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

Case No. 05-CV-4115
Regular Panel Decision
Sep 04, 2008

UFCW Local 1776 & Participating Employers Health & Welfare Fund v. Eli Lilly & Co.

Institutional plaintiffs, primarily third-party payors, filed a class action lawsuit against Eli Lilly and Company. They alleged that Lilly fraudulently marketed its antipsychotic drug, Zyprexa, by misrepresenting its safety and efficacy, downplaying serious side effects like weight gain and diabetes, and promoting off-label uses. The lawsuit claimed these actions led to overpayments for Zyprexa prescriptions. The court certified a class of third-party payors on federal Racketeer Influenced and Corrupt Organizations Act (RICO) claims, specifically for alleged overpricing of Zyprexa during the period of June 20, 2001, to June 20, 2005. Individual payor claims were denied class certification due to potential conflicts of interest, and state consumer protection claims were deferred. The court's decision emphasized that common questions of law and fact predominated, making a class action a superior and manageable method for adjudication.

Class ActionRICO ClaimsPharmaceutical FraudDrug MisrepresentationOff-Label MarketingZyprexa LitigationAntipsychotic DrugsThird-Party Payor ClaimsConsumer ProtectionEconomic Damages
References
82
Case No. MISSING
Regular Panel Decision

Rosenthal v. Ann Service Corp.

Plaintiff Michael Rosenthal, a trustee and participant in four taxicab industry benefit funds, initiated an action against nineteen taxicab employers. He alleged that the employers violated a collective bargaining agreement by failing to make required contributions, inadequately reporting participants' eligibility loss, and fraudulently manipulating fund participant ratios, asserting claims under ERISA and New York State law. Defendants moved for summary judgment, challenging the court's subject matter jurisdiction and plaintiff's standing. The court found that it had subject matter jurisdiction under ERISA, deeming the collective bargaining agreement an ERISA "plan." However, the motion for summary judgment was granted in favor of the defendants due to the plaintiff's lack of standing. The court ruled that Rosenthal could not proceed as an individual trustee without the approval of his co-trustees, which would violate the Taft-Hartley Act's equal representation provisions, nor as a participant seeking to vindicate the fund's rights rather than his own personal benefits.

ERISATaft-Hartley ActStandingSubject Matter JurisdictionSummary JudgmentCollective Bargaining AgreementEmployee Benefit PlansFiduciary DutyTrustee LitigationMultiemployer Plans
References
10
Case No. MISSING
Regular Panel Decision
Jul 07, 2003

Cuevas v. Americorps

This case involves an appeal from a Workers' Compensation Board decision that found a claimant's workers' compensation claim was not preempted by federal law. The claimant, a participant in the Americorps program through the Red Hook Public Safety Corps, sustained back and neck injuries while performing community gardening. The Workers' Compensation Board determined she was a general employee of the Fund for the City of New York, Inc. (FCNY) and a special employee of Americorps. FCNY and its carriers appealed, arguing that 42 USC § 12511 explicitly preempts state law by stating that Americorps participants are not employees for the purposes of that subchapter. The court affirmed the Board's decision, concluding that the federal statute's definition of 'participant' as 'not an employee' was limited to the purposes of the federal subchapter and did not dictate employee status for state workers' compensation benefits. The court further noted that 42 USC § 12594 (b) contemplates states treating participants as employees for workers' compensation purposes, reinforcing the lack of preemptive intent.

Federal preemptionAmericorps programEmployment status determinationStatutory interpretationFund for the City of New YorkCommunity service injuryWorkers' Compensation Board appealAppellate review42 USC 1251142 USC 12594
References
4
Case No. MISSING
Regular Panel Decision

In re Claim of Drassenower

The case concerns an appeal by members of the International Association of Machinists, Local 1056, whose unemployment benefits were suspended for seven weeks. Their idleness resulted from a strike against Trans World Airlines by flight attendants, even though the claimants themselves were not participants in the strike. The Unemployment Insurance Appeal Board affirmed the suspension, applying Labor Law § 592(1) which mandates a suspension of benefits for those whose unemployment is triggered by an industrial controversy in their workplace. The claimants challenged the statute's constitutionality, arguing violations of due process and equal protection, and its misapplication to non-participants, as well as contending it was contrary to public policy. The Appellate Division affirmed the Board's decision, upholding the statute's constitutionality based on numerous precedents and confirming its applicability to non-participating employees within a struck establishment, while reiterating that public policy is a legislative determination.

Unemployment Benefits SuspensionIndustrial StrikeNon-Participant IdlenessLabor Law ConstitutionalityDue Process ChallengeEqual Protection ChallengePublic Policy DeterminationUnemployment Insurance BoardAppellate ReviewLabor-Management Relations
References
6
Case No. 93
Regular Panel Decision
Nov 20, 2025

Matter of Garcia v. WTC Volunteer

This case concerns a claim for death benefits filed by Francisca Garcia, the spouse of a volunteer involved in 9/11 World Trade Center recovery efforts, who had previously received lifetime benefits for related health conditions. The primary legal issue was whether Workers' Compensation Law § 168, which extends the filing period for certain claims, applies to death benefit claims brought by beneficiaries or solely to claims by the direct 'participant.' Both the Workers' Compensation Board and the Appellate Division found the claim untimely, determining that WCL § 168's plain language limits its applicability to the participant. The Court of Appeals affirmed, holding that the claimant's filing, made more than two years after her husband's death, was barred by WCL § 28, as section 168 does not extend the statute of limitations for claims made by a participant's survivors. The Court did not rule on whether Article 8-A generally authorizes death benefits for volunteers, as the untimeliness of the claim was determinative.

Workers' Compensation LawDeath BenefitsWorld Trade Center9/11 Recovery EffortsStatute of LimitationsVolunteer BenefitsArticle 8-AClaim TimelinessStatutory InterpretationAppellate Review
References
3
Case No. ADJ351684 (LAO 0887175)
Regular
May 03, 2011

JOHNNY STEWART vs. PRAXAIR, INC./OLD REPUBLIC INSURANCE COMPANY; As Administered By BROADSPIRE

The Workers' Compensation Appeals Board dismissed the defendant's petition for reconsideration as the WCJ's order was not final. The Board granted removal, rescinded the WCJ's order, and returned the case for further proceedings. The Board found that the parties had already participated in the AME/QME process, citing the applicant's failure to attend multiple scheduled appointments. Therefore, the WCJ's order compelling further AME/QME participation was premature and prejudicial.

Workers' Compensation Appeals BoardPraxair Inc.Old Republic Insurance CompanyBroadsplireJohnny StewartAgreed Medical EvaluatorQualified Medical EvaluatorLabor Code Section 4062.2Findings of Fact and OrderPetition for Reconsideration
References
0
Case No. ADJ8739446
Regular
Aug 26, 2014

SAMUEL TAPIA, JR. vs. GOLDEN STATE HEALTH CENTERS, INC., dba SYLMAR HEALTH AND REHABILITATION CENTERS, Permissibly Self-Insured; METRO RISK MANAGEMENT

This case concerns a workers' compensation claim where the applicant sustained an injury during a workplace "dog pile." The initial decision denied the claim, finding it barred by the horseplay defense. On reconsideration, the Appeals Board found the applicant to be a non-participant, despite evidence of prior similar incidents and alleged invitations, and therefore not barred from recovery. The Board rescinded the original denial and found the injury to be industrial, though one Commissioner dissented, deferring to the WCJ's credibility findings that the applicant was a participant.

horseplay defenseindustrial injuryco-workersinstigatorsinnocent bystanderdog pileskylarkingemployer awarenessclocked outWCJ credibility
References
9
Case No. ADJ7597809
Regular
Oct 28, 2013

VICKI GREGORY vs. COUNTY OF LOS ANGELES

The Workers' Compensation Appeals Board denied the County of Los Angeles' petition for reconsideration. The Board adopted the judge's report, which found that applicant Vicki Gregory's injuries sustained when thrown from a horse at an annual trail ride arose out of and occurred in the course of her employment. The judge determined that Gregory reasonably and subjectively believed her participation was required as part of her training for the Sheriff's Department Mounted Enforcement Unit. Credible MED Unit witnesses corroborated that such participation was essential for certification and duty readiness.

Workers' Compensation Appeals BoardPetition for ReconsiderationInjury AOE/COEMounted Enforcement DetailDeputy SheriffTrail RideTraining ExerciseMED Unit CertificationSubjective BeliefReasonable Belief
References
0
Case No. ADJ13096148
Regular
Dec 03, 2020

JUSTINO MONTIEL vs. SOCAL FRAMINGS, INC., REDWOOD FIRE & CASUALTY INSURANCE, BERKSHIRE HATHAWAY HOMESTATE INSURANCE COMPANIES

The applicant properly selected Dr. Patterson at Casa Colina as his treating physician for his admitted injury, as Casa Colina is listed as a provider within the defendant's Medical Provider Network (MPN). The Board affirmed the WCJ's decision, finding that an acknowledgment of MPN membership is not required for physicians who are shareholders, partners, or employees of a medical group that has elected to participate in the MPN. The defendant failed to provide evidence that Casa Colina's participation was limited to ancillary services. Therefore, the defendant's petition for reconsideration was denied.

Medical Provider NetworkMPNTreating PhysicianLabor Code Section 4600Expedited HearingFindings of FactAncillary ServicesMedical GroupUtilization ReviewPetition for Reconsideration
References
1
Case No. ADJ7793914
Regular
Sep 10, 2014

KEITH BOOTH vs. CHICAGO BULLS, TIG INSURANCE

The Appeals Board reversed the WCJ's finding of jurisdiction, holding that the applicant did not present substantial evidence of a cumulative industrial injury incurred in California. Despite participating in practices on three occasions, the Board found these contacts insufficient to establish California's legitimate interest in adjudicating the claim, citing the *Johnson* case's standard. The Board determined that the applicant's participation in practices in California was de minimis and did not warrant the application of California workers' compensation law. Therefore, the applicant was ordered to take nothing on his claim.

cumulative traumaworkers' compensation jurisdictionprofessional athleteCalifornia contactde minimisdue processlegitimate interestsports injuryindustrial injuryPetition for Reconsideration
References
8
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