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Case Law Database

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

Case No. MISSING
Regular Panel Decision
Feb 01, 2002

Storms v. Dominican College of Blauvelt

The plaintiff, a laborer employed by Schaeffer Construction Co., fell 25 feet while dismantling scaffolding at a residence hall construction site for Dominican College of Blauvelt. The plaintiff asserted claims of negligence and Labor Law violations against Dominican College of Blauvelt and the general contractor, Fred L. Holt, Inc. The Supreme Court denied Holt's cross motion for summary judgment dismissing the complaint due to unresolved factual issues regarding proximate cause and safety measures. Holt's claim for indemnification against Schaeffer was also denied based on Workers’ Compensation Law § 11 and the anti-subrogation rule. However, Dominican College of Blauvelt was granted summary judgment on its common-law and contractual indemnification claims against both Holt and Schaeffer, as there was no evidence Dominican directed or controlled the work's safety. Additionally, certain appeals by Holt and Schaeffer were dismissed.

Personal InjuryScaffolding AccidentLabor Law ViolationsIndemnificationSummary JudgmentSubcontractor LiabilityGeneral Contractor LiabilityWorkers' Compensation LawAnti-Subrogation RuleAppellate Division
References
8
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. 2014-1527 Q C
Regular Panel Decision
Dec 08, 2017

AVM Chiropractic, P.C. v. American Tr. Ins. Co.

This case concerns an appeal from an order of the Civil Court of the City of New York regarding assigned first-party no-fault benefits. Plaintiff, AVM Chiropractic, P.C., sought to recover benefits from American Transit Ins. Co. The Civil Court initially granted some branches of the defendant's motion for summary judgment and reduced claims based on a fee schedule defense. The Appellate Term modified the order, denying summary judgment for the defendant on specific causes of action (second, third, and sixth through eighth) and vacating findings on others (ninth and tenth). The court found that the defendant did not adequately demonstrate appropriate reductions in accordance with workers' compensation Ground Rules for several claims.

No-Fault BenefitsSummary JudgmentWorkers' Compensation Fee ScheduleAppellate ReviewInsurance ClaimsAssigneeFirst-Party BenefitsCivil ProcedureGround RulesNew York Law
References
1
Case No. 2014-1568 S C
Regular Panel Decision
Jul 20, 2016

Chirocare Chiropractic Assoc. v. State Farm Mut. Auto. Ins. Co.

This case involves a provider, Chirocare Chiropractic Associates, as assignee of Antoneta Mertiri, seeking first-party no-fault benefits from State Farm Mutual Automobile Insurance Company. The District Court initially granted State Farm's motion for summary judgment, dismissing the complaint based on a workers' compensation fee schedule defense. The Appellate Term reversed this order, finding that the District Court erred by dismissing the entire complaint on this ground, as the fee schedule defense only applied to amounts in excess of the schedule. Furthermore, the District Court failed to address State Farm's primary defense of lack of medical necessity, which could have been dispositive of the whole action. The matter was remitted to the District Court for a new determination addressing the medical necessity defense first.

No-fault insuranceAutomobile insuranceSummary judgmentAppellate reversalRemittiturMedical necessity defenseWorkers' compensation fee scheduleFirst-party benefitsAssignee claimChiropractic care
References
2
Case No. 2015-1649 Q C
Regular Panel Decision
Jan 20, 2017

Flatbush Chiropractic, P.C. v. American Tr. Ins. Co.

Flatbush Chiropractic, P.C., as assignee of Pierre Luxio, appealed an order that granted American Transit Ins. Co.'s motion to dismiss the complaint and denied plaintiff's cross-motion for leave to renew its prior motion for summary judgment. The Civil Court initially denied plaintiff's summary judgment motion and granted defendant's cross-motion, requiring Workers' Compensation Board resolution within 90 days due to an issue of fact regarding the accident occurring in the course of employment. After 21 months, defendant moved to dismiss for non-compliance, and plaintiff cross-moved to renew, presenting an affidavit indicating no record of a workers' compensation application. The Appellate Term affirmed the Civil Court's decision, stating that the alleged 'new facts' would not change the prior determination and plaintiff failed to show good cause against dismissal.

No-Fault BenefitsWorkers' Compensation IssueSummary Judgment MotionMotion to DismissLeave to RenewAppellate ReviewProcedural ComplianceAssignor-AssigneeCivil CourtAppellate Term
References
1
Case No. 2016-329 S C
Regular Panel Decision
Apr 27, 2017

Spineisland for Chiropractic, P.C. v. 21st Century Advantage Ins. Co.

This case involves an appeal by Spineisland For Chiropractic, P.C., acting as an assignee, against 21st Century Advantage Insurance Company concerning first-party no-fault benefits. The plaintiff sought to recover for services billed under CPT code 95831. The District Court of Suffolk County had previously granted the defendant's motion for summary judgment, asserting that the defendant had appropriately paid the plaintiff based on the workers' compensation fee schedule. On appeal, the Appellate Term affirmed the lower court's decision. The Appellate Term found that the defendant had adequately demonstrated the proper application of CPT code 95833 for the services billed under CPT code 95831, and the plaintiff failed to present a triable issue of fact.

No-fault benefitsSummary judgmentCPT codeWorkers' compensation fee scheduleAppellate TermSuffolk CountyAssigneeInsurance disputeChiropractic servicesMedical billing
References
1
Case No. MISSING
Regular Panel Decision

Holt Construction Corp. v. Grand Palais, LLC

Holt Construction Corp. initiated an action against Grand Palais, LLC, Grand Palais Development, Inc., Platte River Insurance Company, and Howard Lepow, seeking to foreclose a mechanic’s lien, set aside fraudulent conveyances, and recover damages for diversion of trust assets. The Supreme Court initially ruled in favor of Holt on multiple causes of action. Defendants appealed, and Holt cross-appealed from portions of the judgment entered January 19, 2012. The appellate court dismissed certain appeals, modified the judgment by dismissing the seventh cause of action and portions of the twelfth and thirteenth causes of action related to Lien Law § 13 (5), and reversed the dismissal of claims against Howard Lepow for violations of Lien Law §§ 72 and 77, awarding judgment in favor of Holt against Lepow for $935,342.55. As modified, the judgment was affirmed with costs to the plaintiff.

Mechanic's LienFraudulent ConveyanceDiversion of Trust AssetsDebtor and Creditor LawLien LawAppellate ReviewJudgment ModificationNonjury TrialCorporate Officer LiabilityConstruction Contract
References
11
Case No. ADJ6669872
Regular
Jul 02, 2012

NANCY HOLT vs. COUNTY OF SAN BERNARDINO

This case involves a petition for reconsideration filed by applicant Nancy Holt. The Workers' Compensation Appeals Board (WCAB) reviewed the petition and the report of the workers' compensation administrative law judge. Finding no error and adopting the judge's reasoning, the WCAB denied Holt's petition. Therefore, the original decision in favor of the County of San Bernardino stands.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ reportdeny reconsiderationself-insuredSan Bernardino Countyapplicantdefendantadministrative law judgeSan Francisco
References
0
Case No. 2018 NY Slip Op 03093
Regular Panel Decision
May 01, 2018

Contact Chiropractic, P.C. v. New York City Tr. Auth.

This case addresses the applicable statute of limitations for no-fault claims against a self-insured entity. The Court of Appeals determined that the three-year statute of limitations under CPLR 214 (2) governs such claims, as the obligation to provide no-fault benefits by a self-insurer is statutory rather than contractual. This decision reversed the Appellate Division, which had applied a six-year statute of limitations based on a contractual nature. The Court clarified that in the absence of a private insurance contract, the self-insurer's liability for first-party benefits is wholly statutory. The ruling impacts procedural aspects without altering the substantive no-fault obligations of self-insurers.

Statute of LimitationsNo-Fault InsuranceSelf-Insurer LiabilityCPLR 214 (2)CPLR 213 (2)Statutory ObligationContractual ObligationFirst-Party BenefitsMotor Vehicle AccidentsAppellate Review
References
30
Case No. ADJ9040017, ADJ9040025
Regular
Jan 03, 2017

Superior Chiropractic Care vs. WES-LAR, INC.; TOWER GROUP COMPANIES administered by AMTRUST NORTH AMERICA

The Workers' Compensation Appeals Board denied reconsideration for lien claimant Superior Chiropractic Care's petition to reinstate its dismissed lien. The Board found that the lien claimant was properly served with notices for a lien conference and an intent to dismiss its lien, despite their claims of non-receipt. Evidence showed the lien claimant had notice of the proceedings and failed to appear or object timely. Consequently, the Board affirmed the administrative law judge's dismissal of the lien due to the claimant's lack of participation.

Lien claimantReconsiderationOrder Dismissing LienDue ProcessEvidentiary HearingNotice of Intent to DismissWCAB Rule 10562(d)WCAB Rule 10770.1(i)Declaration of Readiness to ProceedLien Conference
References
1
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