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

Case No. 2017 NY Slip Op 04184 [150 AD3d 1589]
Regular Panel Decision
May 25, 2017

New York State Workers' Compensation Board v. Program Risk Management, Inc.

The New York State Workers' Compensation Board, acting as administrator and successor to the Community Residence Insurance Savings Plan, initiated legal action against various entities and individuals after the trust became severely underfunded. Defendants include Program Risk Management, Inc. (administrator), PRM Claims Services, Inc. (claims administrator), individual officers of PRM, the Board of Trustees, and Thomas Gosdeck (trust counsel). The plaintiff sought damages for claims such as breach of contract, breach of fiduciary duty, and legal malpractice. The Supreme Court's order partially dismissed some claims and denied others. On cross-appeal, the Appellate Division, Third Department, modified the Supreme Court's order, notably reversing the dismissal of several breach of fiduciary duty claims and common-law indemnification against PRMCS, while affirming denials of motions to dismiss breach of contract, legal malpractice, and unjust enrichment claims. The court's decision was influenced by recent rulings in State of N.Y. Workers' Compensation Bd. v Wang.

Workers' Compensation LawGroup Self-Insured TrustBreach of ContractBreach of Fiduciary DutyLegal MalpracticeUnjust EnrichmentStatute of LimitationsEquitable EstoppelAlter Ego LiabilityCommon-Law Indemnification
References
20
Case No. MISSING
Regular Panel Decision
Jun 11, 1993

Empire Insurance v. Workers' Compensation Board

Empire Insurance Company denied Hugh Wofsy's no-fault benefits claim, alleging he was a Dial-a-Car, Inc. employee requiring Workers' Compensation. An Administrative Law Judge later found Wofsy an independent contractor, denying him Workers' Compensation. Empire sought to reopen the Workers' Compensation claim to participate, which the Board denied. Empire then initiated a CPLR article 78 proceeding, where the IAS Court allowed the reopening and ordered Empire to pay Wofsy, with potential reimbursement. The Appellate Division subsequently reversed this judgment, dismissing Empire's petition, emphasizing that Workers' Compensation Law § 23 vests exclusive appeal jurisdiction with the Third Department and precludes article 78 proceedings for reviewing Board decisions' substance.

No-fault insuranceIndependent contractor disputeEmployee status determinationCPLR Article 78 proceedingAppellate Division jurisdictionWorkers' Compensation Law § 23Judicial review of administrative decisionsInsurance coverage disputeAdministrative Law Judge rulingReimbursement claim
References
2
Case No. MISSING
Regular Panel Decision

Workers' Compensation Board v. Met-Impro Services, Inc.

This case involves four related actions under Workers' Compensation Law § 26 concerning the enforcement of a Workers' Compensation award. The Supreme Court had erroneously granted defendant Robert San Miguel's motion to vacate judgments against him. San Miguel, identified as the president of the corporate employers, was held personally liable for unpaid benefits under Workers’ Compensation Law § 26-a (1) (a). The court clarified that personal liability for corporate officers does not depend on active management or involvement in the underlying accident. Furthermore, there is no statutory basis to vacate a judgment merely because an officer was not specifically named in the initial administrative determination. Consequently, San Miguel's vague denial of involvement was insufficient, and his motion to vacate the judgments against him was denied.

Workers' CompensationPersonal LiabilityCorporate OfficerJudgment VacationAdministrative LawAppellate ReviewStatutory InterpretationEmployer LiabilityUnpaid BenefitsNew York Law
References
3
Case No. MISSING
Regular Panel Decision

Claim of D'Addio v. Peter Annis, Inc.

A widow filed a claim for workers' compensation death benefits after her husband, who had an established claim for asbestosis, died. A Workers' Compensation Law Judge (WCLJ) found a work-related death and ordered the employer's carrier to deposit funds into the aggregate trust fund (ATF) in July 2010. The carrier did not appeal this initial decision. After a subsequent WCLJ decision in December 2010 reiterated the ATF deposit, the carrier sought review, arguing the deposit was unwarranted. The Workers' Compensation Board denied the carrier's application as untimely. The appellate court affirmed the Board's decision, holding that the 30-day appeal period for the July 2010 decision had expired and the later WCLJ decision did not extend that timeframe. The court found no abuse of discretion by the Board.

Workers' CompensationUntimely ApplicationAggregate Trust FundDeath BenefitsAsbestosisOccupational DiseaseAppellate ReviewBoard DiscretionTimelinessAppeal Denial
References
5
Case No. MISSING
Regular Panel Decision

Claim of Seo v. UTOG 2-Way Radio, Inc.

The claimant, a limousine driver for UTOG 2-Way Radio, Inc., was injured in an automobile accident while driving home from work. Initially, a Workers’ Compensation Law Judge (WCLJ) denied benefits, ruling the injuries did not arise from employment. Eagle Insurance Company, the no-fault carrier, appealed to the Workers’ Compensation Board, which initially reversed the WCLJ, deeming the claimant an 'outside worker' eligible for 'portal to portal' coverage. UTOG appealed this reversal, but the full Board rescinded the decision and referred it back. Upon reconsideration, the Board panel determined that Eagle lacked standing as it was not a party in interest under Workers’ Compensation Law § 23 and affirmed the WCLJ's denial of benefits. Eagle then appealed to the Appellate Division, which reversed the Board's decision, citing prior cases, and remitted the matter for further proceedings.

Automobile AccidentLimousine DriverWorkers' Compensation BenefitsStanding to AppealNo-Fault Insurance CarrierOutside WorkerPortal to Portal CoverageAppellate ReviewBoard ReconsiderationRemittal
References
2
Case No. MISSING
Regular Panel Decision

Matter of Bank v. Village of Tuckahoe

The Workers' Compensation Board ruled that liability for a claimant's left knee injury shifted to the Special Fund for Reopened Cases under Workers' Compensation Law § 25-a. The claimant sustained a work-related injury in June 2005, and compensation benefits were paid until June 20, 2005. In April 2012, a physician requested an MRI, which was performed and revealed a meniscal tear. Subsequently, surgery was authorized and performed in July 2012. The self-insured employer and its third-party administrator sought to shift liability to the Special Fund, a move initially rejected by a Workers' Compensation Law Judge but later approved by the Board. The Special Fund appealed the Board's decision. The appellate court reversed the Board's decision, finding that the case was not "truly closed" after the MRI request was approved. The court held that the case was reopened in April 2012, within the statutory seven-year period from the date of injury, thus precluding the shifting of liability to the Special Fund. The matter was remitted to the Board for further proceedings.

Workers' Compensation Law § 25-aSpecial Fund LiabilityReopened Case DoctrineMedical Treatment AuthorizationCase Closure DeterminationSeven-Year RuleLast Payment of CompensationMeniscal TearMRI AuthorizationSurgery Authorization
References
5
Case No. MISSING
Regular Panel Decision

Matter of Covert v. Niagara County

Claimant, a public assistance recipient, suffered a work-related injury while assigned to Niagara County through a work experience program. A Workers’ Compensation Law Judge initially established the claim and determined an average weekly wage based on public assistance benefits. After public assistance benefits were suspended, the claimant sought lost wage benefits. The Workers’ Compensation Board affirmed a WCLJ decision, ruling that payments made under the work experience program constituted "wages" under the Workers’ Compensation Law. Niagara County and its third-party administrator appealed this decision. The appellate court dismissed the appeal, holding that the Board's decision was interlocutory and did not dispose of all substantive issues, thus precluding immediate appeal. The court noted that review could be sought if and when a final determination on wage replacement benefits is issued.

Wage DeterminationPublic Assistance BenefitsWork Experience ProgramInterlocutory AppealAppellate JurisdictionMedical Evidence SufficiencySchedule Loss of UseLost Wage ClaimWorkers' Compensation Board ReviewFinality of Decision
References
9
Case No. MISSING
Regular Panel Decision
Jul 27, 2001

Claim of Losurdo v. Asbestos Free, Inc.

The case involves a claimant appealing a Workers’ Compensation Board decision. The Board ruled that the claimant violated Workers’ Compensation Law § 114-a by failing to disclose prior left and right knee injuries to physicians and under oath, leading to disqualification from future wage replacement benefits. Although a Workers’ Compensation Law Judge initially found no fraud, the Board reversed this determination on administrative appeal, concluding the claimant knowingly made false statements. The Appellate Division affirmed the Board's decision, finding it supported by substantial evidence, emphasizing the Board's authority as the sole arbiter of witness credibility. The court rejected the claimant's explanations of forgetting the prior incidents as not credible.

Workers' Compensation FraudMisrepresentation of Medical HistoryFalse Statements Under OathWage Replacement Benefits DisqualificationWorkers' Compensation Law Section 114-aAppellate Review of Board DecisionWitness CredibilitySubstantial EvidencePrior Knee InjuriesAdministrative Appeal
References
11
Case No. MISSING
Regular Panel Decision

Claim of Schell v. Right

A claimant was injured in April 1993, establishing accident, notice, and causal relationship. Compensation was stipulated at $225 per week for physical disability. Later, a consequential psychiatric condition was affirmed, setting a higher payment rate of $358.73 per week from 1994. The workers' compensation carrier failed to pay this higher rate retroactively after the August 9, 2000 determination. A Workers' Compensation Law Judge imposed a penalty under Workers’ Compensation Law § 25 (3) (f) for this failure, but the Workers’ Compensation Board rescinded it due to a lack of sufficient evidence. The claimant appealed, arguing that the penalty provisions are self-executing and mandatory for late payments. The appellate court reversed the Board's decision, finding no substantial evidence to support the rescission, and remitted the matter for further proceedings, emphasizing the mandatory nature of the penalty for delayed award payments.

Workers' CompensationPenalty AssessmentLate PaymentRetroactive BenefitsPsychiatric DisabilityCarrier LiabilityMandatory PenaltyBoard ReversalAppellate ReviewRemand
References
3
Case No. MISSING
Regular Panel Decision

Claim of Good v. Town of Brutus

A claimant, employed as a court clerk since 2002, developed carpal tunnel syndrome and filed a workers’ compensation claim in 2007, which was established as an occupational disease. She was awarded a 25% schedule loss of use of the left hand. The employer’s workers’ compensation carrier sought apportionment of liability with her two most recent prior employers under Workers’ Compensation Law § 44. A Workers’ Compensation Law Judge and the Board denied this request, finding no medical evidence of the condition arising from prior employment. The Appellate Division affirmed the Board’s determination, stating that despite the claimant experiencing symptoms previously and an independent medical examiner suggesting apportionment, there was no objective medical proof that she contracted the condition while working for a previous employer. The court emphasized that the focus for apportionment is whether the claimant contracted the occupational disease during that specific employment.

Occupational DiseaseCarpal Tunnel SyndromeApportionment of LiabilityWorkers' Compensation Law § 44Prior EmployersMedical EvidenceIndependent Medical ExaminerSchedule Loss of UseWorkers' Compensation BoardAppellate Review
References
3
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