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

Case No. 05-01158
Regular Panel Decision

In Re ACE Elevator Co., Inc.

The Trustees of the National Elevator Industry Benefit Plans sought administrative priority for delinquent contributions from A.C.E. Elevator Co., Inc. (ACE), based on various sections of the Bankruptcy Code. The court denied administrative priority for most claims, including those under 11 U.S.C. §§ 503(b)(1)(A), 507(a)(1), and 1113(f), reasoning that the contributions were for prepetition work and that section 1113(f) does not create super-priority. However, the motion was partially granted under 11 U.S.C. § 1114(e) for Welfare Plan contributions, recognizing them as retiree benefits despite their prepetition nature, but requiring further information on the exact allocation to retirees. Claims for interest, liquidated damages, and attorney's fees were denied priority, as was ACE's request for costs. This decision underscores the careful interpretation of priority schemes within bankruptcy law.

Bankruptcy LawAdministrative PriorityEmployee BenefitsPension PlansWelfare PlansCollective Bargaining AgreementsDebtor-in-PossessionRetiree Benefits Bankruptcy Protection ActPrepetition ClaimsPostpetition Claims
References
27
Case No. MISSING
Regular Panel Decision
Jan 15, 1988

Pension Benefit Guaranty Corp. v. LTV Corp.

David H. Miller and William W. Shaffer ("Miller and Shaffer") moved to intervene individually and as representatives of participants in the Jones & Laughlin Retirement Plan in an action filed by the Pension Benefit Guaranty Corporation (PBGC) against LTV Corporation and LTV Steel Company ("LTV"). LTV did not object to individual intervention but opposed class action intervention, arguing it would delay the PBGC action. The court granted the motion, allowing Miller and Shaffer to intervene both individually and as class representatives. The decision emphasized that Miller and Shaffer met the minimal burden of showing that PBGC's representation might be inadequate, as their interests, seeking full plan benefits, could diverge from PBGC's role as plan administrator. This opinion allows the class action to proceed under Rule 23(e), preventing dismissal or compromise without court approval.

InterventionERISAPension PlansBankruptcyClass ActionRule 24Rule 23(e)Adequate RepresentationPlan TerminationRestoration
References
6
Case No. MISSING
Regular Panel Decision

Lyublinsky v. Barnhart

A 73-year-old disabled plaintiff, who has received Social Security Disability (SSD) benefits since 1993, brought this action to review the Commissioner's final determination concerning his benefit rate calculation. The plaintiff argued that his benefit rate was improperly calculated, citing discrepancies in earnings records and claims of discrimination. The case has a lengthy procedural history, including multiple remands from the District Court due to issues like denial of a fair hearing and lack of legal representation. The Court conducted a de novo review of the Social Security Administration's (SSA) benefit calculations, utilizing the Average Indexed Monthly Earnings (AIME) method, and found no mathematical errors. Ultimately, the plaintiff failed to present compelling evidence to disprove the SSA's records, which are considered conclusive after a statutory period. Consequently, the Commissioner's motion for judgment on the pleadings was granted, the complaint was dismissed, and the Administrative Law Judge's (ALJ) decision was affirmed.

Social Security DisabilityBenefit CalculationAIME MethodAdministrative Law JudgePro Se PlaintiffFederal Court ReviewEarnings RecordsBurden of ProofRemandJudgment on the Pleadings
References
3
Case No. MISSING
Regular Panel Decision

Protocare of Metropolitan N.Y., Inc. v. Mutual Ass'n Administrators, Inc.

Plaintiff Protocare of Metropolitan N.Y., Inc. brought an action against Mutual Association Administrators, Inc. and Neighborhood Cleaners Association Employees Benefit Plan alleging breach of contract and violation of ERISA. The claims arose after Chae Chun Im's medical benefits were denied due to false information provided on his application regarding a pre-existing stomach cancer condition. The court converted the defendants' motion to dismiss into a motion for summary judgment. The court granted the motion to dismiss the breach of contract claim, finding it preempted by ERISA and also lacking on the merits due to the plaintiff's misrepresentation. However, the court denied the motion to dismiss the ERISA claim concerning the plan administrator's failure to provide information, affirming Protocare's standing as an assignee beneficiary. Despite this, the court denied any statutory penalties against the administrator, citing the legal ambiguity surrounding assignee rights and the administrator's lack of bad faith.

ERISAPreemptionBreach of ContractSummary JudgmentStandingAssignee RightsBeneficiaryPlan AdministratorFiduciary DutyMedical Benefits
References
19
Case No. MISSING
Regular Panel Decision

Mejias v. Social Security Administration

Plaintiff seeks judicial review of a determination by the Secretary of Health, Education, and Welfare denying him Supplemental Security Income (SSI) benefits. The plaintiff's application, based on a disability claim stemming from bronchial asthma, was initially denied by an Administrative Law Judge in July 1976 and subsequently affirmed by the Appeals Council in December 1976. The court found that despite the plaintiff's subjective complaints of disability and submissions from medical social workers and treating physicians asserting a deterioration in his condition, the administrative record contained substantial evidence that his asthma responded to treatment and his symptoms were minimal. The court affirmed the Secretary's decision to deny SSI benefits, but dismissed the complaint without prejudice, allowing the plaintiff to present additional, substantiated medical evidence to the Social Security Administration.

Supplemental Security IncomeSSI BenefitsDisability ClaimBronchial AsthmaAdministrative ReviewJudicial ReviewSubstantial EvidenceTreating Physician OpinionSubjective SymptomsMedical Evidence
References
15
Case No. MISSING
Regular Panel Decision

Elias v. Apfel

Mounir Elias appealed a final administrative determination by the Social Security Administration Commissioner, denying his disability benefits application under the Social Security Act. Elias, who suffered from severe neck and back injuries from an auto accident, claimed disability since 1993. The Administrative Law Judge (ALJ) denied benefits, finding Elias could perform light work despite his impairments, a decision upheld by the Appeals Council. The District Court affirmed the Commissioner's decision, denying Elias's motion for judgment on the pleadings and granting the defendant's motion, concluding the ALJ's findings were supported by substantial evidence and that Elias received a fair hearing even without legal counsel, thus dismissing the complaint.

Social Security Disability BenefitsAdministrative ReviewDisability DeterminationSubstantial Evidence ReviewResidual Functional CapacityLight Work CapacityTreating Physician OpinionVocational ExpertPro Se ClaimantFederal Rules of Civil Procedure 12(c)
References
24
Case No. MISSING
Regular Panel Decision
Jun 22, 2011

Griffin v. Town of Dewitt

Claimant, a heavy truck mechanic, sustained a back injury requiring surgery in 2009. Despite returning to work without restrictions, he felt unable to perform his duties and retired in 2010, subsequently seeking lost time benefits. The employer and its third-party administrator argued that he had voluntarily withdrawn from the labor market. A Workers' Compensation Law Judge initially found a permanent partial disability but denied benefits due to voluntary withdrawal. However, the Workers' Compensation Board reversed this, finding an involuntary retirement and awarding continuing benefits. The employer and administrator appealed this decision. The Appellate Division affirmed the Board's decision, citing substantial evidence that the claimant's disability significantly contributed to his decision to retire and his ongoing wage loss, supported by his testimony and medical opinions.

Workers' CompensationInvoluntary RetirementPermanent Partial DisabilityLost Time BenefitsLabor Market WithdrawalBack InjuryDisability BenefitsAppellate ReviewMedical OpinionSocial Security Benefits
References
5
Case No. MISSING
Regular Panel Decision

In re Miceli

The claimant, a former software engineer for IBM, sought extended unemployment insurance benefits under the Temporary Extended Unemployment Compensation Act of 2002 (TEUC-A) after her initial benefits were exhausted. The Unemployment Insurance Appeal Board reversed an Administrative Law Judge's decision and denied her application, ruling she was ineligible. Eligibility for TEUC-A benefits requires that airline-related employment ended due to specific events like reductions in service caused by the September 11, 2001 terrorist attacks, airport closures, or the military conflict with Iraq. The court found no basis to disturb the Board’s decision, as the claimant failed to demonstrate that her layoff due to 'lack of work' was directly attributable to any of the qualifying airline-related events specified in TEUC-A. The court also noted that certain documents offered by the claimant to support her assertion were outside the administrative record. Accordingly, the decision of the Board was affirmed.

Unemployment InsuranceExtended Unemployment CompensationTEUC-AAirline-related WorkersSoftware EngineerLayoffSeptember 11 AttacksIraq WarEligibility CriteriaAdministrative Law Judge
References
1
Case No. MISSING
Regular Panel Decision

In re the Claims of Noss

Claimants, employees of Lawrence Aviation Industries, Inc. and union members, commenced a strike in 1984. During the strike, they received weekly strike benefits from their union and later unemployment insurance benefits. The employer challenged these benefits, arguing that strike benefits were contingent on performing union duties, making claimants not 'totally unemployed,' and alleged willful misrepresentation. Both the Administrative Law Judge and the Unemployment Insurance Appeal Board found that the strike benefits were not conditional and no misrepresentation occurred. The appellate court affirmed the Board's decision, emphasizing that strike benefits not conditioned on services are not considered remuneration under 12 NYCRR 490.2 (b) and that the Board's factual findings, supported by substantial evidence, should not be disturbed.

Unemployment BenefitsStrike BenefitsTotal UnemploymentWillful MisrepresentationLabor UnionAdministrative LawJudicial ReviewSubstantial EvidenceConditional PaymentsNew York Labor Law
References
4
Case No. MISSING
Regular Panel Decision

York v. Comm'r of Soc. Sec.

The plaintiff appealed the Commissioner of Social Security's denial of disability benefits. An Administrative Law Judge (ALJ) initially found the plaintiff not disabled, a decision affirmed by the Appeals Council. The plaintiff subsequently moved for judgment on the pleadings, requesting a remand for benefits or further administrative proceedings. The court found that the ALJ erred in evaluating the plaintiff's spinal impairments under Listing 1.04 and in assessing medical opinion evidence from Dr. Harbinder Toor. Consequently, the court granted the plaintiff's motion, denied the Commissioner's cross-motion, and remanded the case for further proceedings, including a reassessment of Listing 1.04 and reconsideration of Dr. Toor's opinion.

Disability BenefitsSocial Security ActALJ Decision ReviewRemandLumbar Spinal StenosisDegenerative Disc DiseaseMedical Opinion EvidenceResidual Functional Capacity (RFC)Vocational Expert TestimonyAppeals Council
References
7
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