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

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

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. MISSING
Regular Panel Decision
Nov 24, 2009

Nassau Health Care Corp. v. Civil Service Employees Ass'n

The Nassau Health Care Corporation appealed a Supreme Court judgment that denied its petition to modify an arbitration award and granted a petition by Saderia Burke and the Civil Service Employees Association, Inc., to confirm a suspension. The appellate court reversed the judgment, finding that the arbitrator exceeded authority by imposing a suspension despite a prior consent award mandating termination for disciplinary infractions. Consequently, the Corporation's petition to modify the arbitration award was granted, the suspension penalty was vacated, and the implied penalty of termination was reinstated.

Arbitration Award ModificationCPLR Article 75Arbitrator Exceeded AuthorityConsent AwardEmployment TerminationDisciplinary ActionSuspension PenaltyAppellate ReviewPublic Policy ViolationIrrational Award
References
5
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. 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. ADJ7138854, ADJ7135575
Regular
Mar 15, 2013

EVA PATRICIA MARTINEZ vs. HEALTH CARE SERVICES GROUP, ZURICH LOS ANGELES

This case concerns Eva Patricia Martinez and her workers' compensation claims against Health Care Services Group and Zurich Los Angeles. A petition for reconsideration of a December 20, 2012 decision was filed. However, the petitioner has since withdrawn this petition. Consequently, the Workers' Compensation Appeals Board has dismissed the petition for reconsideration.

Petition for ReconsiderationDismissedWithdrawn PetitionerWorkers' Compensation Appeals BoardZurich Los AngelesHealth Care Services GroupADJ7138854ADJ7135575
References
0
Case No. 2016-1365 K C
Regular Panel Decision
Nov 16, 2018

New York Infinity Health Care, LCSW, P.C. v. Farmington Cas. Co.

This action involves a healthcare provider, New York Infinity Health Care, seeking assigned first-party no-fault benefits from Farmington Casualty Company. The Civil Court denied the plaintiff's motion for summary judgment and granted the defendant's cross-motion, dismissing the complaint because the amounts sought for services rendered prior to April 1, 2013, exceeded the workers' compensation fee schedule. The Appellate Term affirmed the Civil Court's order, finding the defendant sufficiently established the proper mailing of the denial of claim forms.

No-fault benefitsSummary judgmentDenial of claimWorkers' compensation fee scheduleAppellate reviewMailing proofHealthcare providerInsurance disputeAssigned benefitsCivil Court
References
1
Case No. MISSING
Regular Panel Decision

Melson v. Secretary of Health and Human Services

The plaintiff, Mrs. Melson, initiated this action against the Secretary of Health and Human Services, seeking Medicare benefits for her husband, James Melson, following a heart attack and subsequent brain damage. Mr. Melson was hospitalized, and his treating physician, Dr. William C. Baker, determined he no longer required acute inpatient care after December 26, 1984, recommending transfer to a skilled nursing facility (SNF). Despite the availability of SNF beds, Mrs. Melson refused the transfer, preferring to wait for placement at the Veterans Administration Hospital. Medicare benefits for the extended hospital stay were consequently terminated. Both an Administrative Law Judge and the Secretary found that SNF beds were available, making Mr. Melson ineligible for reimbursement for the continued hospital care. The court ultimately granted summary judgment to the defendant, affirming the Secretary's decision based on substantial evidence.

Medicare benefitsSkilled Nursing FacilityAcute inpatient carePatient transfer refusalAdministrative Law JudgeSecretary of Health and Human ServicesJudicial reviewSubstantial evidenceMedicare coverage denialTreating physician's certification
References
4
Case No. MISSING
Regular Panel Decision

Hypolite v. Health Care Services of New York Inc.

The plaintiff, Allison Hypolite, on behalf of a putative class of home health aides, moved for conditional certification and notice to a proposed class under the FLSA. The defendants, HCS Healthcare and Agnes Shemia, opposed and moved to strike portions of the plaintiff's reply. The court denied the motion to strike. The court granted conditional certification for the period between January 1, 2015, and October 13, 2015, finding that the defendants failed to comply with revised FLSA regulations concerning the Home Health Aide Exemption during this time. However, the motion was denied for the period before January 1, 2015, as the plaintiff did not sufficiently demonstrate that other potential opt-in plaintiffs were similarly situated, given the fact-specific nature of the prior exemption rules. The plaintiff's request to extend the notice period to six years for state law claims was also denied.

FLSAConditional CertificationCollective ActionHome Health AidesOvertime PayWage and HourThird Party EmployerCompanionship Services ExemptionDepartment of Labor RegulationsRetroactive Effect
References
36
Case No. MISSING
Regular Panel Decision

NYAHSA Servs., Inc., Self-Insurance Trust v. People Care Inc.

This case involves an appeal from an order of the Supreme Court, which granted the plaintiff's motions for leave to amend complaints. The plaintiff, a group self-insured trust, initiated collection actions against former member employers, People Care Incorporated and Recco Home Care Services, Inc., for unpaid workers' compensation adjustment bills. The plaintiff sought to add its trustees as party plaintiffs and to update allegations to include subsequently accrued unpaid bills. The appellate court affirmed the Supreme Court's decision, clarifying that an evidentiary showing of merit is not required for leave to amend pleadings under CPLR 3025 (b) unless there is prejudice, surprise, palpable insufficiency, or patent lack of merit. The court found no such grounds for denial and also rejected the defendants' statute of limitations arguments, affirming that for contracts requiring continuing performance, each breach can restart the limitations period.

Workers' Compensation CoverageSelf-Insured TrustBreach of ContractUnjust EnrichmentPleading AmendmentCPLR 3025 (b)Statute of LimitationsPrejudiceAppellate ReviewSupreme Court Order
References
18
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