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

Case No. 2024 NY Slip Op 00599 [224 AD3d 428]
Regular Panel Decision
Feb 06, 2024

Matter of New Millennium Pain & Spine Medicine, P.C. v. Garrison Prop. & Cas. Ins. Co.

This case involves two appeals by New Millennium Pain & Spine Medicine, P.C. against Garrison Property & Casualty Insurance Company and GEICO Casualty Company. New Millennium sought to vacate master arbitration awards that denied its claims for no-fault benefits for medical services. The Supreme Court denied these applications. The Appellate Division, First Department, affirmed the Supreme Court's decisions, stating that an arbitrator's award will not be set aside unless it is irrational. The court also addressed the argument regarding a 20% wage offset in no-fault benefits, finding it unavailing under Insurance Law § 5102 (b). Ultimately, New Millennium was not entitled to attorneys' fees as it was not the prevailing party.

No-fault benefitsarbitration awardvacaturinsurance lawwage offsetappellate reviewmedical servicesno-fault policy exhaustionattorneys' feesCPLR Article 75
References
8
Case No. 534402
Regular Panel Decision
Dec 15, 2022

Matter of Oberg v. Consolidated Edison Co. of N.Y., Inc.

Claimant Donald Oberg sustained neck injuries in a work-related motor vehicle accident in August 2020 and sought to amend his claim to include bilateral shoulder injuries. His treating orthopedist, Joseph Giovinazzo, opined that the shoulder injuries were causally related. However, independent medical examiner Vito Loguidice concluded that the shoulder injuries were not causally related, a finding supported by surveillance video of the accident. A Workers' Compensation Law Judge initially credited Giovinazzo and amended the claim, but the Workers' Compensation Board subsequently rescinded this amendment, crediting Loguidice's opinion. The Appellate Division affirmed the Board's decision, finding that substantial evidence supported the Board's determination to disallow the amendment of Oberg's claim for bilateral shoulder injuries.

Workers' Compensation LawCausal RelationshipBilateral Shoulder InjuriesCervical RadiculopathyIndependent Medical ExaminationTreating Physician OpinionConflicting Medical EvidenceSubstantial EvidenceAppellate ReviewWorkers' Compensation Board Discretion
References
5
Case No. ADJ1088522 (RIV 0015524)
Regular
Jan 03, 2013

SAMANTHA VAN DUINHOVEN vs. SPA HOTEL & CASINO, CALIFORNIA CASUALTY, Administered by GAB ROBINS NORTH AMERICA

This case involved an applicant who claimed industrial injury to her neck, back, left shoulder, psyche, and associated chronic pain syndrome, resulting in a finding of permanent total disability. The defendant sought reconsideration, arguing the medical evidence did not support injury to the low back or a diagnosis of chronic pain syndrome. The Appeals Board reversed the findings on the low back and chronic pain syndrome, finding no substantial evidence to support them. Consequently, the applicant's permanent disability award was amended to 70%, based on ratings for her neck, left shoulder, and psyche.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPermanent Total DisabilityChronic Pain SyndromeAgreed Medical EvaluatorQualified Medical EvaluatorMedical Record ReviewIndustrial InjuryPermanent Disability Indemnity
References
0
Case No. MISSING
Regular Panel Decision

Baker v. Orange Heating & Cooling

Claimant, who suffered a work-related injury in 1994, began experiencing right arm and shoulder pain four years later, which treating physicians diagnosed as reflex sympathy dystrophy (RSD) causally related to the 1994 incident. However, a Workers’ Compensation Law Judge and subsequently the Workers’ Compensation Board found that the right arm and shoulder pain was not causally related to the earlier accident. On appeal, the Board's determination was supported by expert testimony from Michael Weintraub, a clinical professor of neurology, who attributed the pain to the claimant’s severe diabetes rather than RSD. The appellate court affirmed the Board’s decision, emphasizing that the Board is the arbiter of credibility determinations, especially concerning causation. Thus, the court upheld the denial of workers’ compensation benefits.

Workers' CompensationCausationReflex Sympathy DystrophyDiabetesMedical Expert TestimonyBoard DecisionAppellate AffirmationInjury ClaimCredibilityMedical Evidence
References
2
Case No. MISSING
Regular Panel Decision

Matter of White v. Bethany House

Claimant, a certified nurse assistant, sustained a work-related left shoulder injury in August 2010, leading to an established workers' compensation claim, surgeries, and temporary partial disability. Subsequently, she developed right shoulder pain and sought to amend her claim, contending a consequential injury arising from her initial left shoulder injury. Both a Workers' Compensation Law Judge and the Workers' Compensation Board affirmed this causal connection, prompting an appeal by the employer and its carrier. The carrier argued insufficient medical evidence to establish the causal nexus; however, the appellate court found substantial evidence, particularly the report from pain management specialist Mary Trusilo, supported the Board's determination. The court also deemed the carrier's orthopedist's conflicting testimony speculative, ultimately affirming the Board's decisions.

Workers' CompensationConsequential InjuryShoulder InjuryCausal RelationshipMedical EvidenceAppellate ReviewDisabilityNurse AssistantPain Management
References
7
Case No. MISSING
Regular Panel Decision
May 05, 2000

Pain Resource Center v. Travelers Insurance

This case addresses a dispute regarding the payment of first-party no-fault benefits to a health provider, Pain Resource Center, as the assignee of John Hiotis, who was injured in an auto accident. The defendant, Travelers Ins. Co., challenged the validity of the assignment and the necessity of the medical services provided. The court affirmed the validity of the assignment under New York's Insurance Law and related regulations. However, based on conflicting expert testimonies, the court limited the compensable medical services to six hours and awarded the plaintiff $566.10, along with statutory interest and attorney's fees.

No-Fault InsuranceFirst-Party BenefitsAssignment ValidityMedical ServicesPeer ReviewInsurance LawHealth Provider ClaimAutomobile AccidentDamagesStatutory Interpretation
References
5
Case No. MISSING
Regular Panel Decision

Universal Acupuncture Pain Services, P.C. v. Lumbermens Mutual Casualty Co.

The New York court addresses a motion for reargument by Universal Acupuncture Pain Services, P.C. against Lumbermens Mutual Casualty Company concerning no-fault insurance claims. The central legal question is whether an expert witness's peer review report, created after a timely denial of a no-fault claim, can be admitted at trial, specifically under the Cirucci precedent regarding the specificity of denial grounds. The court grants the motion for reargument but upholds its initial ruling, which granted partial summary judgment on one of five claims. It clarifies that the expert's testimony must be strictly limited to the "concurrent or excessive care" ground initially stated by the insurer, excluding any new grounds like "medical necessity" not specified in the original denial. The court emphasizes that the issue of whether different treatment modalities constitute concurrent care for the same condition requires a trial for factual determination.

No-Fault InsurancePeer ReviewExpert Witness TestimonySummary Judgment MotionInsurance Law InterpretationSpecificity of DenialConcurrent Medical CareAcupuncture TreatmentChiropractic TreatmentPhysical Therapy
References
7
Case No. 534402
Regular Panel Decision
Dec 15, 2022

In the Matter of the Claim of Donald Oberg

Donald Oberg, an automobile mechanic, appealed a Workers' Compensation Board decision denying his request to amend his claim to include bilateral shoulder injuries. Oberg had an established claim for neck injuries from an August 2020 work-related motor vehicle accident. Conflicting medical opinions arose regarding the causal relationship of his bilateral shoulder injuries, with his treating orthopedist, Joseph Giovinazzo, opining they were causally related, and independent medical examiner Vito Loguidice concluding they were not. A Workers' Compensation Law Judge initially credited Giovinazzo and amended the claim, but the Board rescinded this, crediting Loguidice's opinion based on medical evidence and accident video. The Appellate Division affirmed the Board's decision, finding substantial evidence supported the Board's determination to disallow the amendment.

Workers' CompensationShoulder InjuryCausal RelationshipMedical EvidenceIndependent Medical ExaminationTreating PhysicianAppellate ReviewBoard DecisionConflicting Medical OpinionsMotor Vehicle Accident
References
5
Case No. 07-CV-2634; 07-CV-4841
Regular Panel Decision
Apr 05, 2010

Price v. Reilly

Plaintiff Anthony Price, a pro se inmate, alleged deliberate indifference to his serious medical needs at Nassau County Correctional Center, violating his Eighth Amendment rights under 42 U.S.C. § 1983. Price claimed incorrect medication dosage for renal disease, failure to be tested for a kidney transplant, and inadequate treatment for shoulder pain against Sheriff Edward Reilly, Kim Edwards, Perry Intal, Mary Sullivan, Dr. Benjamin Okonta, and Nassau University Medical Center. The court granted defendants' motion for summary judgment regarding the medication dosage and all claims against Sheriff Reilly. However, the motion was denied concerning the kidney transplant request and shoulder pain claims, as genuine issues of material fact remained. The court also addressed the exhaustion of administrative remedies, finding defendants failed to establish plaintiff's non-exhaustion for the kidney transplant claim.

Eighth AmendmentDeliberate IndifferenceMedical NeedsPrisoner RightsSummary JudgmentKidney DiseaseRenal FailureDialysisShoulder PainInmate Grievance
References
70
Case No. MISSING
Regular Panel Decision
Jun 25, 2001

Claim of Ritton v. AT&T—New York

Claimant appealed an amended Workers' Compensation Board decision concerning her disability rate. She had established occupational diseases including bilateral carpal tunnel syndrome, myofascial pain syndrome, thoracic outlet, and neck, arm, and shoulder injuries. Initially receiving total disability benefits, the Board later found only a mild to moderate disability for the period from March 1998 to September 1999, crediting the employer's physician, Syed Ehtisham, over the claimant's physician, Michael Lax. The court affirmed the Board's decision, finding substantial evidence to support the mild to moderate disability finding and upholding the Board's authority in resolving conflicting medical opinions.

Workers' CompensationDisability BenefitsCarpal Tunnel SyndromeMyofascial Pain SyndromeThoracic Outlet SyndromeMedical TestimonyConflicting Medical EvidenceAppellate ReviewCredibility DeterminationOccupational Disease
References
2
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