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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
Apr 05, 1990

Service Sign Erectors Co. v. Allied Outdoor Advertising, Inc.

Plaintiff Service Sign, a subcontractor, initiated an action for damages in breach of contract or quantum meruit against Allied, the defendant and third-party plaintiff, after a billboard Allied had contracted to build for the Authority collapsed due to insufficient support. Allied subsequently filed a third-party action against the Authority, seeking indemnification. The Supreme Court initially granted dismissal of the first cause of action in the third-party complaint but denied dismissal for the second and third causes of action. On appeal, the higher court modified this decision, ruling that implied indemnification was not available to Allied. The court found that the existing contract between Allied and the Authority explicitly provided for one-way indemnification from Allied to the Authority, thereby precluding any reciprocal implied obligation. Consequently, the appellate court granted the dismissal of all three causes of action in Allied's third-party complaint against the Authority, affirming the modification without costs.

IndemnificationImplied IndemnificationExpress ContractSummary JudgmentThird-Party ComplaintBreach of ContractQuantum MeruitSubcontractorAppellate ReviewContract Interpretation
References
7
Case No. 2015-1094 K C
Regular Panel Decision
Dec 22, 2017

V.S. Care Acupuncture, P.C. v. NY Cent. Mut. Fire Ins. Co.

This case involves an appeal brought by NY Central Mutual Fire Ins. Co. against V.S. Care Acupuncture, P.C., an assignee, concerning first-party no-fault benefits. The defendant appealed an order from the Civil Court that denied its motion for summary judgment to dismiss claims for services rendered between October 2009 and February 2010. The Appellate Term found that the defendant had properly mailed denial of claim forms and established that the amounts sought by the plaintiff exceeded the applicable workers' compensation fee schedule. Consequently, the Appellate Term reversed the lower court's order and granted the defendant's motion for summary judgment, dismissing the relevant parts of the complaint.

No-Fault BenefitsSummary JudgmentAppellate ReviewFee Schedule DefenseDenial of ClaimWorkers' Compensation Fee ScheduleInsurance LawFirst-Party BenefitsAssignee RightsCivil Court Order
References
1
Case No. 2013-2706 Q C
Regular Panel Decision
Sep 19, 2016

NYS Acupuncture, P.C. v. State Farm Mut. Auto. Ins. Co.

This case, NYS Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co., concerned an appeal from an order of the Civil Court of the City of New York, Queens County. The plaintiff, NYS Acupuncture, P.C., sought assigned first-party no-fault benefits from State Farm, which had moved for summary judgment arguing full payment according to the workers' compensation fee schedule. The Civil Court initially granted State Farm's motion. On appeal, NYS Acupuncture, P.C. contended that the fee schedule reductions were improper. The Appellate Term, Second Department, affirmed the prior ruling, finding that State Farm adequately demonstrated it had fully compensated the plaintiff for acupuncture services based on the applicable workers' compensation fee schedule for services performed by chiropractors, referencing Great Wall Acupuncture, P.C. v Geico Ins. Co.

Workers' Compensation Fee ScheduleNo-Fault BenefitsAcupuncture ServicesChiropractorsSummary JudgmentAppellate ReviewInsurance DisputeFee Schedule ReductionAssigned BenefitsMedical Billing
References
1
Case No. 2017-913 K C
Regular Panel Decision
Aug 02, 2019

Oriental Health Acupuncture, P.C. v. State Farm Mut. Auto. Ins. Co.

This case concerns an appeal initiated by Oriental Health Acupuncture, P.C., acting as the assignee of Carrington, Earnel, against State Farm Mutual Automobile Ins. Co. The appeal originated from an order by the Civil Court of the City of New York, Kings County, which had granted State Farm's motion for summary judgment and dismissed the plaintiff's complaint seeking first-party no-fault benefits. The Civil Court's decision was predicated on the finding that the amounts claimed by the plaintiff exceeded the limits established by the workers' compensation fee schedule. The Appellate Term, Second Department, affirmed the lower court's order. This decision was made in conjunction with a related case, BQE Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co., decided concurrently.

No-fault benefitsSummary judgmentAppellate reviewWorkers' compensation fee scheduleAutomobile insuranceFirst-party benefitsMedical provider claimAssigned benefitsCivil Court appealAppellate Term decision
References
1
Case No. 2017-1180 K C
Regular Panel Decision
Aug 02, 2019

Merrick Med., P.C. v. A Cent. Ins. Co.

The case of Merrick Med., P.C. v A Central Ins. Co. concerned a provider's action to recover assigned first-party no-fault benefits from an insurer. The defendant insurer, A Central Insurance Company, moved for summary judgment to dismiss the complaint, asserting that a portion of the claim exceeded the workers' compensation fee schedule and other claims lacked medical necessity. Initially, the Civil Court denied the defendant's motion in part, making CPLR 3212 (g) findings. However, the Appellate Term, Second Department, modified the Civil Court's order. The appellate court concluded that the defendant's motion for summary judgment dismissing the complaint should have been entirely granted, as the specific claim was properly paid under the fee schedule, and the remaining claims were successfully challenged on medical necessity grounds by the defendant, which the plaintiff failed to rebut.

No-fault benefitsSummary judgment motionWorkers' compensation fee scheduleMedical necessity defenseAppellate Term decisionInsurance litigationAssignee claimCivil procedurePeer review reportIndependent medical examination
References
3
Case No. 2014-1942 K C
Regular Panel Decision
Sep 22, 2017

AL Acupuncture, P.C. v. Geico Ins. Co.

This case, AL Acupuncture, P.C. v Geico Ins. Co., concerns an appeal from a Civil Court order regarding assigned first-party no-fault benefits. The plaintiff, AL Acupuncture, P.C., sought summary judgment for services rendered, while defendant Geico Insurance Company cross-moved for dismissal. The Appellate Term modified the lower court's order. It denied the plaintiff's motion for summary judgment on claims from September 8 to September 25, 2008, citing the plaintiff's failure to prove the claim was not timely denied and issues with IME scheduling evidence. Conversely, the court granted the defendant's cross-motion, dismissing claims for services from July 8 to September 5, 2008, as Geico demonstrated timely denial and payment under the workers' compensation fee schedule. The order was affirmed as modified.

No-fault benefitsSummary judgmentIndependent medical examinationsTimely denialWorkers' compensation fee scheduleAcupuncture servicesAppellate TermProvider actionAssigned claimsCivil Court order
References
5
Case No. 16-CV-3812, 16-CV-5302
Regular Panel Decision
Nov 29, 2018

Lighton Indus., Inc. v. Allied World Nat'l Assurance Co.

This case involves consolidated actions by Lighton Industries, Inc. and Hibuild Limited Liability Company against Allied World National Assurance Company and Mt. Hawley Insurance Company. Plaintiffs sought declaratory judgment regarding the insurers' duty to defend and indemnify them in an underlying personal injury action, the Tunkara Action, stemming from an August 16, 2014 accident at Brooklyn College. The court granted Lighton and Hibuild's motions for summary judgment, determining that Allied and Mt. Hawley owe a duty to defend the plaintiffs in the Tunkara Action. This decision was based on ambiguities in the insurance policies' Classification Limitation and Designated Ongoing Operations Exclusion, which were construed against the insurers. However, all motions for summary judgment concerning indemnification were denied, and these claims were dismissed without prejudice as premature, as liability in the underlying Tunkara Action had not yet been determined.

Insurance CoverageDuty to DefendDuty to IndemnifySummary JudgmentContract InterpretationAmbiguityPolicy ExclusionClassification LimitationOngoing Operations ExclusionSubcontractor Liability
References
73
Case No. 2018 NY Slip Op 07194 [167 AD3d 142]
Regular Panel Decision
Oct 25, 2018

American Intl. Specialty Lines Ins. Co. v. Allied Capital Corp.

This appeal concerns an arbitration dispute between American International Specialty Lines Insurance Company (AISLIC) and Allied Capital Corporation regarding insurance coverage for a $10.1 million settlement. An arbitration panel initially issued a Partial Final Award (PFA) on liability but later reconsidered and reversed its decision, leading to a corrected PFA and a final award. AISLIC petitioned to vacate these subsequent awards and confirm the original PFA. The Appellate Division, First Department, ruled that the arbitration panel exceeded its authority under the functus officio doctrine by reconsidering its prior final determination on liability. Consequently, the corrected PFA and the final award were vacated, and the original PFA was reinstated.

ArbitrationFunctus OfficioPartial Final AwardVacaturInsurance CoverageAppellate ReviewJurisdictionArbitrator AuthorityLiabilityDamages
References
32
Case No. 2013-1419 K C
Regular Panel Decision
Jun 03, 2016

GBI Acupuncture, P.C. v. Tri State Consumers Ins. Co.

In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint, arguing that it had fully paid plaintiff in accordance with the workers' compensation fee schedule. The Civil Court granted defendant's motion. For the reasons stated in Renelique, as Assignee of Yvon Delgado v Tri State Consumers Ins. Co. (___ Misc 3d ___, 2016 NY Slip Op _____ [appeal No. 2013-1709 Q C], decided herewith), the order is affirmed.

No-fault benefitsSummary judgmentWorkers' compensation fee scheduleAssigneeAppellate TermFirst-party benefitsInsurance disputeCivil CourtKings County
References
1
Case No. 2014-2010 Q C
Regular Panel Decision
Sep 22, 2017

Charles Deng Acupuncture, P.C. v. 21st Century Ins. Co.

The case *Charles Deng Acupuncture, P.C. v 21st Century Ins. Co.*, decided on September 22, 2017, by the Appellate Term, Second Department, involved an appeal concerning first-party no-fault benefits. The plaintiff-appellant, Charles Deng Acupuncture, P.C., challenged an order from the Civil Court that denied its motion for summary judgment and granted the defendant-respondent's cross-motion for summary judgment and to compel disclosure. The Appellate Term affirmed the lower court's decision, finding that the plaintiff failed to establish its prima facie entitlement to summary judgment regarding claim denials. The court also affirmed that insurers may use the workers' compensation fee schedule for acupuncture services by chiropractors to determine payments for licensed acupuncturists and upheld the defendant's right to discovery due to the plaintiff's untimely objections.

no-fault insurancesummary judgmentacupuncture servicesCPT codesworkers' compensation fee schedulediscovery disputeappellate reviewmedical billinginsurance claimstimely denial
References
7
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