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

Case No. 2018 NY Slip Op 08227
Regular Panel Decision
Nov 29, 2018

Matter of Kelly v. New York State Workers' Compensation Bd.

In 2006, claimant Grace Kelly established a workers' compensation claim for an occupational disease. The State Insurance Fund (SIF) repeatedly sought to transfer liability to the Special Fund for Reopened Cases, which was denied by Workers' Compensation Law Judges. The Workers' Compensation Board affirmed these denials and assessed $500 penalties against both SIF and its counsel, Walsh and Hacker, for filing an application for review without reasonable grounds. Walsh and Hacker appealed the penalty imposed against them to the Appellate Division, Third Department. The Appellate Division found insufficient evidence to support the Board's finding that Walsh and Hacker's application lacked reasonable grounds, and therefore reversed the penalty against them, modifying and affirming the Board's decision.

PenaltiesAppellate ReviewSpecial Fund for Reopened CasesWorkers' Compensation Law § 25-aWorkers' Compensation Law § 114-aAttorney SanctionsAdministrative LawBoard DecisionJudiciary Law § 431
References
4
Case No. 2017 NY Slip Op 08595 [156 AD3d 1043]
Regular Panel Decision
Dec 07, 2017

New York State Workers' Compensation Board v. Any-Time Home Care Inc.

The New York State Workers' Compensation Board, acting as administrator for a dissolved self-insured trust, initiated an action to recover a $133 million cumulative deficit from former trust members. Various defendants sought to dismiss the complaint, asserting claims were time-barred by a three-year statute of limitations for statutory liabilities, failed to adequately state claims against individual partners, and were barred by the doctrine of laches. The Supreme Court denied these motions. On appeal, the Appellate Division, Third Department, affirmed the Supreme Court's order, ruling that the claims were contractual, subject to a six-year limitation period, and that laches did not apply against the state enforcing a public right. The court also found the complaint sufficiently specific regarding the liability of individual defendants.

Workers' Compensation LawSelf-Insurance TrustJoint and Several LiabilityStatute of LimitationsContractual LiabilityLaches DoctrineAppellate ReviewGroup Self-InsurerDeficit RecoveryPartnership Liability
References
16
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. 2017 NY Slip Op 27428
Regular Panel Decision
Dec 14, 2017

New York State Workers' Compensation Bd. v. Compensation Risk Mgrs., LLC

This action was brought by the New York State Workers' Compensation Board (WCB), as an assignee of former members of the Healthcare Industry Trust of New York (HITNY), against Compensation Risk Managers, LLC (CRM), HITNY trustees, and auditing firm UHY LLP. The WCB alleged mismanagement, breach of fiduciary duty, and negligent auditing, leading to the Trust's insolvency. Defendants moved to dismiss on grounds of standing, statute of limitations, and pleading particularity. The court dismissed certain derivative claims and negligent misrepresentation claims against some trustees due to standing issues and statute of limitations. All claims against UHY LLP were dismissed for lack of a near-privity relationship or prior precedent. An implied indemnity claim against the trustees was sustained. The WCB's cross-motion to consolidate related actions was denied.

Workers' Compensation LawGroup Self-Insured Trust (GSIT)Fiduciary DutyNegligenceNegligent MisrepresentationStatute of LimitationsStandingDerivative ActionImplied IndemnityAuditing Firm Liability
References
46
Case No. MISSING
Regular Panel Decision

Nuara v. State of New York Workers' Compensation Board

Petitioners, two terminated group self-insured trusts (GSITs), challenged monetary assessments levied against them by the New York State Workers' Compensation Board and its chairman. The assessments were imposed pursuant to various sections of the Workers’ Compensation Law, utilizing a "pure premium calculation" method established by 2007 amendments. The court considered new 2008 legislation that further amended the calculation method for ceased self-insurers but declined to apply it retroactively. Ultimately, the court found the Board's interpretation of "the preceding year" in its pure premium calculation for terminated GSITs to be unreasonable and contrary to the clear statutory language. Consequently, the levied assessments were annulled and vacated.

Group Self-Insured TrustsMonetary AssessmentsStatutory InterpretationRetroactive ApplicationPure Premium CalculationAdministrative LawCPLR Article 78Legislative IntentStatutory ConstructionSelf-Insurance Liabilities
References
19
Case No. 2022 NY Slip Op 06850 [212 AD3d 126]
Regular Panel Decision
Dec 01, 2022

Matter of Levi v. New York State Workers' Compensation Bd.

Petitioner, a licensed chiropractor, was removed from the list of authorized medical providers by the New York State Workers' Compensation Board after an investigation revealed he received unlawful payments from a durable medical equipment (DME) supplier, Elite Medical Supply of New York, LLC. This was deemed a violation of Workers' Compensation Law §§ 13-d (2) (g), 13-l (10) (g) and 8 NYCRR 29.1 (b) (3). Petitioner challenged this removal via a CPLR article 78 proceeding, asserting a statutory right to a hearing before the Chiropractic Practice Committee (CPC) prior to removal. The Supreme Court dismissed the petition, and the Appellate Division, Third Department, affirmed. The appellate court held that while Workers' Compensation Law § 13-l (10) outlines a CPC hearing process, the Chair of the Workers' Compensation Board also possesses independent authority under Workers' Compensation Law §§ 13-l (12) and 13-d (1) to investigate and remove a provider without a hearing when the underlying facts, such as petitioner's admitted receipt of unlawful payments, are undisputed and do not present questions of fact.

ChiropractorMedical ProviderAuthorization RemovalUnlawful PaymentsDurable Medical EquipmentWorkers' Compensation BoardProfessional MisconductDue ProcessAdministrative LawCPLR Article 78
References
4
Case No. MISSING
Regular Panel Decision

Lubrano v. New York State Workers' Compensation Board

This case concerns a proceeding initiated by petitioners under CPLR article 78 to prevent the New York State Workers’ Compensation Board from issuing money judgments. The petitioners sought to enjoin the board until they were granted a full fact-finding hearing, challenging the board's determination that they failed to make compensation payments. The Supreme Court, Suffolk County, initially ruled in favor of the petitioners, vacating existing judgments and directing the board to provide a hearing. However, the Workers' Compensation Board appealed this decision. The Appellate Division reversed the Supreme Court's judgment and dismissed the proceeding. The appellate court held that the Appellate Division, Third Judicial Department, has exclusive jurisdiction over matters reviewable by it, thereby precluding recourse to a CPLR article 78 proceeding. Any claims of procedural due process failures in administrative decisions, according to the court, are exclusively for the appellate court to resolve.

CPLR Article 78Workers' Compensation BoardJurisdictionAppellate ReviewProcedural Due ProcessInjunctionMoney JudgmentsAdministrative DecisionSuffolk County Supreme CourtThird Judicial Department
References
2
Case No. 2023 NY Slip Op 04054
Regular Panel Decision
Jul 28, 2023

New York State Workers' Compensation Bd. v. Episcopal Church Home & Affiliates, Inc.

The New York State Workers' Compensation Board (plaintiff) assumed administration of the Long Term Care Risk Management Group, a self-insurance trust, and levied assessments against its former members (defendants) to cover an accumulated deficit. Defendants appealed an order granting plaintiff partial summary judgment, raising issues regarding the summons's jurisdictional sufficiency, the timeliness of plaintiff's subsequent assessments, and the applicability of a collection fee. The Appellate Division determined the summons was jurisdictionally sound and that the statutory 120-day period for levying assessments was directory, not mandatory, thus upholding the validity of later assessments. However, the Court modified the order by dismissing the plaintiff's claim for a collection fee, ruling that the fluctuating and unliquidated nature of the deficit did not meet the "liquidated sum" requirement of State Finance Law § 18. Consequently, the appeal was partially dismissed, the order and judgment modified to remove the collection fee, and affirmed in all other respects.

Group Self-Insurance TrustWorkers' Compensation AssessmentsStatutory InterpretationTimeliness of AssessmentsJurisdictional DefectSummary JudgmentState Finance LawCollection FeesLiquidated DebtAppellate Review
References
24
Case No. 532391
Regular Panel Decision
Nov 18, 2021

Matter of Richman v. New York State Workers' Compensation Bd.

Claimant, Rebecca Richman, appealed three decisions from the Workers' Compensation Board regarding her claim for a work-related right shoulder injury. She alleged a fall at work on January 19, 2018, but did not seek medical treatment for 19 months. A Workers' Compensation Law Judge initially established the claim, but the Board reversed, finding that Richman failed to submit sufficient, credible medical evidence to demonstrate a causally-related injury and denied her claim. The Board subsequently denied her application for reconsideration and/or full Board review. The Appellate Division affirmed the Board's decisions, concluding that the Board's finding of no causally-related injury was supported by substantial evidence and that the Board did not abuse its discretion in denying reconsideration.

Workers' Compensation ClaimCausation (Medical)Shoulder InjuryMedical Evidence SufficiencyBoard ReversalAppellate Division ReviewBurden of ProofCredibility of EvidenceOsteoarthritis DiagnosisDelayed Medical Treatment
References
8
Case No. MISSING
Regular Panel Decision
Feb 18, 1988

Claim of De Carr v. New York State Workers' Compensation Board

The claimant, an employee of the Workers’ Compensation Board, suffered a broken nose while playing softball in an off-duty State agency league. The Board initially found the injury compensable, citing the use of State-owned fields, interoffice mail, and employer equipment for league activities. However, the appellate court reversed this decision, referencing a 1983 amendment to Workers’ Compensation Law § 10 (1) which limits benefits for off-duty athletic injuries to instances of employer-required participation, compensation, or overt sponsorship. The court determined that the Board's cited factors constituted only incidental contact rather than overt employer encouragement or sponsorship, thus dismissing the claim as the injury did not arise out of and in the course of employment.

Workers' Compensation Law § 10(1)off-duty athletic injuryemployer sponsorship criteriaincidental employer contactreversal of Board decisionclaim dismissalcompensability of sports injuriesstatutory interpretationWorkers' Compensation Board appeal1983 amendment impact
References
4
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