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

Case No. 2024 NY Slip Op 00599 [224 AD3d 428]
Regular Panel Decision
Feb 06, 2024

Matter of New Millennium Pain & Spine Medicine, P.C. v. Garrison Prop. & Cas. Ins. Co.

This case involves two appeals by New Millennium Pain & Spine Medicine, P.C. against Garrison Property & Casualty Insurance Company and GEICO Casualty Company. New Millennium sought to vacate master arbitration awards that denied its claims for no-fault benefits for medical services. The Supreme Court denied these applications. The Appellate Division, First Department, affirmed the Supreme Court's decisions, stating that an arbitrator's award will not be set aside unless it is irrational. The court also addressed the argument regarding a 20% wage offset in no-fault benefits, finding it unavailing under Insurance Law § 5102 (b). Ultimately, New Millennium was not entitled to attorneys' fees as it was not the prevailing party.

No-fault benefitsarbitration awardvacaturinsurance lawwage offsetappellate reviewmedical servicesno-fault policy exhaustionattorneys' feesCPLR Article 75
References
8
Case No. ADJ7924562
Regular
Sep 19, 2014

RAUL HERNANDEZ vs. LOS ANGELES UNIFIED SCHOOL DISTRICT

The applicant sought reconsideration of a WCJ decision that found an industrial injury to the low back but not the cervical spine or left ankle, with no permanent disability or further medical treatment. The applicant argued the QME's reports were insubstantial and that prior permanent disability was not considered. The Appeals Board granted reconsideration to amend the original award to include injury to the cervical spine, affirming the remainder of the decision. Therefore, the applicant sustained injury to his low back and cervical spine.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryLow Back InjuryCervical Spine InjuryPermanent DisabilityFurther Medical TreatmentPanel Qualified Medical EvaluatorLabor Code Section 4664(b)
References
0
Case No. MISSING
Regular Panel Decision

Claim of Steuber v. Home Properties, Inc.

Claimant applied for workers' compensation benefits after a March 2010 work fall, establishing injuries to his back, left knee, and left hip. After thoracic spine surgery in 2011, the employer and its workers' compensation carrier objected to coverage, arguing it was not causally connected to the initial claim. The Workers’ Compensation Board agreed, a decision which the appellate court affirmed. The court credited an independent medical examiner's opinion that the thoracic condition and subsequent falls were unrelated to the compensable accident, despite the claimant's orthopedic surgeon's testimony suggesting otherwise.

Workers' Compensation BenefitsCausal RelationThoracic Spine InjuryDegenerative ConditionIndependent Medical ExaminationSubsequent FallsBoard DecisionAppellate ReviewCredibility AssessmentSubstantial Evidence
References
3
Case No. MISSING
Regular Panel Decision

Claim of Fonda v. Norton Co.

Claimant suffered serious injuries to his right leg, hip, and spine in February 1988, necessitating two laminectomies for a herniated disc. The employer and its insurer challenged the Workers’ Compensation Board's determination that the claimant's permanent disability resulted solely from his back injury, arguing that a preexisting dormant heart condition contributed. The court affirmed the Board's decision, finding substantial evidence that the claimant's disability was not materially or substantially greater due to the heart condition. The Board's prerogative to resolve conflicting medical opinions was upheld. Furthermore, the court found the employer's argument regarding a contractually based reimbursement claim could not be raised for the first time on appeal, as it was not addressed administratively.

Workers' CompensationBack InjuryPreexisting ConditionHeart ConditionDisabilityLaminectomyCausationMedical EvidenceFactual DisputeAppellate Review
References
2
Case No. MISSING
Regular Panel Decision
Aug 07, 1984

Murtaugh v. Bankers Trust Co.

In November 1978, claimant Murtaugh filed a discrimination claim against Bankers Trust Company of Albany, N. A. following her 1977 dismissal, citing Workers’ Compensation Law § 241. The Workers’ Compensation Board affirmed a discrimination finding, which was subsequently upheld by the Appellate Division. An administrative law judge directed Murtaugh's reinstatement and awarded back wages from January 1, 1978, to October 19, 1982, with an offset for unemployment benefits. The Bank appealed this decision, contending the back pay award was unauthorized under Workers’ Compensation Law § 120, arguing Murtaugh failed to accept reemployment or mitigate damages. The court found substantial evidence that no bona fide reemployment offer was made and that the issue of mitigation of damages was not properly raised. Consequently, the court affirmed the Board's decision, upholding Murtaugh's entitlement to back pay.

Workers' Compensation LawDiscriminationBack Pay AwardReinstatementMitigation of DamagesUnemployment BenefitsOffer of ReemploymentAppellate DivisionNew York LawEmployer Liability
References
4
Case No. ADJ8883423; ADJ11327965
Regular
Feb 21, 2023

MICKEY THORNTON vs. NORTHWEST LINEMAN COLLEGE/GRID TRAINING CORPORATION, ALASKA NATIONAL INSURANCE COMPANY, LASSEN MUNICIPAL UTILITY DISTRICT, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration to review the finding of "new and further disability" to the applicant's low back stemming from a 2013 cervical spine injury. The Board found the current medical evidence insufficient to establish a causal link between the 2013 injury and the low back condition. Therefore, the issue of new and further low back disability is deferred for further development of the record with substantial medical evidence. The Board stressed its duty to ensure substantial justice by not leaving undeveloped matters.

New and further disabilityReconsiderationStipulated awardAgreed medical evaluatorSubstantial evidenceMedical opinionRecord developmentCervical spineLow back injuryApportionment
References
5
Case No. MISSING
Regular Panel Decision

Claim of Porter v. New York State Electric & Gas Corp.

The claimant, who sustained head, neck, and back injuries in 2004, had a workers' compensation case established for occupational disease, with 22.5% liability for neck and back injuries apportioned to the incident. After experiencing continued back problems and being diagnosed with severe biforaminal stenosis, the Chair authorized an MRI in 2010 and lumbar spine surgery in 2011. The workers’ compensation carrier sought to transfer liability to the Special Fund for Reopened Cases under Workers' Compensation Law § 25-a, a request initially denied by a WCLJ but granted by the Board, which found the April 27, 2011 order authorizing surgery constituted a 'true closing' of the case. The Special Fund appealed the Board's decision, arguing against the transfer of liability. The appellate court affirmed the Board's decision, concluding that substantial evidence supported the finding that the case was truly closed, thereby shifting liability to the Special Fund.

Workers' Compensation Law § 25-aSpecial Fund for Reopened CasesLiability ShiftClosed CaseTrue ClosingMedical AuthorizationLumbar Spine SurgeryCervical Spine MRIOccupational DiseaseApportionment
References
8
Case No. 526688
Regular Panel Decision
Dec 27, 2018

Matter of Bufearon v. City of Rochester Bur. of Empl. Relations

Claimant Kamren Bufearon sustained work-related injuries in a motor vehicle collision on March 4, 2016, for which his workers' compensation claim was established for injuries to his left shoulder, left hip, and lower back. Subsequently, he sought to amend his claim to include a causally-related cervical spine injury, which was initially approved by a Workers' Compensation Law Judge. However, the Workers' Compensation Board reversed this decision, finding that the claimant failed to sufficiently demonstrate a causal relationship between his cervical spine condition and the March 4, 2016 incident. The Appellate Division affirmed the Board's decision, noting that the medical testimony from two physicians contained conflicting findings and equivocal narratives regarding causation. The court concluded that the Board was entitled to reject the physicians' opinions as speculative, particularly since neither physician had reviewed the claimant's prior medical records for a pre-existing cervical spine fusion surgery.

Cervical spine injuryCausal relationshipMedical evidenceSubstantial evidence reviewAppellate DivisionWorkers' Compensation BoardPre-existing conditionCredibility of physiciansBurden of proofMotor vehicle accident
References
13
Case No. MISSING
Regular Panel Decision

Claim of Neal v. Blue Circle Cement

The claimant, a laborer, suffered a compensable back injury in November 1998 and returned to work after eight months. In January 2002, he sustained another back injury. A Workers’ Compensation Law Judge determined that the January 2002 injury was an aggravation of the prior 1998 injury, assigned disability levels from January 2002 to April 2003, and found no compensable lost time thereafter. The Workers’ Compensation Board affirmed this decision. The Appellate Division found substantial evidence, including medical testimony and MRI comparisons, to support the Board’s determination regarding the aggravation of the injury and the disability levels. The court also upheld the Board's prerogative to resolve conflicting medical evidence and make credibility determinations, particularly in light of evidence that the claimant exaggerated his symptoms.

Workers' CompensationBack InjuryAggravation of InjuryDisability LevelsMedical EvidenceCredibility AssessmentEmployer LiabilityJudicial ReviewAppellate DivisionAdministrative Law
References
4
Case No. No. 84
Regular Panel Decision
Dec 22, 2020

Deutsche Bank National Trust Company v. Morgan Stanley Mortgage Capital Holdings

The New York Court of Appeals reversed an Appellate Division order, reinstating the Supreme Court's decision in a residential mortgage-backed securities (RMBS) put-back action. The core issue was whether allegations of gross negligence could render a contractual "sole remedy provision" unenforceable, allowing for broader compensatory and punitive damages. The Court held that the public policy exception for gross negligence only applies to exculpatory or nominal damages clauses, not to contractual limitations on remedies that provide for more than nominal relief and are intended to make the injured party whole. It found the sole remedy provision (cure or repurchase of defective loans) to be neither exculpatory nor nominal. Additionally, claims for punitive damages and attorneys' fees were dismissed, as no independent tort was established for punitive damages and the contract did not clearly authorize attorneys' fees.

RMBS litigationcontractual limitationsgross negligencesole remedyexculpatory clausenominal damagesbreach of contractpublic policypunitive damagesattorneys' fees
References
42
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