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

Case No. 2013-2706 Q C
Regular Panel Decision
Sep 19, 2016

NYS Acupuncture, P.C. v. State Farm Mut. Auto. Ins. Co.

This case, NYS Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co., concerned an appeal from an order of the Civil Court of the City of New York, Queens County. The plaintiff, NYS Acupuncture, P.C., sought assigned first-party no-fault benefits from State Farm, which had moved for summary judgment arguing full payment according to the workers' compensation fee schedule. The Civil Court initially granted State Farm's motion. On appeal, NYS Acupuncture, P.C. contended that the fee schedule reductions were improper. The Appellate Term, Second Department, affirmed the prior ruling, finding that State Farm adequately demonstrated it had fully compensated the plaintiff for acupuncture services based on the applicable workers' compensation fee schedule for services performed by chiropractors, referencing Great Wall Acupuncture, P.C. v Geico Ins. Co.

Workers' Compensation Fee ScheduleNo-Fault BenefitsAcupuncture ServicesChiropractorsSummary JudgmentAppellate ReviewInsurance DisputeFee Schedule ReductionAssigned BenefitsMedical Billing
References
1
Case No. 26 NY3d 107 (2016)
Regular Panel Decision
Jun 09, 2016

S.B. v. A.C.C.

This case addresses the definition of "parent" under Domestic Relations Law § 70 (a) for purposes of custody and visitation for unmarried couples. The New York Court of Appeals overrules its 1991 decision in Matter of Alison D. v Virginia M., which had limited parental standing to biological or adoptive parents. The Court now holds that a non-biological, non-adoptive partner has standing if they can show by clear and convincing evidence that the parties agreed to conceive and raise a child together. In Matter of Brooke S.B. v Elizabeth A.C.C., the Appellate Division's order is reversed and the matter remitted for further proceedings under this new standard. In Matter of Estrellita A. v Jennifer L.D., the Appellate Division's order is affirmed, upholding standing based on judicial estoppel. This decision aims to address the unworkability of the Alison D. rule in light of evolving familial relationships, particularly for same-sex couples, and to protect the best interests of children.

Parental RightsCustodyVisitationSame-Sex CouplesNontraditional FamiliesEquitable EstoppelJudicial EstoppelPre-Conception AgreementDomestic Relations LawOverruling Precedent
References
28
Case No. 2014-1942 K C
Regular Panel Decision
Sep 22, 2017

AL Acupuncture, P.C. v. Geico Ins. Co.

This case, AL Acupuncture, P.C. v Geico Ins. Co., concerns an appeal from a Civil Court order regarding assigned first-party no-fault benefits. The plaintiff, AL Acupuncture, P.C., sought summary judgment for services rendered, while defendant Geico Insurance Company cross-moved for dismissal. The Appellate Term modified the lower court's order. It denied the plaintiff's motion for summary judgment on claims from September 8 to September 25, 2008, citing the plaintiff's failure to prove the claim was not timely denied and issues with IME scheduling evidence. Conversely, the court granted the defendant's cross-motion, dismissing claims for services from July 8 to September 5, 2008, as Geico demonstrated timely denial and payment under the workers' compensation fee schedule. The order was affirmed as modified.

No-fault benefitsSummary judgmentIndependent medical examinationsTimely denialWorkers' compensation fee scheduleAcupuncture servicesAppellate TermProvider actionAssigned claimsCivil Court order
References
5
Case No. 2023 NY Slip Op 23398 [81 Misc 3d 21]
Regular Panel Decision
Nov 30, 2023

Associated Plastic Surgeons & Consultants, P.C. v. Global Commodities, Inc.

Plaintiff, Associated Plastic Surgeons & Consultants, P.C., filed a commercial claims action against Global Commodities, Inc. for $5,000 for unpaid medical services provided to an alleged employee. Plaintiff claimed defendant agreed to pay privately. The District Court dismissed the action after excluding a document detailing telephone conversations, which plaintiff argued was admissible under the business records exception or relaxed commercial claims evidence rules. The Appellate Term affirmed the dismissal, ruling that plaintiff failed to prove the patient was injured during employment or that the document was admissible as a business record, thus failing to establish defendant's liability for the medical bill. The court emphasized that while commercial claims courts are not bound by strict evidence rules, judgments cannot rest solely on hearsay.

Commercial claimsMedical servicesUnpaid billsBusiness records exceptionHearsayEvidence rulesEmploymentWorkers' Compensation LawAppellate reviewSubstantial justice
References
10
Case No. MISSING
Regular Panel Decision
Jul 10, 2013

Christopher C. v. Bonnie C.

This divorce action between Christopher C. and Bonnie C. addresses equitable distribution, spousal maintenance, and counsel fees. The defendant, Bonnie C., who has a court-appointed guardian due to mental and emotional difficulties, had separated from the plaintiff in 2003 and informally divided marital assets. The court ratified this prior asset division, noting the defendant had dissipated her share. Finding the defendant unable to work and self-support, and the plaintiff capable of employment despite his claims of disability, the court awarded the defendant non-durational permanent maintenance of $2,500 per month and substantial attorney's fees. The plaintiff's motion to suspend or refund temporary maintenance was denied.

DivorceSpousal MaintenanceEquitable DistributionGuardianshipMental Health IssuesAsset DissipationAttorney's FeesFinancial CapacityPermanent MaintenanceMarital Property
References
12
Case No. 2022 NY Slip Op 06475 [210 AD3d 884]
Regular Panel Decision
Nov 16, 2022

Kreutzberg v. Law Offs. of John Riconda, P.C.

The plaintiff, Thomas Kreutzberg, commenced an action to recover damages for legal malpractice against the Law Offices of John Riconda, P.C. The plaintiff alleged that the defendants failed to obtain the required consent from his workers' compensation carrier for the settlement of a no-fault and personal injury claim in 2009, violating Workers' Compensation Law § 29 (5). The defendants moved to dismiss the complaint as time-barred under CPLR 3211 (a) (5). The Supreme Court, Suffolk County, granted the motion, ruling that the three-year statute of limitations for legal malpractice accrued in 2009 and had expired by the time the action was commenced in 2020. The Appellate Division, Second Department, affirmed the Supreme Court's order, concluding that the defendants successfully established the action was time-barred and the plaintiff failed to raise a question of fact in opposition.

Legal MalpracticeStatute of LimitationsCPLR 3211 (a) (5)Workers' Compensation Law § 29 (5)Appellate DivisionSuffolk CountyTime-barred claimConsent RequirementNo-fault claim settlementPersonal injury action settlement
References
11
Case No. 2013-1461 K C
Regular Panel Decision
Mar 16, 2016

Performance Plus Med., P.C. v. Nationwide Ins.

This case involves an appeal by Performance Plus Medical, P.C., acting as an assignee, against Nationwide Ins. The plaintiff sought to recover assigned first-party no-fault benefits. The Civil Court had previously granted the defendant's motion for summary judgment, leading to the dismissal of the complaint. The Appellate Term affirmed this order, ruling that the defendant's timely verification request tolled the insurer's time to pay or deny the claim, thus rendering the plaintiff's action premature due to a failure to respond to the request. Additionally, the court found that the defendant had successfully demonstrated a prima facie case for denying claims related to the first cause of action based on the workers' compensation fee schedule, which the plaintiff failed to rebut.

No-fault benefitsSummary judgmentVerification requestInsurer's time to payPremature actionWorkers' compensation fee scheduleAppellate reviewCivil Court orderFirst-party benefitsAssigned claims
References
2
Case No. 2014-1527 Q C
Regular Panel Decision
Dec 08, 2017

AVM Chiropractic, P.C. v. American Tr. Ins. Co.

This case concerns an appeal from an order of the Civil Court of the City of New York regarding assigned first-party no-fault benefits. Plaintiff, AVM Chiropractic, P.C., sought to recover benefits from American Transit Ins. Co. The Civil Court initially granted some branches of the defendant's motion for summary judgment and reduced claims based on a fee schedule defense. The Appellate Term modified the order, denying summary judgment for the defendant on specific causes of action (second, third, and sixth through eighth) and vacating findings on others (ninth and tenth). The court found that the defendant did not adequately demonstrate appropriate reductions in accordance with workers' compensation Ground Rules for several claims.

No-Fault BenefitsSummary JudgmentWorkers' Compensation Fee ScheduleAppellate ReviewInsurance ClaimsAssigneeFirst-Party BenefitsCivil ProcedureGround RulesNew York Law
References
1
Case No. 2016-910 K C
Regular Panel Decision
Jan 12, 2018

Precious Acupuncture Care, P.C. v. Hereford Ins. Co.

This case concerns an action by Precious Acupuncture Care, P.C., as assignee of James Hough, against Hereford Insurance Company to recover assigned first-party no-fault benefits. Plaintiff sought the unpaid balance of five claims for services rendered between December 2013 and April 2014. Defendant cross-moved for summary judgment, asserting that the amounts claimed exceeded the workers' compensation fee schedule. The Civil Court initially granted plaintiff's motion, ruling that defendant was precluded from the defense due to untimely denial. However, the Appellate Term reversed this decision, clarifying that under 11 NYCRR 65-3.8 (g) (1) (ii); (2), for services rendered after April 1, 2013, payment is not due for fees exceeding permissible charges, irrespective of timely denial. Consequently, the Appellate Term vacated the prior order, denied plaintiff's motion, and granted defendant's cross-motion for summary judgment dismissing the complaint.

No-Fault BenefitsSummary JudgmentFee Schedule DefenseAppellate ReviewTimely DenialWorkers' Compensation Fee ScheduleMedical BillingInsurance LawCivil CourtAppellate Term
References
5
Case No. 2016-263 Q C
Regular Panel Decision
May 25, 2018

Mind & Body Acupuncture, P.C. v. Allstate Ins. Co.

Mind & Body Acupuncture, P.C., as assignee, appealed an order denying its summary judgment motion and granting Allstate Insurance Company's cross-motion to dismiss the complaint regarding first-party no-fault benefits. The Appellate Term, Second Department, modified the Civil Court's order, affirming the denial of the plaintiff's motion but reversing the grant of the defendant's cross-motion. The court ruled that Allstate failed to establish timely mailing of its denial of claim forms, thus precluding its defense. However, the plaintiff also failed to prove that the claims were not timely denied or that the denials were without merit, leading to the proper denial of its summary judgment motion.

No-Fault BenefitsSummary Judgment MotionAppellate TermInsurance DefenseDenial of ClaimTimely MailingWorkers' Compensation Fee ScheduleAssignee ClaimCivil Court OrderAffidavit Sufficiency
References
4
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