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

Case No. B167017
Significant
Nov 18, 2004

General Casualty Insurance and Regent Insurance, Joseph A. Lane, American Home Assurance Company vs. Workers' Compensation Appeals Board and California Insurance Guarantee Association

The court has requested responses from the Workers' Compensation Insurance Rating Bureau (WCIRB) and the California Insurance Commissioner regarding the exclusion of special employees from a special employer's workers' compensation policy, specifically questioning the use and requirements of Form No. 11 for this purpose.

WCIRBForm No. 11limiting endorsementsrestricting endorsementsspecial employeesgeneral employerstemporary employeesleased employeesInsurance CommissionerCalifornia Code of Regulations
References
1
Case No. MISSING
Regular Panel Decision
Jun 11, 1993

Empire Insurance v. Workers' Compensation Board

Empire Insurance Company denied Hugh Wofsy's no-fault benefits claim, alleging he was a Dial-a-Car, Inc. employee requiring Workers' Compensation. An Administrative Law Judge later found Wofsy an independent contractor, denying him Workers' Compensation. Empire sought to reopen the Workers' Compensation claim to participate, which the Board denied. Empire then initiated a CPLR article 78 proceeding, where the IAS Court allowed the reopening and ordered Empire to pay Wofsy, with potential reimbursement. The Appellate Division subsequently reversed this judgment, dismissing Empire's petition, emphasizing that Workers' Compensation Law § 23 vests exclusive appeal jurisdiction with the Third Department and precludes article 78 proceedings for reviewing Board decisions' substance.

No-fault insuranceIndependent contractor disputeEmployee status determinationCPLR Article 78 proceedingAppellate Division jurisdictionWorkers' Compensation Law § 23Judicial review of administrative decisionsInsurance coverage disputeAdministrative Law Judge rulingReimbursement claim
References
2
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. 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. 2017 NY Slip Op 08595 [156 AD3d 1043]
Regular Panel Decision
Dec 07, 2017

New York State Workers' Compensation Board v. Any-Time Home Care Inc.

The New York State Workers' Compensation Board, acting as administrator for a dissolved self-insured trust, initiated an action to recover a $133 million cumulative deficit from former trust members. Various defendants sought to dismiss the complaint, asserting claims were time-barred by a three-year statute of limitations for statutory liabilities, failed to adequately state claims against individual partners, and were barred by the doctrine of laches. The Supreme Court denied these motions. On appeal, the Appellate Division, Third Department, affirmed the Supreme Court's order, ruling that the claims were contractual, subject to a six-year limitation period, and that laches did not apply against the state enforcing a public right. The court also found the complaint sufficiently specific regarding the liability of individual defendants.

Workers' Compensation LawSelf-Insurance TrustJoint and Several LiabilityStatute of LimitationsContractual LiabilityLaches DoctrineAppellate ReviewGroup Self-InsurerDeficit RecoveryPartnership Liability
References
16
Case No. MISSING
Regular Panel Decision

Claim of Cruz v. City of New York Department of Children's Services

Claimant, injured in an automobile accident while working, received workers' compensation benefits and later settled a third-party action. A Workers’ Compensation Law Judge (WCLJ) and the Workers’ Compensation Board ruled that the self-insured employer was not entitled to offset the third-party settlement against a schedule loss of use (SLU) award, even for the portion initially designated as temporary total disability. The employer appealed, arguing the offset was permissible because the weekly award exceeded statutory thresholds for basic economic loss. However, the court affirmed the Board's decision, clarifying that a schedule loss of use award is not allocable to any specific period of disability and thus is not subject to offset under Workers’ Compensation Law § 29 against first-party benefits, regardless of initial labeling or monthly rate.

Schedule Loss of Use Award OffsetThird-Party SettlementTemporary Total DisabilityPermanent Partial DisabilityBasic Economic LossNo-Fault LawInsurance LawStatutory InterpretationWorkers' Compensation Law § 29Appellate Division
References
6
Case No. 2018 NY Slip Op 08227
Regular Panel Decision
Nov 29, 2018

Matter of Kelly v. New York State Workers' Compensation Bd.

In 2006, claimant Grace Kelly established a workers' compensation claim for an occupational disease. The State Insurance Fund (SIF) repeatedly sought to transfer liability to the Special Fund for Reopened Cases, which was denied by Workers' Compensation Law Judges. The Workers' Compensation Board affirmed these denials and assessed $500 penalties against both SIF and its counsel, Walsh and Hacker, for filing an application for review without reasonable grounds. Walsh and Hacker appealed the penalty imposed against them to the Appellate Division, Third Department. The Appellate Division found insufficient evidence to support the Board's finding that Walsh and Hacker's application lacked reasonable grounds, and therefore reversed the penalty against them, modifying and affirming the Board's decision.

PenaltiesAppellate ReviewSpecial Fund for Reopened CasesWorkers' Compensation Law § 25-aWorkers' Compensation Law § 114-aAttorney SanctionsAdministrative LawBoard DecisionJudiciary Law § 431
References
4
Case No. MISSING
Regular Panel Decision
Sep 15, 2011

Colortone Camera, Inc. v. New York State Compensation Insurance Rating Board

Colortone Camera, Inc. challenged the reclassification of its employees from Workers' Compensation Classification Code 8017 to 8018, which resulted in significantly increased insurance rates. The company's appeal to the Superintendent of Insurance, affirming the New York State Compensation Insurance Rating Board's determination, was reviewed in this hybrid CPLR article 78 proceeding. The court confirmed the Superintendent's determination, finding it supported by substantial evidence that Colortone's business was primarily wholesale. Additionally, Colortone sought a declaratory judgment that portions of the Workers Compensation & Employers Liability Insurance Manual were unconstitutional for vagueness. This aspect of the case was remitted to the Supreme Court, Westchester County, for severance and further proceedings, as it was not properly before the appellate court.

Workers' CompensationInsurance RatesBusiness ReclassificationAdministrative ReviewJudicial ReviewCPLR Article 78Declaratory JudgmentConstitutional LawVagueness ChallengeSubstantial Evidence
References
8
Case No. MISSING
Regular Panel Decision

Nuara v. State of New York Workers' Compensation Board

Petitioners, two terminated group self-insured trusts (GSITs), challenged monetary assessments levied against them by the New York State Workers' Compensation Board and its chairman. The assessments were imposed pursuant to various sections of the Workers’ Compensation Law, utilizing a "pure premium calculation" method established by 2007 amendments. The court considered new 2008 legislation that further amended the calculation method for ceased self-insurers but declined to apply it retroactively. Ultimately, the court found the Board's interpretation of "the preceding year" in its pure premium calculation for terminated GSITs to be unreasonable and contrary to the clear statutory language. Consequently, the levied assessments were annulled and vacated.

Group Self-Insured TrustsMonetary AssessmentsStatutory InterpretationRetroactive ApplicationPure Premium CalculationAdministrative LawCPLR Article 78Legislative IntentStatutory ConstructionSelf-Insurance Liabilities
References
19
Case No. 2017 NY Slip Op 08244
Regular Panel Decision
Nov 22, 2017

Matter of New York State Workers' Compensation Bd. v. Murray Bresky Consultants, Ltd

This appeal concerns the allocation of settlement proceeds from a defunct group self-insured trust. The New York State Workers' Compensation Board, as administrator of the Manufacturing Self Insurance Trust Fund, sought judicial apportionment of settlement funds recovered from third parties. Murray Bresky Consultants, Ltd, a former member of the trust, objected to the Board receiving all proceeds and asserted a counterclaim for its share and an accounting. The Supreme Court granted the Board all proceeds and dismissed Murray Bresky's objections. The Appellate Division modified this decision, ruling that Murray Bresky was entitled to share in the jointly-recovered settlement proceeds and that the Board must file a verified accounting, remitting the matter for further proceedings.

Workers' Compensation LawSelf-Insurance TrustSettlement ProceedsJudicial ApportionmentVerified AccountingCPLR Article 77Contractual InterpretationTrust DeficitAppellate ReviewFiduciary Duty
References
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