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

Case No. ADJ1857578
Regular
Jun 23, 2009

MIRNA LICEA vs. MINSON CORPORATION, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for PHICO INSURANCE COMPANY in liquidation

This case involves a lien claim by Missirian Orthopedic Medical Group, assigned to KM Financial Services, for medical treatment provided to Mirna Licea. The California Insurance Guarantee Association (CIGA), representing the insolvent insurer Phico Insurance Company, denied the lien based on Insurance Code § 1063.1(c)(9), which excludes claims by assignees. The Workers' Compensation Appeals Board denied reconsideration, affirming that the statute clearly prohibits payment to assignees, including medical providers who have assigned their accounts receivable. The Board relied on *Baxter Healthcare Corp. v. CIGA* for the principle that assigned claims are not "covered claims" under the Guarantee Act.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGAPhico Insurance Companyliquidationinsolvent insurerlien claimantassigneecovered claimInsurance Code 1063.1(c)(9)
References
4
Case No. MISSING
Regular Panel Decision

Rivera v. Lutheran Medical Center

Felix Rivera sued Lutheran Medical Center (LMC) and Myles Davis for retaliatory and discriminatory discharge under New York State and City Human Rights Laws, alleging termination due to his association with a sister-in-law who previously sued LMC. The court granted the defendants' motion to dismiss the claim under the NYSHRL, finding it does not support association discrimination, but denied dismissal for the NYCHRL claim, which explicitly allows such a cause of action. Separately, plaintiff moved to disqualify defendants' law firm, Morgan Lewis & Bockius, LLR, for improperly soliciting non-party witnesses. The court found that Morgan Lewis violated professional conduct rules by soliciting these witnesses to gain a tactical advantage, ordering their disqualification from representing four specific individuals and mandating disclosure of this to the witnesses. The overall decision represents a partial victory for both sides, with motions granted and denied in part.

Retaliatory DischargeDiscriminatory DischargeHuman Rights LawNYSHRLNYCHRLAssociation DiscriminationAttorney DisqualificationProfessional ResponsibilityConflict of InterestWitness Solicitation
References
9
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

Martinez v. Downstate Medical Center of State University of New York

The petitioner, an associate professor and director of a Joint Respiratory and Surgical Intensive Care Unit, was reassigned and later terminated following a leave of absence for a heart attack. He initiated a CPLR article 78 proceeding to challenge his reassignment, the transfer of the ICU, and his termination from a tenured position. The Supreme Court's initial judgment was appealed. The appellate court modified the judgment by granting the petitioner's request for reinstatement to a comparable ICU director position. It also remitted the issue of reinstatement as a tenured associate professor to Downstate for review under its medical staff bylaws, displacing a prior referral to the UUP agreement. However, the court affirmed the dismissal of the claim concerning the ICU transfer and found the promotion issue time-barred under the UUP grievance procedure.

ReinstatementTenurePromotion DisputeCPLR Article 78Administrative ReviewMedical Staff BylawsCollective Bargaining AgreementJudicial Review ScopeHospital AdministrationAcademic Appointment
References
6
Case No. MISSING
Regular Panel Decision
Jun 29, 2004

Claim of Rothe v. United Medical Associates

This case involves an appeal from a Workers’ Compensation Board decision, filed on June 29, 2004. The Board reversed a Workers’ Compensation Law Judge's determination that the claimant, a physician with a permanent partial disability, had maintained an attachment to the labor market subsequent to September 18, 2002. The appellate court affirmed the Board's decision, finding that the claimant did not provide evidence demonstrating that his inability to obtain employment was caused by or related to his permanent partial disability. Consequently, the Board's conclusion that the claimant failed to maintain an attachment to the labor market was supported by substantial evidence.

Workers' Compensation AppealLabor Market AttachmentPermanent Partial DisabilityVoluntary WithdrawalAppellate ReviewSubstantial EvidencePhysician ClaimantEmployment SearchWorkers' Compensation Board ReversalJudicial Affirmation
References
5
Case No. MISSING
Regular Panel Decision
Mar 09, 2001

Convenient Medical Care, P.C. v. Medical Business Associates, Inc.

Plaintiff, a professional medical corporation, entered into a billing services contract with defendant, a medical billing service provider, in early 1997. The agreement was terminated by plaintiff in 1998 due to alleged failures by the defendant in timely billing worker's compensation patients and delays in returning billing records. Defendant subsequently moved for summary judgment on its counterclaims for breach of contract and an account stated, which the Supreme Court denied. On appeal, the appellate court modified the lower court's order, reversing the denial of summary judgment for defendant's breach of contract counterclaim and granting summary judgment to the defendant on the issue of liability. The court found plaintiff's arguments and evidence insufficient to defeat the defendant's prima facie showing for summary judgment, but denied summary judgment for an account stated due to discrepancies in claimed amounts.

Breach of ContractSummary JudgmentMedical Billing ServicesNegligenceCounterclaimsAppellate ReviewContract TerminationWorker's Compensation PatientsEvidentiary ProofMerger Clause
References
10
Case No. MISSING
Regular Panel Decision

Bruno v. Dynamic Enterprises, Inc.

This case involves a personal injury action where Dynamic Enterprises, Inc. appealed a judgment in favor of the plaintiff. Dynamic contended it was engaged in a joint venture with Executive Club International, Inc. (ECI), the plaintiff's employer, arguing for dismissal based on workers' compensation exclusivity. However, the court found no joint venture, noting Dynamic and ECI were separate corporate entities, filed separate tax returns, and did not share income or losses. Consequently, Dynamic's workers' compensation defense was dismissed, and the judgment was unanimously affirmed with costs.

Personal InjuryJoint VentureWorkers' Compensation ExclusivityCorporate LiabilityAffirmation of JudgmentAppellate ReviewEmployer-Employee RelationshipNegligenceBusiness LawLegal Precedent
References
5
Case No. MISSING
Regular Panel Decision
May 20, 1994

Twyford v. Production Associates, Inc.

Production Associates, Inc. appealed an order from the Supreme Court, Richmond County, which granted McDonald’s Corporation’s motion to dismiss a third-party complaint. The primary action involved Thomas E. Twyford, a McDonald's employee, who sued Production Associates for injuries suffered at a convention. Production Associates then sought contribution from McDonald's. The Supreme Court initially applied Pennsylvania law, leading to the dismissal of the third-party complaint. However, the appellate court reversed this decision, concluding that Illinois law should apply based on an 'interests analysis' approach, as both Production Associates and McDonald's have significant ties to Illinois. Illinois workers' compensation law, unlike Pennsylvania's or New Jersey's, does not preclude third-party contribution claims against an employer.

Personal InjuryThird-Party ActionWorkers' CompensationChoice of LawConflict of LawsContribution ClaimsSummary JudgmentAppellate ReviewIllinois LawPennsylvania Law
References
4
Case No. MISSING
Regular Panel Decision
Jun 19, 2001

Carman v. Abter

A nurse employed by a medical center providing dialysis services alleged she contracted HIV after a needle stick injury sustained while drawing blood from a patient. She filed a medical malpractice action against the medical center, a salaried physician (Dr. Ma) employed by a nephrology group associated with the center, and an independent infectious disease consultant (Dr. Abter) used by the group. The Supreme Court initially dismissed the complaint against all defendants, applying the Workers' Compensation Law's "fellow employee rule." On appeal, the judgment was modified. The appellate court affirmed the dismissal for the medical center and Dr. Ma, concluding their services to the plaintiff were employment-related and not available to the general public. However, the complaint against Dr. Abter was reinstated, as the fellow-employee rule was found not to apply to him given his status as an independent consultant.

Medical malpracticeHIV exposureNeedle stick injuryWorkers' CompensationFellow employee ruleIndependent contractorPhysician negligenceEmployer liabilityAppellate reviewNew York law
References
1
Case No. MISSING
Regular Panel Decision

Queens Blvd. Medical, P.C. v. Travelers Indemnity Co.

The plaintiff, Queens Blvd. Medical, P.C., sought $950 in first-party no-fault benefits for biofeedback medical services provided to its assignor for lower back and chronic pain syndrome. The central issue at trial was the medical necessity of these services under Insurance Law § 5102 (a) (1). The plaintiff established a prima facie case with expert testimony from a board-certified neurologist affirming the medical appropriateness of biofeedback. The defendant insurance company failed to present admissible evidence to disprove medical necessity, as its expert was deemed incompetent to testify on biofeedback for back pain. Consequently, the court granted the plaintiff's motion for a directed verdict, awarding judgment for $950 along with statutory costs, interest, and attorney's fees.

No-fault benefitsMedical necessityBiofeedback treatmentExpert testimonyDirected verdictInsurance lawChronic pain syndromeBack injuryCPT codesBurden of proof
References
9
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