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Case Law Database

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

Case No. 05-CV-1573
Regular Panel Decision

Magin v. Cellco Partnership

This action was brought under ERISA by David Magin against Verizon Wireless entities and MetLife Corporation after his short-term disability benefits were denied. Plaintiff also implicitly sought long-term disability benefits. The court considered cross-motions for summary judgment. Applying an arbitrary and capricious standard of review, the court found MetLife's denial of short-term disability benefits was not an abuse of discretion, citing a lack of material medical evidence. The claim for long-term disability benefits was dismissed as it was never properly filed. Consequently, the defendants' motion for summary judgment was granted, and the plaintiff's complaint was dismissed.

ERISADisability BenefitsShort Term DisabilityLong Term DisabilitySummary JudgmentAbuse of DiscretionDe Novo ReviewFiduciary DutyClaims DenialMedical Evidence
References
38
Case No. MISSING
Regular Panel Decision

Medoy v. Warnaco Employees' Long Term Disability Insurance Plan

Plaintiff, Audrey Medoy, sued Warnaco Employees’ Long Term Disability Insurance Plan and Warnaco, Inc. (Defendants) under ERISA, alleging wrongful termination of disability benefits, failure to provide requested documents, and failure to retain claims records. Medoy's disability benefits were discontinued in 1987 without notice. After years of requesting information and appealing the decision, which was hampered by the destruction of her claims file, she filed this action in 1997. Defendants moved to dismiss the complaint, arguing that the claims were untimely, that Medoy was not a 'participant' entitled to disclosure, and that ERISA § 1027 did not cover claims records. The court denied Defendants' motion to dismiss on all grounds, finding her claims timely, her status as a 'participant' colorable, and claims records subject to retention under ERISA § 1027.

ERISALong-term Disability BenefitsStatute of LimitationsFailure to DiscloseRecord RetentionFutility ExceptionAccrual of ActionPlan Administrator DutiesParticipant StatusMotion to Dismiss
References
37
Case No. 2020 NY Slip Op 01694
Regular Panel Decision
Mar 12, 2020

Matter of Christakis v. New York City Tr. Auth.

Petitioner Gregorios Christakis appealed a Supreme Court judgment denying his petition to annul the New York City Transit Authority's denial of short-term disability benefits. Christakis, a General Superintendent, sought benefits for PTSD after his Workers' Compensation claim was denied. The respondent denied his short-term disability application, citing a prohibition against using sick leave for injury on duty and an alleged ineligibility for those who filed Workers' Compensation, neither of which was explicitly stated in policy. The Appellate Division found the denial arbitrary and capricious because the respondent failed to notify Christakis of the true reason, there was no risk of 'double-dipping' as the Workers' Compensation claim had been denied, and the sick leave exhaustion argument was disingenuous. The court reversed the lower court's decision, granted the petition, and remanded the matter for calculation of petitioner's benefits.

Disability BenefitsShort Term DisabilityWorkers' CompensationArticle 78 PetitionArbitrary and CapriciousAdministrative LawSick LeavePost-Traumatic Stress DisorderBenefit DenialJudicial Review
References
4
Case No. MISSING
Regular Panel Decision

Parish v. DiNapoli

Petitioner, a correction officer, was injured in April 1999 and May 2004, leading to her being placed on leave without pay. She applied for disability retirement benefits and performance of duty disability retirement benefits, both of which were denied. The Hearing Officer found the disability retirement application untimely and that the injury was not a result of a direct act of an inmate for performance of duty benefits. The Respondent adopted these findings, leading to this CPLR article 78 proceeding. The court confirmed the determination, dismissing the petition, finding the application for disability benefits untimely and agreeing that a floor waxing by an inmate does not constitute an 'act of an inmate' for performance of duty disability retirement benefits.

Disability RetirementPerformance of Duty DisabilityCorrection OfficerTimeliness of ApplicationAct of an InmateWorkers' Compensation BenefitsMedical Leave of AbsenceCPLR Article 78New York LawPublic Employees
References
2
Case No. 12 Civ. 5645(KPF)
Regular Panel Decision
Feb 18, 2015

Wedge v. Shawmut Design & Construction Group Long Term Disability Insurance Plan

This case involves Plaintiff William Wedge's challenge under ERISA against the Shawmut Plan and Reliance Standard Life Insurance Company (RSLI) for the termination of his long-term disability benefits. Wedge, a former Senior Project Manager, suffered from Central Serous Chorioretinopathy (CSCR) and had his benefits denied by RSLI, which determined he was not "Totally Disabled" under the "Any Occupation" clause. The court applied an arbitrary and capricious standard of review, considering RSLI's structural conflict of interest but finding it warranted minimal weight. Ultimately, the court concluded that RSLI's decision, supported by comprehensive medical and vocational evidence, including an Independent Medical Examination, was reasonable and not arbitrary or capricious. Therefore, Plaintiff's motion for summary judgment was denied, and Defendants' motion was granted.

ERISA LitigationLong Term DisabilityBenefits DenialArbitrary and Capricious ReviewSummary Judgment MotionDiscretionary AuthorityConflict of InterestCentral Serous ChorioretinopathyMedical EvidenceVocational Assessment
References
46
Case No. MISSING
Regular Panel Decision

Bullard v. St. Mary's Hospital

Claimant, a secretary at St. Mary's Hospital, developed rheumatoid arthritis, resulting in a permanent partial disability. The Workers' Compensation Board ruled it an occupational disease and awarded compensation. Liability was apportioned among three employers: Rochester Savings Bank, Woodward Health Center, and St. Mary's Hospital. The Special Disability Fund (SDF) was deemed liable for benefits after the initial 104-week disability period. SDF appealed, contending its reimbursement should be limited to St. Mary's Hospital's one-third share. The court affirmed the Board's decision, holding that Workers' Compensation Law § 44 makes the last employer (St. Mary's) responsible for total compensation, and Workers' Compensation Law § 15 (8) (d) requires SDF to fully reimburse the employer's carrier, Sedgwick James, for benefits paid after 104 weeks.

Occupational DiseaseRheumatoid ArthritisPermanent Partial DisabilityApportionmentSpecial Disability FundReimbursementWorkers' Compensation LawLast Employer LiabilityInsurance CarrierWorkers' Compensation Board
References
0
Case No. MISSING
Regular Panel Decision

Truly v. Regan

Petitioner, employed by Brooklyn Developmental Center, sustained a lower back and left leg injury in January 1986. After a period of inactivity, she stopped working in March 1987 due to her injuries and began receiving workers' compensation benefits. In February 1988, her applications for ordinary disability retirement benefits (under Retirement and Social Security Law art 14) and article 15 disability retirement benefits (under art 15) were denied by the respondent. The ordinary disability application was denied because she was not 'in service' at the time of filing, having been terminated in May 1987. The article 15 disability application was deemed untimely, as it was filed in February 1988, beyond the three-month window from her last payroll date of March 27, 1987, and she lacked approved medical leave. The court confirmed the denial and dismissed her petition.

Disability RetirementOrdinary Disability BenefitsArticle 15 Disability BenefitsIn Service RequirementTimely FilingCPLR Article 78 ProceedingEmployment TerminationMedical LeaveNew York State Employees' Retirement SystemAlbany County
References
5
Case No. MISSING
Regular Panel Decision
Jul 09, 1984

Claim of Holmes v. Cornell University

A claimant challenged Cornell University's denial of disability benefits, arguing he was not an academic employee excluded from coverage under the Disability Benefits Law. The Workers’ Compensation Board affirmed an administrative law judge's decision, ruling the claimant was not engaged in a professional capacity and thus eligible for benefits. Cornell appealed, but the court affirmed the board's decision, finding its interpretation of the statute within its area of competence was not irrational. The court noted Cornell had previously deducted disability benefit payments from the claimant's paycheck, further supporting the board's classification.

Disability Benefits LawProfessional CapacityAcademic EmployeeCoverage ExclusionWorkers' Compensation BoardStatutory InterpretationPayroll DeductionsEligibility for BenefitsAppellate Review
References
1
Case No. MISSING
Regular Panel Decision

Lampo v. Eastman Kodak Co.

The claimant appealed three decisions by the Workers' Compensation Board that denied additional disability benefits and rejected an application for reconsideration of a discrimination claim. The court found substantial evidence in Dr. David Smith's testimony, which indicated normal visual performance, supporting the Board's conclusion that the claimant had no loss of visual acuity. It was also noted that the claimant received 26 weeks of disability payments, and the employer's long-term disability plan, which exceeds state requirements, is governed solely by ERISA. The Board's decision to deny reconsideration of the discrimination claim was deemed neither an abuse of discretion nor arbitrary, as no new evidence was presented. Consequently, the court affirmed the Board's decisions.

Workers' Compensation BoardDisability BenefitsVisual AcuityERISADiscrimination ClaimReconsideration DenialSubstantial EvidenceCredibility IssueAppellate ReviewAffirmed Decision
References
3
Case No. MISSING
Regular Panel Decision

Smith v. New York State & Local Retirement Systems

Petitioner, a taxpayer services representative, sustained a back injury in March 1981 while lifting forms, leading to a decline in attendance and eventual termination in November 1989. She applied for accidental and ordinary disability retirement benefits, both of which were denied by the Comptroller. The accidental disability claim was denied because the incident was not deemed an 'accident' under Retirement and Security Law § 63. The ordinary disability claim was denied as untimely, having been filed approximately six months after her termination, exceeding the 90-day limit stipulated by Retirement and Social Security Law § 62. The Supreme Court dismissed the challenge to the ordinary disability denial due to untimeliness and transferred the accidental disability challenge to this Court. This Court confirmed the Comptroller's determination on both counts, rejecting the petitioner's estoppel argument regarding the untimely ordinary disability application and finding substantial evidence to support the finding that the injury did not constitute an 'accident' within the meaning of the relevant law, as it resulted from ordinary employment duties without an unexpected event.

Disability Retirement BenefitsAccidental DisabilityOrdinary DisabilityUntimely ApplicationEstoppel Against GovernmentWork-Related InjuryBack InjuryDefinition of AccidentOrdinary Employment DutiesSubstantial Evidence Review
References
16
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