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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

Government Employees Insurance v. Uptown Health Care Management, Inc.

Plaintiffs GEICO allege a scheme where defendants, including Uptown Health Care Management d/b/a East Tremont, Hisham Elzanaty, Alan Goldenberg, Dr. Hisham Ahmed, and Dr. Jadwiga Pawlowski, fraudulently billed GEICO for millions in services. GEICO contends East Tremont was ineligible for reimbursement under New York's no-fault insurance laws, operating without a legitimate medical director, violating its operating certificate, and paying kickbacks for referrals. The complaint raises six causes of action, including declaratory judgment, RICO violations (18 U.S.C. §§ 1962(c), 1962(d)), common law fraud, aiding and abetting fraud, and unjust enrichment. Defendants moved to dismiss under Rule 12(b)(1) for Burford abstention and Rule 12(b)(6) for failure to state a claim, arguing GEICO's claims would invalidate a DOH license and interfere with state oversight. Citing the similar Allstate Ins. v. Elzanaty action, the court denied defendants' motions, affirming that insurers can challenge fraudulent licensing and conduct under RICO and fraud claims, even if state authorities have approved the facility. The court concluded that such claims do not disrupt New York's regulatory scheme and need not be raised exclusively with the DOH or through an Article 78 proceeding.

Insurance FraudNo-Fault InsuranceRICO ActMedical LicensingHealthcare FraudAbstention DoctrineRule 12(b)(1) MotionRule 12(b)(6) MotionArticle 28 FacilitiesKickbacks
References
21
Case No. ADJ6786389
Regular
Aug 14, 2013

LORENZO CASTILLO vs. Controlled Health Management Inc FRONTLINE MEDICAL ASSOCIATES STATE COMPENSATION INSURANCE FUND

This Workers' Compensation Appeals Board case involves a Petition for Reconsideration filed by Controlled Health Management, Inc. for lien claimant Frontline Medical Associates. Frontline's lien was dismissed for failure to pay the lien activation fee. The Board denied the petition, finding that Frontline was properly served with notice of the hearing despite claims of mail delivery issues. The Petitioner's contention that they did not receive notice due to a missing P.O. Box number was also rejected.

Workers' Compensation Appeals BoardPetition for ReconsiderationLien ClaimOrder Dismissing Lien ClaimLien Activation FeeCompromise and ReleaseProof of ServiceDeclarationNotice of HearingService Address
References
0
Case No. 2016 NY Slip Op 00302 [135 AD3d 572]
Regular Panel Decision
Jan 19, 2016

Domaszowec v. Residential Management Group LLC

Plaintiff Tracy Domaszowec's decedent died from a fall while cleaning a window on the 13th floor of an apartment building. The Appellate Division, First Department, modified a Supreme Court order, granting plaintiff's motion for partial summary judgment on her Labor Law § 240 (1) claim against Residential Management Group LLC and 40 Fifth Avenue Corporation (40 Fifth defendants), the building owner and manager. The court found the decedent was engaged in "commercial window washing," thereby making Labor Law § 240 (1) applicable. The court affirmed the dismissal of Labor Law § 202 against Veronica Bulgari and Stephen Haimo due to lack of exclusive control, and common-law negligence claims against T&L Contracting of N.Y., Inc. and Greenpoint Woodworking Inc. due to the lack of an exception to the contractual obligation rule. Issues of fact precluded summary judgment on negligence claims against Panorama Windows, Ltd., and the doctrine of res ipsa loquitur was deemed inapplicable to certain defendants.

Window cleaner fatalityScaffold LawSummary judgment appealAppellate Division First DepartmentCommercial vs. routine window washingLabor Law applicabilityContractual tort liabilityRes ipsa loquitur in negligencePunitive damages dismissalExpert witness evidence
References
8
Case No. MISSING
Regular Panel Decision
Dec 27, 2001

MacRo v. Independent Health Ass'n, Inc.

Plaintiffs Cheryl Macro and Kim Zastrow, insured under a group health contract with Independent Health through the Tonawanda City School District, initiated a class action in state court to challenge Independent Health's modification of infertility treatment coverage. Defendant Independent Health removed the case to federal court, asserting ERISA preemption. Plaintiffs moved to remand, arguing that their claims fell under New York Insurance Law, which is exempt from ERISA preemption by the saving clause, and that their health plan qualified as a 'governmental plan' also exempt from ERISA. The District Court granted the plaintiffs' motion, concluding that the claims were indeed saved from ERISA preemption and that the plan was exempt, thus rendering federal subject matter jurisdiction absent. The court accordingly remanded the case back to New York State Supreme Court.

Infertility CoverageHealth Insurance DisputesERISA PreemptionSaving ClauseGovernmental PlansRemoval to Federal CourtSubject Matter JurisdictionNew York Insurance LawClass Action LitigationEmployee Benefits Plan
References
31
Case No. 99 Civ. 11886 WCC
Regular Panel Decision
Jul 11, 2000

Leonard v. DUTCHESS CTY. DEPT. OF HEALTH

Plaintiffs, including restaurant and bowling center owners and the National Smokers Alliance, challenged smoking regulations promulgated by the Dutchess County Department of Health and Board of Health. They alleged violations of equal protection, free speech, 42 U.S.C. § 1983, the New York State Constitution, and Article 78. The defendants moved to dismiss, arguing lack of subject matter jurisdiction, while plaintiffs moved for summary judgment and injunctive relief. The court, treating both as motions for summary judgment, found that the Board of Health exceeded its authority under the New York State separation of powers doctrine by enacting regulations that balanced economic, social, and privacy interests, rather than solely health concerns. Specifically, the court noted the Board's consideration of non-health factors, the non-interstitial nature of the regulations compared to state law, and the County Legislature's prior failure to pass similar legislation. Consequently, the court granted plaintiffs' motion for summary judgment and permanently enjoined the defendants from enforcing the challenged smoking regulations.

Smoking RegulationsPublic Health LawSeparation of PowersAdministrative Agency OverreachSummary JudgmentInjunctive ReliefDutchess CountyClean Indoor Air ActConstitutional LawArticle 78
References
12
Case No. ADJ722399 (SDO 0324979) ADJ1109167 (SDO 0339490)
Regular
Feb 07, 2011

SAMANTHA HOWE vs. SCRIPPS HEALTH, Permissibly Self-Insured

The Appeals Board denied defendant Scripps Health's petition for removal, upholding the WCJ's decision to deny a compel order for a QME examination. Scripps Health sought to compel an examination by Dr. Strauser regarding applicant Samantha Howe's pain management treatment. The Board ruled that Scripps Health's objection to the pain management treatment must be addressed through utilization review, not a QME evaluation, citing the *Sandhagen* Supreme Court decision. Therefore, Scripps Health is barred from using Labor Code section 4062 to dispute treatment recommendations for pain management.

Petition for RemovalQualified Medical EvaluationMedical ExaminationPain Management TreatmentUtilization ReviewLabor Code Section 4610Labor Code Section 4062Industrial InjurySurgical TechnicianDental Treatment
References
1
Case No. MISSING
Regular Panel Decision
Jul 20, 2009

Franco v. Kaled Management Corp.

The defendant Kaled Management Corp. d/b/a Wisteria Tower Condominium appealed an order from the Supreme Court, Nassau County, which denied its motion for summary judgment in a personal injury action. Kaled argued that the plaintiff's claims were precluded by the exclusivity provisions of the Workers' Compensation Law, on the basis that the plaintiff was its special employee. The court outlined the legal framework for determining a special employment relationship, emphasizing factors like control over the employee's work, wage payment, equipment furnishing, and the right to discharge. The appellate court found that Kaled failed to establish, prima facie, that the plaintiff was its special employee. The submitted affidavit did not eliminate all material issues of fact regarding whether Wisteria Tower Condominium had relinquished control over hiring. Consequently, the appellate court affirmed the denial of Kaled's motion for summary judgment.

Personal InjuryWorkers' CompensationSpecial EmploymentGeneral EmploymentSummary JudgmentExclusivity ProvisionAppellate ReviewLabor LawEmployer LiabilityControl Test
References
16
Case No. MISSING
Regular Panel Decision

Washington Heights-West Harlem-Inwood Mental Health Council, Inc. v. District 1199, National Union of Hospital & Health Care Employees, RWDSU

This case involves a dispute between District 1199, National Union of Hospital and Health Care Employees, and Washington Heights-West Harlem-Inwood Mental Health Council, Inc. The union sought to enforce an arbitration award requiring the Council to rehire and provide back pay to an employee, Edward Lane. The Council cross-moved to vacate the award, arguing that no valid collective bargaining agreement with an arbitration clause existed between the parties. Although the parties had acted under the terms of a proposed agreement for a period, including processing some grievances and wage increases, no formal, signed contract had ever been executed. Citing recent appellate court decisions emphasizing contract formalism over implied intent, the District Court granted the Council's motion to vacate the arbitration award and denied the union's motion to enforce it, concluding that without a signed agreement, there was no contractual duty to arbitrate.

Arbitration AwardSummary JudgmentContract FormationCollective BargainingLabor DisputeContract FormalismVacation of AwardEnforcement of AwardMeeting of the MindsFederal Court
References
23
Case No. MISSING
Regular Panel Decision

Reyes v. Arco Wentworth Management Corp.

The plaintiff, German Reyes, was injured while employed by Grasskeepers Landscaping, Inc. on property owned by Ramapo Cirque Homeowners Association, Inc. and managed by Arco Wentworth Management Corporation. The injury occurred when his lawn mower entered a hole, causing it to tip and injure his leg. Reyes filed a lawsuit alleging common-law negligence and violations of Labor Law §§ 200 and 241 (6), citing both unsafe premises conditions and defective equipment due to the absence of an emergency shut-off switch. Ramapo moved for summary judgment, arguing it lacked supervisory control over the work and that the work was routine maintenance, thus falling outside the scope of Labor Law § 241 (6). The court denied Ramapo's motion for summary judgment, determining that Ramapo failed to meet its prima facie burden regarding premises liability and that a triable issue of fact existed under Labor Law § 241 (6). The court also discussed the inadmissibility of the plaintiff's English-language affidavit without a qualified translator's affidavit, but noted that other admissible evidence, such as the translated deposition transcript, still raised sufficient issues of fact to defeat summary judgment. Arco's separate motion for summary judgment was denied as premature.

Workers' CompensationPremises LiabilityDangerous EquipmentSummary JudgmentLabor LawNotice RequirementSupervision and ControlConstruction SafetyExcavationOSHA Violations
References
45
Case No. MISSING
Regular Panel Decision

Control Network Communications, Inc. v. International Brotherhood of Electrical Workers

Plaintiff Control Network Communications, Inc. (CNC) initiated an action against defendant International Brotherhood of Electrical Workers, Local Union No. 236, alleging breach of contract and fraud under the Labor Management Relations Act (LMRA). CNC contended that Local 236 violated a 'most favored nations' clause in their collective bargaining agreement by offering more favorable terms to another employer, Adirondack Cabling. CNC's grievance was ultimately denied by the Labor Management Committee (LMC). The court granted Local 236's motion to dismiss, finding the LMC's decision on the breach of contract claim to be final and binding due to CNC's failure to timely petition for vacation. Additionally, the court ruled that CNC's fraud claim was preempted by the LMRA, as its resolution required interpretation of the collective bargaining agreement.

Breach of contractFraud claimLabor Management Relations Act (LMRA)Most favored nations clauseCollective bargaining agreement (CBA)Grievance procedureMotion to dismissFederal preemptionLabor Management Committee (LMC)Final and binding determination
References
20
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