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

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imposed a penalty under Workers’ Compensation Law § 25 (3) (f) for this failure, but the Workers’ Compensation Board rescinded it due to a lack of sufficient evidence.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. 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

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
Case No. MISSING
Regular Panel Decision
Apr 19, 2004

Claim of Provoncha v. Anytime Home Care, Inc.

A 17-year-old certified nurses aid, identified as the claimant, sustained a back injury while employed by Anytime Home Care, Inc. The Workers' Compensation Board initiated proceedings to determine if her employment violated the Labor Law, which would entitle her to double compensation under Workers’ Compensation Law § 14-a. Despite requests, the employer failed to produce the required employment certificate at two hearings and its requests for further adjournments or to present alternative testimony were denied. Both the Workers’ Compensation Law Judge and the Board found the claimant was illegally employed due to the lack of an employment certificate. Consequently, the Board affirmed her entitlement to double compensation. The appellate court reviewed the employer's contentions and ultimately affirmed the Board's decision.

Workers' CompensationChild Labor LawIllegal EmploymentDouble CompensationEmployment CertificateAdministrative HearingAppellate ReviewEmployer ResponsibilityLabor Law ViolationWorkers' Compensation Board
References
5
Case No. MISSING
Regular Panel Decision

Claim of Capodagli v. West Seneca Central School District

This case involves an appeal from a Workers' Compensation Board decision concerning the applicability of Workers’ Compensation Law § 25-a to a claimant's award of benefits. The claimant was injured in October 2003, received benefits, and the case was closed. The employer later sought to shift liability to the Special Fund for Reopened Cases. The Special Fund requested claimant's testimony regarding advance payments of compensation, which was denied by the Workers' Compensation Law Judge, who determined liability shifted. The Board affirmed. The appellate court found that the Board's decision was not supported by substantial evidence because the record lacked information on whether the claimant performed light or limited duties while receiving full wages, which could prevent the shifting of liability. The decision was reversed, and the matter remitted for further proceedings.

Workers' CompensationSpecial Fund for Reopened CasesSection 25-aAdvance PaymentsLiability ShiftMedical TreatmentLight Duty WorkSubstantial EvidenceRemittalAppellate Review
References
5
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
Oct 09, 2012

Claim of Schuss v. Delta Airlines, Inc.

Claimant sustained a work-related injury in February 2010 and received workers' compensation benefits. The employer’s carrier subsequently alleged claimant violated Workers’ Compensation Law § 114-a by misrepresenting her work activity while receiving benefits. A Workers’ Compensation Law Judge and the Workers’ Compensation Board found a violation and disqualified her from future benefits. The Appellate Division affirmed this decision, finding substantial evidence in surveillance videos and a private investigator’s report showing claimant working at a chiropractor’s office. The court rejected the claimant's due process arguments, stating she was aware of the evidence and made a late request for rebuttal testimony.

Workers' CompensationFraudMisrepresentationSurveillance EvidenceDue ProcessAdministrative LawBenefits DisqualificationWork ActivityJudicial ReviewAppellate Review
References
4
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. MISSING
Regular Panel Decision

Claim of Elmer v. Marocchi Trucking Co.

In 1997, a claimant sustained injuries while working as a truck driver for Marocchi Trucking Company, Inc., leading to workers' compensation awards for physical injuries, depression, and narcotic addiction. The workers’ compensation carrier alleged a violation of Workers’ Compensation Law § 114-a, presenting video surveillance that contradicted the claimant's asserted limitations, such as being wheelchair-bound. A Workers’ Compensation Law Judge and subsequently a panel of the Workers’ Compensation Board found no violation, crediting the claimant's explanations regarding heavy narcotic use and physicians' assumptions. On appeal, the court affirmed the Board's decision, concluding that it was supported by substantial evidence and that resolving conflicting evidence was within the Board's province.

Workers' CompensationFraud AllegationSection 114-aSubstantial EvidenceMedical TestimonyVideo SurveillanceCredibilityNarcotic AddictionAppellate ReviewAffirmed Decision
References
3
Case No. MISSING
Regular Panel Decision

Claim of Willard v. O-At-Ka Milk Products Cooperative

A claimant was awarded workers' compensation benefits after falling from a milk truck in 2009, suffering multiple injuries. The employer alleged the claimant violated Workers’ Compensation Law § 114-a by failing to disclose a 2007 motor vehicle accident and related neck pain. While a Workers’ Compensation Law Judge initially found a violation, the Workers’ Compensation Board rescinded this decision, concluding no violation occurred, and remitted the case for further development on the degree of disability. The employer appealed. The appellate court affirmed the Board's decision, finding substantial evidence supported the conclusion that the claimant did not knowingly make a false statement, given testimony that she was not specifically asked about prior neck issues and that her previous neck soreness was minor and temporary.

Workers' CompensationFraud AllegationMisrepresentationPrior Injury DisclosureIndependent Medical ExaminationAppellate ReviewSubstantial EvidenceNew York LawNeck InjuryDisability Assessment
References
3
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