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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

Claim of Foti-Crawford v. Buffalo General Hospital

A registered nurse sustained a back injury in July 1991 while concurrently employed by Buffalo General Hospital and Supplemental Health Care, leading to permanent partial disability. The Workers’ Compensation Board awarded benefits of $153.36 per week and ruled that the Special Disability Fund should reimburse the hospital's carrier for most of these benefits under Workers’ Compensation Law § 14 (6). The Fund appealed, contending that reimbursement was unwarranted as the benefits did not exceed the maximum amount the hospital would have paid without concurrent employment. The court affirmed the Board's decision, finding its interpretation rational, especially given the claimant returned to work for the primary employer.

Workers' CompensationConcurrent EmploymentSpecial Disability FundReimbursementPermanent Partial DisabilityAverage Weekly WageAppellate ReviewBack InjuryNurseWorkers' Compensation Law
References
2
Case No. MISSING
Regular Panel Decision

Claim of Sciame v. Airborne Express, Inc.

This case addresses the application of Workers’ Compensation Law § 15 (6) (a) concerning the maximum weekly benefits a claimant can receive for concurrent schedule and nonschedule awards. The court reaffirms its established precedent that these concurrent payments cannot exceed the statutory cap of $400 per week for 2004 injuries, irrespective of whether the nonschedule award stems from a permanent disability. This principle was also extended to include periodic payments for a schedule loss of use award and nonschedule award payments for temporary disability. The court concluded that the 2009 amendments to Workers’ Compensation Law §§ 15 and 25 did not indicate legislative intent to overturn this longstanding cap. Consequently, the Board's decision, which held that the claimant's receipt of maximum weekly benefits from a nonschedule award precluded additional benefits from a schedule loss of use award, was affirmed.

Workers' Compensation BenefitsBenefit MaximumsConcurrent AwardsSchedule Loss of Use AwardNonschedule AwardStatutory CapJudicial Precedent AffirmationWorkers' Compensation Law Interpretation2009 Amendments AnalysisPermanent Disability Benefits
References
11
Case No. MISSING
Regular Panel Decision

Claim of Hope v. Warren County Board of Elections

This case involves an appeal by a workers' compensation carrier regarding the calculation of a claimant's average weekly wage based on concurrent employment. The claimant, injured on November 3, 2009, had employment as a polling inspector and concurrently with a retail store. A Workers’ Compensation Law Judge (WCLJ) and subsequently the Workers’ Compensation Board calculated the claimant's average weekly wage based on both employments, totaling $80.69, and directed the carrier to continue awards. The carrier appealed, arguing that awards should only be based on the primary employment wage of $3.56 due to the inability to seek reimbursement from the Special Disability Fund for concurrent employment amounts following 2007 amendments to Workers’ Compensation Law § 14 (6). The Appellate Court affirmed the Board's decision, interpreting the statutory language to mean that primary employers are liable for benefits calculated on combined average weekly wages, and the 2007 amendments did not intend to reduce benefits for injured workers.

Concurrent Employment BenefitsAverage Weekly Wage CalculationSpecial Disability Fund ClosureWorkers' Compensation Law § 14(6)Statutory Amendment ImpactEmployer Liability LimitsTemporary Total DisabilityTemporary Partial DisabilityAppellate Review of WCABLegislative Purpose Analysis
References
5
Case No. MISSING
Regular Panel Decision
Jun 16, 2006

Fortis Benefits v. Cantu

Vanessa Cantu suffered severe injuries in a car accident and sued multiple parties. Her medical insurer, Fortis Benefits, intervened, seeking subrogation for medical benefits paid under the policy. After Cantu settled with the defendants, Fortis pursued recovery from Cantu. Cantu argued that the equitable "made whole" doctrine barred Fortis's claim because her total losses exceeded the settlement amount plus the benefits Fortis paid. The trial court and court of appeals sided with Cantu. The Texas Supreme Court reversed, holding that the "made whole" doctrine does not override an insurer's clear contractual subrogation rights. The Court affirmed the dismissal of Fortis's claims against Ford due to a pretrial agreement.

Insurance SubrogationMade Whole DoctrineContractual SubrogationEquitable SubrogationERISATexas LawInsurance Policy InterpretationPersonal InjuryAutomobile AccidentSettlement Proceeds
References
28
Case No. MISSING
Regular Panel Decision
Feb 02, 1984

Krebbeks v. Regan

Petitioner, the widow of a Department of Transportation employee, applied for accidental death benefits after her husband's service-connected death in July 1981. Although her application for accidental death benefits was approved, these benefits were entirely offset by workers' compensation payments, leaving her with no current payments from the State Employees’ Retirement System. Subsequently, petitioner sought a lump-sum ordinary death benefit, which was denied because she was deemed eligible for accidental death benefits, even if offset. This appeal ensued after the denial of her application by a hearing officer and Special Term's concurrence. The court affirmed the denial, citing Retirement and Social Security Law § 60 (a) (3), which states an ordinary death benefit is not payable if an accidental death benefit is payable, with a narrow exception not applicable here.

Accidental Death BenefitsOrdinary Death BenefitsWorkers' Compensation OffsetRetirement and Social Security LawStatutory InterpretationDeath Benefits EligibilityPublic Employee BenefitsAdministrative Law AppealDeath Benefit Offset
References
2
Case No. MISSING
Regular Panel Decision
Feb 22, 1984

Barnhardt v. Hudson Valley District Council of Carpenters Benefit Funds

The plaintiff, injured in May 1978 during maintenance work, was denied workers' compensation due to the absence of an employer-employee relationship. Subsequently, he sought reimbursement for medical expenses from the Hudson Valley District Council of Carpenters Benefit Funds (Benefit Funds) through a union insurance policy. Continental Assurance Company (Continental), Benefit Funds' insurer, rejected the claim, citing an employment-related injury exclusion in the policy. The plaintiff then initiated an action against Benefit Funds, which in turn filed a third-party action against Continental seeking indemnification. Continental's motion for summary judgment, asserting the exclusion, was denied by the County Court. The appellate court affirmed this denial, ruling that the exclusionary language was ambiguous and applied only in cases where a clear employer-employee relationship existed, a fact still to be determined.

Insurance Policy InterpretationEmployment StatusWorkers' Compensation ExclusionSummary Judgment MotionContractual AmbiguityGroup Health InsuranceMedical Expense ReimbursementThird-Party ActionAppellate ReviewEmployer-Employee Relationship
References
10
Case No. MISSING
Regular Panel Decision

Cook v. Pension Benefit Guarantee Corp.

The Trustees of the Local 852 General Warehouseman’s Union Pension Fund sued the Pension Benefit Guarantee Corporation (PBGC) seeking reimbursement for pension benefits paid to retirees of two closed warehouses. The Fund argued for recovery based on equitable estoppel, asserting detrimental reliance on an initial PBGC determination that it would guarantee these benefits. The PBGC moved for summary judgment, contending that estoppel against a federal agency requires a showing of affirmative misconduct or manifest injustice. The Court found no evidence of affirmative misconduct by the PBGC and concluded that its change in determination, made to conform with Congressional intent, did not constitute manifest injustice. Consequently, the Court granted the PBGC's motion for summary judgment, ruling that equitable estoppel was inapplicable.

Equitable EstoppelFederal Agency EstoppelSummary JudgmentERISAPension BenefitsMulti-employer PlanPension Benefit Guarantee Corporation (PBGC)Affirmative MisconductManifest InjusticeDetrimental Reliance
References
10
Case No. Civ. A. No. 3:93-CV-0171-G.
Regular Panel Decision
Aug 31, 1993

Mills v. INJURY BENEFITS PLAN OF SCHEPPS-FOREMOST

Walter Mills was injured during his employment and sought benefits under his employer's Injury Benefits Plan. He subsequently filed a civil action alleging wrongful termination in retaliation for filing a workers' compensation claim under Texas law. Defendants removed the case to federal court, asserting ERISA preemption. The court granted the defendants' motion to dismiss Mills' claims against the Injury Benefits Plan, finding them preempted by ERISA. However, the court denied the dismissal of Mills' state law claims against Schepps-Foremost, Inc., d/b/a Oak Farms Dairies. Ultimately, the court remanded the remaining state law claims against Schepps-Foremost, Inc. to the County Court at Law Number 5 of Dallas County, Texas, due to a lack of federal subject matter jurisdiction.

ERISA preemptionWorkers' CompensationRetaliatory dischargeTexas lawFederal jurisdictionMotion to dismissRemandEmployee benefitsCivil procedureDallas County
References
18
Case No. MISSING
Regular Panel Decision

Jeffries v. Pension Trust Fund of the Pension, Hospitalization & Benefit Plan of the Electrical Industry

Plaintiff Claude Jeffries, a retired electrician, sued the Pension Trust Fund of the Electrical Industry under ERISA, seeking to include pension credits from 1969-1975 in his current benefits. He alleged the Plan should have declared a partial termination during a 1975-1979 New York recession, which would have vested his benefits. The defendant moved to dismiss the complaint, arguing lack of standing and statute of limitations, while plaintiff moved for class certification for similarly affected members. The court denied the defendant's motion to dismiss the claim for benefits, finding it timely, but granted dismissal for the breach of fiduciary duty claim as time-barred. The plaintiff's motion for class certification was denied due to insufficient evidence for numerosity, with leave to refile after discovery.

ERISAPension BenefitsClass CertificationMotion to DismissStatute of LimitationsFiduciary DutyPartial TerminationBenefit ForfeitureUnemploymentLabor Union
References
15
Case No. ADJ3388364 (VNO 0526713) ADJ2633182 (VNO 0342427)
Regular
Oct 24, 2014

RICHARD FROMKNECHT vs. SUBSEQUENT INJURIES BENEFITS TRUST FUND

The applicant sought reconsideration of a decision denying him benefits from the Subsequent Injuries Benefits Trust Fund (SIBTF). The applicant claimed a pre-existing disability from a 1996 spinal injury caused further permanent disability with a subsequent 1998 spinal injury. However, both injuries became permanent and stationary concurrently, meaning there was no distinct pre-existing ratable disability at the time of the second injury. Therefore, the applicant did not meet the criteria for SIBTF benefits under Labor Code section 4751, and his petition for reconsideration was denied.

Subsequent Injuries Benefits Trust FundLabor Code section 4751Petition for ReconsiderationFindings and OrderStipulations with Requests for AwardsAgreed Medical Evaluatorapportionmentpermanent and stationarypreexisting disabilityindustrial injury
References
0
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