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Case Law Database

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. ADJ9282902
Regular
Oct 10, 2017

JUAN CARRILLO vs. ASKEW INDUSTRIAL CORPORATION, TWIN CITY FIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the Employment Development Department's (EDD) petition for reconsideration. The EDD sought interest on reimbursement awarded for disability benefits, but the original Findings and Award did not specify the reimbursement amount or rule on interest. The Board found the EDD was not aggrieved by the initial award, as the parties were instructed to adjust the amount themselves. Therefore, the EDD must first seek a final order on the reimbursement amount before pursuing reconsideration.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and Awardtemporary disability indemnityreimbursementEmployment Development Department (EDD)lienUnemployment Insurance Code section 2629.1interestadministrative law judge (WCJ)
References
0
Case No. ADJ2834079 (SDO 0293027) ADJ2839895 (SDO 0358837)
Regular
Jun 25, 2009

THUAN CRIM-ROLFE vs. LA COSTA RESORT AND SPA, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for LEGION INSURANCE COMPANY, BROADSPIRE, SAFETY NATIONAL CASUALTY INSURANCE COMPANY

This case involves a clerical error in a prior Workers' Compensation Appeals Board (WCAB) decision. The WCAB previously ordered Safety National Casualty Insurance Company (SNCC) to reimburse the California Insurance Guarantee Association (CIGA) a specific amount for bill review charges. CIGA requested clarification, noting the amount ordered was incorrect. The WCAB affirmed its earlier decision that CIGA is entitled to reimbursement for bill review costs but amended the order nunc pro tunc. The corrected order now states SNCC must reimburse CIGA for bill review charges, with the exact amount to be determined by the parties or the arbitrator.

California Insurance Guarantee AssociationLegion Insurance CompanySafety National Casualty Insurance Companynunc pro tuncclerical errorbill review chargesliquidationcovered claimsreimbursementpetition for reconsideration
References
6
Case No. MISSING
Regular Panel Decision

Claim of McFadden v. New York City Department of Correction

This case involves an appeal from a Workers' Compensation Board decision concerning an employer's entitlement to reimbursement for benefits paid to a claimant. The claimant, a correction officer, sustained a work-related shoulder injury in 2002, leading to a schedule loss of use award. Initially, a WCLJ denied the self-insured employer's request for reimbursement, citing a failure to file the request properly. However, the Workers’ Compensation Board disagreed and awarded the employer $39,172.17 in reimbursement. The claimant appealed this determination, arguing that the reimbursement amount was not supported by substantial evidence. The Appellate Division affirmed the Board's decision, finding sufficient record evidence to support the reimbursement amount and noting the Board's authority to modify prior WCLJ decisions despite a lack of appeal.

Workers' CompensationReimbursementSchedule Loss of UseEmployer RightsAppellate ReviewWorkers’ Compensation BoardSick LeaveCorrection OfficerSubstantial EvidenceBoard Authority
References
3
Case No. MISSING
Regular Panel Decision
May 12, 1999

Claim of Evans v. Plattsburgh Construction

Claimant, a welder, injured himself in 1994 while working for Plattsburgh Construction, one of his concurrent employers. He filed for workers' compensation benefits, and his case was established, with a Workers’ Compensation Law Judge (WCLJ) awarding reduced earnings based on combined average weekly wages from both employers. Plattsburgh’s workers’ compensation carrier sought reimbursement from the Special Funds Conservation Committee for these reduced earnings. The WCLJ initially ruled that Special Funds should reimburse the full amount. However, the Workers’ Compensation Board, referencing Matter of Tucker, affirmed the finding of concurrent employment but applied a "ceiling" to Special Funds' reimbursement, limiting it to the amount exceeding two-thirds of the primary employer's average weekly wage. On appeal, the carrier argued for full reimbursement, but the Court affirmed the Board's decision, upholding the application of the reimbursement ceiling based on precedent.

Workers' CompensationConcurrent EmploymentReduced EarningsReimbursementSpecial FundsWorkers' Compensation Law § 14 (6)Reimbursement CeilingAppellate ReviewJudicial PrecedentEmployer Liability
References
4
Case No. ADJ987318 (VNO 0512447)
Regular
Nov 21, 2011

HECTOR MARTINEZ vs. SHIMA NURSERY, PREFERRED EMPLOYERS INSURANCE COMPANY

This case concerns a dispute over the reimbursement amount for self-procured psychological treatment. The Workers' Compensation Appeals Board (WCAB) granted reconsideration to modify an award to a lien claimant. While affirming the compensability of the applicant's psychological injury, the WCAB found that the lien claimant failed to meet her burden of proof for the full billed amount. Consequently, reimbursement was limited to the amount prescribed by the Official Medical Fee Schedule (OMFS), rather than the higher provider fee initially awarded.

Workers' Compensation Appeals BoardSelf-Procured Medical TreatmentLien ClaimantAgreed Medical ExaminerIndustrial CausationPsyche InjuryLabor Code Section 4906Official Medical Fee ScheduleReasonable and Customary ChargesCompromise and Release
References
5
Case No. ADJ248306 (SAC 0298167) ADJ870873 (SAC 0298071)
Regular
Jul 28, 2017

Lonnie Roberts vs. Capital Plumbing, California Insurance Guarantee Association, Reliance National Indemnity Company, SEDGWICK CLAIMS MANAGEMENT SERVICES, ACE USA

The Workers' Compensation Appeals Board granted reconsideration to clarify ACE USA's liability for reimbursement to CIGA. ACE USA argued that CIGA's claim lacked sufficient proof and that the initial order failed to specify an amount. The Board affirmed the finding that ACE USA is liable for reimbursement to CIGA for temporary disability, medical treatment, bill review, and utilization review for services paid after January 26, 2001. However, the Board amended the order to clarify that the parties must adjust the reimbursement amount, with the trial judge retaining jurisdiction if an agreement is not reached.

Workers' Compensation Appeals BoardCIGAACE USAReimbursementLiquidationJointly and Severally LiableOther InsuranceBenefit PrintoutLabor Code Section 5815Unclean Hands Doctrine
References
1
Case No. MISSING
Regular Panel Decision

Claim of Koslosky v. Paul

This case concerns an appeal challenging a decision by the Workers’ Compensation Board. The core issue was whether the Uninsured Employers’ Fund was entitled to reimbursement for amounts attributed to a claimant's concurrent employment on the date of their accident. The Special Disability Fund argued that the Board's conclusion, made under Workers’ Compensation Law § 15 (8) (l), was erroneous. However, the appellate court reviewed the arguments and ultimately found no grounds for reversal, affirming the Board's original decision. All remaining contentions raised by the Special Disability Fund were considered and rejected as unpersuasive.

Workers' CompensationUninsured Employers FundSpecial Disability FundReimbursementConcurrent EmploymentAppellate ReviewStatutory InterpretationFund LiabilityWorkers' Compensation BoardDecision Affirmed
References
0
Case No. MISSING
Regular Panel Decision
Oct 26, 2015

Matter of Newbill v. Town of Hempstead

Claimant, a sanitation crew chief, injured his right ankle and foot at work and was awarded disability benefits. His self-insured employer paid his full weekly wages during a period of disability and timely sought reimbursement for these advanced payments. A Workers’ Compensation Law Judge granted the employer's reimbursement request against a 20% schedule loss of use award for the right foot. The Board affirmed this decision, and the claimant appealed, arguing that reimbursement should not cover periods where no compensation awards were initially made. The court affirmed the Board's decision, reiterating that an employer is entitled to full reimbursement from a schedule loss of use award for advanced wages paid during disability, as schedule awards are not allocable to specific periods of lost work.

Schedule Loss of UseReimbursementAdvanced Wage PaymentsDisability BenefitsEmployer RightsAppellate ReviewWorkers’ Compensation BoardStatutory InterpretationPermanent Partial DisabilityTimely Claim
References
10
Case No. MISSING
Regular Panel Decision

Claim of Guarascio v. Spargo Wire Co.

The claimant, a truck driver, suffered work-related back and shoulder injuries in October 1995. The employer’s workers’ compensation carrier paid benefits. In 2000, the carrier sought reimbursement from the Special Disability Fund under Workers’ Compensation Law § 15 (8) (d) for these payments. A Workers’ Compensation Law Judge (WCLJ) established the claim in 2002 and later found the claimant permanently partially disabled, ruling on apportionment but deferring the reimbursement issue. The WCLJ subsequently found the carrier’s request for reimbursement timely. The Workers’ Compensation Board affirmed this decision. This appeal concerns the Board’s ruling that the carrier’s C-250 claim for reimbursement was timely filed within the statutory 52-week period, despite the underlying claim documents being posted by the Board in 2000.

ReimbursementSpecial Disability FundTimeliness of ClaimPermanent Partial DisabilityWorkers' Compensation LawPreexisting ImpairmentWork-related InjuryC-250 ClaimStatute of LimitationsAppellate Review
References
3
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