CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

Case Law Database

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

Case No. 2015-2337 Q C
Regular Panel Decision
May 18, 2018

Sama Physical Therapy, P.C. v. Hereford Ins. Co.

This case concerns an action by Sama Physical Therapy, P.C., as assignee, to recover first-party no-fault benefits from Hereford Insurance Co. The defendant argued that the plaintiff's assignor had been injured during the course of employment. The Civil Court conditionally granted defendant's cross-motion for summary judgment, ordering the plaintiff to file an application with the Workers' Compensation Board within 90 days. Plaintiff failed to comply with this order, and upon renewal, the Civil Court adhered to its prior determination. The Appellate Term, Second Department, affirmed the Civil Court's order, finding that the plaintiff did not demonstrate compliance with the order to make a proper application under the Workers' Compensation Law.

No-Fault BenefitsSummary JudgmentWorkers' Compensation BoardAppellate ReviewConditional GrantFailure to ComplyRenewal MotionInsurance LawAssigneeMedical Provider
References
1
Case No. 2015-608 Q C
Regular Panel Decision
Dec 19, 2017

Adelaida Physical Therapy, P.C. v. 21st Century Ins. Co.

In this case, Adelaida Physical Therapy, P.C., acting as an assignee, appealed an order from the Civil Court of the City of New York, Queens County. The original order had granted 21st Century Insurance Company's motion for summary judgment, dismissing parts of a complaint seeking first-party no-fault benefits for services billed under specific CPT codes (97010, 97110, and 97124). The Appellate Term, Second Department, reversed the lower court's decision. The appellate court found that 21st Century Insurance Company failed to demonstrate that it had used the correct conversion factor to calculate the reimbursement rate, thus not establishing its defense that the charged fees exceeded the workers' compensation fee schedule. As a result, the branches of the defendant's motion for summary judgment related to those CPT codes were denied.

No-Fault BenefitsCPT CodesSummary JudgmentWorkers' Compensation Fee ScheduleReimbursement RateAppellate ReviewInsurance DisputeCivil ProcedureConversion FactorMedical Billing
References
2
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. 46885/05, 47943/05, 47945/05
Regular Panel Decision

Robert Physical Therapy, P.C. v. State Farm Mutual Automobile Insurance

This case involves three consolidated claims for first-party no-fault benefits related to physical therapy services. The plaintiff's assignors received physical therapy, and the defendant, an insurer, denied some claims due to disputes over billing codes. The central legal issues concerned whether a physical therapist could utilize billing codes from the medicine fee schedule when such services were not explicitly in the physical medicine schedule, and if range of motion and muscle testing could be billed separately from evaluation and management on the same day. The court determined that physical therapists are not confined to the physical medicine section and can use codes from any section of the medical fee schedule. Furthermore, the defendant failed to provide sufficient evidence to justify its denials regarding separate billing for range of motion and muscle testing. Consequently, the court ruled in favor of the plaintiff, awarding judgment for all disputed amounts.

Physical Therapy BillingNo-Fault BenefitsMedical Fee ScheduleCPT CodesWorkers' Compensation RegulationsEvaluation and Management ServicesRange of Motion TestingMuscle TestingProvider SpecialtyBilling Disputes
References
4
Case No. ADJ7994035
Regular
Apr 26, 2013

EMILY NOE vs. R\&L CARRIERS, THE HARTFORD INSURANCE COMPANY

The Workers' Compensation Appeals Board denied reconsideration of the applicant's case, affirming the Workers' Compensation Judge's (WCJ) finding of a compensable continuous trauma injury. The defendants argued that the applicant's misstatements on a DOT physical form negated her claim. However, the Board found substantial evidence supported the WCJ's decision, giving great weight to the judge's credibility findings. The WCJ determined that the applicant's testimony and medical reports established a compensable injury despite the conflicting DOT physical answers.

Workers' Compensation Appeals BoardReconsideration DeniedContinuous Trauma InjuryAOE/COEPQMEMedical EvidenceCredibility FindingJob DutiesDOT PhysicalHealth History
References
1
Case No. MISSING
Regular Panel Decision

Claim of Walton v. Lin-Dot

Claimant, a plumber, developed cervical stenosis while working for Lin-Dot in March 2003 and subsequently filed a workers' compensation claim for an occupational disease. The employer's workers' compensation carrier sought to apportion responsibility for the claim among the claimant's prior employers under Workers' Compensation Law § 44. However, a Workers' Compensation Law Judge denied this request, and the Workers' Compensation Board affirmed that decision. The Board found no objective medical proof that the occupational disease was contracted during prior employment. The Appellate Division affirmed the Board's determination, concluding that the claimant contracted the disease while employed by Lin-Dot and that the Board's decision was supported by substantial evidence.

Occupational DiseaseApportionmentPrior EmploymentCervical StenosisWorkers' Compensation LawMedical EvidenceSubstantial EvidenceAppellate ReviewEmployer ResponsibilityCarrier Liability
References
3
Case No. MISSING
Regular Panel Decision
Nov 14, 1991

Pellach v. Pellach

The Supreme Court modified an earlier order denying plaintiff's motion to reopen a maintenance and support hearing and compel defendant's physical examination. The record before the Special Referee was reopened, allowing the plaintiff to subpoena defendant's bank account records due to alleged discovery of new information and previous attorney refusal. However, the court affirmed the denial of the physical examination request, noting the defendant's prior adjudication of permanent disability by the Workers’ Compensation Board. The delay in the divorce action, pending since 1988, was largely attributed to the defendant's frequent changes of attorneys.

DivorceMaintenanceSupportFinancial DisclosureBank AccountsPhysical ExaminationWorkers' CompensationJudicial DiscretionAppellate ReviewReopening Record
References
1
Case No. MISSING
Regular Panel Decision

Denise AA. v. David AA.

This case is an appeal from a Family Court order granting the petitioner primary physical custody of two children, Rebecca and Chelsea, while maintaining joint legal custody. The respondent, appealing pro se after an adjournment request was denied, argued that the Family Court abused its discretion in the custody award and in denying the adjournment. The appellate court affirmed the Family Court's decision, finding no abuse of discretion in denying the adjournment given the respondent's ample time to secure counsel. The court also found the custody award to the petitioner to be in the children's best interest, despite concerns about the petitioner's judgment regarding her older daughter's sexual activity and cohabitation plans. The decision emphasized the deference given to Family Court's factual findings and the desirability of keeping siblings together.

child custodyphysical custodyjoint legal custodyvisitation rightsFamily Court Act Article 6pro se representationadjournment denialbest interest of the childparental judgmentappellate review
References
7
Case No. MISSING
Regular Panel Decision

Village of Westbury v. Department of Transportation

The Village of Westbury initiated a CPLR article 78 proceeding against the Department of Transportation (DOT) for alleged violations of the State Environmental Quality Review Act (SEQRA). The Village sought to annul a negative declaration issued by DOT for the reconstruction of an interchange and a proposed widening of the Northern State Parkway, arguing that the projects' cumulative environmental effects required an Environmental Impact Statement (EIS). The Supreme Court dismissed the petition, but the Appellate Division reversed, annulling the negative declaration and remitting the case to DOT. The Court of Appeals affirmed the Appellate Division's order, concluding that DOT erred by not considering the combined environmental effects of the interchange reconstruction and the parkway widening, as these were interdependent projects under SEQRA regulations. The Court also held that DOT must apply the more protective Department of Environmental Conservation (DEC) regulations and that the Village's proceeding was timely because DOT failed to provide proper notice of the negative declaration.

Environmental LawSEQRACPLR Article 78Negative DeclarationEnvironmental Impact StatementProject SegmentationCumulative ImpactsNotice RequirementsStatute of LimitationsHighway Construction
References
7
Case No. 2018 NY Slip Op 03678 [161 AD3d 1074]
Regular Panel Decision
May 23, 2018

Matter of Greco v. Robert N. Greco

The mother, Susan Greco, appealed an order from the Family Court, Nassau County, which denied her petition to modify a prior physical access order and directed her to pay supervised physical access costs exceeding $100 per month. The Appellate Division, Second Department, affirmed the Family Court's order. The court found that the mother failed to demonstrate a change in circumstances warranting modification of the custody and physical access arrangement. It also determined that a more flexible physical access schedule was in the children's best interests and upheld the Family Court's financial determination regarding supervised physical access costs based on the parties' financial situation.

Child CustodyPhysical AccessFamily LawAppellate ReviewOrder ModificationSupervised VisitationBest Interests of the ChildParental Financial ObligationNassau CountyPro Se Representation
References
6
Showing 1-10 of 835 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational