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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

Elmont Open MRI & Diagnostic Radiology, P.C. v. New York Central Mutual Fire Insurance

Plaintiff Elmont Open MRI & Diagnostic Radiology, PC. sued defendant New York Central Mutual Fire Insurance Company (NYCMFIC) for overdue first-party no-fault benefits following a brain MRI performed on Abdelghani Kinane. NYCMFIC moved for summary judgment, asserting the action was premature because Elmont allegedly failed to respond to verification requests, thereby tolling NYCMFIC's time to pay or deny the claim. Elmont countered with an affidavit from its billing supervisor, Brijkumar Yamraj, and a certificate of mailing, proving the requested MRI films and information were sent to NYCMFIC on November 12, 2008. The court found Elmont's proof of mailing sufficient to establish a response, thus denying NYCMFIC's motion and subsequently granting summary judgment to Elmont upon searching the record.

No-fault insuranceVerification requestsSummary judgmentProof of mailingMedical benefitsInsurance claims processTolling of time limitMotor vehicle accidentRadiology fee scheduleBusiness records
References
24
Case No. ADJ1195708
Regular
Feb 11, 2011

ERNESTO VELEZ vs. BIRRIERIA JALISCO, INC., CYPRESS INSURANCE COMPANY c/o BERKSHIRE HATHAWAY HOMESTATE COMPANIES

The Workers' Compensation Appeals Board granted reconsideration for lien claimants M.R. Diagnostic Imaging and San Fernando Diagnostic Imaging. The Board rescinded the administrative law judge's dismissal of their liens, which was based on their alleged failure to object to a Notice of Intention to Dismiss. This dismissal occurred because the lien claimants' timely objection, filed due to an inability to attend a hearing, was not processed by the court. The case is now returned to the trial level for further proceedings and decision, ensuring the lien claimants' response is considered.

WCABLien ClaimantsReconsiderationDismissal of LiensNotice of Intention to DismissGood CauseTimely ObjectionDue ProcessWCJCompromise and Release
References
1
Case No. MISSING
Regular Panel Decision

State Farm Mutual Automobile Insurance v. Rabiner

State Farm Mutual Automobile Insurance Company (Plaintiff) sued Eric Hagerbrant and other defendants, including Metropolitan Radiological Imaging, P.C., to recover over $2,000,000 in alleged fraudulent no-fault insurance payments. Plaintiff asserted claims for common law fraud, unjust enrichment, and sought a declaratory judgment, alleging that Metropolitan was fraudulently incorporated and ineligible for payments. Defendants moved to dismiss the action, arguing preemption by New York Insurance Law § 5109, disputing the eligibility of independent contractors for No-Fault benefits, and asserting a statute of limitations defense. The court denied the defendants' motion in its entirety, finding that § 5109 did not eliminate a private right of action, the Insurance Department's position on independent contractors was valid, and the statute of limitations argument was premature.

Fraudulent IncorporationNo-Fault InsuranceUnjust EnrichmentDeclaratory Judgment ActionMotion to DismissPrivate Right of ActionInsurance Law InterpretationMedical Professional CorporationsIndependent Contractors EligibilityStatute of Limitations Defense
References
40
Case No. MISSING
Regular Panel Decision

Ultra Diagnostics Imaging v. Liberty Mutual Insurance

The Appellate Term reversed a lower court order, granting the plaintiff's motion for summary judgment in an action to recover no-fault benefits for medical services. The court found that the plaintiff had established prima facie entitlement and that the defendant's denial of claims was untimely, thus precluding most defenses. Furthermore, the defendant's submitted evidence for a fraud defense was deemed incompetent, and the court determined that the fraud defense did not fall under the 'lack of coverage' exception to the preclusion rule. The matter was remanded for the calculation of statutory interest and attorney's fees.

No-fault benefitsSummary judgmentTimely denialPreclusionFraud defenseInsurance LawAttorney's feesStatutory interestMedical servicesAssignor
References
12
Case No. MISSING
Regular Panel Decision

Travelers Indemnity Co. v. United Diagnostic Imaging, P.C.

This case involves an appeal from an order denying a petition to vacate a master arbitrator's award. The petitioner sought to vacate the award, which confirmed an arbitrator's decision directing payment of no-fault insurance benefits, arguing the master arbitrator exceeded their power and acted arbitrarily. The court reiterated that grounds for vacating no-fault arbitration awards are few and narrowly applied, upholding awards supported by evidence and not arbitrary or capricious. The petitioner failed to demonstrate grounds for vacating the award under CPLR 7511 (b) (1) (iii). The master arbitrator's determination had evidentiary support and a rational basis, leading the Supreme Court to properly deny the petition.

Arbitration AwardVacatur PetitionNo-Fault Insurance BenefitsMaster ArbitratorCPLR Article 75Arbitrary and CapriciousEvidentiary SupportRational BasisAppellate ReviewSupreme Court Order
References
4
Case No. ADJ1651527 (SBR 0314707)
Regular
Apr 11, 2023

TERRI GLASGOW vs. MASSIE DIAGNOSTIC IMAGING, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior award, rescinded the award, and returned the case to the trial level for further proceedings. The applicant contended the judge failed to rate her bladder injury and ignored vocational expert opinions. The WCAB agreed that the judge improperly applied the pyramiding principles to rate the bladder and lumbar injuries and misapplied case law regarding the consideration of medical and vocational expert opinions. Additionally, the WCAB noted the decision lacked sufficient detail regarding the basis for the overall permanent disability rating.

Petition for ReconsiderationFindings and AwardPermanent Disability RatingBladder InjuryUrinary Stress IncontinenceSacral NeuropathyLumbar Spine InjuryPyramiding PrincipleMultiple Disabilities TableApportionment
References
9
Case No. ADJ7845438
Regular
Dec 08, 2011

TERESA ROJO vs. QUEST DIAGNOSTICS, TRAVERLERS

The defendant, Quest Diagnostics, filed a Petition for Removal seeking to rescind an order continuing the case for trial, arguing they lacked opportunity to rebut a newly received medical report. However, at the subsequent trial, both parties agreed to an Agreed Medical Evaluator and took the case off calendar. As the case is no longer proceeding to trial, the defendant's Petition for Removal has become moot. Consequently, the Appeals Board has dismissed the petition.

Petition for RemovalMandatory Settlement ConferenceAgreed Medical EvaluatorOff CalendarMootDismissedWorkers' Compensation Appeals BoardWCJRebuttal ReportMedical Report
References
0
Case No. ADJ7809684
Regular
Oct 09, 2014

SUSAN NELSON vs. QUEST DIAGNOSTICS, TRAVELERS

This case involves defendant Quest Diagnostics' petitions for removal and disqualification of the workers' compensation judge. The defendant sought to set the case for trial solely on its petitions to dismiss, arguing a mandatory settlement conference would incur additional costs. The Appeals Board denied both petitions, finding defendant's petition for removal contained false statements and applicant's answer was offensive, potentially warranting sanctions. The Board also rejected the disqualification request, agreeing with the judge that no bias was demonstrated.

Petition for RemovalPetition for DisqualificationWCJ Report and RecommendationWCAB Rule 10561(b)(5)(A)WCAB Rule 10561(b)(9)(A)Labor Code Section 5813SanctionsLack of ProsecutionPetition to DismissMandatory Settlement Conference
References
0
Case No. MISSING
Regular Panel Decision

Jones v. Inter-County Imaging Centers

Plaintiff Earlston Jones, diagnosed with sickle cell disease, filed an action alleging employment discrimination under the Americans with Disabilities Act (ADA) and the New York Human Rights Law against Inter-County Imaging Center (ICIC) and Diane Demers. Jones claims he was denied a promotion and terminated due to his medical condition to avoid insurance costs. Defendants moved to dismiss, challenging ICIC's employer status, the number of employees for ADA applicability, and Demers' liability. The court denied dismissal of the ADA and Human Rights Law claims, pending discovery on employer identity and size. However, the court granted the dismissal of claims against Demers in her individual capacity and also dismissed the Title VII and Section 1981 claims.

Employment DiscriminationAmericans with Disabilities ActNew York Human Rights LawMotion to DismissSummary JudgmentEmployer DefinitionIndividual LiabilityRepresentative CapacityEEOC ChargeSickle Cell Disease
References
23
Case No. ADJ7902535
Regular
Dec 02, 2013

MARIA SANCHEZ vs. TARGET CORPORATION

In this workers' compensation case, the Appeals Board denied California Imaging Solutions' petition for reconsideration. The Board also dismissed AR Med Management's petition for reconsideration on behalf of Dr. Saghafi and Spectrum Medical Supply because it was not timely filed. Even if timely, the AR Med Management petition would have been denied on its merits. The Board adopted the findings of the administrative law judge in both instances.

Workers' Compensation Appeals BoardPetition for ReconsiderationAR Med ManagementCalifornia Imaging SolutionsWCJ Reporttimely-filedmeritsSpectrum Medical SupplyDr. SaghafiTarget Corporation
References
0
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