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

Case No. 2021 NY Slip Op 00133 [190 AD3d 505]
Regular Panel Decision
Jan 12, 2021

Santana v. MMF 1212 Assoc L.L.C.

Plaintiff, Juan C. Santana, was injured during demolition work when a ceiling fell and struck him. He brought claims under Labor Law §§ 241 (6) and 200, alleging violations of Industrial Code (12 NYCRR) §§ 23-1.8 (c) and 23-3.3 (c). The Appellate Division affirmed the denial of Richard Mishkin Contracting Inc.'s motion for summary judgment on the Labor Law § 241 (6) claim, finding issues of fact regarding the provision of safety hats and ongoing inspections. The court also affirmed the dismissal of the Labor Law § 200 claim against MMF 1212 Assoc L.L.C. and Finkelstein Timberger East Real Estate LLC, as plaintiff did not oppose and they lacked control over the work. Finally, Mishkin's cross-claims for common-law contribution and indemnification were not dismissed due to conflicting expert opinions on the gravity of plaintiff's brain injury under Workers' Compensation Law § 11.

Demolition AccidentFalling ObjectsConstruction SafetyLabor LawIndustrial CodeSummary JudgmentContribution ClaimIndemnification ClaimWorkers' CompensationAppellate Review
References
4
Case No. ADJ4403161
Regular
Apr 04, 2013

LORENA IBARRA vs. BOONE INTERNATIONAL, INTERCARE INSURANCE SERVICES, INC.

The Workers' Compensation Appeals Board denied reconsideration of a joint and several award against Boone International and its carrier. The Board adopted the WCJ's report, which found the petition for reconsideration was not properly verified and lacked merit. The WCJ concluded that defendant Select Personnel and its carrier were properly included in the joint and several award under Labor Code § 5500.5(c), as they were joined as parties before the applicant's election against Boone International. The Board affirmed that Select's rights to contribution proceedings under Labor Code § 5500.5(e) remain available.

Workers' Compensation Appeals BoardContinuous TraumaJoint and Several AwardLabor Code § 5500.5Petition for ReconsiderationStipulation with Request for AwardDue ProcessApportionment of LiabilityRight of ContributionEmployer Joinder
References
0
Case No. 2025 NY Slip Op 05500 [242 AD3d 829]
Regular Panel Decision
Oct 08, 2025

DeMarco v. C.A.C. Indus., Inc.

The plaintiff, Peter DeMarco, suffered personal injuries when excavation walls collapsed at a Queens work site. He sued C.A.C. Industries, Inc., a contractor that provided a backhoe and operating engineer to his employer, the City of New York Department of Environmental Protection (DEP). The Supreme Court, Queens County, partially granted the defendant's motion for summary judgment, dismissing claims under Labor Law § 200 and certain Labor Law § 241 (6) violations, while denying dismissal of the common-law negligence claim. The plaintiff's cross-motion for summary judgment was denied. On appeal, the Appellate Division, Second Department, affirmed the Supreme Court's order, finding that the defendant lacked authority to supervise for the Labor Law claims but failed to demonstrate a special employment relationship, leaving triable issues of fact regarding the common-law negligence claim and whether the defendant's excavation created or exacerbated the dangerous condition.

Excavation CollapseTrench SafetyLabor Law 200Labor Law 241(6)Industrial Code ViolationsSpecial EmploymentContractor NegligencePremises LiabilitySummary Judgment AppealDuty of Care
References
21
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. 2016-119 K C
Regular Panel Decision
Jul 06, 2018

Jing Luo Acupuncture, P.C. v. NY City Tr. Auth.

This case involves an appeal from an order and judgment concerning a claim for first-party no-fault benefits for acupuncture services. The plaintiff, Jing Luo Acupuncture, P.C., as assignee of Sarah Adams, sought to recover unpaid balances from the NY City Transit Authority. The Civil Court initially granted the plaintiff's motion for summary judgment and denied the defendant's cross-motion. On appeal, the Appellate Term reversed the judgment, finding that the plaintiff failed to establish prima facie entitlement to summary judgment. The court also held that the defendant was not precluded from interposing its fee schedule defense, as it had fully paid for services billed under CPT codes 97811, 97813, and 97814 according to the workers' compensation fee schedule. Consequently, the plaintiff's motion for summary judgment was denied, and the defendant's cross-motion was granted in part for those specific CPT codes, while denied for CPT code 99262 and the seventh cause of action.

Acupuncture ServicesNo-Fault BenefitsSummary JudgmentFee Schedule DefenseWorkers' Compensation Fee ScheduleCPT CodesAppellate ReviewInsurance LawTimely DenialFirst-Party Benefits
References
14
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. ADJ994369
Regular
Jan 19, 2014

JOSE JUAREZ vs. WATKINS MANUFACTURING CORPORATION

The Workers' Compensation Appeals Board (WCAB) is reconsidering a decision that awarded the applicant medical mileage and a penalty for unreasonable delay in compensation payments but denied attorney's fees. The WCAB believes attorney's fees are warranted under Labor Code section 5814.5 for enforcing the payment of awarded compensation. The case is being returned to the trial level for the judge to determine and award these attorney's fees.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardMedical Mileage Expense ReimbursementAttorney's FeesLabor Code Section 5814Labor Code Section 5813Labor Code Section 5814.5Cumulative Industrial InjuryPulmonary System Injury
References
0
Case No. ADJ6671169
Regular
Oct 16, 2013

Christian Fauria vs. Carolina Panthers, Great Divide Insurance Co., Berkley Specialty Underwriting Managers, LLC, Washington Redskins, ESIS Insurance, New England Patriots, Liberty Mutual Insurance Co., Travelers Indemnity Co., Golf Insurance Co., Seattle Seahawks

The Workers' Compensation Appeals Board (WCAB) rescinded a prior award finding California jurisdiction over Christian Fauria's claim due to lack of "regular employment" in California, as defined by Labor Code Section 3600.5(a). The case was remanded to the trial level to determine if jurisdiction exists based on injuries sustained within California or if the contract of hire was made in California, as per Labor Code Section 5305. The WCAB also instructed the judge to address all issues, including apportionment and liability periods under Labor Code Section 5500.5. The decision highlights the need for substantial evidence to establish jurisdiction and injury contribution within the state.

Workers' Compensation Appeals BoardChristian FauriaProfessional AthleteIndustrial InjuryPermanent DisabilityFurther Medical TreatmentLabor Code Section 3600.5(a)Statute of LimitationsLabor Code Section 5500.5Jurisdiction
References
29
Case No. MISSING
Regular Panel Decision

Becerra v. Promenade Apartments Inc.

In this dissenting opinion, Judge DeGrasse argues against the majority's implicit finding of liability under Labor Law § 241 (6), which was predicated on Industrial Code (12 NYCRR) § 23-1.5 (c) (3). The plaintiff, a demolition worker, was injured by an angle grinder lacking a guard. Judge DeGrasse contends that Industrial Code § 23-1.5 (c) (3) is a general safety standard and does not specifically mandate guarding for grinders, unlike saws which are explicitly covered in § 23-1.12 (c) (1). Applying statutory construction principles, the dissent concludes that the omission of grinder guarding requirements in the Industrial Code signifies an intentional exclusion, thus precluding liability under the invoked provision.

Labor Law Section 241(6)Industrial Code 12 NYCRR 23-1.5(c)(3)Industrial Code 12 NYCRR 23-1.12(c)(1)Angle Grinder InjuryDemolition WorkerStatutory InterpretationRegulatory InterpretationSafety Device RequirementsMachinery GuardingDissenting Opinion
References
5
Case No. ADJ8059450
Regular
Aug 25, 2017

REYNA I. SANCHEZ vs. UNILEVER, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA, ALBERTO CULVER COMPANY, ACE AMERICAN INSURANCE

The WCAB granted reconsideration and rescinded the WCJ's decision to allow further proceedings. The employer's stipulation of employment for the entire cumulative trauma period was invalid as they only represented one insurer. Crucially, the date of injury must be determined under Labor Code § 5412 to establish liability under § 5500.5 for the correct employer(s). The applicant's election against Unilever was permissible under § 5500.5(c), and any future awards for jointly liable employers must be joint and several.

Workers Compensation Appeals BoardUnileverBroadspireAlberto CulverACE American InsuranceSecond Amended Findings and AwardPetition for ReconsiderationLabor Code Section 5412Date of InjuryCumulative Trauma
References
0
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