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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

Franzese v. United Health Care/Oxford

Plaintiffs Robert and Elizabeth Franzese, parents and legal guardians of disabled adult Robert Franzese Jr. ("Bobby"), sued United Health Care/Oxford under ERISA to recover medical benefits. Bobby, suffering from chronic lung disease, requires 24/7 in-home nursing care. Oxford denied preauthorization for private duty nursing, citing it as an exclusion, and denied home health care services. The court granted Oxford's summary judgment motion regarding private duty nursing and Xopenex preauthorization, finding private duty nursing not covered. However, the court denied Oxford's motion regarding home health care services, deeming Oxford's denial arbitrary and capricious due to lack of substantial evidence. The case is remanded to Oxford for reconsideration of home health care benefits.

Employee Retirement Income Security Act (ERISA)Medical BenefitsHealth Insurance DenialSummary JudgmentArbitrary and Capricious StandardHome Health CarePrivate Duty NursingPreauthorizationMedical NecessityChronic Lung Disease
References
37
Case No. No. 11, No. 12
Regular Panel Decision
Mar 26, 2019

Lilya Andryeyeva v. New York Health Care , Adriana Moreno v. Future Care Health Services

The New York Court of Appeals addressed a common issue in two joint appeals: whether home health care aides on 24-hour shifts must be paid for each hour. The Department of Labor (DOL) interpreted its Wage Order (12 NYCRR part 142) to allow payment for at least 13 hours if the employee receives at least 8 hours for sleep (with 5 uninterrupted) and 3 hours for meals. The Appellate Division rejected this, but the Court of Appeals reversed, deferring to DOL's interpretation as rational and consistent with the Wage Order's plain language. The cases were remitted for lower courts to evaluate class certification issues in accordance with DOL's interpretation.

Home Health Care24-Hour ShiftsMinimum Wage ActWage OrderDepartment of Labor InterpretationClass CertificationAppellate ReviewLabor Law ViolationsSleep BreaksMeal Breaks
References
49
Case No. MISSING
Regular Panel Decision

Washington Heights-West Harlem-Inwood Mental Health Council, Inc. v. District 1199, National Union of Hospital & Health Care Employees, RWDSU

This case involves a dispute between District 1199, National Union of Hospital and Health Care Employees, and Washington Heights-West Harlem-Inwood Mental Health Council, Inc. The union sought to enforce an arbitration award requiring the Council to rehire and provide back pay to an employee, Edward Lane. The Council cross-moved to vacate the award, arguing that no valid collective bargaining agreement with an arbitration clause existed between the parties. Although the parties had acted under the terms of a proposed agreement for a period, including processing some grievances and wage increases, no formal, signed contract had ever been executed. Citing recent appellate court decisions emphasizing contract formalism over implied intent, the District Court granted the Council's motion to vacate the arbitration award and denied the union's motion to enforce it, concluding that without a signed agreement, there was no contractual duty to arbitrate.

Arbitration AwardSummary JudgmentContract FormationCollective BargainingLabor DisputeContract FormalismVacation of AwardEnforcement of AwardMeeting of the MindsFederal Court
References
23
Case No. 2020 NY Slip Op 04473 [186 AD3d 594]
Regular Panel Decision
Aug 12, 2020

Moreno v. Future Health Care Servs., Inc.

The Appellate Division, Second Department, affirmed the denial of class certification for a putative class action brought by former home health care aides against Future Health Care Services, Inc. Plaintiffs alleged violations of Labor Law article 19, specifically concerning minimum wage payments for 24-hour shifts. The court, upon remittitur from the Court of Appeals, considered the Department of Labor's interpretation of Minimum Wage Order Number 11, which permits exclusion of up to 11 hours for sleep and meal breaks in 24-hour shifts. Consequently, the plaintiffs failed to demonstrate commonality, as they did not allege a lack of prescribed breaks or provide sufficient evidentiary basis for systemwide wage violations, thus failing to meet the requirements of CPLR article 9. Therefore, the Supreme Court's decision to deny class certification was upheld.

Class ActionLabor LawMinimum Wage24-hour ShiftsHome Health Care AidesClass CertificationWage OrderAppellate ReviewJudicial InterpretationNew York Department of Labor
References
7
Case No. MISSING
Regular Panel Decision

Hylton v. Norrell Health Care of New York

Paulette B. Hylton, a home health aide, sued her employer, Norrell Health Care of New York, alleging sexual harassment and retaliation in violation of Title VII. Hylton claimed that after reporting sexual harassment by a patient's son, she received fewer assignments, was denied her W-2 form, and received a negative work reference. The court found that the sexual harassment was not caused by Norrell, and Norrell took prompt and reasonable remedial action. Furthermore, the court determined that Hylton failed to establish a prima facie case of retaliation, as her reduced work was due to her taking assignments with competing agencies and a general business downturn at Norrell, and the W-2 and reference issues were not causally linked to her complaint. Therefore, the District Court granted Norrell's motion for summary judgment and dismissed Hylton's complaint.

Sexual HarassmentRetaliationTitle VIISummary JudgmentHome Health AideTemporary Staffing AgencyEmployer LiabilityHostile Work EnvironmentCausalityAdverse Employment Action
References
14
Case No. ADJ1513511
Regular
Sep 21, 2015

RIZALINA DERRO vs. KAISER PERMANENTE, WEST ANAHEIM MEDICAL CENTER, TERRACE VIEW CONVALESCENT HOSPITAL, COVENANT CARE, SOUTH GATE CARE CENTER, BROADSPIRE, SUN HEALTH CARE, AIG CLAIM SERVICES

The Workers' Compensation Appeals Board denied reconsideration of a decision that found Sun Health Care/Regency and CNA Claims Plus liable for the applicant's left wrist injury. The applicant sustained a cumulative trauma injury to her left wrist during the period of 11-1-1995 to 11-1-1996, while employed by both Covenant Care (insured by AIG) and Sun Health Care (insured by CNA). A previous Compromise and Release barred claims against Covenant Care and AIG, leaving Sun Health Care and CNA liable. The Board adopted the WCJ's report, which relied on medical evidence and legal precedent to uphold the finding of industrial injury and liability.

Workers' Compensation Appeals BoardPetition for ReconsiderationAdministrative Law JudgeCumulative TraumaLeft Wrist InjuryCarpal Tunnel SyndromeCompromise and ReleaseApportionmentDate of InjuryMedical Probability
References
0
Case No. No. 77 Civ. 4712 (MP)
Regular Panel Decision
Mar 27, 1978

National Ben. Fund, Etc. v. Presby. H., Etc.

The National Benefit Fund for Hospital and Health Care Workers and the National Pension Fund for Hospital and Health Care Workers (the Funds) sued Presbyterian Hospital in the City of New York, Inc. (Hospital) to recover allegedly owed contributions based on collective bargaining agreements. The Hospital moved to dismiss, asserting the action was barred by a prior arbitration award between the Union (District 1199, National Union of Hospital and Health Care Employees) and the Hospital, which concerned the same contributions and was dismissed due to the Union's unreasonable delay. The District Court, treating the motion as one for summary judgment, held that the arbitration award had res judicata effect. The court determined that the Funds were either in privity with the Union or acted as third-party beneficiaries subject to the same defenses as the promisee Union. Consequently, the court granted the Hospital's motion to dismiss the complaint.

Arbitration AwardRes Judicata DoctrineEmployee Benefit FundsCollective Bargaining DisputesSummary Judgment MotionHospital Labor RelationsUnion RepresentationERISA ClaimsPreclusionFederal District Court
References
19
Case No. MISSING
Regular Panel Decision

Blumberg v. Nassau Health Care Corp.

Denise Blumberg filed an ADA lawsuit against Nassau Health Care Corporation (NUMC), alleging wrongful termination due to disability discrimination after her breast cancer diagnosis. NUMC sought to dismiss the ADA claims, arguing Eleventh Amendment immunity as a state entity, and to strike the demand for punitive damages. The court analyzed whether NUMC qualified as an 'arm of the state' for immunity purposes, considering factors like its creation, funding, governance, and state control. Ultimately, the court determined that NUMC was not an 'arm of the state' and thus denied the motion to dismiss the ADA claims. The motion to strike punitive damages was granted, as conceded by the plaintiff.

Eleventh Amendment ImmunityADA ClaimsDisability DiscriminationMotion to DismissPunitive DamagesPublic EntityState ActorEmployment LawFederal JurisdictionNassau University Medical Center
References
24
Case No. ADJ10954204
Regular
Sep 15, 2022

MARIA FLORES vs. PINNACLE HEALTH CORP., SUMMARY OF EVIDENCE INSURANCE COMPANY OF THE WEST, AFFINITY HOME HEALTH CARE SERVICES, FALLS LAKE FIRE & CASUALTY INSURANCE, SEDGWICK CMS, HOME HEALTH CARE SOLUTIONS, INC.

The Workers' Compensation Appeals Board denied a petition for reconsideration filed by Home Health Care Solutions. The applicant, an LVN, was injured in a car accident while traveling between patients for multiple agencies. The Board adopted the WCJ's report, which found the injury arose out of and occurred in the course of employment for Home Health Care Solutions. This decision was based on the fact that the applicant was required to use her own vehicle, which extended the employer-employee relationship beyond direct service. The WCJ also found the going and coming rule did not bar the claim due to the required use of transportation between patient locations.

Workers' Compensation Appeals BoardPetition for ReconsiderationGoing and Coming RuleAOE/COELVNCar AccidentAutomobile ExceptionTransitEmployment RelationshipRequired Vehicle Use
References
6
Case No. 06-CV-4757
Regular Panel Decision

Whyte v. Nassau Health Care Corp.

Plaintiff Carol Whyte sued Nassau Health Care Corporation and Rita Bernhardt for race and national-origin discrimination and retaliation under Title VII, §§ 1981, 1983, and the New York Human Rights Law. Whyte, a black woman of Jamaican national origin, alleged discriminatory employment practices during her probationary period as a Medical Technologist I at Nassau University Medical Center. She claimed inadequate training, public humiliation, a forced exam, isolation, and ultimately, wrongful termination due to her race and national origin. The defendants moved for summary judgment. The Court found that Whyte failed to establish a prima facie case of discrimination, as she was not qualified for her position due to numerous admitted errors, and could not demonstrate an inference of discrimination or a hostile work environment. Furthermore, her retaliation claim lacked evidence of pretext for the alleged adverse actions. Consequently, the defendants' motion for summary judgment was granted, and all of Whyte's claims were dismissed.

Employment DiscriminationRace DiscriminationNational Origin DiscriminationRetaliationTitle VIISection 1981Section 1983Summary JudgmentPrima Facie CaseHostile Work Environment
References
53
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