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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

Yuhas v. Provident Life & Casualty Insurance

Deborah Yuhas sued Provident Life and Casualty Insurance Company under ERISA for long-term disability benefits, claiming physical disability. Yuhas, a graphic designer, initially received benefits for a mental condition, which ceased after 24 months due to policy limitations. She subsequently appealed, claiming physical disabilities from a car accident, leading to a retroactive award of benefits for a specific period (October 1991 through May 1993) but no further benefits. Provident repeatedly denied her claim for benefits beyond May 1993, citing lack of objective physical disability and the expiration of appeal periods. Yuhas filed suit in September 2000, but the court granted Provident's motion for summary judgment, ruling that her claim was barred by the three-year statute of limitations, which had accrued by December 13, 1993, at the latest.

ERISALong Term Disability BenefitsSummary JudgmentStatute of LimitationsAccrual of Cause of ActionDisability Insurance PolicyMental DisorderPhysical InjuryAppeals ProcessRepudiation of Claim
References
13
Case No. MISSING
Regular Panel Decision

St. Vincent Medical Care, P.C. v. Country-Wide Insurance

The case concerns a provider's action to recover assigned first-party no-fault benefits from an insurer. The trial court initially granted the provider's summary judgment motion, but the appellate judgment modified the award, severing a $228.55 claim for February 22, 2006, services. This specific claim was denied summary judgment because it was timely denied by the insurer as exceeding the workers' compensation fee schedule. For the remaining claims, the appellate court affirmed summary judgment for the provider, determining that the insurer's follow-up verification requests were prematurely mailed and thus ineffective, precluding most defenses due to untimely denials. The insurer's cross-motion for summary judgment was consequently denied.

No-fault benefitsSummary judgmentVerification requestsTimely denialInsurance claimsWorkers' compensation fee scheduleAppellate reviewMedical servicesOverdue paymentsStatutory claim form
References
8
Case No. MISSING
Regular Panel Decision

Great Wall Acupuncture, P.C. v. GEICO Insurance

This case involves an action brought by a medical provider against an insurer to recover assigned first-party no-fault benefits. The insurer partially paid the claim but denied the remaining portion, arguing that charges for acupuncture treatments exceeded the maximum fees allowed under the applicable fee schedule. Following a nonjury trial, the Civil Court ruled in favor of the defendant, dismissing the complaint. The court held that an insurer may utilize the workers’ compensation fee schedule for acupuncture services rendered by chiropractors, even when the services are performed by a licensed acupuncturist. The appellate court affirmed this judgment, concluding that since the defendant reimbursed the plaintiff according to the workers’ compensation fee schedule for chiropractor-provided acupuncture services, no additional reimbursement was due.

Acupuncture ServicesChiropracticNo-Fault InsuranceFee ScheduleWorkers' Compensation Fee ScheduleLicensure RequirementsFirst-Party BenefitsAppellate ReviewInsurance ReimbursementCivil Court Decision
References
4
Case No. ADJ8331259
Regular
Dec 21, 2012

MARIELA GOMEZ vs. PROVIDENCE FARMS, LLC, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration. The Board adopted the WCJ's report, emphasizing that the defendant's failure to properly notify the applicant about changing treating physicians within the Medical Provider Network (MPN) resulted in a denial of necessary medical treatment. This failure to inform the applicant of her rights, particularly regarding physician selection and dispute resolution processes within the MPN, constituted a neglect or refusal to provide reasonable medical treatment, as established by precedent. Consequently, the applicant was permitted to continue receiving treatment outside the MPN until she could begin care with a designated physician within the network.

Workers' Compensation Appeals BoardProvidence FarmsLLCZenith Insurance CompanyMariela GomezADJ8331259Order Denying ReconsiderationPetition for ReconsiderationMedical TreatmentMedical Provider Network
References
2
Case No. MISSING
Regular Panel Decision

Government Employees Insurance v. Kolodny

Government Employees Insurance Company (GEICO) initiated a declaratory judgment action to determine if it was obligated to indemnify Chaim S. Kolodny or provide coverage for claims stemming from a fatal 1990 automobile accident. GEICO argued a policy exclusion applied because the vehicle was for Kolodny's regular use. The Supreme Court initially granted GEICO's motion for summary judgment. However, the appellate court reversed this decision, ruling that GEICO's disclaimer, issued over a year after receiving notice of the accident, was untimely and lacked an adequate explanation for the delay. Consequently, GEICO was found to be obligated to provide coverage. The appeal from the intermediate order was dismissed.

Insurance CoverageAutomobile AccidentDeclaratory JudgmentTimely DisclaimerPolicy ExclusionSummary JudgmentAppellate ReviewEstate AdministrationIndemnificationRegular Use Clause
References
6
Case No. ADJ7825620
Regular
Sep 04, 2018

URBAN JONES vs. THE HIGHER PATH HOLISTIC CARE, INC.

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior award concerning medical treatment for applicant Urban Jones. The WCAB amended the award to find applicant entitled to an inpatient psychological rehabilitation program, which had been approved by utilization review (UR). Two earlier UR decisions regarding outpatient cognitive behavioral therapy and medication management were found untimely due to improper notification to applicant's attorney, and the issue of their medical necessity was deferred. The WCAB affirmed the entitlement to the inpatient program, ordering it provided at the specified facility as per the UR approval.

Uninsured Employers Benefits Trust FundUtilization ReviewPetition for ReconsiderationCognitive Behavioral TherapyInpatient Psychological Rehabilitation ProgramTimeliness of Utilization ReviewIndependent Medical ReviewMedical TreatmentAdministrative Law JudgeFindings of Fact & Award
References
12
Case No. 2025 NY Slip Op 03700
Regular Panel Decision
Jun 18, 2025

Cabrera v. Provident Alpine Partners, L.P.

The plaintiffs, Luis Cabrera and his wife, appealed an order from the Supreme Court, Nassau County, concerning personal injuries Luis Cabrera sustained from falling off an A-frame ladder while performing demolition work. The Supreme Court had denied the plaintiffs' motion for summary judgment on their Labor Law § 240 (1) claim and granted the defendant's cross-motion to dismiss claims under Labor Law §§ 240 (1) and 241 (6). The Appellate Division, Second Department, modified the Supreme Court's order by denying the defendant's cross-motion to dismiss the Labor Law claims, while affirming the denial of the plaintiffs' motion for summary judgment. The court found triable issues of fact regarding whether Cabrera needed protection from gravity and if his actions were the sole proximate cause of his injuries under Labor Law § 240 (1). Additionally, it clarified the nondelegable duty under Labor Law § 241 (6) and highlighted the defendant's failure to demonstrate prima facie compliance with specific Industrial Code provisions (12 NYCRR 23-1.21 [b] [3] [iv] and [4] [ii]).

Labor LawSafe Place to WorkLadder FallSummary JudgmentAppellate DivisionPersonal InjuryConstruction AccidentIndustrial Code ViolationNondelegable DutyProximate Cause
References
19
Case No. ADJ2706622 (POM 0301949)
Regular
Jan 17, 2012

JANETTE CHAVEZ vs. SUPERIOR TRAILER, BARRETT SERVICES, INC.

The Workers' Compensation Appeals Board granted reconsideration of a prior finding that the defendant failed to provide proper notice of its Medical Provider Network (MPN). The defendant provided applicant's attorney with MPN provider lists, but one list provided months before the applicant's treatment did not include Dr. Higginbotham. Despite this, the Board found that the defendant provided adequate notice by including a website URL for the MPN directory and printed lists, establishing that Dr. Higginbotham was not an approved provider. Consequently, the Board amended the findings to state the defendant is not liable for Dr. Higginbotham's lien.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNLiensFindings of FactReconsiderationWCJCompromise and ReleasePetition for ReconsiderationReport and Recommendation
References
1
Case No. ADJ7309107
Regular
Dec 20, 2011

JENNA VISCUSO vs. PROVIDENT CREDIT UNION

In **Viscuso v. Provident Credit Union**, the Workers' Compensation Appeals Board (WCAB) granted the defendant's petition for reconsideration of a decision filed October 6, 2011. This grant was made due to statutory time constraints and an initial review indicating further study of factual and legal issues was necessary. The WCAB aims to gain a complete understanding of the record to issue a just and reasoned decision after reconsideration. All future communications are to be directed to the WCAB's Office of the Commissioners.

Petition for ReconsiderationWorkers' Compensation Appeals BoardPermissibly Self-InsuredStatutory time constraintsFactual and legal issuesJust and reasoned decisionDecision After ReconsiderationOffice of the CommissionersSan FranciscoCalifornia
References
0
Case No. MISSING
Regular Panel Decision

Concerned Home Care Providers, Inc. v. Cuomo

Plaintiffs, an association of home care providers and five licensed home care services agencies, challenged the New York Public Health Law § 3614-c (Wage Parity Law), alleging preemption by NLRA and ERISA, and violations of Equal Protection and Due Process. The Court dismissed claims against Governor Andrew M. Cuomo and all claims related to NLRA preemption, Equal Protection, and Due Process. However, the Court denied dismissal of the ERISA preemption claim against Commissioner Nirav R. Shah, finding subdivision 4 of the Wage Parity Law invalid as preempted by ERISA. Consequently, subdivision 4 was severed, and Commissioner Shah was permanently enjoined from enforcing it, while the remainder of the Wage Parity Law was upheld.

Wage Parity LawERISA PreemptionNLRA PreemptionEqual ProtectionDue ProcessStandingSeverabilityHome Care ServicesMedicaidCollective Bargaining
References
14
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