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

Case No. 2015-451 K C
Regular Panel Decision
Dec 22, 2017

Z.M.S. & Y Acupuncture, P.C. v. GEICO Gen. Ins. Co.

This case concerns an action by Z.M.S. & Y Acupuncture, P.C., as assignee of Melo, Carmen, to recover assigned first-party no-fault benefits from GEICO General Insurance Company. The plaintiff moved for summary judgment, while the defendant cross-moved to dismiss claims. The Civil Court of the City of New York, Kings County, limited the issues for trial regarding the application of the workers' compensation fee schedule to services billed under specific CPT codes. On appeal to the Appellate Term, Second Department, the Civil Court's order was modified. The Appellate Term granted the branches of GEICO's cross motion seeking summary judgment dismissing claims for services under CPT codes 97811, 97813, and 97814, and as so modified, affirmed the order.

no-fault benefitsacupuncturesummary judgmentCPT codesworkers' compensation fee scheduleAppellate Terminsurance claimprofessional corporationsassigned benefits
References
1
Case No. 2015-1563 K C
Regular Panel Decision
Dec 22, 2017

Z. M. S. & Y Acupuncture, P.C. v. GEICO Gen. Ins. Co.

This case involves an appeal by GEICO General Insurance Company from an order of the Civil Court that denied branches of its cross-motion for summary judgment. The plaintiff, Z. M. S. & Y Acupuncture, P.C., sought to recover assigned first-party no-fault benefits for services billed under CPT codes 97811, 97813, and 97814. The Appellate Term, Second Department, reversed the lower court's order, granting GEICO's cross-motion for summary judgment. The court found that GEICO had fully paid the plaintiff for services in accordance with the workers' compensation fee schedule for acupuncture, and since the services were rendered after April 1, 2013, the defense regarding the fee schedule was not subject to preclusion. Plaintiff failed to rebut this showing.

No-fault benefitsAcupuncture servicesWorkers' compensation fee scheduleSummary judgmentCPT codesAppellate reviewInsurance disputeMedical billingFee dispute
References
2
Case No. 2015-1094 K C
Regular Panel Decision
Dec 22, 2017

V.S. Care Acupuncture, P.C. v. NY Cent. Mut. Fire Ins. Co.

This case involves an appeal brought by NY Central Mutual Fire Ins. Co. against V.S. Care Acupuncture, P.C., an assignee, concerning first-party no-fault benefits. The defendant appealed an order from the Civil Court that denied its motion for summary judgment to dismiss claims for services rendered between October 2009 and February 2010. The Appellate Term found that the defendant had properly mailed denial of claim forms and established that the amounts sought by the plaintiff exceeded the applicable workers' compensation fee schedule. Consequently, the Appellate Term reversed the lower court's order and granted the defendant's motion for summary judgment, dismissing the relevant parts of the complaint.

No-Fault BenefitsSummary JudgmentAppellate ReviewFee Schedule DefenseDenial of ClaimWorkers' Compensation Fee ScheduleInsurance LawFirst-Party BenefitsAssignee RightsCivil Court Order
References
1
Case No. 2025 NY Slip Op 25024
Regular Panel Decision
Jan 29, 2025

Matter of W.S. v. G.S.

The petitioner (W.S.) filed a family offense petition against the respondent (G.S.), his sister, alleging harassment in the second degree. W.S. claimed G.S. threatened 'further consequences' and made false statements in a Mental Hygiene Law article 9 petition, leading to W.S.'s arrest. G.S. argued her statements were privileged and made due to genuine fear and concerns about W.S.'s mental health and hoarding. The court held that communications made in support of a Mental Hygiene Law petition are subject to a qualified privilege and serve a 'legitimate purpose' unless made with knowing/reckless disregard of falsity and solely to alarm/annoy. The court found W.S. failed to prove G.S.'s statements met this higher standard or that her other alleged actions constituted harassment. Consequently, the petition was dismissed.

Family OffenseHarassment Second DegreeMental Hygiene Law Article 9Qualified PrivilegeLegitimate Purpose DefenseIntent to HarassBurden of ProofCredibility of WitnessesStatements to PoliceMalice Standard
References
22
Case No. 2018 NY Slip Op 01069 [158 AD3d 703]
Regular Panel Decision
Feb 14, 2018

Matter of Bella S. (Sarah S.)

The case "Matter of Bella S. (Sarah S.)" involves an appeal from a Family Court order that found Sarah S. (mother) neglected her child, Bella S. The Administration for Children's Services had petitioned, alleging the mother's untreated bipolar disorder and other mental illnesses put the child at risk. The Family Court agreed, but the Appellate Division, Second Department, reversed this finding. The Appellate Division concluded that the petitioner failed to prove inadequate treatment or imminent harm, noting the mother's consistent efforts in seeking housing, prenatal care, methadone treatment, and psychiatric medication. Consequently, the petition against the mother was denied, and the proceeding dismissed.

Child NeglectParental RightsMental IllnessBipolar DisorderAdequate TreatmentAppellate ReviewBurden of ProofImminent DangerFamily Court ActKings County
References
8
Case No. MISSING
Regular Panel Decision

Indagro S.A. v. Bauche S.A.

Indagro S.A. initiated a maritime attachment action against Bauche S.A. to recover demurrage payments allegedly due under a fertilizer sale contract. Indagro claimed to have fulfilled its obligations, but Bauche failed to pay demurrage. Indagro obtained an ex parte Rule B Order, resulting in $804,219.90 of Bauche's funds being restrained. Bauche moved to vacate this order, arguing the contract was not maritime in nature and Indagro's claim was merely a contingent indemnity. The court, presided over by Judge Paul G. Gardephe, ruled that Indagro failed to demonstrate a valid prima facie maritime claim, asserting that the sales contract's primary objective was non-maritime, and the "demurrage" provision was likely a contingent indemnity not yet ripe. Consequently, Bauche's motion to vacate was granted, the Rule B Order was vacated, and the verified complaint was dismissed.

Maritime attachmentRule B OrderDemurrageContract disputeAdmiralty jurisdictionSeverable maritime obligationContingent indemnity claimEnglish lawVacatur of attachmentSale of goods
References
52
Case No. 2018 NY Slip Op 07960
Regular Panel Decision
Nov 20, 2018

Matter of Juliette S. v. Tykym S.

This case involves an appeal by Juliette S. against Tykym S. concerning the dismissal of her petition to modify a custody and visitation order. The Family Court in New York County had dismissed the petition without a hearing. The Appellate Division, First Department, reversed this decision, stating that the Family Court erred by dismissing the petition solely based on an 'unfounded' child abuse letter, which was hearsay, and without allowing the mother to respond. The Appellate Division concluded that the mother's allegations of changed circumstances, including the children's expressed fear of the father, were sufficient to warrant a hearing to determine the child's best interests. The matter was remanded back to the Family Court for further proceedings.

Custody modificationvisitation rightschild's best interestsFamily Court proceduredue processhearsay evidencechanged circumstanceschild abuse allegationsparental rightsappellate review
References
3
Case No. 2023 NY Slip Op 06460 [222 AD3d 503]
Regular Panel Decision
Dec 14, 2023

Matter of Jaiyana S. (Perla S.)

The Appellate Division, First Department, affirmed a Family Court order finding that the respondent mother, Perla S., neglected her children, Jaiyana S. and another child, by inflicting excessive corporal punishment. The court found that a preponderance of the evidence supported the neglect finding, relying on the children's consistent out-of-court statements to a child protective specialist detailing repeated physical abuse, including beatings with belts and pinching, which resulted in injuries and their fear of the mother. These statements were cross-corroborated by each other and further supported by the child protective specialist's observation of visible scratch marks on one child. The Appellate Division upheld the Family Court's credibility determinations, rejecting the mother's self-serving testimony and her argument for a missing witness inference.

Child NeglectCorporal PunishmentExcessive ForceChild Protective SpecialistOut-of-Court StatementsCross-CorroborationCredibility DeterminationMissing Witness InferenceFamily CourtAppellate Review
References
7
Case No. MISSING
Regular Panel Decision
Dec 03, 1990

In re Mary S.

This is an appeal from an order terminating a father's parental rights to his daughter, Mary S., on the grounds of permanent neglect. The Family Court found the father failed to make diligent efforts to reunite with Mary, citing non-compliance with court-ordered therapy and housing requirements, despite maintaining contact and visitation. Mary S. had a history of neglect, initially placed in foster care in 1986, and was later found to be mildly retarded, eventually bonding with the foster parents who adopted her brother. The appellate court affirmed the Family Court's decision, rejecting claims of an unfair hearing and improper testimony, emphasizing that the Department of Social Services fulfilled its duty and termination was in Mary's best interest. The decision allowed Mary S. to be freed for adoption by her foster parents.

Permanent NeglectParental Rights TerminationChild NeglectFoster CareAdoptionFamily LawSocial ServicesAppellate DecisionChild WelfareDiligent Efforts
References
4
Case No. 2016-334 S C
Regular Panel Decision
Apr 27, 2017

2 & 9 Acupuncture, P.C. v. 21st Century Advantage Ins. Co.

This case concerns an appeal by 2 & 9 Acupuncture, P.C. from an amended order that granted summary judgment to 21st Century Advantage Insurance Company, dismissing a complaint to recover assigned first-party no-fault benefits. The defendant argued it had paid the plaintiff in accordance with the workers' compensation fee schedule. The Appellate Term, Second Department, reversed the lower court's decision, finding that the defendant failed to prima facie demonstrate proper denial of payment for services billed under CPT codes 97026 and 97016. Consequently, the defendant's motion for summary judgment regarding these specific CPT codes was denied.

No-Fault BenefitsSummary JudgmentCPT CodesWorkers' CompensationAppellate ReviewInsurance LawMedical BillingAcupunctureSuffolk CountyPayment Dispute
References
3
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