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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ7258268
Regular
Dec 20, 2013

PATRICIA SMITH vs. WELLPOINT HEALTH NETWORKS, INC.; and ZURICH NORTH AMERICA INSURANCE CO.

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the original award. The Board found substantial evidence supported the necessity of a Jenny Craig weight loss program, including special diet food products, as reasonably necessary treatment. This was based on the applicant's need to lose weight for industrial back surgery and the program's proven success, evidenced by the applicant's 54-pound weight loss. The Board adopted the administrative law judge's report and recommendation in its entirety.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationDENIEDJenny Craigweight loss programspecial diet food productsreasonably necessary treatmentindustrial back surgerysubstantial evidencemedical treatment
References
2
Case No. 2018 NY Slip Op 07391
Regular Panel Decision
Nov 01, 2018

Matter of Community Hous. Improvement Program v. Commissioner of Labor

The Appellate Division, Third Department, dismissed an appeal filed by the Community Housing Improvement Program against the Commissioner of Labor. The appeal sought to challenge a decision by the Industrial Board of Appeals regarding a minimum wage order for the building service industry. The court determined it lacked subject matter jurisdiction because the petitioner failed to properly file a notice of appeal with the court of original instance, which was the Industrial Board of Appeals, not the Appellate Division. Additionally, the petitioner failed to timely and correctly serve the notice of appeal on the respondent's counsel at the designated address. Consequently, due to the complete failure to comply with CPLR 5515, the appeal was dismissed.

JurisdictionAppeal ProcedureService of ProcessAppellate DivisionIndustrial Board of AppealsMinimum WageLabor LawCPLRNew York CourtsStatutory Interpretation
References
12
Case No. 142 SSM 33
Regular Panel Decision
Nov 16, 2017

The Matter of the Claim of Lidia Burgos v. Citywide Central Insurance Program

The New York Court of Appeals affirmed the order of the Appellate Division. The decision concerned the claim of Lidia Burgos against Citywide Central Insurance Program and the Workers' Compensation Board. The Appellate Division had concluded that substantial evidence supported the Workers' Compensation Board's determinations regarding the claimant's degree of impairment and loss of wage-earning capacity. The Court of Appeals found no reason to overturn this conclusion.

Workers' CompensationImpairmentWage-earning CapacitySubstantial EvidenceAppellate DivisionClaimantInsurance ProgramBoard DeterminationJudicial ReviewAffirmed Order
References
1
Case No. 2017 NY Slip Op 04184 [150 AD3d 1589]
Regular Panel Decision
May 25, 2017

New York State Workers' Compensation Board v. Program Risk Management, Inc.

The New York State Workers' Compensation Board, acting as administrator and successor to the Community Residence Insurance Savings Plan, initiated legal action against various entities and individuals after the trust became severely underfunded. Defendants include Program Risk Management, Inc. (administrator), PRM Claims Services, Inc. (claims administrator), individual officers of PRM, the Board of Trustees, and Thomas Gosdeck (trust counsel). The plaintiff sought damages for claims such as breach of contract, breach of fiduciary duty, and legal malpractice. The Supreme Court's order partially dismissed some claims and denied others. On cross-appeal, the Appellate Division, Third Department, modified the Supreme Court's order, notably reversing the dismissal of several breach of fiduciary duty claims and common-law indemnification against PRMCS, while affirming denials of motions to dismiss breach of contract, legal malpractice, and unjust enrichment claims. The court's decision was influenced by recent rulings in State of N.Y. Workers' Compensation Bd. v Wang.

Workers' Compensation LawGroup Self-Insured TrustBreach of ContractBreach of Fiduciary DutyLegal MalpracticeUnjust EnrichmentStatute of LimitationsEquitable EstoppelAlter Ego LiabilityCommon-Law Indemnification
References
20
Case No. 2021 NY Slip Op 04638 [197 AD3d 800]
Regular Panel Decision
Aug 05, 2021

Matter of McMillian v. Krygier

Petitioner, an incarcerated person, challenged a reduction in his pay rate by the Department of Corrections and Community Supervision (DOCCS) after refusing to participate in recommended programming. His grievance was denied by the facility Superintendent and his subsequent appeal to the Central Office Review Committee (CORC) remained undecided for over eight months. Petitioner then initiated a CPLR article 78 proceeding, which the Supreme Court dismissed on the merits. On appeal, the Appellate Division affirmed the Supreme Court's judgment. The court found that exhaustion of administrative remedies was excused due to both futility and the presence of pure questions of law, concluding that DOCCS's policies linking pay reduction to program refusal were within its statutory authority and were properly applied.

Inmate RightsPrison AdministrationAdministrative RemediesExhaustion DoctrineCPLR Article 78 ReviewNew York State LawCorrectional FacilitiesDue ProcessGrievance ProceduresJudicial Review
References
30
Case No. ADJ2117331 (OAK 0261803)
Regular
May 31, 2017

Janice Payne vs. Federal Express, BROADSPIRE

This case involves Janice Payne seeking reconsideration of a Workers' Compensation Appeals Board (WCAB) decision denying her weight loss program extension. The WCJ initially ruled he lacked jurisdiction due to prior Utilization Review (UR) and Independent Medical Review (IMR) denials, which were not appealed. However, the applicant argued a 2003 Compromise and Release agreement designated Dr. Mandel as the ultimate medical arbiter for treatment disputes, superseding UR/IMR. The WCAB granted reconsideration, finding the contractual agreement to use Dr. Mandel remains enforceable despite subsequent UR/IMR legislation. The case is remanded to the trial level to consider Dr. Mandel's opinions on the weight loss program's medical necessity.

Compromise and ReleaseMedical ArbiterUtilization ReviewIndependent Medical ReviewWeight Loss ProgramContractual AgreementJurisdictionSubstantial JusticeStipulationMedical Treatment Dispute
References
18
Case No. MISSING
Regular Panel Decision

Lugo v. Gaines

This dissenting opinion concerns a petitioner's request for review of a determination terminating his participation in a temporary release program and for monetary damages. The petitioner, an inmate, was removed from the program after a urine sample tested positive for cocaine. The dissent argues that the procedures followed, despite a lack of formal chain of custody documentation, did not violate the petitioner's due process rights, as strict rules of evidence are not required in such disciplinary proceedings. Citing judicial precedent, the dissenting judges emphasize that an inmate's constitutional protections are diminished by institutional needs. Therefore, they would affirm the termination of the petitioner's work release program.

temporary release programdrug testingdue processinmate rightscorrectional facilitiesadministrative hearingchain of custodyurine analysisArticle 78State liability
References
8
Case No. 2007 NY Slip Op 31662(U)
Regular Panel Decision
Jul 26, 2007

J Squared Software, LLC v. Bernette Knitware Corp.

The Supreme Court of New York County issued a judgment on July 26, 2007, affirming a prior order from June 18, 2007. This order had denied the plaintiff's motion for partial summary judgment on liability, granted the defendants' cross-motion for summary judgment dismissing the complaint in an action for conversion of a software program, and vacated a preliminary injunction. The appellate court unanimously affirmed this decision, holding that the plaintiff lacked a cause of action for conversion as the program was obtained under a valid contract and its return was never demanded. Consequently, the preliminary injunction was properly vacated upon the dismissal of the complaint.

conversionsoftware programsummary judgmentpreliminary injunctioncontract lawlicenseecause of actionappellate reviewjudgment affirmedcomplaint dismissal
References
2
Case No. MISSING
Regular Panel Decision
Feb 25, 1976

In re the Claim of Phelosof

The claimant appealed a decision from the Unemployment Insurance Appeal Board, which affirmed the Industrial Commissioner's determination that the claimant was ineligible for benefits under the Federal Special Unemployment Assistance Program (SUA). The claimant, who was terminated from employment by Monroe County, was receiving benefits under the New York State Labor Law based on prior covered employment. The Board denied SUA benefits, reasoning that eligibility for State benefits precluded eligibility for SUA, as the Federal program is intended for those not otherwise eligible for unemployment allowances under any other law. The court affirmed the Board's decision, emphasizing that SUA is not a substitute for minimum wage law or an economic floor, and eligibility under State law disqualifies one from SUA benefits.

Unemployment BenefitsFederal Special Unemployment Assistance ProgramEligibility CriteriaNew York State Labor LawCovered EmploymentUncovered EmploymentUnemployment Insurance Appeal BoardIndustrial CommissionerAppellate ReviewStatutory Interpretation
References
2
Case No. MISSING
Regular Panel Decision
Oct 26, 1982

In re the Claim of Peat

The claimant appealed a decision by the Unemployment Insurance Appeal Board, which affirmed a reduction in her unemployment benefits. The reduction was made under Labor Law § 600(7) due to her receipt of Social Security benefits. The court, citing precedents Matter of Cullen and Rivera v Patino, ruled that Social Security benefits derived from a non-base period employer should not offset unemployment benefits from a different base period employer. As the claimant's Social Security benefits vested from prior employment, the board's decision to reduce her unemployment rate was reversed. The case was remitted to the Unemployment Insurance Appeal Board for further proceedings.

Unemployment BenefitsSocial Security OffsetLabor Law 600(7)Benefit Rate ReductionPrior EmploymentBase Period EmployerAdministrative AppealRemittitur
References
2
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