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

Case No. 2011-192 K C
Regular Panel Decision
Dec 19, 2017

Jamaica Dedicated Med. Care, P.C. v. Tri State Consumer Ins. Co.

This case concerns an appeal from an order of the Civil Court of the City of New York, Kings County, which denied defendant Tri State Consumer Ins. Co.'s cross motion for summary judgment. Jamaica Dedicated Medical Care, P.C., as assignee, sought first-party no-fault benefits. Tri State Consumer Ins. Co. contended that it had either properly reimbursed services according to the workers' compensation fee schedule or timely denied others due to lack of medical necessity. The Appellate Term found a triable issue of fact regarding medical necessity and that the defendant failed to establish its workers' compensation fee schedule defense as a matter of law. Consequently, the order denying summary judgment was affirmed.

No-fault benefitsSummary judgmentMedical necessityWorkers' compensation fee scheduleAppellate reviewAssigneeInsurance claimCivil CourtAppellate TermKings County
References
2
Case No. 2013-1709 Q C
Regular Panel Decision
Jun 03, 2016

Renelique v. Tri State Consumers Ins. Co.

Pierre Jean Jacques Renelique, as Assignee of Yvon Delgado, initiated an action to recover assigned first-party no-fault benefits from Tri State Consumers Ins. Co. The defendant successfully moved for summary judgment in the Civil Court of the City of New York, Queens County, arguing that it had fully compensated the plaintiff in accordance with the workers' compensation fee schedule. On appeal, the plaintiff contended that the defendant was precluded from asserting its defense regarding the fee schedule due to insufficient particularity in the denial of claim form; however, this argument was deemed to lack merit by the Appellate Term. Furthermore, the plaintiff's attempt to challenge the calculation of the recoverable amount under the workers' compensation fee schedule was not considered by the appellate court, as it was raised for the first time on appeal. Consequently, the Appellate Term affirmed the Civil Court's order, finding no basis to disturb it.

no-fault insuranceworkers' compensationsummary judgmentappellate reviewclaim denialmedical billingfee scheduleassigneeassignorinsurance defense
References
3
Case No. 2013-1427 K C
Regular Panel Decision
Jun 03, 2016

Harvard Med., P.C. v. Tri State Consumers Ins. Co.

This is an appeal by Harvard Medical, P.C., as assignee of Lenford Carty, against Tri State Consumers Ins. Co. The appeal is from an order of the Civil Court of the City of New York, Kings County, entered April 12, 2013, which granted the defendant's motion for summary judgment. The defendant argued that it had fully paid the plaintiff in accordance with the workers' compensation fee schedule for first-party no-fault benefits. The Appellate Term, Second Department, affirmed the Civil Court's order, citing a related case, Renelique, as Assignee of Yvon Delgado v Tri State Consumers Ins. Co.

No-fault benefitsSummary JudgmentAppellate ReviewWorkers' Compensation Fee ScheduleAssignee
References
1
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. 02-14-00191-CV
Regular Panel Decision
May 07, 2015

Fix It Today, LLC and Banatex, LLC v. Santander Consumer USA, Inc.

Appellants Fix It Today, LLC and Banatex, LLC (collectively, FIT Finance) appealed a judgment in favor of Santander Consumer USA, Inc. (SCUSA). FIT Finance operated a scheme to make loans for emergency auto repair, claiming superior worker's liens over SCUSA's perfected purchase money security interests. SCUSA sued for conversion, tortious interference, damages under the Texas Theft Liability Act, conspiracy, and sought a declaratory judgment. The trial court initially ruled for SCUSA, but the Court of Appeals reversed the conspiracy claim, entering a take-nothing judgment. Additionally, the conversion, tortious interference, Texas Theft Liability Act claims, and the attorney's fee award were reversed and remanded for a new trial. The declaratory judgment portion of the trial court's decision was affirmed.

Texas LawCivil ConspiracyConversionTortious InterferenceTexas Theft Liability ActWorkers' Lien StatuteDeclaratory JudgmentAppellate ReviewSufficiency of EvidenceDamages Calculation
References
29
Case No. MISSING
Regular Panel Decision
May 23, 2017

Gentle Acupuncture, P.C. v. Tri-State Consumer Ins. Co.

Gentle Acupuncture, P.C., as an assignee, appealed an order from the District Court of Suffolk County that granted Tri-State Consumer Insurance Company's motion for summary judgment, dismissing a claim for first-party no-fault benefits. The Appellate Term reversed the order, denying the defendant's motion. The court found that the defendant failed to establish prima facie entitlement to summary judgment regarding the workers' compensation fee schedule, as it did not provide an expert's affidavit for interpretation. Furthermore, while the defendant submitted an independent medical examination report by Dr. LoCascio, the plaintiff's affirmation from Dr. Vatelman sufficiently rebutted its conclusions regarding medical necessity, and any objections to the affirmation's technical defects were deemed waived by the defendant.

No-fault benefitsSummary judgmentMedical necessityWorkers' compensation fee scheduleIndependent medical examination (IME)AcupunctureAppellate TermExpert affidavit requirementCPLR 2106(a)Jurat defect
References
5
Case No. 03-18-00364-CV
Regular Panel Decision
Apr 30, 2020

Low Income Consumers, Mary Wilson and Hipolita Lutz v. Public Utility Commission of Texas

This case involves a direct appeal challenging amendments to Rules 25.478 and 25.480 adopted by the Public Utility Commission (PUC) of Texas. The appellants, "Low Income Consumers," Mary Wilson, and Hipolita Lutz, along with the intervenor City of Houston, argued that the PUC failed to comply with the rulemaking provisions of the Administrative Procedure Act (APA) and misconstrued relevant statutes. They specifically contested the repeal of the split-deposit provision in former Rule 25.478(e)(3) and amendments to Rule 25.480 concerning late fees and deferred payment plans, asserting these were essential customer protections rather than benefits tied to the expired System Benefit Fund (SBF). The Court of Appeals affirmed the Commission’s order, concluding that the Commission acted within its statutory authority and adhered to the APA's notice and reasoned justification requirements. The court found that the contested provisions were not mandated protections under other sections of the Public Utility Regulatory Act (PURA).

Public Utility CommissionAdministrative Procedure Act (APA)System Benefit Fund (SBF)RulemakingCustomer ProtectionsLow-income customersSplit-deposit provisionDeferred payment plansLate-fee waiverStatutory interpretation
References
22
Case No. 2022 NY Slip Op 07309 [211 AD3d 621]
Regular Panel Decision
Dec 22, 2022

Matter of Runway Towing Corp., Inc. v. New York City Dept. of Consumer & Worker Protection

The Appellate Division, First Department, reversed a Supreme Court order that had vacated a determination by the New York City Department of Consumer and Worker Protection (DCPW). Runway Towing Corp. Inc. had challenged DCPW's denial of its tow truck license renewal due to repeated overcharges for towing and storage fees under various programs. The Appellate Division found DCPW's determination rational and its penalty of license renewal denial proportionate to Runway's numerous violations over a two-year period. The court also dismissed Runway's claims that 6 RCNY 6-36 limited penalties to monetary fines and its due process arguments regarding license renewal.

Tow Truck LicenseExcessive Towing FeesLicense Renewal DenialAdministrative Code ViolationsProportionality of PenaltyDue Process RightsArticle 78 ProceedingAppellate ReviewConsumer ProtectionWorker Protection
References
4
Case No. 03-02-00246-CV
Regular Panel Decision
Aug 26, 2004

Reliant Energy, Incorporated Office of Public Utility Counsel And Gulf Coast Coalition of Cities/Magic Valley Electric Cooperative, Inc. Medina Electric Cooperative, Inc. Rayburn Country Electric Cooperative, Inc. And City of Bryan v. Public Utility Commission of Texas Consumer Owned Power Systems City of Houston Texas Industrial Energy Consumers State of Texas And Constellation NewEnergy, Inc./Public Utility Commission of Texas And Reliant Energy, Incorporated

This case concerns appeals from a district court's judgment affirming a Public Utility Commission (PUC) final order that set cost-of-service rates for Reliant Energy, Inc.'s transmission and distribution utility (TDU). Appellants, including Reliant Energy, Office of Public Utility Counsel, and various consumer groups, challenged the PUC's decisions on rate base calculations, return on equity, and operational expenses. The district court had largely affirmed the PUC's order, finding only one aspect to be a prohibited advisory opinion. The Court of Appeals, Third District, At Austin, reversed the district court's judgment regarding the inclusion of $107.3 million for the interconnection of Merchant Plant 4, citing a lack of substantial evidence. In all other respects, the Court of Appeals affirmed the district court's judgment and remanded the Merchant Plant 4 issue to the Commission for further proceedings.

Utility RegulationElectricity RatesPublic Utility CommissionCost-of-ServiceRate BaseReturn on EquityConsolidated Tax SavingsTransmission and Distribution UtilityAppellate ReviewAdministrative Law
References
38
Case No. 2022 NY Slip Op 05964 [209 AD3d 596]
Regular Panel Decision
Oct 25, 2022

Pirozzo v. Laight St. Fee Owner LLC

Plaintiff Paul Pirozzo sought summary judgment on his Labor Law § 240 (1) claim against defendants Laight Street Fee Owner LLC, Laight Street Fee Owner II LLC, and Sciame Construction, LLC, which was granted by the Supreme Court. The Appellate Division, First Department, affirmed this decision. The plaintiff established a prima facie case by demonstrating that the scaffold he was working on collapsed without an apparent reason. The defendants' arguments that the plaintiff was the sole proximate cause, either by failing to lock scaffold pins or remaining on the scaffold while it was moved, were deemed unavailing. The court noted that these actions, even if proven, would amount to comparative negligence, which is not a defense to a Labor Law § 240 (1) claim, and there was no evidence of specific instructions to the plaintiff that were disobeyed.

Summary judgmentLabor Law § 240 (1)Scaffold collapseSole proximate causeComparative negligenceWorkers' compensation Form C-2Hearsay objectionPersonal knowledgeRecalcitranceAppellate Division
References
9
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