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

Case No. MISSING
Regular Panel Decision

Normile v. Allstate Insurance

Chief Judge Cooke's dissenting opinion critiques the majority's interpretation of Insurance Law section 671 (subd 2, par [b]) regarding how collateral source payments affect an insurer's aggregate $50,000 liability for basic economic loss. The dissent argues that the majority's method, which allows insurers to reduce their total liability by these payments, leads to an incomplete recovery for injured parties, particularly when total losses exceed $50,000. Cooke proposes an alternative allocation where collateral source payments are first applied to cover losses beyond the $50,000 basic economic loss threshold. This approach, he contends, ensures that insurers pay the full $50,000 in first-party benefits and only take credit for collateral sources that would otherwise result in a double recovery within the basic economic loss limit, or for amounts exceeding the $50,000 threshold. The dissenting judge asserts that the Legislature did not intend to create such an inequity, where injured individuals are left with less than full compensation while insurers avoid their primary obligation.

Insurance Law InterpretationBasic Economic LossCollateral Source PaymentsNo-Fault InsuranceWorkers' Compensation BenefitsSocial Security Disability BenefitsDissenting OpinionAggregate LiabilityFirst-Party BenefitsDouble Recovery
References
2
Case No. MISSING
Regular Panel Decision

Hyde v. North River Insurance

This case examines whether an insurance carrier, having paid no-fault benefits, can assert a lien against a judgment recovered by its insured for pain, suffering, and future economic loss. The plaintiff, an injured insured, received $50,000 in no-fault benefits from North River Insurance Company. In a subsequent tort action against the County of Rensselaer, the plaintiff secured a $1,000,000 verdict. The insurance company filed a lien against this judgment. The Special Term and appellate courts affirmed that the lien was invalid because the jury's verdict explicitly excluded basic economic loss, thereby preventing a double recovery. The decision clarifies that liens are only enforceable against recoveries that duplicate previously paid basic economic losses.

No-Fault BenefitsInsurance LienSummary Judgment AppealPersonal Injury CompensationBasic Economic LossNon-Economic LossPain and Suffering DamagesDouble Recovery PreventionStatutory LienAutomobile Accident
References
12
Case No. MISSING
Regular Panel Decision

Ortiz v. Queens Transit Corp.

This case addresses whether a plaintiff in a negligence action can recover for basic economic loss from a third-party tort-feasor when a worker's compensation carrier has asserted a lien against the judgment proceeds. The Court reverses an order granting a new trial, holding that the plaintiff may not recover for basic economic loss from the third-party tort-feasor under these circumstances. Referencing Grello v Daszykowski, the court clarifies that if the workers' compensation carrier executes on its lien, the no-fault carrier must bear the loss, implying the plaintiff should seek recourse from the no-fault carrier rather than the third party for basic economic loss. This decision reiterates that subdivision 1 of section 673 of the Insurance Law prohibits recovery for basic economic loss from a covered third-party tort-feasor.

negligencethird-party liabilityworkers' compensationinsurance lawno-fault benefitsstatutory interpretationlieneconomic losstort-feasorappellate review
References
3
Case No. 11-19-00123-CV
Regular Panel Decision
Apr 08, 2021

Pedro De La Rosa and Angelina De La Rosa v. Basic Energy Services, L.P., by and Through Its General Partner, Basic Energy Services GP, LLC

Pedro and Angelina De La Rosa appealed a trial court's order granting a plea to the jurisdiction filed by Basic Energy Services, L.P. and Basic Energy Services GP, LLC. The De La Rosas alleged intentional injuries to Pedro during a work-related truck accident and subsequent medical interference, plus Angelina's loss of consortium. The Eleventh Court of Appeals determined that the Appellants' claims fell under the intentional-injury exception to the Texas Workers’ Compensation Act, thereby establishing subject-matter jurisdiction. The court also clarified that election of remedies is an affirmative defense, not a jurisdictional bar. Consequently, the appellate court reversed the trial court's order and remanded the case for further proceedings.

Intentional InjuryWorkers Compensation ActSubject Matter JurisdictionPlea to JurisdictionExclusive RemedyElection of RemediesTruck AccidentEmployer LiabilityMedical InterferenceLoss of Consortium
References
33
Case No. MISSING
Regular Panel Decision

Austin v. Meade

This negligence action arose from an automobile accident where the defendant conceded liability, and a jury awarded the plaintiff damages for lost earnings, future medical expenses, future loss of earnings, and pain and suffering. A dispute arose regarding the reduction of the verdict due to the prohibition against recovering basic economic loss under Insurance Law § 5104 (a). The Supreme Court initially reduced the verdict by the amount the plaintiff received from other sources for lost wages ($38,977.94). On appeal, the court clarified that the proper methodology involves calculating the plaintiff's basic economic loss (including medical expenses and a portion of lost earnings) and reducing the verdict accordingly. The appellate court modified the judgment, ruling that the verdict should be reduced by $42,967.10, representing basic economic loss for lost earnings, and affirmed the judgment as so modified, resulting in a final judgment for the plaintiff of $265,905.70.

NegligenceAutomobile AccidentDamagesLost EarningsMedical ExpensesBasic Economic LossInsurance LawVerdict ReductionCollateral Source RuleAppellate Review
References
6
Case No. MISSING
Regular Panel Decision

State Farm Mutual Automobile Insurance Co. v. Pender

This case involves a subrogation action initiated by an unnamed plaintiff (subrogee) to recover $15,200 in additional personal injury protection (APIP) benefits paid to its subrogor, Darci Plumbing Co., Inc., for an employee, Kareem Atkins. The defendants moved to dismiss the complaint based on documentary evidence, collateral estoppel, and res judicata, arguing that a prior Workers’ Compensation Board decision from November 24, 2008, which awarded Atkins basic economic loss benefits, was determinative. The plaintiff cross-moved for sanctions. The court found that APIP benefits, defined by 11 NYCRR 65-1.3, are distinct from statutory basic economic loss benefits and that an insured's subrogation rights for APIP are equitable, existing under common law. Therefore, the workers' compensation award was not res judicata, and the plaintiff was not precluded from asserting its subrogation rights for amounts paid in addition to the statutory basic economic loss. Consequently, the defendants' motion to dismiss was denied, and the plaintiff's cross-motion for sanctions was also denied.

SubrogationAPIP BenefitsPersonal Injury ProtectionWorkers' CompensationCollateral EstoppelRes JudicataMotion to DismissSanctionsNo-Fault LawInsurance Law
References
1
Case No. 2023 NY Slip Op 03113 [217 AD3d 1382]
Regular Panel Decision
Jun 09, 2023

Sywak v. Grande

Plaintiff William M. Sywak commenced an action seeking damages for injuries allegedly sustained in a motor vehicle accident, naming Barbara Grande and Joseph D. Dwyer and Robert D. Dwyer (Dwyer defendants) as parties. Plaintiff alleged serious injuries under various categories of Insurance Law § 5102 (d) and claimed economic loss beyond basic economic loss. The Supreme Court partially granted the defendants' motion for summary judgment, dismissing some serious injury claims but preserving others, including those for lumbar spine injuries. On appeal by the Dwyer defendants, the Appellate Division, Fourth Department, modified the Supreme Court's order. The appellate court granted the Dwyer defendants' motion to dismiss claims related to plaintiff's cervical spine, left hip, left arm, left shoulder, and left leg injuries under Insurance Law § 5102 (d), and also dismissed the claim for economic loss in excess of basic economic loss, noting plaintiff's prior unemployment due to a workers' compensation accident. However, the Appellate Division affirmed the denial of the motion regarding plaintiff's lumbar spine injury under the permanent consequential limitation of use and significant limitation of use categories, finding a triable issue of fact.

Motor Vehicle AccidentSerious InjuryInsurance LawSummary JudgmentAppellate DivisionCervical Spine InjuryLumbar Spine InjuryPermanent Consequential Limitation of UseSignificant Limitation of Use90/180-Day Category
References
17
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. MISSING
Regular Panel Decision

Soriano v. Martin

In this automobile accident case, defendants conceded liability, and a jury awarded the plaintiff $20,000 for past pain and suffering and $5,000 for lost earnings. Following the verdict, defendants moved to strike the lost earnings award, arguing that under the No-Fault Law, basic economic loss cannot be recovered in a plenary action between covered persons. The court ruled that the plaintiff's eligibility for workers' compensation benefits did not exempt him from the No-Fault Law's prohibition. Consequently, the court granted the defendants' motion and struck the $5,000 jury award for lost earnings, affirming that basic economic loss up to $50,000 is not recoverable in such a tort action.

No-Fault Lawautomobile accidentlost earningsbasic economic losstort actionworkers' compensationserious injurycollateral source ruleinsurance lawjury verdict
References
7
Case No. MISSING
Regular Panel Decision

Barnhart v. Branch Motor Lines, Inc.

This case addresses motions regarding jury verdicts in a personal injury trial where liability was conceded, focusing on damages and the application of "no-fault" insurance law limitations on "basic economic loss" recovery. Plaintiff Leon Barnhart sustained injuries from two accidents, with the second deemed a consequence of the first. The court determined how to calculate deductions for basic economic loss from lost wages and medical expenses, specifically forgoing deductions for lost wages after the initial three-year period following the first accident. Both plaintiffs' and defendants' motions to set aside the verdicts were denied, resulting in judgments awarded to Leon Barnhart for $125,183.30 and Nora Barnhart for $10,000.

No-fault InsuranceBasic Economic LossPersonal InjuryDamages CalculationLost WagesMedical ExpensesConsequential InjuryInsurance LawJury VerdictsMotion Practice
References
9
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