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

Case No. MISSING
Regular Panel Decision

Franzese v. United Health Care/Oxford

Plaintiffs Robert and Elizabeth Franzese, parents and legal guardians of disabled adult Robert Franzese Jr. ("Bobby"), sued United Health Care/Oxford under ERISA to recover medical benefits. Bobby, suffering from chronic lung disease, requires 24/7 in-home nursing care. Oxford denied preauthorization for private duty nursing, citing it as an exclusion, and denied home health care services. The court granted Oxford's summary judgment motion regarding private duty nursing and Xopenex preauthorization, finding private duty nursing not covered. However, the court denied Oxford's motion regarding home health care services, deeming Oxford's denial arbitrary and capricious due to lack of substantial evidence. The case is remanded to Oxford for reconsideration of home health care benefits.

Employee Retirement Income Security Act (ERISA)Medical BenefitsHealth Insurance DenialSummary JudgmentArbitrary and Capricious StandardHome Health CarePrivate Duty NursingPreauthorizationMedical NecessityChronic Lung Disease
References
37
Case No. No. 11, No. 12
Regular Panel Decision
Mar 26, 2019

Lilya Andryeyeva v. New York Health Care , Adriana Moreno v. Future Care Health Services

The New York Court of Appeals addressed a common issue in two joint appeals: whether home health care aides on 24-hour shifts must be paid for each hour. The Department of Labor (DOL) interpreted its Wage Order (12 NYCRR part 142) to allow payment for at least 13 hours if the employee receives at least 8 hours for sleep (with 5 uninterrupted) and 3 hours for meals. The Appellate Division rejected this, but the Court of Appeals reversed, deferring to DOL's interpretation as rational and consistent with the Wage Order's plain language. The cases were remitted for lower courts to evaluate class certification issues in accordance with DOL's interpretation.

Home Health Care24-Hour ShiftsMinimum Wage ActWage OrderDepartment of Labor InterpretationClass CertificationAppellate ReviewLabor Law ViolationsSleep BreaksMeal Breaks
References
49
Case No. 2025 NY Slip Op 03972 [240 AD3d 409]
Regular Panel Decision
Jul 01, 2025

Matter of K.J.L. v. C. L.

The Appellate Division, First Department, affirmed a Family Court decision that terminated a mother's parental rights due to permanent neglect. The children, K.J.L. and another, had been in foster care for over three years, and their foster parents wished to adopt them. The mother, C.L., failed to complete her service plan, which included substance abuse and mental health treatment. The court found that termination was in the children's best interests, rejecting a suspended judgment due to the mother's unresolved difficulties. The wishes of the older child to return to the mother were noted but not legally binding as the child is under 14.

Permanent NeglectParental Rights TerminationBest Interests of ChildrenFoster CareService Plan FailureSubstance Abuse TreatmentMental Health TreatmentSpecial Needs ChildrenSuspended JudgmentAdoption Proceedings
References
7
Case No. MISSING
Regular Panel Decision

Washington Heights-West Harlem-Inwood Mental Health Council, Inc. v. District 1199, National Union of Hospital & Health Care Employees, RWDSU

This case involves a dispute between District 1199, National Union of Hospital and Health Care Employees, and Washington Heights-West Harlem-Inwood Mental Health Council, Inc. The union sought to enforce an arbitration award requiring the Council to rehire and provide back pay to an employee, Edward Lane. The Council cross-moved to vacate the award, arguing that no valid collective bargaining agreement with an arbitration clause existed between the parties. Although the parties had acted under the terms of a proposed agreement for a period, including processing some grievances and wage increases, no formal, signed contract had ever been executed. Citing recent appellate court decisions emphasizing contract formalism over implied intent, the District Court granted the Council's motion to vacate the arbitration award and denied the union's motion to enforce it, concluding that without a signed agreement, there was no contractual duty to arbitrate.

Arbitration AwardSummary JudgmentContract FormationCollective BargainingLabor DisputeContract FormalismVacation of AwardEnforcement of AwardMeeting of the MindsFederal Court
References
23
Case No. 2020 NY Slip Op 04473 [186 AD3d 594]
Regular Panel Decision
Aug 12, 2020

Moreno v. Future Health Care Servs., Inc.

The Appellate Division, Second Department, affirmed the denial of class certification for a putative class action brought by former home health care aides against Future Health Care Services, Inc. Plaintiffs alleged violations of Labor Law article 19, specifically concerning minimum wage payments for 24-hour shifts. The court, upon remittitur from the Court of Appeals, considered the Department of Labor's interpretation of Minimum Wage Order Number 11, which permits exclusion of up to 11 hours for sleep and meal breaks in 24-hour shifts. Consequently, the plaintiffs failed to demonstrate commonality, as they did not allege a lack of prescribed breaks or provide sufficient evidentiary basis for systemwide wage violations, thus failing to meet the requirements of CPLR article 9. Therefore, the Supreme Court's decision to deny class certification was upheld.

Class ActionLabor LawMinimum Wage24-hour ShiftsHome Health Care AidesClass CertificationWage OrderAppellate ReviewJudicial InterpretationNew York Department of Labor
References
7
Case No. MISSING
Regular Panel Decision

Pig Newton, Inc. v. Boards of Directors of the Motion Picture Industry Pension Plan

Plaintiff Pig Newton, Inc. commenced an action against the Boards of Directors of the Motion Picture Industry Pension Plan, Health Plan, and Individual Account Plan, seeking a declaration that certain provisions of the Plans’ Trust Agreements were invalid and unenforceable. The Defendants counterclaimed for delinquent contributions under ERISA. The core dispute revolved around "Controlling Employee Provisions" in the Trust Agreements, which obligated employers to contribute for Controlling Employees for a specified number of hours and weeks regardless of actual hours worked. Pig Newton argued these provisions were invalid, not properly incorporated, or conflicted with collective bargaining agreements (CBAs). The Court, applying federal common law and an arbitrary and capricious standard of review for the Directors' interpretation, found the provisions valid, properly incorporated, and not in conflict with the CBAs, concluding that Szekely (Pig Newton's sole owner) qualified as a Controlling Employee. Consequently, the Court denied Plaintiff's motion for summary judgment and granted Defendants' cross-motion for summary judgment, dismissing Plaintiff's complaint and awarding Defendants the sought-after contributions, interest, auditors’ fees, and liquidated damages.

ERISAMultiemployer PlanPension PlanHealth PlanDeclaratory JudgmentSummary JudgmentTrust AgreementsCollective Bargaining AgreementsControlling Employee ProvisionsDelinquent Contributions
References
44
Case No. MISSING
Regular Panel Decision

Hylton v. Norrell Health Care of New York

Paulette B. Hylton, a home health aide, sued her employer, Norrell Health Care of New York, alleging sexual harassment and retaliation in violation of Title VII. Hylton claimed that after reporting sexual harassment by a patient's son, she received fewer assignments, was denied her W-2 form, and received a negative work reference. The court found that the sexual harassment was not caused by Norrell, and Norrell took prompt and reasonable remedial action. Furthermore, the court determined that Hylton failed to establish a prima facie case of retaliation, as her reduced work was due to her taking assignments with competing agencies and a general business downturn at Norrell, and the W-2 and reference issues were not causally linked to her complaint. Therefore, the District Court granted Norrell's motion for summary judgment and dismissed Hylton's complaint.

Sexual HarassmentRetaliationTitle VIISummary JudgmentHome Health AideTemporary Staffing AgencyEmployer LiabilityHostile Work EnvironmentCausalityAdverse Employment Action
References
14
Case No. MISSING
Regular Panel Decision

American Prescription Plan, Inc. v. American Postal Workers Union AFL-CIO Health Plan

This case involves appeals and a cross-appeal from an order of the Supreme Court, Nassau County. Defendant American Postal Workers Union, AFL-CIO Health Plan (APWU-HP) appealed the denial of its motion for summary judgment concerning the fourth, fifth, and fourteenth causes of action. Defendant Administrative Consultants, Inc. (ACI) appealed the denial of its motion for summary judgment regarding the tenth and eleventh causes of action. The plaintiff cross-appealed the partial dismissal of the first, third, and sixth causes of action. The appellate court reversed the order for the defendants, granting their motions for summary judgment and dismissing all causes of action asserted against them. The order was affirmed insofar as cross-appealed by the plaintiff, upholding the partial dismissals against the plaintiff.

Summary JudgmentContract DisputeOral RepresentationsStatute of FraudsEquitable EstoppelAppellate ProcedureDismissal of ClaimsBreach of ContractMootness DoctrineAuthority to Contract
References
7
Case No. MISSING
Regular Panel Decision

Sibley-Schreiber v. Oxford Health Plans (N.Y.), Inc.

This class action involves several plaintiffs challenging Oxford Health Plans' denial of insurance coverage for Viagra. Defendants moved to dismiss the complaint, alleging that the plaintiffs failed to exhaust administrative remedies. Plaintiffs countered that pursuing these remedies would have been futile given the defendants' public 'no pay' and 'six pill' policies and the lack of clear appeal processes. The court denied the defendants' motions to dismiss and for summary judgment, concluding that the plaintiffs had made reasonable efforts to seek coverage and that further administrative appeals would have been futile.

ERISAInsurance CoverageHealthcare BenefitsViagraErectile DysfunctionExhaustion of Administrative RemediesFutility DoctrineClass ActionMotion to DismissSummary Judgment
References
16
Case No. ADJ1513511
Regular
Sep 21, 2015

RIZALINA DERRO vs. KAISER PERMANENTE, WEST ANAHEIM MEDICAL CENTER, TERRACE VIEW CONVALESCENT HOSPITAL, COVENANT CARE, SOUTH GATE CARE CENTER, BROADSPIRE, SUN HEALTH CARE, AIG CLAIM SERVICES

The Workers' Compensation Appeals Board denied reconsideration of a decision that found Sun Health Care/Regency and CNA Claims Plus liable for the applicant's left wrist injury. The applicant sustained a cumulative trauma injury to her left wrist during the period of 11-1-1995 to 11-1-1996, while employed by both Covenant Care (insured by AIG) and Sun Health Care (insured by CNA). A previous Compromise and Release barred claims against Covenant Care and AIG, leaving Sun Health Care and CNA liable. The Board adopted the WCJ's report, which relied on medical evidence and legal precedent to uphold the finding of industrial injury and liability.

Workers' Compensation Appeals BoardPetition for ReconsiderationAdministrative Law JudgeCumulative TraumaLeft Wrist InjuryCarpal Tunnel SyndromeCompromise and ReleaseApportionmentDate of InjuryMedical Probability
References
0
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