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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

Claim of Lewis v. Stewart's Marketing Corp.

A claimant sustained serious injuries in 1997 and was awarded workers' compensation benefits. In 2008, a dispute arose regarding the permanency and degree of disability, with conflicting medical reports submitted by the claimant (permanent total disability) and the employer (moderate partial disability). The Workers' Compensation Law Judge denied the employer's request to cross-examine the claimant and his physician, subsequently ruling that the claimant had a permanent total disability. Upon appeal, the Workers’ Compensation Board affirmed this decision. The appellate court reversed the Board's decision, emphasizing that denying the employer's timely request for cross-examination was improper, especially given the conflicting medical evidence, and remitted the matter for further proceedings.

Workers’ CompensationDisability AssessmentPermanent Total DisabilityIndependent Medical ExaminationCross-Examination RightsProcedural Due ProcessConflicting Medical EvidenceRemittalAppellate ReviewBoard Decision Reversal
References
3
Case No. MISSING
Regular Panel Decision

Misuraca v. Perales

This case involves appeals by the State and local Commissioners from two Supreme Court orders in a CPLR article 78 proceeding. The initial proceeding challenged a denial of a shelter allowance to an unnamed petitioner and was settled by stipulation. The Supreme Court had awarded attorney's fees to the petitioner as a 'prevailing party' under 42 USC § 1983. The appeals court dismissed the appeal concerning the denial of reargument, noting no appeal lies from such an order. Crucially, the court reversed the order awarding attorney's fees, ruling that the petitioner's federal due process claim, concerning the failure to produce a witness, was 'wholly without merit.' The court found the dispute involved a legal conclusion from undisputed facts, not a factual issue requiring cross-examination under Goldberg v Kelly, thus not entitling the petitioner to attorney's fees under 42 USC § 1988.

Attorney's FeesCPLR Article 78Due ProcessShelter AllowancePrevailing PartyFederal Constitutional ClaimState ClaimsStipulation of Settlement42 USC § 198342 USC § 1988
References
9
Case No. MISSING
Regular Panel Decision
May 17, 2004

Claim of Patterson v. Empire Blue Cross & Blue Shield

The claimant sustained physical and psychological injuries on September 11, 2001, during the evacuation of her workplace at World Trade Center Tower One in Manhattan. In March 2003, the employer moved to discontinue benefits, arguing that claimant no longer had a work-related disability. A Workers’ Compensation Law Judge (WCLJ) ordered depositions of medical experts. Claimant’s attorney failed to appear for the deposition of the employer’s orthopedic expert. Consequently, the WCLJ ruled that the claimant waived her right to cross-examine the expert and found no further work-related disability after May 12, 2003. The Workers’ Compensation Board affirmed this decision, which the claimant subsequently appealed. The Appellate Division affirmed the Board’s determination, citing substantial evidence supporting the finding of no further disability and concluding that the WCLJ did not abuse its discretion in denying an adjournment for cross-examination.

Workers' CompensationDisabilityMedical Expert TestimonyWaiver of Cross-ExaminationAdjournmentAppellate ReviewSeptember 11World Trade CenterNew York StateWorkers' Compensation Board
References
7
Case No. MISSING
Regular Panel Decision

Monaco v. CIS Corp. (In Re CIS Corp.)

This adversary proceeding involved a former employee, Patrick R. Monaco, suing debtors CIS and Chapter 11 Trustee James P. Hassett for unpaid vacation pay and commissions. The court addressed cross-motions for partial summary judgment on Counts Two and Three of Monaco's complaint. On Count Two, seeking commissions for two Bell South transactions, the court granted the Trustee's motion, finding Monaco was not entitled to these payments due to unfulfilled contractual approval conditions. On Count Three, Monaco sought liquidated damages and attorneys' fees under New York Labor Law for conceded unpaid commissions and vacation pay. The court granted Monaco's cross-motion for these amounts, ruling that the failure to pay the undisputed wages was willful. Pre-judgment interest was denied, but Monaco was awarded $6160 in commissions, $3000 in vacation pay, $2290 in attorneys' fees, and $2290 in liquidated damages.

CommissionsVacation PaySummary JudgmentNew York Labor LawWillful Wage Non-PaymentAttorneys' FeesLiquidated DamagesContract InterpretationBankruptcy Adversary ProceedingEmployee Termination
References
39
Case No. MISSING
Regular Panel Decision

MIA Acupuncture, P.C. v. Praetorian Insurance

This case involves a provider seeking assigned first-party no-fault benefits. The plaintiff moved for summary judgment, and the defendant cross-moved to dismiss the complaint. The court addressed three main issues: the timeliness of claim submission for services rendered in May 2007, the adequacy of a "fee schedule review" for services from May to August 2007, and the medical necessity of acupuncture services from August 29 to September 6, 2007, based on an independent medical examination. The court found an issue of fact regarding claim mailing for the May services and insufficient evidence for the fee schedule review. However, it granted the defendant's cross-motion to dismiss the claim for services from August 29 to September 6, 2007, due to a lack of medical necessity established by the IME report.

No-Fault BenefitsAcupuncture ServicesSummary JudgmentMedical NecessityClaim TimelinessFee Schedule ReviewIndependent Medical ExaminationInsurance Regulations
References
3
Case No. 2014-2086 Q C
Regular Panel Decision
Dec 08, 2017

Adelaida M. Laga, P.T. v. GEICO Ins. Co.

Plaintiff Adelaida M. Laga, P.T., as assignee, sought to recover assigned first-party no-fault benefits from GEICO Ins. Co. The Civil Court had previously granted the plaintiff's motion for summary judgment and denied the defendant's cross-motion for summary judgment. The Appellate Term reversed the Civil Court's judgment, vacating the grant of summary judgment to the plaintiff and denying the plaintiff's motion. The court found that the plaintiff failed to establish a prima facie entitlement to summary judgment by not proving that the claim was timely denied or that the denial was without merit. However, the Appellate Term upheld the denial of the defendant's cross-motion, concluding that the defendant did not demonstrate, as a matter of law, that fees exceeded the workers' compensation fee schedule or that the assignor failed to appear for independent medical examinations.

No-Fault BenefitsSummary JudgmentAppellate ReviewInsurance ClaimPrima Facie CaseBurden of ProofWorkers' Compensation Fee ScheduleIndependent Medical ExaminationCivil ProcedureDenial of Claim
References
7
Case No. 2016-198 Q C
Regular Panel Decision
Jun 01, 2018

Comprehensive Care Physical Therapy, P.C. v. Allstate Ins. Co.

This case concerns a provider, Comprehensive Care Physical Therapy, P.C., seeking no-fault benefits from Allstate Insurance Company. The Civil Court initially denied the plaintiff's summary judgment motion and granted the defendant's cross-motion, dismissing the complaint based on the assignor's failure to appear for independent medical examinations (IMEs) and claims exceeding the fee schedule. On appeal, the Appellate Term modified this order, finding that Allstate failed to provide sufficient proof of timely denial form mailing, thereby precluding its defenses regarding IMEs and the fee schedule. Consequently, Allstate's cross-motion for summary judgment was denied, reversing that part of the lower court's decision. However, the Appellate Term affirmed the denial of the plaintiff's summary judgment motion, as the plaintiff also failed to establish their claims.

no-fault insurancesummary judgmentindependent medical examinationstimely denialinsurance defenseappellate reviewmedical billingassignee rightsprocedural requirementsfee schedule
References
5
Case No. MISSING
Regular Panel Decision
Aug 24, 1999

Town of Hempstead v. Inc. Village of Atlantic Beach

This case involves two related actions arising from inter-municipal agreements for waste disposal services. The defendants appealed from initial court orders concerning their obligations to pay minimum waste commitment tonnage fees and their entitlement to various credits, including those for private carters, recyclable materials, and yard waste. The plaintiffs cross-appealed regarding the methodology for calculating yard waste credits and the fees for using the Town's transfer facility. The Supreme Court, Nassau County, issued an initial order and a subsequent amended order upon reargument, clarifying several points. The Appellate Division affirmed the amended order, holding that the agreements unambiguously required villages to pay minimum tonnage fees regardless of actual waste delivered. The court also determined that the villages were only obligated to pay transfer facility fees based on actual waste delivered and that any ambiguities regarding yard waste credits should be interpreted against the Town as the drafter of the agreements.

Inter-municipal agreementsWaste disposalSummary judgmentContract interpretationMinimum commitment feesYard waste creditTransfer facility feesUnambiguous agreementsExtrinsic evidenceAmbiguity construction
References
10
Case No. MISSING
Regular Panel Decision
Apr 15, 1983

American White Cross Laboratories, Inc. v. North River Insurance

Vincent Yeager, an employee of American White Cross Laboratories, Inc. (American), was injured during employment, leading to a lawsuit against a machine manufacturer, who then brought a third-party action against American for indemnification. American was covered by both a workers’ compensation policy from the State Insurance Fund and a general liability policy from North River Insurance Co. North River disclaimed liability, citing exclusions for workers’ compensation obligations and bodily injury to employees. American then initiated a fourth-party action against North River for contribution. The Supreme Court initially denied American's summary judgment motion and granted North River's cross-motion to dismiss, with leave to replead for indemnification. This court reversed, holding that North River's exclusions do not insulate it from American’s claims because the employer's liability to a third-party tort-feasor for an employee's injury arises from equitable apportionment, not directly from workers' compensation law, thus granting American's motion for summary judgment and denying North River's cross-motion.

Insurance coverage disputeGeneral liability policyWorkers' compensation exclusionContribution between tort-feasorsIndemnificationSummary judgmentFourth-party actionDole-Dow doctrineEquitable apportionmentEmployer liability
References
2
Case No. 2024 NY Slip Op 00844 [224 AD3d 1079]
Regular Panel Decision
Feb 15, 2024

Matter of Cross v. New York State Dept. of Corr. & Community Supervision

Brenda Cross, the claimant, established a workers' compensation claim for knee and ankle injuries from a 2020 work accident. The employer's carrier required her to use contracted providers for diagnostic testing. After an approved MRI for her right ankle was performed by a non-contracted provider, the carrier objected to payment. The WCLJ and Workers' Compensation Board sided with the carrier but found claimant not responsible for the bill. Cross appealed, but the Appellate Division, Third Department, dismissed the appeal, ruling that Cross lacked standing as she was not aggrieved, since she was not responsible for the medical bill and any dispute over reimbursement rates was between the provider and the carrier.

Workers' Compensation ClaimMedical Bill DisputeDiagnostic TestingContracted ProvidersStanding (Law)Aggrieved PartyAppeal DismissedWorkers' Compensation Board DecisionAppellate DivisionMedical Reimbursement
References
2
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