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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
Jun 22, 1999

Claim of Mace v. Owl Wire & Cable Co.

The claimant's husband suffered a heart attack in 1971 and died in 1991, with the death causally related to the 1971 injury. The Workers’ Compensation Board determined that a 3% interest rate, applicable to 1971 accidents under Workers’ Compensation Law § 27 (5), should be used to calculate the present value of the death benefits award to be paid into the Aggregate Trust Fund. The workers’ compensation carrier appealed, contending that the 6% rate, in effect at the time of the decedent's death in 1991, should apply. The court affirmed the Board's decision, holding that the statutory interest rate for calculating the present value of awards to the Aggregate Trust Fund is tied to the date of the original accident, not the subsequent causally-related death. This interpretation aligns with legislative intent and prior Board decisions.

Workers' CompensationAggregate Trust FundInterest Rate CalculationStatutory InterpretationDeath BenefitsDate of AccidentLegislative IntentPresent ValueInsurance Carrier LiabilityAppellate Review
References
16
Case No. MISSING
Regular Panel Decision

Atlantic Casualty Insurance v. Value Waterproofing, Inc.

Atlantic Casualty Insurance Company sought a declaratory judgment that it had no duty to defend or indemnify Value Waterproofing, Inc. in an underlying breach of contract and negligence lawsuit. Value counterclaimed, requesting a declaration that Atlantic Casualty was required to defend and indemnify. The court granted Atlantic Casualty's request, finding that Value failed to provide timely notice of the claim, thereby prejudicing Atlantic Casualty's investigation capabilities. Additionally, the court ruled that Value's work on a commercial property was not covered by its residential-only roofing insurance policy, further justifying the denial of coverage.

Insurance disputeBreach of contractNegligenceDeclaratory judgmentTimely noticeCoverage exclusionCommercial General LiabilityResidential roofingPolicy interpretationPrejudice
References
46
Case No. ADJ4258585 (OXN 0130492) ADJ220258 (OXN 0130487)
Regular
Apr 17, 2018

ENRIQUE HERRERA vs. MAPLE LEAF FOODS, U.S. FIRE INSURANCE COMPANY, ALEA NORTH AMERICAN INSURANCE COMPANY

This notice informs parties that the Workers' Compensation Appeals Board (WCAB) intends to admit its rating instructions and a disability rater's recommended permanent disability rating into evidence. The WCAB previously granted reconsideration for further study. Parties have seven days to object to the rating instructions or the recommended rating, with specific procedures for addressing objections. If no timely objection is filed, the matters will be submitted for decision thirty days after service.

WORKERS' COMPENSATION APPEALS BOARDPermanent Disability RatingDisability Evaluation UnitRating InstructionsRecommended Permanent Disability RatingJoint RatingReconsiderationObjectionRater Cross-ExaminationRebuttal Evidence
References
0
Case No. ADJ9184413
Regular
Oct 27, 2020

JEFFREY SPRINGER vs. RJ DONOVAN CORRECTIONAL FACILITY, STATE COMPENSATION INSURANCE FUND

This case involves a workers' compensation claim by Jeffrey Springer against RJ Donovan Correctional Facility. The Applicant sustained injuries resulting in industrially caused hypertension, hypertensive kidney disease, and hypertensive heart disease. The primary dispute centered on how to combine a prior 28% permanent disability rating for kidney disease with a new 49% rating for heart disease. The defendant argued these were part of a single cardiovascular system and sought to subtract the prior award's monetary value from the new rating. The WCJ found the injuries to the kidney and heart were distinct, justifying combining them, and awarded 63% permanent disability after deducting the prior award's value. The Appeals Board denied the defendant's petition for reconsideration, adopting the WCJ's reasoning.

Workers Compensation Appeals BoardRJ Donovan Correctional FacilityLegally UninsuredState Compensation Insurance FundPetition for ReconsiderationPermanent DisabilityHypertensionHypertensive Kidney DiseaseHypertensive Heart DiseaseHypertensive Cardiovascular Disease
References
1
Case No. MISSING
Regular Panel Decision

People v. Young

An attorney representing an indigent defendant in Monroe County filed an application seeking reimbursement for legal services at a rate of $200 per hour, mirroring the rate charged by the Special Prosecutor, rather than the statutory rates under County Law § 722-b. The attorney argued that the significant disparity in hourly compensation violated the defendant's right to equal protection and that his qualifications justified the requested rate. The New York State Association of Criminal Defense Lawyers supported the application as amicus curiae, while Monroe County opposed it, arguing the request was untimely and lacked extraordinary circumstances. Presiding Judge Donald J. Mark, J., acknowledged the court's authority to grant compensation in excess of statutory limits under extraordinary circumstances but ultimately denied the application. The denial was based on the court's reasoning that an analogous argument was previously rejected, that linking assigned counsel rates to prosecutor rates would render County Law § 722-b ineffective, and that extraordinary circumstances could not be demonstrated prior to the conclusion of the criminal action. The court, however, reserved the right to reconsider an increased hourly fee upon the case's termination if such circumstances are then proven.

Assigned CounselLegal Aid CompensationCounty Law Section 722-bHourly Rate DisputeSpecial Prosecutor FeesIndigent RightsJudicial DiscretionExtraordinary CircumstancesMonroe County LawEqual Protection Challenge
References
16
Case No. ADJ4243140 (OXN 0130418)
Regular
Sep 23, 2009

ALMALILIA MARTINEZ vs. TRACEY VILLA, NATIONAL FIRE INSURANCE OF HARTFORD, CNA CLAIMS PLUS

The Workers' Compensation Appeals Board granted reconsideration to amend a prior award concerning a lien claimant's fees for medical interpreting services. The amended award clarifies that certain specific medical sessions are valued at the greater of the stipulated market rate or the billed amount. Other medical interpreting services are awarded at one-half of the greater of the market rate or billed amount, with the total value of the lien affirmed as previously decided.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationJoint Findings and AwardWorkers' Compensation JudgeMedical Interpreting ServicesMarket RateAdministrative Director RulesReasonable ValueWCAB Appearances
References
1
Case No. MISSING
Regular Panel Decision

Claim of Perrin v. Builders Resource, Inc.

The case concerns an appeal from a Workers' Compensation Board decision regarding the reimbursement rate for home health aide services provided to a claimant by their sister. Initially, the carrier denied payment but was later directed to pay. The Workers’ Compensation Law Judge set the reimbursement rate at $12 per hour for services starting in 2011, which the Board affirmed. The claimant appealed, solely challenging this rate. The court dismissed the appeal, ruling that the claimant was not an aggrieved party concerning the reimbursement rate, as the dispute was between the care provider (the sister) and the carrier. The court affirmed that the claimant received the care sought and could not raise issues on behalf of the care provider.

Workers' CompensationHome Health Aide ServicesReimbursement RateAppeal DismissalAggrieved PartyCare ProviderWorkers' Compensation BoardAppellate ProcedureNew York LawCarrier Liability
References
4
Case No. ADJ7369877, ADJ7369872
Regular
Jan 20, 2016

SAMUEL DEBONE vs. CEMEX, INC., AMERICAN HOME ASSURANCE COMPANY, INC., GALLAGHER BASSETT SERVICES

The Workers' Compensation Appeals Board granted reconsideration to correct errors in a previous permanent disability rating. The WCJ incorrectly applied the Agreed Medical Examiner's (AME) WPI ratings, conflating cervical and lumbar spine impairments and miscalculating lower extremity to WPI conversions for the hips. The case is returned to the trial level for a new rating based on correct WPI values and to clarify the basis for any departure from AMA Guides ratings. The apportionment of disability was found to be correct.

Workers' Compensation Appeals BoardPetition for ReconsiderationPermanent DisabilityApportionmentAgreed Medical Examiner (AME)Cumulative TraumaCervical SpineLumbar SpineHipsDRE Method
References
1
Case No. MISSING
Regular Panel Decision

Anthony L. Jordan Health Corp. v. Axelrod

The Anthony L. Jordan Health Center, a not-for-profit corporation, challenged the New York State Department of Health's recalculation of its Medicaid reimbursement rates for the 1983-1984 and 1984-1985 periods. Following an appeal, the parties entered into a stipulation agreement. However, the Department, while recalculating the rates in accordance with the stipulation, unilaterally changed the group composition, resulting in a significant negative adjustment and recoupment from Jordan. The court determined that this regrouping constituted an 'error of judgment,' not a permissible correction for mathematical error or an audit finding. Consequently, the court found that the Department did not have the right to retroactively adjust the rates based on this discretionary change. The petition was granted.

Medicaid ReimbursementRate RecalculationAdministrative ReviewStipulation AgreementError of JudgmentGroup CompositionRetroactive AdjustmentHealth Care LawJudicial ReviewDepartment of Health
References
5
Case No. MISSING
Regular Panel Decision

In re Striley

This case addresses an employer's constitutional challenge to the New York State Unemployment Insurance Law concerning payments to striking workers and the application of the 'experience rating' method (Labor Law, § 581). The employer questioned the constitutionality under both Federal and State Constitutions. The court referenced W. H. H. Chamberlin, Inc., v. Andrews, which previously affirmed the constitutionality of taking money from employers for a general fund to pay strikers, and extended this principle to the 'experience rating' method. The decision emphasized that the method of assessment is a legislative matter and found no unreasonable or arbitrary act or constitutional violation in the change from a percentage ratio to 'experience rating'. The court affirmed the decision of the Unemployment Insurance Board.

Unemployment Insurance LawConstitutionalityExperience RatingStriking WorkersLabor LawLegislative IntentJudicial ReviewStatutory InterpretationEmployer ContributionsBenefit Payments
References
3
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