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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

Indian Harbor Insurance v. Global Transport System, Inc.

Indian Harbor Global Insurance Company filed a complaint against Global Transport System seeking a declaratory judgment that it was not obligated to indemnify Global for the loss of Barge MST 17, and a stay of arbitration proceedings. Global moved to dismiss the complaint and compel arbitration, relying on a binding arbitration clause in their insurance policy. The dispute arose after the Barge MST 17 sank following Global's attempt to amend its policy for navigation coverage, which Indian Harbor claimed was not properly accepted. The court, presided over by District Judge Sweet, granted Global's motion, dismissing the complaint and compelling Indian Harbor to proceed to arbitration, finding that the broad arbitration clause covered disputes regarding policy modifications or terminations.

Arbitration AgreementInsurance Coverage DisputeMaritime LawPolicy EndorsementContract InterpretationFederal Rules of Civil ProcedureFederal Arbitration ActMotion to DismissDeclaratory ReliefSeaworthiness
References
19
Case No. 2019 NY Slip Op 03692
Regular Panel Decision
May 09, 2019

Matter of Global Liberty Ins. Co. v. McMahon

Global Liberty Insurance Co. appealed an order denying its petition to vacate an arbitration award in favor of Mark S. McMahon, M.D. The dispute stemmed from a no-fault claim where Global partially paid for arthroscopic surgery, relying on the CPT Assistant newsletter for its valuation. The lower arbitrator and master arbitrator refused to consider CPT Assistant, leading to an award for McMahon. The Appellate Division determined that the Official New York Workers' Compensation Medical Fee Schedule, applicable to no-fault claims, incorporates the CPT book which references CPT Assistant. Consequently, the court found the arbitration award legally incorrect due to the exclusion of CPT Assistant. The court reversed the Supreme Court's order, granted Global's petition, vacated the award, and remanded the matter for a new arbitration.

No-Fault LawInsurance LawArbitration AwardVacate AwardMedical Fee ScheduleCPT AssistantWorkers' Compensation BoardAppellate ReviewStatutory InterpretationRemand
References
2
Case No. 2019 NY Slip Op 08951 [178 AD3d 525]
Regular Panel Decision
Dec 12, 2019

Matter of Global Liberty Ins. Co. of N.Y. v. North Shore Family Chiropractic, PC

The Appellate Division, First Department, affirmed the dismissal of a petition by Global Liberty Insurance Company of New York, which sought to vacate an arbitration award denying their claim. Global Liberty had argued that workers' compensation benefits were available to the assignor, Ramon Martinez, and thus their denial of the no-fault insurance claim to North Shore Family Chiropractic, PC (Martinez's assignee) was proper. The court found that Global Liberty failed to prove Martinez was injured in the course of his employment. The order was modified to remand the matter for a determination of attorneys' fees owed to North Shore Family Chiropractic, PC, including those for the appeal.

Insurance DenialNo-Fault BenefitsArbitration AwardAttorneys' FeesWorkers' Compensation CoverageEmployment StatusAppellate ReviewRemandBurden of ProofAssignor
References
4
Case No. 2018-962 K C
Regular Panel Decision
Nov 01, 2019

Acupuncture Now, P.C. v. Global Liberty Ins.

This case involves an appeal by Global Liberty Insurance from an order of the Civil Court of the City of New York, Kings County. The Civil Court had denied the insurer's cross motion for summary judgment in an action brought by Acupuncture Now, P.C., as assignee of Cleotilde Lozano, to recover first-party no-fault benefits. The Appellate Term, Second Department, reversed the lower court's decision. It found that Global Liberty Insurance had provided sufficient proof of timely mailing of denial of claim forms and had fully paid for the services according to the workers' compensation fee schedule for acupuncture. Consequently, the Appellate Term granted the defendant's cross motion for summary judgment, as the plaintiff failed to raise a triable issue of fact.

No-Fault BenefitsSummary JudgmentAppellate ReviewTimely MailingDenial of ClaimWorkers' Compensation Fee ScheduleAcupuncture ServicesInsurance LawFirst-Party BenefitsCivil Court Appeal
References
2
Case No. 2015-516 Q C
Regular Panel Decision
Dec 19, 2017

Healthway Med. Care, P.C. v. Global Liberty Ins.

The case "Healthway Med. Care, P.C. v Global Liberty Ins." involved an appeal by Healthway Medical Care, P.C. against Global Liberty Insurance concerning assigned first-party no-fault benefits. The plaintiff appealed an order from the Civil Court, Queens County, which denied the plaintiff's motion for summary judgment on certain causes of action (third through tenth) and granted the defendant's cross-motion to dismiss those same causes of action. The Appellate Term, Second Department, modified the Civil Court's order by denying the branches of the defendant's cross-motion seeking summary judgment to dismiss the third through tenth causes of action. The court found the defendant failed to establish that fees exceeded workers' compensation schedules or that independent medical examinations (IMEs) were properly scheduled. However, the plaintiff was not granted summary judgment either, as they failed to demonstrate that the claims were not timely denied or that the denials were without merit. The order was affirmed as modified.

No-fault benefitssummary judgmentindependent medical examinationIME schedulingfee scheduleworkers' compensationappellate reviewcivil proceduremedical billingassigned claims
References
6
Case No. 570383/18
Regular Panel Decision
Dec 12, 2018

Urban Well Acupuncture, P.C. v. Global Liberty Ins. Co. of N.Y.

The case involves an appeal by Global Liberty Insurance Company of New York from an order of the Civil Court denying its motion for summary judgment against Urban Well Acupuncture, P.C. a/a/o Manuel Guaman. The Appellate Term, First Department, reversed the lower court's decision, granting the defendant's motion and dismissing the complaint. The plaintiff failed to counter the insurer's prima facie showing of lack of medical necessity and that the amounts claimed exceeded the workers' compensation fee schedule. However, the dismissal did not apply to claims seeking $439.25, as the defendant had agreed to this amount after correcting alleged coding errors in the plaintiff's bills.

Summary JudgmentAppellate ReviewMedical NecessityWorkers' Compensation Fee ScheduleInsurance LawChiropractic IMENo-Fault InsuranceProfessional CorporationCivil CourtAppellate Term
References
1
Case No. 2019 NY Slip Op 08942 [178 AD3d 512]
Regular Panel Decision
Dec 12, 2019

Global Liberty Ins. Co. of N.Y. v. North Shore Family Chiropractic, PC

This case addresses the appropriate fee schedule for licensed acupuncturists providing services to individuals injured in motor vehicle accidents under no-fault insurance. Plaintiff insurers moved for summary judgment, contending that acupuncturists should be reimbursed according to the workers' compensation fee schedule for chiropractors, not physicians. The Supreme Court denied this motion, and the Appellate Division, First Department, affirmed. The Appellate Division ruled that plaintiffs failed to make a prima facie showing of entitlement to judgment as a matter of law, noting the lack of a specific fee schedule for acupuncturists by the superintendent and prior rulings allowing flexibility in using either chiropractor or physician schedules based on consistency. The court also found an issue of fact raised by defendants regarding the physician fee schedule's applicability and deemed the motion for summary judgment on overbilling premature prior to discovery.

No-fault insuranceacupuncturefee scheduleworkers' compensationinsurance lawsummary judgmentappellate reviewmedical reimbursement11 NYCRR 68.5[b]judicial deference
References
11
Case No. MISSING
Regular Panel Decision
Mar 31, 2009

Global Reinsurance Corp. of America v. Argonaut Insurance

This case concerns Global Reinsurance Corporation of America's petition to confirm an arbitration award against Argonaut Insurance Company. The arbitration panel found Argonaut liable for over $1.9 million under reinsurance agreements, which Argonaut challenged in part, seeking to vacate the award concerning contingent liabilities known as 'Commutations.' District Judge William H. Pauley III granted Global's petition to confirm the entire award and awarded post-award/pre-judgment interest. The court denied Argonaut's motion to vacate, finding no manifest disregard of the law by the arbitrators regarding notice, the definition of 'Loss Occurrence,' or the 'follow-the-settlements' doctrine. Global's request for attorneys' fees was also denied due to lack of statutory or contractual authority.

Arbitration Award ConfirmationReinsurance AgreementsRetrocessionaire LiabilityContingent LiabilitiesLoss Occurrence InterpretationFollow-the-Settlements DoctrineManifest Disregard of LawPost-Award InterestPre-Judgment InterestAttorneys' Fees Denial
References
26
Case No. 12-1227-cec
Regular Panel Decision

Schroeder v. Global Aviation Holdings, Inc. (In re Global Aviation Holdings, Inc.)

This case addresses a motion for summary judgment filed by Global Aviation Holdings, Inc. and World Airways, Inc. (Defendants) against former airline pilots (Plaintiffs). The Plaintiffs alleged a violation of the WARN Act due to a "mass layoff" without required 60-day notice, claiming the Kansas City, Missouri airport (KMCI) served as their "single site of employment." Defendants countered that KMCI was only a theoretical base for payment calculations and lacked any physical presence or operational connection to their pilots. The Court, citing precedent requiring physical connection for a "home base" under WARN Act regulations, ruled that KMCI did not qualify as a "single site of employment." Therefore, the Defendants' motion for summary judgment was granted, leading to the dismissal of the adversary proceedings.

WARN ActMass LayoffSingle Site of EmploymentSummary JudgmentFederal Rules of Civil ProcedureFederal Rules of Bankruptcy ProcedureAirline PilotsFurloughBankruptcyCollective Bargaining Agreement
References
8
Case No. 2022 NY Slip Op 05964 [209 AD3d 596]
Regular Panel Decision
Oct 25, 2022

Pirozzo v. Laight St. Fee Owner LLC

Plaintiff Paul Pirozzo sought summary judgment on his Labor Law § 240 (1) claim against defendants Laight Street Fee Owner LLC, Laight Street Fee Owner II LLC, and Sciame Construction, LLC, which was granted by the Supreme Court. The Appellate Division, First Department, affirmed this decision. The plaintiff established a prima facie case by demonstrating that the scaffold he was working on collapsed without an apparent reason. The defendants' arguments that the plaintiff was the sole proximate cause, either by failing to lock scaffold pins or remaining on the scaffold while it was moved, were deemed unavailing. The court noted that these actions, even if proven, would amount to comparative negligence, which is not a defense to a Labor Law § 240 (1) claim, and there was no evidence of specific instructions to the plaintiff that were disobeyed.

Summary judgmentLabor Law § 240 (1)Scaffold collapseSole proximate causeComparative negligenceWorkers' compensation Form C-2Hearsay objectionPersonal knowledgeRecalcitranceAppellate Division
References
9
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