, initially denied liability but later accepted and paid temporary disability benefits. The Workers' Compensation Appeals Board granted reconsideration, modifying a prior award. The Board held that applicant's attorney was entitled to fees on temporary disability paid directly to the applicant, but not on amounts paid to satisfy a lien claim by the Employment Development Department. This determination was based on specific statutory requirements for fees from lien claimant recoveries, which were not met in this instance.

Workers Compensation Appeals BoardReconsiderationJoint Findings Award and OrdersAdministrative Law JudgeIndustrial InjuryPsycheTemporary DisabilityAttorney FeesState Compensation Insurance FundEmployment Development Department
References
3
Case No. MISSING
Regular Panel Decision

Claim of Graham v. Life Rollway Corp.

The claimant sustained a leg injury on the employer’s premises and filed for workers’ compensation benefits. The self-insured employer, who had paid disability benefits, controverted the claim. It was later determined that the claimant was entitled to workers’ compensation, and an award was made. A dispute arose regarding the employer's reimbursement for disability benefits paid, specifically whether it should be the full amount or less FICA taxes. The Workers’ Compensation Board ruled the employer was entitled to full reimbursement. The appellate court affirmed this decision, finding the Board's conclusion rational since the full award was effectively paid to the claimant through direct payment and FICA remittances satisfying the claimant's obligations.

Workers' CompensationFICA TaxesDisability Benefits ReimbursementEmployer ReimbursementStatutory InterpretationDue Process ClaimOverpayment RefundAppellate DecisionSocial Security Taxes
References
0
Case No. MISSING
Regular Panel Decision

Claim of Jones v. Chevrolet-Tonawanda Division, GMC

This case involves appeals from two decisions by the Workers’ Compensation Board concerning a self-insured employer’s entitlement to credit for holiday wages paid to disabled employees. Claimants Hanks and Jones were injured during employment, resulting in lost time, including holidays. The employer paid them compensation for lost time but also provided full wages for holidays as per collective bargaining agreements, subsequently seeking reimbursement under Workers’ Compensation Law § 25 (4)(a). The Board denied these reimbursement requests, stating that holiday pay was a contractual right and not intended to be in lieu of compensation. The appellate court reversed the Board’s decisions, ruling that denying reimbursement would lead to claimants receiving both full wages and compensation for the holidays, creating an imbalance. Therefore, the employer is entitled to reimbursement, and the matters are remitted to the Workers’ Compensation Board for further proceedings consistent with this decision.

Workers' CompensationHoliday PayReimbursementCollective Bargaining AgreementDisabled EmployeesLost WagesSelf-Insured EmployerAppellate ReviewBoard Decision ReversalStatutory Interpretation
References
2
Case No. ADJ8215090
Regular
Jun 05, 2019

GUADALUPE MENDOZA vs. GODO FARM LABOR CONTRACTORS, STAR INSURANCE

The Workers' Compensation Appeals Board granted reconsideration and amended a previous decision. The amendment allowed a lien claim for medical treatment provided by Suarez-Toutoundjian Chiropractic to the applicant, Guadalupe Mendoza, in the amount of $780.92. This amount is to be paid by Defendant-Carrier Star Insurance Company. The overall decision of March 14, 2019, was otherwise affirmed.

Workers' Compensation Appeals BoardGuadalupe MendozaGODO FARM LABOR CONTRACTORSSTAR INSURANCEMEADOWBROOKPetition for ReconsiderationWCJ reportDecision After ReconsiderationLien ClaimantSuarez-Toutoundjian Chiropractic
References
0
Case No. ADJ1493279 (LAO 440248)
Regular
Oct 22, 2008

CALDWELL JOHNSON vs. LOS ANGELES DEPARTMENT OF WATER AND POWER, Permissibly Self-Insured

The Workers' Compensation Appeals Board granted reconsideration and rescinded prior orders awarding penalties and attorney fees. The Board found the record unclear regarding whether the defendant had fully paid awarded penalties and returned the matter to the trial level for further clarification on this issue. The ultimate goal is to ensure a fair balance and substantial justice between the parties concerning the amounts paid versus owed.

Labor Code section 5814Labor Code section 5814.5penalty awardattorney feesreconsiderationaccounting summaryunreasonable delaypayment of compensationestate of applicantself-insured
References
0
Case No. ADJ2831208 (GOL 0090431) ADJ894034 (GOL 0090432)
Regular
Aug 10, 2009

JOSE LOPEZ vs. QUALITY PLASTERING, GOLDEN EAGLE INSURANCE COMPANY

The applicant, Jose Lopez, was awarded a 25% penalty for the defendant's failure to pay the full settlement amount. The defendant sought reconsideration, arguing they paid the amount agreed upon in the addenda to the Compromise and Release Agreement. However, the Board found the Orders Approving Compromise and Release, which specified a higher payment to the applicant, became final when the defendant failed to seek timely reconsideration. Therefore, the defendant's petition for reconsideration was denied, affirming the penalty.

Workers' Compensation Appeals BoardQuality PlasteringGolden Eagle Insurance CompanyJose LopezReconsiderationFindings and AwardLabor Code section 5814PenaltyAttorney's FeeLabor Code section 5814.5
References
3
Case No. ADJ126279 (OAK 0305558)
Regular
Dec 20, 2011

STEPHEN CLAY vs. LOWE'S HIW, INC., AIG INSURANCE COMPANY

The Workers' Compensation Appeals Board reconsidered a WCJ's decision denying St. Francis Memorial Hospital's lien claim entirely. The Board, agreeing with the WCJ's recommendation, rescinded the original order. St. Francis Memorial Hospital's lien is now allowed in the amount of $8,379.22, excluding amounts already paid. However, the lien claimant's request for interest and penalties was denied due to timely and reasonable payment on the hospital bill.

St. Francis Memorial Hospitallien claimantpetition for reconsiderationWCJ's Findings and Orderstipulated Awardindustrial injurypermanent disabilityfurther medical treatmentpenaltiesinterest
References
2
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