Preview
FILED: QUEENS COUNTY CLERK 01/22/2023 11:20 AM INDEX NO. 707343/2016
NYSCEF DOC. NO. 100 RECEIVED NYSCEF: 01/22/2023
Exhibit J
FILED: QUEENS COUNTY CLERK 01/22/2023 11:20 AM INDEX NO. 707343/2016
21471976
NYSCEF DOC. NO. 100 RECEIVED NYSCEF: 01/22/2023
STATE OF NEW YORK
WORKERS'
COMPENSATION BOARD
PO BOX 5205
BlNGHAMTON, NY 13902-5205
www.wch.ny.gov
Robert eloten
(877) 632-4996
- Workers'
State of New York Compensation Board
In regard to Marcelo Lema, WCB Case #G140 0014
NOTICE OF DECISION
keepforyour acords
Workers'
At the Compensation hearing held on 09/29/2015 involving the claim of Marcelo Lema at theQueens
hearing location,Judge Lucky Enobakhare made the following decision,findings and directions:
DECISION: SIF-State Fund raiseall controversy issues;especiallyno employer/employee relationship;no
coverage etc
As per WCB investigation,SSW...appears to have no coverage.
There is PFME forthe neck,back, chest,both shoulders and right thumb
As per coverage search,SSW Realty...theallegedemployer has no coverage
. Case iscontinued.
Information about Next Hearing / Meeting
C-7; coverage?
Claimant - Marcelo Lema Employer - SSW Realty, LLC
Social No. - Carrier- State Insurance Fund
Security
WCB Case No. - GI40 0014 CarrierID No.- W204002
Date of Accident - 06/18/2015 CarrierCase No.- 68060573
DistrictOffice - NYC Date of of thisDecision- 10/02/2015
Filing
ATENCION:
Puede llamara la oficina
de la Junta
de Compensacion Obrera,en su area correspondiente,
cuyo numero de telefonoaparece al
principio y pida
de la pagina informacion acercade su reclamacion(caso).
EC-23 (4/98) Page 1 of1
FILE COPY
FILED: QUEENS COUNTY CLERK 01/22/2023 11:20 AM INDEX NO. 707343/2016
21562520
NYSCEF DOC. NO. 100 RECEIVED NYSCEF: 01/22/2023
STATE OF NEW YORK
WORKERS'
COMPENSATION BOARD
PO BOX 5205
B1NGHAMTON, NY 13902-5205
www.wch.ny.gov
Robert E. Beloten
Chair (800) 877-4461
- Workers'
State of New York Compensation Board
In regard to Marcelo Lema, WCB Case #G140 0014
NOTICE OF DECISION
NO INSURANCE CASE
keepforyouroveon/s
Workers'
At the Compensation hearing held on 11/16/2015 involving the claim of Marcelo Lema at theQueens
hearing location,Judge Peter Georgalos made the following decision,findings and directions:
DECISION: I findjurisdictionover SSW Realty LLC by appearance here today.
Xiangan Gong is placedon notice per OC-406, sent forscanning.
. Case iscontinued.
Information about Next Hearing / Meeting
1/21/16 at 3:00pm for 75 minutes
Claimant totestifywith use of interpreter.
Alleged employer to testifywith use ofinterpreter.
StateInsurance Fund witness to testify.
Summations.
Claimant - Marcelo Lema Employer - SSW REALTY LLC
Social No. - - *** Undetermined ***
Security Carrier Carrier
WCB Case No. - GI40 0014 Carrier ID No.- W000004
Date of Accident - 06/18/2015 Carrier Case No. -
DistrictOffice - NYC Date of of thisDecision- 11/18/2015
Filing
ATENCION:
Puede llamara la oficina
de la Junta
de Compensacion Obrera,en su area correspondiente,
cuyo nmnero de telefonoaparece at
principiode la pagina
y pida informacionacercade su reclamacion(caso).
EC-23 (4/98) Page 1 of1
FILE COPY
FILED: QUEENS COUNTY CLERK 01/22/2023 11:20 AM INDEX NO. 707343/2016
21690103
NYSCEF DOC. NO. 100 RECEIVED NYSCEF: 01/22/2023
STATE OF NEW YORK
WORKERS'
COMPENSATION BOARD
PO BOX 5205
BINGHAMTON, NY 13902-5205
www.wch.ny.gov
Rober eloten
(800) 877-4461
- Workers'
State of New York Compensation Board
In regard to Marcelo Lema, WCB Case #G140 0014
NOTICE OF DECISION
NO INSURANCE CASE
keepforyour records
Workers'
At the Compensation hearing held on 01/21/2016 involving the claimof Marcelo Lema at theQueens
hearing location,Judge Peter Georgalos made the following decision, fmdings and directions:
AWARD : The employer or insurance carrieris directedtopay thefollowing awards, lesspayments already made
by the employer orcarrier,forthe periods indicated below, unless employer orcarrier filesan applicationwithin 30
days afterthe dateon which the decision was duly filedand served.
fordisability over a period of at rate
weeks from to per week the sum of
0 6/18/2015 7/3/2015 SO.00 $0.00
- Held in abeyance possible reimb to StateInsumnce Fund.
28.8 7/3/2015 1/21/2016 S433.33 $12,479.90
Carrier to continuepayments at $433.33.
FEES:
As lien on above award payable by separate check by carrier TO CLAIMANTS REPRESENTATIVE
OR ATTORNEY:
Sum of To
$2,000.00 Harris Law Group, LLP
DECISION: The claimant Marcelo Lema had a work relatedinjury to thehead/post-concussion syndrome,
neck,back , bothshoulders, chest/ribcontusions, leftinguenal hernia,right foot. The claimant's avenge weekly
wage forthe year worked before thiswork relatedinjury or occupational disease is$650.00 perrecord w/out
prejudice. Medical treatment and care, as necessary,forestablished sitesof injuryand/or conditions, isauthorized.
Treatment rendered to one of thebody partscovered by the Medical Treatment Guidelines must be consistentwith
those Guidelines.
*** Continued on next page***
Claimant - Marcelo Lema Employer - SSW REALTY LLC
- Carrier- *** Undetermined ***
Social Security No. Carrier
WCB Case No. - Gl 40 0014 CarrierID No. - W000004
Date of Accident - 06/18/2015 CarrierCase No.-
DistrictOllice - NYC Date of of thisDecision- 01/26/2016
Filing
ATENCION:
Puede llamara la oficina
de la Junta
de Compensacion Obrera,en su area correspondiente,
cuyo numero de telefonoaparece al
principiode la pagina
ypida informacion acercade sureclamacion(caso).
EC-23 (4/98) Page 1 of2
FILE COPY
FILED: QUEENS COUNTY CLERK 01/22/2023 11:20 AM INDEX NO. 707343/2016
21690103
NYSCEF DOC. NO. 100 RECEIVED NYSCEF: 01/22/2023
Form(s) C-8.1 which raised issuesrelating to treatmentand/or disputed medical billsforservices rendered in New
York Stateare resolved infavor of the medical provider(s).Pursuant to Rule 325-1.25, thecarrieris directedto pay
the within
bill(s) 30 days of the date ofthisdecision or notify theprovider inwriting thereason(s) for non-payment
ifithas not already done so. Ifpayment or a reasonfor non-payment is nottimely rendered, the provider may file
foran administrative award. Ifthe carrierprovides a timely reason for non-payment, the provider may filefor
Request
arbitration. for an administrativeaward or forarbitation may be made by filingform HP-1 with the
Boards Office of Health Provider Administration. no furtheraction. Ifind theclaimant worked forthe (PE)-SSW
Realty LLC. I find SSW Realty LLC had no workers compensation coverage on the date of accidentand I findthe
employer violatedsection 50 penalties assessed under 26-A. The period of non-compliance is from3-18-15 to
6-18-15.
The Court findsthatsection 56 is applicablehere as Pan-Link Construction Co. is thegeneral contractor and on the
building permit and covered by the StateInsurance Fund.
StateInsurance Fund acknowledges thatthey were on the joband no witness was produced. No furtheraction is
planned by the Board atthis time.
Payment Liability
Claimant was theemployee of SSW REALTY LLC. Upon review of allthe evidencein therecord, I findSSW
REALTY LLC, employer number 2891199 was uninsured on the dateof accident or date ofdisablement, and
therefore,is inviolationof WCL § 50. SSW REALTY LLC isthe Sub Contractor. I findPan-Link Construction
Co. General Contactor is theGeneral Contractor. 100% of Awards payable pursuant to WCL § 56,by General
Contractor's State
carrier, Insurance Fund. SSW REALTY LLC isliable for 100.00% of assessments pursuantto
WCL § 26-a. I findthat SSW REALTY LLC was without coverage for thefollowing period(s):3/18/2015 to
6/18/2015. Accordingly, theemployer is assessedper WCL § 26-a a sum of$9,000.00 forsuch non-compliance.
Assessments are payable by SSW REALTY LLC to the Uninsured Employers Fund. Payment is due within 10
days of thefilingdate of thisdecision. Failure to pay theassessment due will constitutea defaultwhich willresult
in an entryof judgment against theemployer.
Claimant - Marcelo Lema Employer - SSW REALTY LLC
- - *** ***
Social Security No. Carrier Carrier Undetermined
WCB Case No. - GI 40 0014 CarrierID No. - W000004
Date of Accident - 06/18/2015 CarrierCase No. -
DistrictOffice - NY C Date of of thisDecision- 01/26/2016
Filing
ATENCION:
Puede liamara la oficina
de la Junta
de Compensacion Obrera,en su area conespondiente,
cuyo nmnero de telefonoaparece al
principiode la pagina
y pidainformacion acercade su reclamacion(caso).
EC-23 (4/98) Page 2 of2
FILE COPY
FILED: QUEENS COUNTY CLERK 01/22/2023 11:20 AM INDEX NO. 707343/2016
22493463
NYSCEF DOC. NO. 100 RECEIVED NYSCEF: 01/22/2023
STATE OF NEW YORK
WORKERS'
BlEw Workers' COMPENSATION BOARD
YORK PO BOX 5205
ATE Compensat1On
BINGHAMTON, NY 13902-5205
www-web.ny.gov
Kenneth J.Munnelly
(877) 632-4996
- Workers'
State of New York Compensation Board
In regard to Marcelo Lema, WCB Case #G140 0014
NOTICE OF DECISION
keep foryour acords
Workers'
At the Compensation hearing held on 03/31/2017 involving the claim of Marcelo Lema at theQueens
hearing location,Judge Steven Miller made the following decision,findings and directions:
AWARD : The employer or insurance carrieris directedtopay thefollowing awards, lesspayments already made
by the employer orcarrier,forthe periods indicated below, unless employer or files
carrier an application within 30
days afterthe dateon which the decision was duly filedand served.
fordisabilityover a period of at rate
weeks from to per week the sum of
62.2 1/21/2016 3/31/2017 $433.33 $26,953.13
- totaldisability.
Temporary
Carrierto continue payments at $375.00 tentative rate.
FEES:
As lien on above award payable by separate check by carrierTO CLAIMANTS REPRESENTATIVE
OR ATTORNEY:
Sum of To
$125.00 Bangel, Cohen & Falconetti LLP
DECISION: Medical treatment and care,as necessary, forestablished sitesofinjuty and/or conditions, is
authorized. Treatment rendered to one ofthe body partscovered by theMedical Treatment Guidelines must be
consistentwith those Guidelines.
Form(s) C-8.1 which raised issuesrelating totreatment and/or disputed medical billsare resolvedin favor of the
carrierC8.1Bs dated 12/20/16, treatment not consistentwith the Medical Treatment Guideline and provided
without a variance.Per WCL section 13, claimant not responsible for payment.
*** on next page**"
Continued
Claimant - Marcelo Lema Employer - Pan- Li:± Construction Co.
Social No.- Carrier- State Insurance Fund
Security
WCB Case No. - GI40 0014 Carrier ID No.- W204002
Date of Accident - 06/18/2015 Carrier Case No. - 68060573-372
DistrictOffice - NYC Date of of thisDecision- 04/05/2017
Filing
ATENCION:
Puede 11amara la oficina
de la Junta
de Compensacion Obrera,en su arca correspondiente,
cuyo munero de telefonoaparece al
principiode la pagina
y pidainformacion acercade su reclamacion(caso).
EC-23 (4/98) Page 1 of2
FILE COPY
FILED: QUEENS COUNTY CLERK 01/22/2023 11:20 AM INDEX NO. 707343/2016
22493463
NYSCEF DOC. NO. 100 RECEIVED NYSCEF: 01/22/2023
RFA-2 is resolved.No further actionis planned by the Board at thistime.
Information about Payment of Awards
Payment of an award of compensation must be issuedwithin 10 days, except where the carrierhas filedan
applicationto theboard fora modification, rescissionor review ofthe award. Ifpayment is nottimely, the Board
imposes a penalty equal to20% ofthe unpaid compensation (WCL § 25[3][f]).That penalty is payabletothe
claimant.
Payment of installmentsof compensation must be issued within 25 days ofbecoming due, orelse thecarriershall
pay an additionalamount of 20% of thecompensation then due, plus$300, tothe claimant, unlessthe Board
excuses the latepayment upon an applicationby the carrier.WCL § 25(1)(e).
Claimant - Marcelo Lema Employer - Pan- Link Construction Co.
Social No. - Carrier - State Insurance Fund
Security
WCB Case No. - GI40 0014 Carrier ID No. - W204002
Date of Accident - 06/18/2015 Carrier Case No. - 68060573-372
DistrictOffice - NY C Date of of thisDecision- 04/05/2017
Filing
ATENCION:
Puede llamara la oficina
de la Juntade Compensacion Obrera,en su area correspondiente,
cuyo numero de telefonoaparece al
principiode la pagina
y pidainformacion acerca de su reclamacion(caso).
EC-23 (4/98) Page 2 of 2
FILE COPY
FILED: QUEENS COUNTY CLERK 01/22/2023 11:20 AM INDEX NO. 707343/2016
23105509
NYSCEF DOC. NO. 100 RECEIVED NYSCEF: 01/22/2023
STATE OF NEW YORK
WOrkerS" WORKERS'
NEW COMPENSATION BOARD
YORK PO BOX 5205
ATE CompenSatlOn
BINGHAMTON, NY 13902-5205
==ckans '
BOard
aRodrigue
(877) 632-4996
C1
- Workers'
State of New York Compensation Board
In regard to Marcelo Lema, WCB Case #G140 0014
NOTICE OF DECISION
keep foryour records
Workers'
At the Compensation hearing held on 03/14/2018 involving the claim of Marcelo Lema atthe Queens
hearing location,Judge Barry Greenberg made the following decision, fmdings and directions:
AWARD : The employer or insurance carrieris directedtopay thefollowing awards, lesspayments alreadymade
by the employer orcarrier,forthe periods indicated below, unless employer or carrierfilesan applicationwithin 30
days afterthe dateon which the decision was duly filedand served.
fordisability over a period of atrate
weeks from to per week the sum of
49.8 3/31/2017 3/15/2018 $375.00 $18,675.00
- Tentativerate.
Carrier to continuepayments at $375.00 tentativerate.
FEES:
As lien on above award payable by separatecheck by carrierTO CLAIMANTS REPRESENTATIVE
OR ATTORNEY:
Sum of To
$125.00 Bangel, Cohen & Falconetti LLP
DECISION: The claimant Marcelo Lema had a work relatedinjury amended to include consequential depressive
disorder. Both sides to produce medical of permanency forall sitesofinjury, including psych. Case iscontinued.
Information about Next Hearing / Meetine
05/23/18 at 09:30 am
*** Continuedon next page***
Claimant - Marcelo Lema Employer - Pan- Link Construction Co.
Social No. - Carrier- State InsuranceFund
Security
WCB Case No. - GI40 0014 CarrierID No. - W204002
Date of Accident - 06/18/2015 CarrierCase No. - 68060573
DistrictOffice- NYC Date of of thisDecision- 03/19/2018
Filing
ATENCION:
Puede llamara la oficina
de la Junta
de Compensacion Obrera,en su area correspondiente,
cuyo numero de telefonoaparece al
principiode la pagina
y pidainformacion acercade su reclamacion(caso).
EC-23 (4/98) Page 1 of2
FILE COPY
FILED: QUEENS COUNTY CLERK 01/22/2023 11:20 AM INDEX NO. 707343/2016
23105509
NYSCEF DOC. NO. 100 RECEIVED NYSCEF: 01/22/2023
information about Payment of Awards
Payment of an award of compensation must be issued within 10 days, exceptwhere the carrierhas filedan
applicationto theboard fora modification, rescissionor review of theaward. Ifpayment is nottimely, the Board
imposes a penaltyequal to 20% ofthe unpaid compensation (WCL § 25[3][f]).That penalty is payabletothe
claimant
Payment of installmentsof compensation must be issued within 25 days of becoming due, or elsethe carriershall
pay an additional amount of20% ofthe compensation then due, plus $300, to theclaimant, unless theBoard
excuses the latepayment upon an applicationby the carrier.WCL § 25(1)(e).
Claimant - Marcelo Lema Employer - Pan- Link Construction Co.
Social No.- Carrier- State Insurance Fund
Security
WCB Case No. - Gl 40 0014 CarrierID No. - W204002
Date of Accident - 06/18/2015 CarrierCase No. - 68060573
DistrictOffice - NYC Date of of thisDecision- 03/19/2018
Filing
ATENCION:
Puede llamara la oficina
de la Junta
de Compensacion Obrera,en su area correspondiente,
cuyo numero de telefonoaparece al
principiode la pagina
ypida informacion acercade sureclamacion(caso).
EC-23 (4/98) Page 2 of2
FILE COPY
FILED: QUEENS COUNTY CLERK 01/22/2023 11:20 AM INDEX NO. 707343/2016
23449229
NYSCEF DOC. NO. 100 RECEIVED NYSCEF: 01/22/2023
STATE OF NEW YORK
Workers' WORKERS'
NEW COMPENSATION BOARD
yonx PO BOx 5205
ATE CompeRSatlOn
BINGHAMTON, 13902-5205
Board
ClarissaM. Rodrigues
Chair (877) 632-4996
- Workers'
State of New York Compensation Board
In regant to Marcelo Lema, WCB Case #G140 0014
NOTICE OF DECISION
keepforyour records
Workers'
At the Compensation hearing held on 05/23/2018 involving the claimof Marcelo Lema atthe Queens
hearing location,Judge Bany Greenberg made the following decision,findings and directions:
AWARD : The employer or insurance carrieris directedtopay thefollowing awards, lesspayments already made
by the employer orcarrier,forthe periods indicated below, unless employer or carrierfilesan applicationwithin 30
days afterthe dateon which the decision was duly filedand served.
fordisability over a periodof at rate
weeks from to per week the sum of
10.0 3/15/2018 5/24/2018 $375.00 $3,750.00
- Tentativerate.
Carrier to continuepayments at $375.00 tentativerate.
FEES:
As lien on above award payable by separate check by carrier TO CLAIMANTS REPRESENTATIVE
OR ATTORNEY:
Sum of To
$125.00 The Garcia Law Firm PC
DECISION: The claimant has not reached maximum medical im provement as based on carrier'sime.
Medical treatmentand care,as necessary, forestablished sitesofinjury and/or conditions, is authorized.Treatment
rendered to one of thebody partscovered by theMedical Treatment Guidelines must be consistentwith those
Guidelines. No further actionis planned by the Board at thistime.
Information about Payment of Awards
*** Continued on next pge ***
Claimant - Marcelo Lema Employer - Pan- Link Construction Co.
Social No. - Carrier- State Insurance Fund
Security
WCB Case No. - GI40 0014 CarrierID No. - W204002
Date of Accident - 06/18/2015 CarrierCase No. - 68060573
DistrictOffice - NY C Date of of thisDecision- 07/26/2018
Filing
ATENCION:
Puede 11amara la oficina
de la Junta
de Compensacion Obrera,en su area correspondiente,
cuyo numero de telefonoaparece al
principiode la pagina
y pida informacionacercade su reclamacion(caso).
EC-23 (4/98) Page 1 of2
FILE COPY
FILED: QUEENS COUNTY CLERK 01/22/2023 11:20 AM INDEX NO. 707343/2016
23449229
NYSCEF DOC. NO. 100 RECEIVED NYSCEF: 01/22/2023
Payment of an award of compensationmust be issued within 10 days, exceptwhere the carrierhas filedan
applicationto theboard fora modification, rescissionor review of the award. Ifpayment is nottimely, the Board
imposes a penaltyequal to 20% ofthe unpaid compensation (WCL § 25[3][fj).That penalty is payableto the
claimant
Payment of installmentsof compensation must be issued within 25 days of becoming due, or elsethe carriershall
pay an additional amount of20% ofthe compensation then due, plus $300, to theclaimant, unless theBoard
excuses the latepayment upon an applicationby the carrier.WCL § 25(1)(e).
Claimant - Marcelo Lema Employer - Pan- Link Construction Co.
Social No.- Carrier- State InsuranceFund
Security
WCB Case No. - G140 0014 CarrierID No. - W204002
Date of Accident - 06/18/2015 CarrierCase No.- 68060573
District OtTice - NYC Date of of thisDecision- 07/26/2018
Filing
ATENCION:
Puede llamara la oficina
de la Junta
de Compensacion Obrera,en su area couTespondiente,
cuyo numero aparece
de telefono al
de la pagina
principio y pida informacionacerca de su reclamacion(caso).
EC-23 (4/98) Page 2 of2
FILE COPY
Preview
FILED: QUEENS COUNTY CLERK 01/22/2023 11:20 AM INDEX NO. 707343/2016 NYSCEF DOC. NO. 100 RECEIVED NYSCEF: 01/22/2023 Exhibit J FILED: QUEENS COUNTY CLERK 01/22/2023 11:20 AM INDEX NO. 707343/2016 21471976 NYSCEF DOC. NO. 100 RECEIVED NYSCEF: 01/22/2023 STATE OF NEW YORK WORKERS' COMPENSATION BOARD PO BOX 5205 BlNGHAMTON, NY 13902-5205 www.wch.ny.gov Robert eloten (877) 632-4996 - Workers' State of New York Compensation Board In regard to Marcelo Lema, WCB Case #G140 0014 NOTICE OF DECISION keepforyour acords Workers' At the Compensation hearing held on 09/29/2015 involving the claim of Marcelo Lema at theQueens hearing location,Judge Lucky Enobakhare made the following decision,findings and directions: DECISION: SIF-State Fund raiseall controversy issues;especiallyno employer/employee relationship;no coverage etc As per WCB investigation,SSW...appears to have no coverage. There is PFME forthe neck,back, chest,both shoulders and right thumb As per coverage search,SSW Realty...theallegedemployer has no coverage . Case iscontinued. Information about Next Hearing / Meeting C-7; coverage? Claimant - Marcelo Lema Employer - SSW Realty, LLC Social No. - Carrier- State Insurance Fund Security WCB Case No. - GI40 0014 CarrierID No.- W204002 Date of Accident - 06/18/2015 CarrierCase No.- 68060573 DistrictOffice - NYC Date of of thisDecision- 10/02/2015 Filing ATENCION: Puede llamara la oficina de la Junta de Compensacion Obrera,en su area correspondiente, cuyo numero de telefonoaparece al principio y pida de la pagina informacion acercade su reclamacion(caso). EC-23 (4/98) Page 1 of1 FILE COPY FILED: QUEENS COUNTY CLERK 01/22/2023 11:20 AM INDEX NO. 707343/2016 21562520 NYSCEF DOC. NO. 100 RECEIVED NYSCEF: 01/22/2023 STATE OF NEW YORK WORKERS' COMPENSATION BOARD PO BOX 5205 B1NGHAMTON, NY 13902-5205 www.wch.ny.gov Robert E. Beloten Chair (800) 877-4461 - Workers' State of New York Compensation Board In regard to Marcelo Lema, WCB Case #G140 0014 NOTICE OF DECISION NO INSURANCE CASE keepforyouroveon/s Workers' At the Compensation hearing held on 11/16/2015 involving the claim of Marcelo Lema at theQueens hearing location,Judge Peter Georgalos made the following decision,findings and directions: DECISION: I findjurisdictionover SSW Realty LLC by appearance here today. Xiangan Gong is placedon notice per OC-406, sent forscanning. . Case iscontinued. Information about Next Hearing / Meeting 1/21/16 at 3:00pm for 75 minutes Claimant totestifywith use of interpreter. Alleged employer to testifywith use ofinterpreter. StateInsurance Fund witness to testify. Summations. Claimant - Marcelo Lema Employer - SSW REALTY LLC Social No. - - *** Undetermined *** Security Carrier Carrier WCB Case No. - GI40 0014 Carrier ID No.- W000004 Date of Accident - 06/18/2015 Carrier Case No. - DistrictOffice - NYC Date of of thisDecision- 11/18/2015 Filing ATENCION: Puede llamara la oficina de la Junta de Compensacion Obrera,en su area correspondiente, cuyo nmnero de telefonoaparece at principiode la pagina y pida informacionacercade su reclamacion(caso). EC-23 (4/98) Page 1 of1 FILE COPY FILED: QUEENS COUNTY CLERK 01/22/2023 11:20 AM INDEX NO. 707343/2016 21690103 NYSCEF DOC. NO. 100 RECEIVED NYSCEF: 01/22/2023 STATE OF NEW YORK WORKERS' COMPENSATION BOARD PO BOX 5205 BINGHAMTON, NY 13902-5205 www.wch.ny.gov Rober eloten (800) 877-4461 - Workers' State of New York Compensation Board In regard to Marcelo Lema, WCB Case #G140 0014 NOTICE OF DECISION NO INSURANCE CASE keepforyour records Workers' At the Compensation hearing held on 01/21/2016 involving the claimof Marcelo Lema at theQueens hearing location,Judge Peter Georgalos made the following decision, fmdings and directions: AWARD : The employer or insurance carrieris directedtopay thefollowing awards, lesspayments already made by the employer orcarrier,forthe periods indicated below, unless employer orcarrier filesan applicationwithin 30 days afterthe dateon which the decision was duly filedand served. fordisability over a period of at rate weeks from to per week the sum of 0 6/18/2015 7/3/2015 SO.00 $0.00 - Held in abeyance possible reimb to StateInsumnce Fund. 28.8 7/3/2015 1/21/2016 S433.33 $12,479.90 Carrier to continuepayments at $433.33. FEES: As lien on above award payable by separate check by carrier TO CLAIMANTS REPRESENTATIVE OR ATTORNEY: Sum of To $2,000.00 Harris Law Group, LLP DECISION: The claimant Marcelo Lema had a work relatedinjury to thehead/post-concussion syndrome, neck,back , bothshoulders, chest/ribcontusions, leftinguenal hernia,right foot. The claimant's avenge weekly wage forthe year worked before thiswork relatedinjury or occupational disease is$650.00 perrecord w/out prejudice. Medical treatment and care, as necessary,forestablished sitesof injuryand/or conditions, isauthorized. Treatment rendered to one of thebody partscovered by the Medical Treatment Guidelines must be consistentwith those Guidelines. *** Continued on next page*** Claimant - Marcelo Lema Employer - SSW REALTY LLC - Carrier- *** Undetermined *** Social Security No. Carrier WCB Case No. - Gl 40 0014 CarrierID No. - W000004 Date of Accident - 06/18/2015 CarrierCase No.- DistrictOllice - NYC Date of of thisDecision- 01/26/2016 Filing ATENCION: Puede llamara la oficina de la Junta de Compensacion Obrera,en su area correspondiente, cuyo numero de telefonoaparece al principiode la pagina ypida informacion acercade sureclamacion(caso). EC-23 (4/98) Page 1 of2 FILE COPY FILED: QUEENS COUNTY CLERK 01/22/2023 11:20 AM INDEX NO. 707343/2016 21690103 NYSCEF DOC. NO. 100 RECEIVED NYSCEF: 01/22/2023 Form(s) C-8.1 which raised issuesrelating to treatmentand/or disputed medical billsforservices rendered in New York Stateare resolved infavor of the medical provider(s).Pursuant to Rule 325-1.25, thecarrieris directedto pay the within bill(s) 30 days of the date ofthisdecision or notify theprovider inwriting thereason(s) for non-payment ifithas not already done so. Ifpayment or a reasonfor non-payment is nottimely rendered, the provider may file foran administrative award. Ifthe carrierprovides a timely reason for non-payment, the provider may filefor Request arbitration. for an administrativeaward or forarbitation may be made by filingform HP-1 with the Boards Office of Health Provider Administration. no furtheraction. Ifind theclaimant worked forthe (PE)-SSW Realty LLC. I find SSW Realty LLC had no workers compensation coverage on the date of accidentand I findthe employer violatedsection 50 penalties assessed under 26-A. The period of non-compliance is from3-18-15 to 6-18-15. The Court findsthatsection 56 is applicablehere as Pan-Link Construction Co. is thegeneral contractor and on the building permit and covered by the StateInsurance Fund. StateInsurance Fund acknowledges thatthey were on the joband no witness was produced. No furtheraction is planned by the Board atthis time. Payment Liability Claimant was theemployee of SSW REALTY LLC. Upon review of allthe evidencein therecord, I findSSW REALTY LLC, employer number 2891199 was uninsured on the dateof accident or date ofdisablement, and therefore,is inviolationof WCL § 50. SSW REALTY LLC isthe Sub Contractor. I findPan-Link Construction Co. General Contactor is theGeneral Contractor. 100% of Awards payable pursuant to WCL § 56,by General Contractor's State carrier, Insurance Fund. SSW REALTY LLC isliable for 100.00% of assessments pursuantto WCL § 26-a. I findthat SSW REALTY LLC was without coverage for thefollowing period(s):3/18/2015 to 6/18/2015. Accordingly, theemployer is assessedper WCL § 26-a a sum of$9,000.00 forsuch non-compliance. Assessments are payable by SSW REALTY LLC to the Uninsured Employers Fund. Payment is due within 10 days of thefilingdate of thisdecision. Failure to pay theassessment due will constitutea defaultwhich willresult in an entryof judgment against theemployer. Claimant - Marcelo Lema Employer - SSW REALTY LLC - - *** *** Social Security No. Carrier Carrier Undetermined WCB Case No. - GI 40 0014 CarrierID No. - W000004 Date of Accident - 06/18/2015 CarrierCase No. - DistrictOffice - NY C Date of of thisDecision- 01/26/2016 Filing ATENCION: Puede liamara la oficina de la Junta de Compensacion Obrera,en su area conespondiente, cuyo nmnero de telefonoaparece al principiode la pagina y pidainformacion acercade su reclamacion(caso). EC-23 (4/98) Page 2 of2 FILE COPY FILED: QUEENS COUNTY CLERK 01/22/2023 11:20 AM INDEX NO. 707343/2016 22493463 NYSCEF DOC. NO. 100 RECEIVED NYSCEF: 01/22/2023 STATE OF NEW YORK WORKERS' BlEw Workers' COMPENSATION BOARD YORK PO BOX 5205 ATE Compensat1On BINGHAMTON, NY 13902-5205 www-web.ny.gov Kenneth J.Munnelly (877) 632-4996 - Workers' State of New York Compensation Board In regard to Marcelo Lema, WCB Case #G140 0014 NOTICE OF DECISION keep foryour acords Workers' At the Compensation hearing held on 03/31/2017 involving the claim of Marcelo Lema at theQueens hearing location,Judge Steven Miller made the following decision,findings and directions: AWARD : The employer or insurance carrieris directedtopay thefollowing awards, lesspayments already made by the employer orcarrier,forthe periods indicated below, unless employer or files carrier an application within 30 days afterthe dateon which the decision was duly filedand served. fordisabilityover a period of at rate weeks from to per week the sum of 62.2 1/21/2016 3/31/2017 $433.33 $26,953.13 - totaldisability. Temporary Carrierto continue payments at $375.00 tentative rate. FEES: As lien on above award payable by separate check by carrierTO CLAIMANTS REPRESENTATIVE OR ATTORNEY: Sum of To $125.00 Bangel, Cohen & Falconetti LLP DECISION: Medical treatment and care,as necessary, forestablished sitesofinjuty and/or conditions, is authorized. Treatment rendered to one ofthe body partscovered by theMedical Treatment Guidelines must be consistentwith those Guidelines. Form(s) C-8.1 which raised issuesrelating totreatment and/or disputed medical billsare resolvedin favor of the carrierC8.1Bs dated 12/20/16, treatment not consistentwith the Medical Treatment Guideline and provided without a variance.Per WCL section 13, claimant not responsible for payment. *** on next page**" Continued Claimant - Marcelo Lema Employer - Pan- Li:± Construction Co. Social No.- Carrier- State Insurance Fund Security WCB Case No. - GI40 0014 Carrier ID No.- W204002 Date of Accident - 06/18/2015 Carrier Case No. - 68060573-372 DistrictOffice - NYC Date of of thisDecision- 04/05/2017 Filing ATENCION: Puede 11amara la oficina de la Junta de Compensacion Obrera,en su arca correspondiente, cuyo munero de telefonoaparece al principiode la pagina y pidainformacion acercade su reclamacion(caso). EC-23 (4/98) Page 1 of2 FILE COPY FILED: QUEENS COUNTY CLERK 01/22/2023 11:20 AM INDEX NO. 707343/2016 22493463 NYSCEF DOC. NO. 100 RECEIVED NYSCEF: 01/22/2023 RFA-2 is resolved.No further actionis planned by the Board at thistime. Information about Payment of Awards Payment of an award of compensation must be issuedwithin 10 days, except where the carrierhas filedan applicationto theboard fora modification, rescissionor review ofthe award. Ifpayment is nottimely, the Board imposes a penalty equal to20% ofthe unpaid compensation (WCL § 25[3][f]).That penalty is payabletothe claimant. Payment of installmentsof compensation must be issued within 25 days ofbecoming due, orelse thecarriershall pay an additionalamount of 20% of thecompensation then due, plus$300, tothe claimant, unlessthe Board excuses the latepayment upon an applicationby the carrier.WCL § 25(1)(e). Claimant - Marcelo Lema Employer - Pan- Link Construction Co. Social No. - Carrier - State Insurance Fund Security WCB Case No. - GI40 0014 Carrier ID No. - W204002 Date of Accident - 06/18/2015 Carrier Case No. - 68060573-372 DistrictOffice - NY C Date of of thisDecision- 04/05/2017 Filing ATENCION: Puede llamara la oficina de la Juntade Compensacion Obrera,en su area correspondiente, cuyo numero de telefonoaparece al principiode la pagina y pidainformacion acerca de su reclamacion(caso). EC-23 (4/98) Page 2 of 2 FILE COPY FILED: QUEENS COUNTY CLERK 01/22/2023 11:20 AM INDEX NO. 707343/2016 23105509 NYSCEF DOC. NO. 100 RECEIVED NYSCEF: 01/22/2023 STATE OF NEW YORK WOrkerS" WORKERS' NEW COMPENSATION BOARD YORK PO BOX 5205 ATE CompenSatlOn BINGHAMTON, NY 13902-5205 ==ckans ' BOard aRodrigue (877) 632-4996 C1 - Workers' State of New York Compensation Board In regard to Marcelo Lema, WCB Case #G140 0014 NOTICE OF DECISION keep foryour records Workers' At the Compensation hearing held on 03/14/2018 involving the claim of Marcelo Lema atthe Queens hearing location,Judge Barry Greenberg made the following decision, fmdings and directions: AWARD : The employer or insurance carrieris directedtopay thefollowing awards, lesspayments alreadymade by the employer orcarrier,forthe periods indicated below, unless employer or carrierfilesan applicationwithin 30 days afterthe dateon which the decision was duly filedand served. fordisability over a period of atrate weeks from to per week the sum of 49.8 3/31/2017 3/15/2018 $375.00 $18,675.00 - Tentativerate. Carrier to continuepayments at $375.00 tentativerate. FEES: As lien on above award payable by separatecheck by carrierTO CLAIMANTS REPRESENTATIVE OR ATTORNEY: Sum of To $125.00 Bangel, Cohen & Falconetti LLP DECISION: The claimant Marcelo Lema had a work relatedinjury amended to include consequential depressive disorder. Both sides to produce medical of permanency forall sitesofinjury, including psych. Case iscontinued. Information about Next Hearing / Meetine 05/23/18 at 09:30 am *** Continuedon next page*** Claimant - Marcelo Lema Employer - Pan- Link Construction Co. Social No. - Carrier- State InsuranceFund Security WCB Case No. - GI40 0014 CarrierID No. - W204002 Date of Accident - 06/18/2015 CarrierCase No. - 68060573 DistrictOffice- NYC Date of of thisDecision- 03/19/2018 Filing ATENCION: Puede llamara la oficina de la Junta de Compensacion Obrera,en su area correspondiente, cuyo numero de telefonoaparece al principiode la pagina y pidainformacion acercade su reclamacion(caso). EC-23 (4/98) Page 1 of2 FILE COPY FILED: QUEENS COUNTY CLERK 01/22/2023 11:20 AM INDEX NO. 707343/2016 23105509 NYSCEF DOC. NO. 100 RECEIVED NYSCEF: 01/22/2023 information about Payment of Awards Payment of an award of compensation must be issued within 10 days, exceptwhere the carrierhas filedan applicationto theboard fora modification, rescissionor review of theaward. Ifpayment is nottimely, the Board imposes a penaltyequal to 20% ofthe unpaid compensation (WCL § 25[3][f]).That penalty is payabletothe claimant Payment of installmentsof compensation must be issued within 25 days of becoming due, or elsethe carriershall pay an additional amount of20% ofthe compensation then due, plus $300, to theclaimant, unless theBoard excuses the latepayment upon an applicationby the carrier.WCL § 25(1)(e). Claimant - Marcelo Lema Employer - Pan- Link Construction Co. Social No.- Carrier- State Insurance Fund Security WCB Case No. - Gl 40 0014 CarrierID No. - W204002 Date of Accident - 06/18/2015 CarrierCase No. - 68060573 DistrictOffice - NYC Date of of thisDecision- 03/19/2018 Filing ATENCION: Puede llamara la oficina de la Junta de Compensacion Obrera,en su area correspondiente, cuyo numero de telefonoaparece al principiode la pagina ypida informacion acercade sureclamacion(caso). EC-23 (4/98) Page 2 of2 FILE COPY FILED: QUEENS COUNTY CLERK 01/22/2023 11:20 AM INDEX NO. 707343/2016 23449229 NYSCEF DOC. NO. 100 RECEIVED NYSCEF: 01/22/2023 STATE OF NEW YORK Workers' WORKERS' NEW COMPENSATION BOARD yonx PO BOx 5205 ATE CompeRSatlOn BINGHAMTON, 13902-5205 Board ClarissaM. Rodrigues Chair (877) 632-4996 - Workers' State of New York Compensation Board In regant to Marcelo Lema, WCB Case #G140 0014 NOTICE OF DECISION keepforyour records Workers' At the Compensation hearing held on 05/23/2018 involving the claimof Marcelo Lema atthe Queens hearing location,Judge Bany Greenberg made the following decision,findings and directions: AWARD : The employer or insurance carrieris directedtopay thefollowing awards, lesspayments already made by the employer orcarrier,forthe periods indicated below, unless employer or carrierfilesan applicationwithin 30 days afterthe dateon which the decision was duly filedand served. fordisability over a periodof at rate weeks from to per week the sum of 10.0 3/15/2018 5/24/2018 $375.00 $3,750.00 - Tentativerate. Carrier to continuepayments at $375.00 tentativerate. FEES: As lien on above award payable by separate check by carrier TO CLAIMANTS REPRESENTATIVE OR ATTORNEY: Sum of To $125.00 The Garcia Law Firm PC DECISION: The claimant has not reached maximum medical im provement as based on carrier'sime. Medical treatmentand care,as necessary, forestablished sitesofinjury and/or conditions, is authorized.Treatment rendered to one of thebody partscovered by theMedical Treatment Guidelines must be consistentwith those Guidelines. No further actionis planned by the Board at thistime. Information about Payment of Awards *** Continued on next pge *** Claimant - Marcelo Lema Employer - Pan- Link Construction Co. Social No. - Carrier- State Insurance Fund Security WCB Case No. - GI40 0014 CarrierID No. - W204002 Date of Accident - 06/18/2015 CarrierCase No. - 68060573 DistrictOffice - NY C Date of of thisDecision- 07/26/2018 Filing ATENCION: Puede 11amara la oficina de la Junta de Compensacion Obrera,en su area correspondiente, cuyo numero de telefonoaparece al principiode la pagina y pida informacionacercade su reclamacion(caso). EC-23 (4/98) Page 1 of2 FILE COPY FILED: QUEENS COUNTY CLERK 01/22/2023 11:20 AM INDEX NO. 707343/2016 23449229 NYSCEF DOC. NO. 100 RECEIVED NYSCEF: 01/22/2023 Payment of an award of compensationmust be issued within 10 days, exceptwhere the carrierhas filedan applicationto theboard fora modification, rescissionor review of the award. Ifpayment is nottimely, the Board imposes a penaltyequal to 20% ofthe unpaid compensation (WCL § 25[3][fj).That penalty is payableto the claimant Payment of installmentsof compensation must be issued within 25 days of becoming due, or elsethe carriershall pay an additional amount of20% ofthe compensation then due, plus $300, to theclaimant, unless theBoard excuses the latepayment upon an applicationby the carrier.WCL § 25(1)(e). Claimant - Marcelo Lema Employer - Pan- Link Construction Co. Social No.- Carrier- State InsuranceFund Security WCB Case No. - G140 0014 CarrierID No. - W204002 Date of Accident - 06/18/2015 CarrierCase No.- 68060573 District OtTice - NYC Date of of thisDecision- 07/26/2018 Filing ATENCION: Puede llamara la oficina de la Junta de Compensacion Obrera,en su area couTespondiente, cuyo numero aparece de telefono al de la pagina principio y pida informacionacerca de su reclamacion(caso). EC-23 (4/98) Page 2 of2 FILE COPY