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

Case No. 2021 NY Slip Op 04527 [196 AD3d 988]

Regular Panel Decision

Jul 22, 2021

Matter of Cardona v. DRG Constr. LLC

In 2018, claimant Alex Adonias Pinto Cardona was injured during construction work, leading to a workers' compensation claim. A dispute arose regarding his employment status with DRG Construction LLC, a subcontractor, and Avitus Inc., a professional employer organization (PEO) providing payroll and HR services to DRG. The Workers' Compensation Board initially found Avitus to be a proper employer and American Zurich Insurance Company, Avitus's insurer, to be the responsible carrier for benefits. Avitus and American Zurich appealed this decision. The Appellate Division affirmed the Board's determination, concluding that substantial evidence supported the employer-employee relationship between DRG and the claimant and that Avitus and American Zurich failed to demonstrate that the claimant was not covered by the insurance policy.

Employer-Employee RelationshipProfessional Employer Organization (PEO)Insurance CoverageSubcontractor LiabilityAppellate ReviewConstruction InjuryPayroll ServicesHuman Resources OutsourcingAdministrative ReviewWorkers' Compensation Board Decision

References

Case No. MISSING

Regular Panel Decision

Meloni v. RGM Distribution, Inc.

This case addresses an alleged breach of an employment contract between Michael Meloni (and his company DRG) and RGM Distribution, Inc. (and its owner Robert Gavartin). Meloni, hired as a consultant, entered negotiations for an in-house contract, but no final agreement was signed before he was fired. Plaintiffs sued for breach of contract and quasi-contractual claims. The court denied cross-motions for summary judgment on the primary contract disputes due to contractual ambiguities, ordering the case for a jury trial. However, summary judgment was granted for individual defendant Robert Gavartin and for defendants on promissory estoppel and quantum meruit claims, with the issue of Meloni's fraudulent résumé also to be decided by a jury.

Breach of employment contractSummary judgment denialJury trial orderedResume fraudQuasi-contractCorporate liabilityIntent to be boundContract interpretationMaterial termsUnsigned agreement

References

Case No. MISSING

Regular Panel Decision

Oct 15, 1999

Garofalo v. Empire Blue Cross and Blue Shield

Plaintiffs Laurie Garofalo and Hilary Rosser, as class representatives, sued their health insurer, Empire Blue Cross and Blue Shield, under ERISA. They alleged Empire paid less than its required 80% share of certain inpatient hospital expenses due to a bimodal coinsurance calculation method (actual charges for participants, DRG rates for insurer). Plaintiffs argued this method violated New York Public Health Law § 2807-c(12) and was preempted by ERISA. The court granted summary judgment to Empire, ruling that its calculation method complied with the NYPHRM, specifically § 2807-c(11)(n)(i), and that ERISA did not preempt this state law as it regulates insurance. The court found plaintiffs lacked standing for the remaining claims and dismissed all inpatient hospitalization claims with prejudice.

ERISA LitigationHealth Insurance LawCoinsurance CalculationDRG RatesSummary JudgmentClass Action LawsuitPlaintiff StandingStatutory PreemptionNew York Public Health LawEmpire Blue Cross Blue Shield

References

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Matter of Cardona v. DRG Constr. LLC

Meloni v. RGM Distribution, Inc.

Breach of employment contractSummary judgment denialJury trial orderedResume fraudQuasi-contractCorporate liabilityIntent to be boundContract interpretationMaterial termsUnsigned agreement

Garofalo v. Empire Blue Cross and Blue Shield

ERISA LitigationHealth Insurance LawCoinsurance CalculationDRG RatesSummary JudgmentClass Action LawsuitPlaintiff StandingStatutory PreemptionNew York Public Health LawEmpire Blue Cross Blue Shield