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

Case No. No. M2018-01696-COA-R3-CV; No. 15-4-IV
Regular Panel Decision
Dec 07, 2020

American Board of Craniofacial Pain v. American Board Of Orofacial Pain

This case involves an appeal concerning a failed merger between two professional dental associations, American Board of Craniofacial Pain (ABCP) and American Board of Orofacial Pain (ABOP). ABCP sued ABOP, alleging a breach of an agreement to merge formed through email exchanges and seeking specific performance and damages. The Chancery Court for Davidson County granted summary judgment to ABOP, finding no meeting of the minds and thus no enforceable contract. The Court of Appeals of Tennessee affirmed this decision, concluding that the parties’ objective manifestations showed a lack of mutual assent because an essential term (disposition of intellectual property) was not agreed upon and they intended to reduce the agreement to a formal Memorandum of Understanding, which was never finalized. The court also agreed that specific performance was not an available remedy due to the incompleteness of the purported contract.

Contract DisputeMerger NegotiationsCorporate MergerDental ProfessionMutual AssentSpecific Performance DenialSummary Judgment AffirmationTennessee Court of AppealsContract FormationLack of Agreement
References
26
Case No. 2024 NY Slip Op 00599 [224 AD3d 428]
Regular Panel Decision
Feb 06, 2024

Matter of New Millennium Pain & Spine Medicine, P.C. v. Garrison Prop. & Cas. Ins. Co.

This case involves two appeals by New Millennium Pain & Spine Medicine, P.C. against Garrison Property & Casualty Insurance Company and GEICO Casualty Company. New Millennium sought to vacate master arbitration awards that denied its claims for no-fault benefits for medical services. The Supreme Court denied these applications. The Appellate Division, First Department, affirmed the Supreme Court's decisions, stating that an arbitrator's award will not be set aside unless it is irrational. The court also addressed the argument regarding a 20% wage offset in no-fault benefits, finding it unavailing under Insurance Law § 5102 (b). Ultimately, New Millennium was not entitled to attorneys' fees as it was not the prevailing party.

No-fault benefitsarbitration awardvacaturinsurance lawwage offsetappellate reviewmedical servicesno-fault policy exhaustionattorneys' feesCPLR Article 75
References
8
Case No. 533203
Regular Panel Decision
Oct 06, 2022

Matter of Cotterell v. Trinity Health Corp.

Claimant, Meggan Cotterell, sustained a lower back injury in 2015 while working for Trinity Health Corporation. Later, a right hip injury was found to be causally-related to the original work injury. The employer and carrier argued the hip injury claim was untimely under Workers' Compensation Law § 28, which mandates claims be filed within two years of the accident. The Workers' Compensation Board affirmed the claim amendment, crediting the treating orthopedist's testimony that initial hip pain was confused with low back symptoms and the hip labral tear was diagnosed later. The Appellate Division affirmed the Board's decision, finding that medical reports indicating hip pain filed within two years, coupled with the delayed diagnosis, provided substantial evidence to support the Board's determination that the amendment was not time-barred.

Workers' CompensationHip InjuryLabral TearTimelinessWorkers' Compensation Law § 28CausationMedical EvidenceOrthopedist TestimonyAppellate ReviewBoard Decision
References
7
Case No. MISSING
Regular Panel Decision

Claim of Stewart v. P & C Food Markets, Inc.

A claimant, who worked as a cashier, developed persistent leg and hip pain diagnosed as a slipped femoral epiphysis requiring surgery in August 1990. Following surgery, he allegedly developed chronic low back pain and filed for workers' compensation benefits. While surgeons opined that neither the slipped hip nor back pain were work-related, chiropractors testified otherwise. The Workers’ Compensation Board ruled in the claimant's favor, finding a causal relationship for both conditions. The employer and its insurer appealed, raising an issue about the chiropractors' qualifications which was deemed not properly preserved. The Appellate Division affirmed the Board's decision, finding substantial evidence for the causal relationship.

Workers' CompensationCausal RelationshipSlipped Femoral EpiphysisBack PainChiropractor TestimonyMedical Expert QualificationSubstantial EvidenceAppellate ReviewEmployer AppealInsurance Carrier
References
4
Case No. 2015-03-0899
Regular Panel Decision
Jul 06, 2016

Spencer, Gerald v. National State Park Concession d/b/a Cades Cove Riding Stables

Employee Gerald Spencer sought temporary disability and medical benefits for alleged right knee and hip/back injuries from an August 1, 2015, work incident at National State Park Concession d/b/a Cades Cove Riding Stable. The court found proper notice of the injury but denied knee-related benefits, as Mr. Spencer failed to present medical evidence refuting Dr. Harrison's opinion that the work injury contributed less than 50% to his pre-existing knee problems. Conversely, the court granted Mr. Spencer medical treatment for his right hip/back/myofascial pain, as the employer did not refute Dr. Harrison's finding linking it to the work injury. However, temporary disability for hip/back/myofascial pain was denied due to lack of medical proof of inability to work. The matter is set for an Initial (Scheduling) Hearing on September 7, 2016.

Workers' CompensationExpedited HearingKnee InjuryHip InjuryMyofascial PainCausationNotice of InjuryPre-existing ConditionMedical BenefitsTemporary Disability
References
1
Case No. MISSING
Regular Panel Decision
May 05, 2000

Pain Resource Center v. Travelers Insurance

This case addresses a dispute regarding the payment of first-party no-fault benefits to a health provider, Pain Resource Center, as the assignee of John Hiotis, who was injured in an auto accident. The defendant, Travelers Ins. Co., challenged the validity of the assignment and the necessity of the medical services provided. The court affirmed the validity of the assignment under New York's Insurance Law and related regulations. However, based on conflicting expert testimonies, the court limited the compensable medical services to six hours and awarded the plaintiff $566.10, along with statutory interest and attorney's fees.

No-Fault InsuranceFirst-Party BenefitsAssignment ValidityMedical ServicesPeer ReviewInsurance LawHealth Provider ClaimAutomobile AccidentDamagesStatutory Interpretation
References
5
Case No. MISSING
Regular Panel Decision

Universal Acupuncture Pain Services, P.C. v. Lumbermens Mutual Casualty Co.

The New York court addresses a motion for reargument by Universal Acupuncture Pain Services, P.C. against Lumbermens Mutual Casualty Company concerning no-fault insurance claims. The central legal question is whether an expert witness's peer review report, created after a timely denial of a no-fault claim, can be admitted at trial, specifically under the Cirucci precedent regarding the specificity of denial grounds. The court grants the motion for reargument but upholds its initial ruling, which granted partial summary judgment on one of five claims. It clarifies that the expert's testimony must be strictly limited to the "concurrent or excessive care" ground initially stated by the insurer, excluding any new grounds like "medical necessity" not specified in the original denial. The court emphasizes that the issue of whether different treatment modalities constitute concurrent care for the same condition requires a trial for factual determination.

No-Fault InsurancePeer ReviewExpert Witness TestimonySummary Judgment MotionInsurance Law InterpretationSpecificity of DenialConcurrent Medical CareAcupuncture TreatmentChiropractic TreatmentPhysical Therapy
References
7
Case No. MISSING
Regular Panel Decision

Nayal v. HIP Network Services IPA, Inc.

Dr. Christine Nayal initiated a class action against HIP Network Services IPA, Inc., alleging breach of contract, unjust enrichment, and a violation of New York General Business Law § 349. As a practicing psychologist, Nayal claimed that HIP, a health maintenance organization, failed to provide timely and adequate reimbursement, including interest, for services rendered under their agreement. HIP responded by filing a motion to compel arbitration, citing a clause in their contract, or, alternatively, seeking dismissal of the claims. The Court, presided over by Judge Victor Marrero, evaluated the enforceability of the arbitration provision. Finding no procedural or substantive unconscionability under New York law, the Court granted HIP's motion to compel arbitration for all claims, subsequently dismissing the entire action without prejudice.

Arbitration AgreementUnconscionabilityClass Action WaiverFederal Arbitration ActNew York General Business LawContract DisputeBreach of ContractUnjust EnrichmentMotion to Compel ArbitrationDismissal Without Prejudice
References
34
Case No. 2018-03-1124
Regular Panel Decision
Feb 28, 2019

Darnell, Lisa v. Star Vending, Inc.

This case involves Lisa Darnell's claim for workers' compensation benefits for low back pain, left knee, and hip injuries sustained from a fall at Star Vending, Inc. While the employer accepted the claim for her knee and hip, treatment for her low back was denied due to questions of causation. The Court found that Ms. Darnell failed to demonstrate her low back pain primarily arose from her employment, citing medical opinions that attributed her back issues to non-work-related causes, especially after she took a standing job outside her restrictions. Furthermore, her claim for temporary partial disability benefits was denied because her refusal of a modified duty offer was based on personal transportation difficulties rather than her work restrictions. Consequently, the Court denied her claim for both medical and temporary partial disability benefits.

Expedited HearingDenial of BenefitsLow Back PainKnee InjuryHip PainCausation of InjuryMedical Treatment DisputeTemporary Partial DisabilityModified Duty OfferRefusal of Work
References
3
Case No. 528152
Regular Panel Decision
Jan 09, 2020

Matter of Sbuttoni v. FOJP Serv. Corp.

Claimant Joseph Sbuttoni sought workers' compensation benefits for lower back and right hip injuries sustained in September 2016. While a Workers' Compensation Law Judge initially established the claim for both, the Workers' Compensation Board later rescinded the establishment for the right hip injury. Sbuttoni appealed this decision. The Board's determination was based on conflicting medical evidence from treating orthopedic surgeon Dr. Louis Rose, who opined a work-related hip injury, and independent medical examiner Dr. Lisa Nason, who concluded the hip pain was referred from the lumbar spine and not a direct injury. The Appellate Division affirmed the Board's decision, finding it supported by substantial evidence and deferring to the Board's resolution of medical conflicts.

Workers' Compensation BenefitsCausationHip InjuryLumbar Spine InjuryMedical Evidence ConflictAppellate DivisionSubstantial Evidence ReviewOrthopedic SurgeryReferred PainBoard Decision Affirmed
References
4
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