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Case Law Database

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

Case No. 25 NY3d 907
Regular Panel Decision
2015-XX-XX

Government Employees Insurance v. Avanguard Medical Group, PLLC

This case addresses whether no-fault insurance carriers are obligated to pay facility fees to New York State-accredited office-based surgery (OBS) centers for the use of their premises and support services. The court concluded that neither existing statutes nor regulations mandate such payments. Plaintiffs, a group of GEICO insurers, successfully sought a declaratory judgment that they are not legally required to reimburse Avanguard Medical Group, PLLC, for OBS facility fees, totaling over $1.3 million. The decision affirmed the Appellate Division's ruling, emphasizing that OBS facility fees are not explicitly covered by statute or fee schedules, nor do they fall under reimbursable "professional health services" as per 11 NYCRR 68.5. The court highlighted the distinct regulatory frameworks for OBS centers compared to hospitals and ambulatory surgery centers, declining to mandate policy changes best left to the legislature.

No-Fault InsuranceOffice-Based Surgery (OBS)Facility FeesInsurance LawBasic Economic LossFee SchedulesWorkers' Compensation BoardDepartment of Financial ServicesStatutory InterpretationRegulatory Framework
References
16
Case No. 2018 NY Slip Op 07814
Regular Panel Decision
Nov 15, 2018

Matter of Varrone v. Coastal Envt. Group

In the Matter of Varrone v Coastal Environment Group, the Appellate Division, Third Department, affirmed a Workers' Compensation Board decision. Claimant Joseph Varrone appealed the Board's modification of his loss of wage-earning capacity, reducing it from 50% to 15% following work-related injuries to his neck, right shoulder, and wrists. The Board considered the nature of his permanent partial disability, his functional capabilities, and vocational factors such as age, education, and skills. The court found substantial evidence, including the opinion of an independent medical examiner and claimant's own testimony, to support the Board's determination. This ruling upholds the Board's assessment of a 15% loss of wage-earning capacity.

Permanent Partial DisabilityWage-Earning CapacityAppellate ReviewMedical ImpairmentVocational FactorsSubstantial EvidenceClaimant AppealBoard Decision ModificationConstruction Project ManagerRepetitive Use Injury
References
4
Case No. 2022 NY Slip Op 02801 [204 AD3d 1016]
Regular Panel Decision
Apr 27, 2022

Matter of Panos v. Mid Hudson Med. Group, P.C.

Spyros Panos was terminated from Mid-Hudson Medical Group (MHMG) for submitting fraudulent medical bills and subsequently pleaded guilty to healthcare fraud. Panos initiated an action for breach of contract against MHMG, which proceeded to arbitration. The arbitrator applied the faithless servant doctrine and granted MHMG's motion for summary judgment, dismissing Panos's claims. Panos then sought to vacate the arbitration award in the Supreme Court, Dutchess County, but the court denied his petition and dismissed the proceeding. On appeal, the Appellate Division affirmed the lower court's judgment, concluding that Panos failed to demonstrate that the arbitrator manifestly disregarded the law.

Arbitration awardVacaturFaithless servant doctrineBreach of contractSummary judgmentHealth care fraudAppellate reviewJudicial reviewEmployment agreementFiduciary duty
References
18
Case No. 2014-1081 K C
Regular Panel Decision
Oct 05, 2016

High Quality Med. Supplies, Inc. v. Mercury Ins. Group

This case involves an appeal concerning assigned first-party no-fault benefits sought by High Quality Medical Supplies, Inc., as assignee of Charles Botwee. The defendant, Mercury Ins. Group, appealed an order from the Civil Court that denied its motion for summary judgment to dismiss the complaint. Mercury Ins. Group contended that billing for durable medical equipment not listed in a fee schedule is not compensable. However, the Appellate Term affirmed the lower court's decision, citing 11 NYCRR 68.5, which specifically permits reimbursement for healthcare services not explicitly covered by fee schedules, thereby rejecting the defendant's argument.

No-Fault BenefitsFirst-Party BenefitsDurable Medical EquipmentFee ScheduleSummary JudgmentAppellate TermAssigned BenefitsInsurance LawReimbursementCivil Court
References
3
Case No. 06 Civ. 0822(RJH)
Regular Panel Decision

Vanamringe v. Royal Group Technologies Ltd.

This Memorandum Opinion and Order addresses two consolidated securities fraud actions against Royal Group Technologies Limited and its officers and directors. The plaintiffs, known as the 'Snow Group', allege a fraudulent scheme involving false and misleading statements to inflate Royal Group's stock price, violating Sections 10(b) and 20(a) of the Exchange Act. The Court consolidated the two actions, Vanamringe v. Royal Group Technologies Limited and Messinger v. Royal Group Technologies Limited, under the caption In re Royal Group Technologies Securities Litigation. The Snow Group's motion for appointment as lead plaintiff was granted, as they demonstrated the largest financial interest and satisfied Rule 23 requirements for typicality and adequacy. The Court also approved the Snow Group's selection of Lerach Coughlin Stoia Geller Rudman & Robbins LLP and Labaton Sucharow & Rudoff LLP as co-lead counsel for the class.

Securities FraudClass ActionLead PlaintiffConsolidationPSLRAFederal Rules of Civil Procedure Rule 23Corporate FraudStock ManipulationInvestor ProtectionExchange Act
References
8
Case No. MISSING
Regular Panel Decision
Sep 16, 1992

Pica v. Montefiore Medical Group

The Supreme Court, Bronx County, dismissed a personal injury action brought by an employee of Montefiore Hospital and Medical Center against Montefiore Medical Group. The dismissal was based on the affirmative defense of Workers' Compensation. The plaintiff failed to demonstrate that Montefiore Medical Group was a separate legal entity from Montefiore Hospital and Medical Center, whose employee controlled her work. Consequently, the court found recovery barred under Workers' Compensation Law § 11. The appellate court unanimously affirmed the dismissal.

Workers' CompensationPersonal InjuryEmployer LiabilityCorporate VeilExclusive RemedyAffirmative DefenseAppellate DecisionMotion to DismissSummary JudgmentBronx County
References
3
Case No. 2023 NY Slip Op 01717 [214 AD3d 1280]
Regular Panel Decision
Mar 30, 2023

Matter of Wilber v. Hamister Group, LLC

Claimant, a licensed practical nurse, sustained work-related injuries in May 2017. In January 2020, she was classified with a 70% permanent partial disability and awarded workers' compensation benefits. Nine months later, the employer offered part-time work within her medical restrictions, which claimant rejected. The employer sought to suspend benefits, but the Workers' Compensation Board affirmed claimant's entitlement. The Appellate Division, Third Department, affirmed the Board's decision, ruling that under the 2017 amendment to Workers' Compensation Law § 15 (3) (w), a claimant classified as permanently partially disabled and awarded benefits is not required to demonstrate an ongoing labor market attachment.

Permanent Partial DisabilityLabor Market AttachmentWorkers' Compensation BenefitsIndemnity BenefitsRefusal of Employment OfferWorkers' Compensation Law § 15 (3) (w)Appellate ReviewMedical RestrictionsStipulationWage Loss
References
4
Case No. MISSING
Regular Panel Decision

Curry v. American International Group, Inc. Plan No. 502

Curry, a former Regional Insurance Underwriting Manager for AIG, sued American International Group, Inc. Plan No. 502 and American International Life Assurance Co. of New York ("AI Life") under ERISA § 502(a) after her long-term disability benefits were terminated. Curry suffers from degenerative osteoarthritis and diabetes. AI Life initially approved her benefits but later terminated them, alleging she could perform a sedentary occupation, relying on unverified medical responses. The court found AI Life's decision to be arbitrary and capricious due to its reliance on unreliable medical opinions, failure to clarify the record, and disregard for Curry's doctors' reports. Consequently, the court granted Curry's motion for summary judgment, denying the defendants' motion, and ordered the reinstatement of her benefits with prejudgment interest and attorney's fees.

ERISALong-term disabilityBenefits terminationArbitrary and capricious standardConflict of interestMedical opinionUnreliable evidenceSummary judgmentOrthopaedic conditionsDiabetes
References
10
Case No. MISSING
Regular Panel Decision

Dewan v. Blue Man Group Limited Partnership

Plaintiff Brian Dewan, a musician, sued the Blue Man Group entities and individuals, seeking a declaration of co-authorship for musical compositions used in their "Blue Man Group: Tubes" performance and damages for state law claims. Dewan claimed he collaborated with the defendants in composing music for the show and was repeatedly assured of his co-authorship rights and that an agreement would be formalized, but it never materialized. Defendants moved to dismiss, arguing the co-authorship claim under the Copyright Act was time-barred. The court found that Dewan's equitable estoppel argument was unreasonable after late 1993 or 1994, as he had sufficient notice that a lawsuit was necessary. Consequently, the court dismissed the federal co-authorship claim due to the expiration of the statute of limitations and declined to exercise supplemental jurisdiction over the remaining state law claims.

Copyright ActCo-authorshipStatute of LimitationsEquitable EstoppelMotion to DismissFederal JurisdictionState Law ClaimsMusical CompositionsCollaborationDeclaratory Judgment
References
11
Case No. VNO 497801; VNO 497802 VNO 497803; VNO 497804
Regular
Feb 14, 2008

ANDREW LAVIGNE vs. COUNTY OF LOS ANGELES

The Appeals Board rescinded the prior award and returned the case for further proceedings, requiring a new WCJ to reconsider permanent disability and apportionment based on *Benson v. The Permanente Medical Group*. The WCJ must determine which Permanent Disability Rating Schedule applies to each injury and may need to further develop the medical record to ensure substantial evidence supports any findings. The decision emphasizes that *Benson*'s rule on apportionment based on causation is now binding.

Appeals BoardReconsiderationJoint Findings and AwardPermanent DisabilityApportionmentWilkinsonBensonPDRSAldiPendergrass
References
16
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