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

Case No. 2017-407 K C
Regular Panel Decision
Jul 12, 2019

Apple Massage Therapy, P.C. v. 21st Century Ins. Co.

This case concerns an appeal by Apple Massage Therapy, P.C., as an assignee, against 21st Century Ins. Co. The plaintiff sought to recover assigned first-party no-fault benefits. The appeal challenged an order from the Civil Court of the City of New York, Kings County, which had granted the defendant's motion for summary judgment, thereby dismissing the complaint. The appellate court found that the defendant adequately demonstrated the proper mailing of denial of claim forms and the correct application of the workers' compensation fee schedule for determining benefits. Consequently, the appellate court affirmed the Civil Court's order.

No-Fault BenefitsSummary JudgmentAppellate ReviewDenial of ClaimWorkers' Compensation Fee ScheduleInsurance LawCivil ProcedureAssignee ClaimMailing PresumptionMedical Provider
References
1
Case No. MISSING
Regular Panel Decision

Claim of Evevsky v. Liberty Mutual Group

This case involves an appeal from a Workers’ Compensation Board decision regarding a claimant's unauthorized medical treatment. The claimant, who sustained neck and shoulder injuries in 1993, had her case reopened in 2001 after the employer's carrier objected to her request for authorized massage therapy. Both the Workers’ Compensation Law Judge and the Board determined that the treatment was not authorized under Workers’ Compensation Law § 13-b, as the massage therapist was not Board-authorized nor supervised by an authorized physician. The appellate court reviewed the Board's decision, affirming that there was no legal basis to overturn the finding. The court also considered and dismissed the claimant's constitutional arguments as being without merit.

Workers' CompensationMedical TreatmentMassage TherapyAuthorizationBoard DecisionAppellate ReviewStatutory InterpretationPhysician SupervisionConstitutionalityPermanent Partial Disability
References
3
Case No. 2014-716 K C
Regular Panel Decision
Jul 21, 2017

Apple Massage Therapy, P.C. v. Adirondack Ins. Exch.

The case involves an appeal from an order of the Civil Court concerning an action by a provider to recover assigned first-party no-fault benefits. The defendant, Adirondack Insurance Exchange, had moved for summary judgment arguing that the plaintiff's assignor failed to appear for examinations under oath (EUOs). The Civil Court initially granted this branch of the defendant's motion. However, the Appellate Term reversed the decision, stating that a mutual rescheduling of an EUO prior to its scheduled date does not constitute a failure to appear. Consequently, the defendant did not demonstrate a failure to appear at both an initial and follow-up EUO, which is a condition precedent to coverage. The matter was remitted to the Civil Court to determine the remaining branch of the defendant's motion regarding recovery in excess of the workers' compensation fee schedule.

No-Fault BenefitsSummary JudgmentExaminations Under Oath (EUOs)Condition Precedent to CoverageMutual ReschedulingWorkers' Compensation Fee ScheduleAppellate TermCivil CourtFirst-Party BenefitsAssigned Benefits
References
4
Case No. MISSING
Regular Panel Decision
Sep 28, 2004

In re Human Performance, Inc.

Human Performance, Inc., doing business as Woodstock Spa & Wellness, appealed a decision by the Unemployment Insurance Appeal Board. The Board had assessed Human Performance, Inc. for additional unemployment insurance contributions for massage therapists and aestheticians, classifying them as employees. Woodstock argued they were not employees. The court affirmed the Board's decision, finding that Woodstock maintained control over important aspects of the therapists' work, including setting fees, scheduling services, handling complaints, providing workers’ compensation coverage, and supplying the workspace, equipment, and supplies.

Unemployment InsuranceMassage TherapistsAestheticiansEmployer-Employee RelationshipWellness CenterDay SpaIndependent ContractorWorkers Compensation CoverageLabor LawAppeal Board Decision
References
1
Case No. ADJ14895207; ADJ162421; ADJ14895259; ADJ14894712
Regular
Feb 13, 2023

DENISE ARMTROUT vs. PLEASANTON UNIFIED SCHOOL DISTRICT, KEENAN ASSOCIATES

This case involves an applicant seeking reconsideration of a Workers' Compensation Appeals Board decision denying her petition. The applicant, Denise Armtrout, sought authorization for lymphatic massage therapy for lymphedema. Independent medical review initially denied the treatment, citing a lack of evidence for its necessity and the applicant's ability to perform self-treatment. The Board adopted the WCJ's report and denied reconsideration, upholding the prior decision to deny the petition.

Workers' Compensation Appeals BoardPetition for ReconsiderationDenying PetitionIndependent Medical Review (IMR)Lymphatic MassageLymphedemaChild Nutrition SpecialistAgreed Medical Evaluator (AME)Utilization Review (UR)Plainly Erroneous Finding of Fact
References
1
Case No. MISSING
Regular Panel Decision

Renzi v. Case Manangement Concepts

In this workers' compensation case, the claimant sustained a compensable injury in 1998, with the claim becoming the Special Fund for Reopened Cases' liability in 2006. In 2008, a licensed massage therapist submitted requests for payment for services allegedly prescribed by the claimant's treating physician. The Special Fund objected, arguing massage therapists are not authorized providers under the Workers’ Compensation Law. A Workers' Compensation Law Judge (WCLJ) initially found massage therapy compensable if performed by a licensed therapist under a physician's supervision, holding payments in abeyance pending prescription submission. The Workers' Compensation Board affirmed this in an amended decision. This Court reversed the Board's decision, concluding that there was insufficient evidence to support the Board’s determination that the Special Fund is liable, as the massage therapist was not an authorized provider nor did they fall under any statutory exceptions like being a registered nurse, person trained in diagnostic techniques, physical therapist, or occupational therapist.

Workers' Compensation LawMassage TherapyAuthorized Medical ProvidersSpecial Fund for Reopened CasesCompensability of TreatmentStatutory ExceptionsAppellate ReviewProvider AuthorizationMedical Treatment GuidelinesSupervision of Care
References
4
Case No. MISSING
Regular Panel Decision
Feb 25, 1998

Claim of Washington v. New York City Department of Transportation

Claimant, an employee of the New York City Department of Transportation, injured his back in a work-related automobile accident. He purchased a self-massage table and had his bathroom remodeled for a whirlpool tub, both medically recommended but without prior employer authorization. A Workers’ Compensation Law Judge awarded reimbursement for the massage table but denied the whirlpool tub installation. The Workers’ Compensation Board modified the decision, awarding an additional $200 for a detachable whirlpool unit. The claimant appealed this modification, and the decision was affirmed, finding substantial evidence to support the Board's decision regarding the reasonableness of costs for the whirlpool tub, despite a physician's letter noting the purchased tub's appropriateness.

Workers' CompensationMedical ReimbursementSelf-insured EmployerAutomobile AccidentBack InjuryPhysical RehabilitationMedical DevicesWhirlpool TubMassage TableReasonableness of Costs
References
1
Case No. ADJ4360135
Regular
Oct 18, 2010

JOSE MARTINEZ vs. JACK NEAL & SON, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for FREMONT INSURANCE COMPANY, CAMBRIDGE INTEGRATED SERVICES

The Workers' Compensation Appeals Board denied CIGA's petition for reconsideration, upholding the administrative law judge's award of medical treatment. CIGA argued the treatment was improperly authorized due to the applicant's alleged failure to object to prior utilization review (UR) denials. However, the Board found CIGA waived this defense by not raising it at trial, and instead litigated the merits of the treatment request. The evidence supported the treating physician's recommendations for a motorized wheelchair, new walker, assisted transportation, exercise, and massage as reasonable and necessary for the applicant's industrial back injury.

CIGAUtilization ReviewLabor Code section 4062Affirmative DefensesWaiverTrialMedical TreatmentMotorized WheelchairAssisted TransportationWCJ
References
19
Case No. ADJ655912 (SDO 0342137) ADJ677760 (SDO 0342143)
Regular
Feb 11, 2009

MARIA E. GARCIA vs. SAN DIEGO UNIFIED PORT DISTRICT, AMERICAN HOME ASSURANCE COMPANY, AIG DOMESTIC CLAIMS

The Workers' Compensation Appeals Board denied both the applicant's and defendant's petitions for reconsideration. The Board upheld the trial judge's decision to deny massage therapy, finding it not medically necessary per ACOEM guidelines and not supported by the treating physician's reports. Conversely, the Board affirmed the need for a sleep study and orthopedic/psychiatric consults based on the primary treating physician's consistent recommendations, rejecting the defendant's challenges to the exclusion of PQME reports and admission of other evidence. Ultimately, the Board found substantial medical evidence supported the original award and denied both parties' requests for review.

Workers' Compensation Appeals BoardIndustrial InjuryRight ShoulderNeckFurther Medical TreatmentSleep StudyOrthopedic ConsultPsychiatric ConsultMassage TherapyPanel Qualified Medical Examiner
References
1
Case No. MISSING
Regular Panel Decision

Upadhyay v. Sethi

Plaintiff Anu Upadhyay sued defendants Neeraj Sethi, Roñica Sethi, Shikha Sethi, and Ganesh Raj, alleging violations of the Fair Labor Standards Act and state laws for minimum wage and overtime. Defendants moved for partial dismissal or summary judgment, arguing a domestic services exemption and the statute of limitations. The court found that massage therapy performed by the plaintiff was not "of a household nature" and therefore not covered by the domestic services exemption, but a de minimis amount of such work did not automatically render all work non-exempt. Consequently, the plaintiff's FLSA overtime claim was dismissed. The court denied summary judgment on the equitable tolling defense due to factual disputes, opting instead for an evidentiary hearing and targeted discovery to resolve the issue.

FLSA ExemptionsDomestic ServiceLive-in NannyOvertime ViolationsMinimum Wage ClaimsEquitable TollingStatute of LimitationsPartial Motion to DismissSummary JudgmentHousehold Nature Test
References
30
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