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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

In Re Pursuant to Section 304 of the Bankruptcy Code of Banco Nacional De Obras Y Servicios Publicos, S.N.C.

The International Association of Machinists and Aerospace Workers (IAM) sought relief from a preliminary injunction to pursue an action against Aeronaves de Mexico, S.A. de C.V. (Aeronaves) for declaratory judgment concerning a collective bargaining agreement. Aeronaves, represented by its Mexican bankruptcy trustee Banobras, objected, arguing the claims should be handled in Mexican bankruptcy court. Judge Tina L. Brozman analyzed the request in the context of section 304 of the Bankruptcy Code, emphasizing the specialized nature of American labor law, particularly the Railway Labor Act (RLA). Balancing international comity with the protection of American creditors, the court found that the issues regarding the existence and terms of the collective bargaining agreement required the expertise of an American district court. Therefore, the motion for relief from the stay was granted to permit the IAM action to proceed in the Southern District of New York.

Bankruptcy LawInternational ComitySection 304 StayRailway Labor Act (RLA)Collective Bargaining AgreementForeign BankruptcyAncillary ProceedingsDeclaratory ReliefLabor DisputeCreditor Claims
References
32
Case No. MISSING
Regular Panel Decision

In Re Lyondell Chemical Co.

Mrs. Regina Jahnke sought administrative expense status under Bankruptcy Code Section 1114 for payments due under a prepetition private annuity contract from Lyondell Chemical Company, the successor to her late husband's employer, ARCO Chemical Company. Lyondell contended that the contract was not covered by Section 1114, arguing that the payments were general unsecured claims. The Court, presided over by Bankruptcy Judge Robert E. Gerber, agreed with Lyondell. The Court found that the contract did not qualify as a "plan, fund, or program" under ERISA standards, and furthermore, the benefits were not "retiree benefits" as defined in Section 1114(a). Therefore, Mrs. Jahnke's motion for administrative status was denied, and her claim remained a general unsecured claim.

BankruptcyAdministrative Expense StatusRetiree BenefitsAnnuity ContractEmployee Retirement Income Security Act (ERISA)Chapter 11Unsecured ClaimsContract LawCorporate SuccessionJudicial Interpretation
References
17
Case No. 2015-976 K C
Regular Panel Decision
Dec 22, 2017

Acuhealth Acupuncture, P.C. v. Hereford Ins. Co.

This case concerns an appeal from an order of the Civil Court regarding a dispute between Acuhealth Acupuncture, P.C. (applicant) and Hereford Ins. Co. (defendant) over first-party no-fault benefits. The applicant sought recovery for services billed under CPT code 97039, which has a 'By Report' designation in the workers' compensation fee schedule requiring additional documentation. The Civil Court initially granted the defendant's motion for summary judgment and denied the applicant's cross-motion. On appeal, the Appellate Term modified the order, denying the branch of the defendant's motion seeking summary judgment on the CPT code 97039 claims, as the defendant failed to demonstrate it requested the required additional verification. However, the applicant's cross-motion for summary judgment was still denied as it failed to establish its prima facie entitlement to judgment.

No-fault insuranceSummary judgment motionCPT codeWorkers' compensation fee scheduleVerification of claimAppellate reviewMedical billing disputeInsurance benefitsAssignee claimCivil procedure
References
5
Case No. 2015-1078 K C
Regular Panel Decision
Jan 20, 2017

Bronx Acupuncture Therapy, P.C. v. Hereford Ins. Co.

This case involves Bronx Acupuncture Therapy, P.C., as assignee of Niurka Mejia, appealing an order from the Civil Court of the City of New York, Kings County. The defendant, Hereford Ins. Co., had moved for summary judgment, arguing full payment according to workers' compensation fee schedules. The Civil Court granted the motion, dismissing claims for services billed under codes 97039 (unlisted modality) and 99199 (unlisted special service). The Appellate Term reversed this decision, finding that the defendant failed to request additional verification within 15 business days for these "By Report" designated codes, as required by 11 NYCRR 65-3.5 (b). Therefore, the defendant was not entitled to summary judgment.

No-Fault BenefitsSummary JudgmentAppellate TermWorkers' Compensation Fee ScheduleUnlisted Medical CodesVerification of ClaimsMoxibustionAcupressureInsurance DisputeHealthcare Provider Reimbursement
References
2
Case No. ADJ6699348
Regular
Mar 17, 2016

KANON MONKIEWICZ vs. RM STORE FIXTURES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) issued a Notice of Intention to find that Labor Code section 4903.8(a) does not preclude awards to lien claimants Rx Funding Solutions, LLC and PharmaFinance, LLC. This is because the 2014 amendments to section 4903.8(a)(2) specify that it does not apply to assignments completed prior to January 1, 2013. Both of the lien claimants' assignments were made before this date, thus exempting them from the preclusion. The WCAB is amending its previous order and returning the case to the trial level for further proceedings on the merits of the liens.

Labor Code 4903.8Lien claimantsAssignment of receivablesCessation of businessPharmacy lienMedical lienSB 863AB 2732Prospective vs. retrospective applicationWCAB rules
References
10
Case No. ADJ4140574 (VNO 0417628) ADJ3588068 (VNO 0472981)
Regular
Jun 03, 2013

KEVIN THOMPSON vs. COUNTY OF LOS ANGELES, TRISTAR RISK MANAGEMENT

The Workers' Compensation Appeals Board awarded applicant Kevin Thompson an additional attorney's fee of $1,500 under Labor Code section 5801. This fee is for services rendered by his attorney in successfully defending against the defendant's petition for writ of review to the Court of Appeal. The Board disallowed the requested clerical fees as section 5801 applies only to attorney services. Additionally, the request for costs under Labor Code section 5811 was denied due to the lack of required itemization and supporting documentation.

Labor Code § 5801Attorney's feePetition for Writ of ReviewAppeals BoardSupplemental awardReasonable attorney's feeAppellate levelPenaltyClerical servicesLabor Code § 5811
References
12
Case No. 2014-781 Q C
Regular Panel Decision
Sep 27, 2016

Gl Acupuncture, P.C. v. Praetorian Ins. Co.

This case involves an appeal by GL Acupuncture, P.C., as assignee of Kenya M. Jones, against Praetorian Ins. Co. The appeal concerned an order from the Civil Court of the City of New York, Queens County, which had granted the defendant's cross motion for summary judgment to dismiss several causes of action for assigned first-party no-fault benefits. The Appellate Term found that while the defendant's proof was sufficient regarding the mailing of denial forms and payments for certain CPT codes, it failed to provide enough evidence to dismiss the plaintiff's claim for an initial acupuncture visit on July 8, 2010. Consequently, the order was modified to deny the dismissal of this specific claim, and affirmed as so modified.

No-fault benefitsSummary judgmentAppellate reviewAcupuncture servicesInsurance claimsWorkers' compensation fee scheduleDenial of claimMedical billingCivil court appealFirst-party benefits
References
2
Case No. ADJ3550549 (LAO 0884192)
Regular
Sep 22, 2016

JACK DUPONT (Dec'd), ANYAWAN DUPONT (Widow) vs. C.R. ENGLAND, INC.; XL SPECIALTY INSURANCE COMPANY, administered by BROADSPIRE

This case involves a remand from the Court of Appeals to the Workers' Compensation Appeals Board (WCAB) for the purpose of awarding attorney's fees and costs under Labor Code Section 5801. Applicant's attorney and the defendant's attorney jointly stipulated to an award of $11,600.00 to resolve this issue. The WCAB approved this stipulation and returned the matter to the trial level.

Labor Code section 5801attorney's feesWorkers' Compensation Appeals Boardremandedstipulationapplicant's attorneydefendant's attorneyjoint lettertrial levelaward
References
0
Case No. ADJ2567272 (AHM 0105012)
Regular
Oct 15, 2012

, Applicant, FELIX NINO MOTA vs. ALLGREEN LANDSCAPE; NATIONAL INSURANCE COMPANY, Administered by FARA Adjusting Services

Applicant's attorneys requested $51,900 in attorney's fees under Labor Code Section 5801 for work related to a writ of review. The Appeals Board found the declarations supporting the request inadequate due to lack of itemization and justification for the hours and rates. Consequently, the Board may award a fee of up to $16,000, but reserves the right to award substantially less or nothing at all due to the potentially inflated nature of the initial request. Applicant's attorneys must provide detailed itemizations and show good cause to receive any fee.

Labor Code section 5801attorney's feespetition for writ of reviewAppeals Boarddeclarationsitemized billingshourly ratecertified workers' compensation specialistclerical tasksunreasonably inflated
References
9
Case No. ADJ10146503
Regular
Oct 20, 2018

ALAN KOON vs. RZ PLUMBING, INC.; AMTRUST

This case concerns an award of attorney's fees and costs to applicant's attorney, Robert Rassp, pursuant to Labor Code section 5801. The Second District Court of Appeals had previously remanded the matter for this purpose. The Workers' Compensation Appeals Board reviewed Rassp's request for 13.25 hours of work and $865.59 in costs, totaling $6,165.59. The Board disallowed two hours of travel time due to lack of clarity on the reasonableness and nature of the activity. Ultimately, the Board awarded Rassp a total of $5,365.59 in attorney's fees and costs.

Labor Code section 5801attorney's feescostsremandWorkers' Compensation Appeals Boardbill of particularsreasonableness of feestravel time deductionawarded amounttrial level return
References
0
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