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Case Law Database

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

Case No. MISSING
Regular Panel Decision

Emspak v. Conroy

The defendants moved for a further bill of particulars regarding item 30 and requested the entire bill be verified by a union officer. The plaintiff's attorney acknowledged the omission for item 30 was an oversight and agreed to provide it. He argued his self-verification was proper under subdivision 3 of rule 99 of the Rules of Civil Practice, citing the plaintiff's absence from the county, and claimed defendants waived objection by not returning the bill within 24 hours. The court clarified that Rules 10 and 11 do not apply to verification. While an attorney can verify a bill of particulars under rule 117, the court ruled that merely stating the party is out of county is insufficient; the attorney must also detail the basis of their knowledge, especially given a prior order requiring an oath for inability to furnish particulars. The motion for a further bill was granted.

Bill of particularsVerificationAttorney verificationRules of Civil PracticeWaiverMotionCourt procedurePleadingSufficiency of verification
References
3
Case No. ADJ6993990
Regular
Apr 13, 2020

CONNIE BERRY vs. LAWRENCE BERKELEY NATIONAL LABORATORY, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to address the defendant's challenge to the WCJ's findings. The WCJ had questioned the credibility of QME Dr. Wolfson's medical opinions based on his billing practices, appointing a new evaluator and referring the billing to the Medical Director. The WCAB found these actions premature, stating that the parties had not yet had an opportunity to conduct discovery into Dr. Wolfson's billing practices. Therefore, the WCAB rescinded the WCJ's orders, substituted new findings and orders to allow for further development of the record on Dr. Wolfson's billing, and returned the matter for further proceedings.

Workers' Compensation Appeals BoardRemovalFindings and OrdersMedical-legal reportingPermanent disabilityQualified Medical Evaluator (QME)Billing practicesSubstantial medical evidenceLabor Code section 5701Medical Director
References
7
Case No. MISSING
Regular Panel Decision
Jun 30, 2010

John Giugliano, DC, P.C. v. Merchants Mutual Insurance

Plaintiff John Giugliano, DC, EC., as assignee of Laura Hebenstreit, initiated this action to recover first party no-fault benefits from defendant Merchants Mutual Ins. Co. The core dispute, following a trial on June 30, 2010, centered on the plaintiff's billing practices under the New York Workers' Compensation Medical Fee Schedule, specifically regarding the use of surgical CPT codes for chiropractic procedures. Defendant argued against the use of surgical codes and duplicate billing for a specific CPT code, while plaintiff maintained these practices were justified because the procedures were not listed under the chiropractic fee schedule and involved distinct treatment areas. The court ultimately ruled in favor of the plaintiff, concluding that the procedures were properly billed according to the Fee Schedule, thereby entitling the plaintiff to reimbursement.

No-Fault BenefitsChiropractic BillingWorkers' Compensation Fee ScheduleCPT CodesSurgical ProceduresCo-Surgeon BillingInsurance ReimbursementMedical Fee Schedule DisputesSpinal ManipulationMandibular Fracture
References
2
Case No. ADJ10317610, ADJ10435596
Regular
Dec 19, 2016

BILL COATS vs. J. B. HUNT TRANSPORT, INC., AMERICAN INTERNATIONAL GROUP, INC.

The Workers' Compensation Appeals Board denied a petition for reconsideration in a case involving Bill Coats against J.B. Hunt Transport and American International Group. The Board adopted the WCJ's report for denying reconsideration. However, the Board clarified that while an attorney disbarred or suspended from practice cannot represent a party, this rule does not prevent such an attorney from appearing before the Board on their own behalf. Therefore, the petition for reconsideration was ultimately denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ reportattorney eligibilitydisbarmentsuspensioninvoluntary inactive enrollmentSupreme Court orderAppeals Board rulerepresentative of party
References
0
Case No. MISSING
Regular Panel Decision

Hojnowski v. Buffalo Bills, Inc.

David Hojnowski, a former equipment manager for the Buffalo Bills, sued his former employer alleging age discrimination under the Age Discrimination in Employment Act, New York State Human Rights Law, and violations of the Employee Retirement Income Security Act. The Buffalo Bills moved to dismiss the claims and compel arbitration, citing an arbitration clause in Hojnowski's employment contract. Hojnowski contended that the arbitration agreement was unenforceable due to the absence of arbitration rules and unconscionability. The court determined that the arbitration rules were sufficiently incorporated into the agreement and that the contract was not unconscionable. Consequently, the court granted the Bills' motion, compelling Hojnowski to arbitration and dismissing his complaint.

Arbitration AgreementEmployment LawAge DiscriminationERISANew York State Human Rights LawMotion to DismissContract EnforceabilityUnconscionability DefenseFederal Arbitration ActNFL Commissioner
References
25
Case No. ADJ8485371
Regular
Dec 01, 2014

MICHAEL (MIKE) STRATTON vs. SAN DIEGO CHARGERS, ZENITH NORTH AMERICA, BUFFALO BILLS

The Workers' Compensation Appeals Board reconsidered a prior decision regarding Michael Stratton's cumulative injury claim against the San Diego Chargers and Buffalo Bills. While the original judge found Stratton's claim against the Bills timely, the Board reversed this, determining it was barred by the statute of limitations. The Board found that neither employer breached a duty to notify Stratton of his workers' compensation rights at the time of his employment. Therefore, the statute of limitations was not tolled, and Stratton's claim against the Buffalo Bills is dismissed.

WCABStatute of LimitationsLabor Code Section 5405Date of InjuryTollingCumulative InjuryProfessional Football PlayerSan Diego ChargersBuffalo BillsZenith North America
References
17
Case No. ADJ3533713
Regular
Nov 07, 2011

JUANA LOPEZ vs. THE MERCHANT OF TENNIS, HARTFORD INSURANCE

The Workers' Compensation Appeals Board (WCAB) removed this matter for the purpose of imposing sanctions. The WCAB found that the petition for reconsideration filed by SIR Practice Solutions, LLC on behalf of several lien claimants was skeletal, unintelligible, and violated multiple WCAB rules regarding evidentiary and legal support. The lien claimants and SIR Practice Solutions, LLC failed to object to the Notice of Intention to Impose Sanctions within the allotted time. Therefore, the WCAB imposed sanctions of $250.00 against each individual lien claimant and found SIR Practice Solutions, LLC jointly and severally liable for these sanctions.

Workers' Compensation Appeals BoardRemovalSanctionsLien ClaimantsSIR Practice SolutionsPetition for ReconsiderationSkeletal PetitionAppeals Board Rule 10846Labor Code Section 5813Notice of Intention to Impose Sanctions
References
6
Case No. MISSING
Regular Panel Decision

Claim of Paddock v. Barclay Knitwear Co.

Howard T. Mowers, a chiropractor, appealed a Workers' Compensation Board decision that denied him further medical payments for services provided. Mowers had previously been awarded additional fees, interest, and penalties by a Workers' Compensation Law Judge, based on the insurance carrier's failure to timely object to his bills. The Board rescinded this award, stating Mowers failed to provide sufficient evidence to justify bills exceeding the established fee schedule. The Appellate Division affirmed the Board's decision, holding that the Board retains its authority to oversee chiropractor billing practices and demand justification, even if a carrier waives its right to object.

Workers' CompensationChiropractic FeesFee ScheduleBilling PracticesTimely ObjectionsWaiverBoard AuthorityMedical TreatmentAppellate Division
References
0
Case No. MISSING
Regular Panel Decision

Hartman v. Bell

This case involves an appeal concerning a contract for the sale of a medical practice. A plaintiff physician agreed to sell his practice to defendant physicians, with payment contingent on a percentage of industrial medicine income over three years, including a minimum payment, and further payments for six months thereafter. The Supreme Court, Queens County, granted the defendants' cross motion for summary judgment, dismissing the complaint against them. The appellate court affirmed this decision, finding the agreement constituted an illegal fee-splitting arrangement under Education Law § 6509-a. The court emphasized that the law would not provide relief to parties involved in illegal arrangements, upholding public policy.

Fee-splittingMedical Practice SaleBreach of ContractSummary JudgmentUnjust EnrichmentPublic PolicyIllegal ContractProfessional Medical GroupAppellate DecisionContract Law
References
3
Case No. MISSING
Regular Panel Decision

Romaine v. Cuevas

Petitioner filed an improper practice charge against the New York City Transit Authority (NYCTA) with the Public Employment Relations Board (PERB), alleging that Level I supervisors were performing work previously exclusive to Level II supervisors, specifically zone supervision, booth audits, and investigations. An Administrative Law Judge (ALJ) initially found a violation for zone supervision but not for the other tasks. PERB subsequently reversed the ALJ's decision regarding zone supervision, concluding that the petitioner failed to establish exclusivity. The petitioner then commenced a CPLR article 78 proceeding to annul PERB's determination. The court, reviewing PERB's decision for substantial evidence, found that the petitioner did not meet its burden of demonstrating exclusivity for any of the disputed tasks due to significant overlap in supervisor duties. Consequently, PERB's determination dismissing the improper practice charge was confirmed.

improper practicepublic sector laborsupervisory rolesjob dutiesexclusivityCPLR article 78PERBNYCTACivil Service Lawzone supervision
References
7
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