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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
Oct 17, 2012

Douyon v. NY Medical Health Care, P.C.

Plaintiff Gabrielle Douyon sued Seymour Schneider, N.Y. Medical Health Care, P.C., Faraidoon Daniel Golyan, M.D., and Kourosh Golyan, alleging unfair debt collection practices under the FDCPA and NY GBL § 349, along with intentional infliction of emotional distress and negligence. The lawsuit stemmed from attempts to collect an alleged medical debt following Douyon's emergency heart surgery performed by Dr. Golyan. Both parties sought summary judgment. The court granted Plaintiff partial summary judgment on FDCPA violations related to statutory disclosures and a threatening voicemail. However, many other FDCPA and NY GBL claims were denied due to factual disputes, and the intentional infliction of emotional distress claim was dismissed for lack of medical evidence, with negligence claims partially allowed to proceed on the basis of fear for physical safety.

Fair Debt Collections Practices ActNew York General Business Law § 349Debt CollectionSummary JudgmentEmotional DistressNegligenceAgency RelationshipVicarious LiabilityFreelance Debt CollectorUnfair and Deceptive Practices
References
105
Case No. 2019 NY Slip Op 06054
Regular Panel Decision
Aug 06, 2019

Wilder v. Fresenius Med. Care Holdings, Inc.

Plaintiff Nicholas Wilder, suffering from end-stage renal disorder, sued Fresenius Medical Care Holdings, Inc. and its subsidiary, Avantus Renal Therapy New York LLC, after they notified him that his dialysis care would be terminated due to disruptive behavior. Wilder sought an injunction to prevent the termination of his life-sustaining dialysis treatment. The Supreme Court, New York County, denied his request for an injunction and vacated a previously granted temporary restraining order (TRO). The Appellate Division, First Department, modified the lower court's order, reversing the denial of the injunction and vacating of the TRO, reinstating the TRO pending a hearing on Wilder's injunction request. The appellate court found that the motion court abused its discretion by vacating the TRO and not holding a hearing on the preliminary injunction, given the substantial factual disputes regarding Wilder's behavior and the defendants' compliance with federal regulations for patient discharge. However, the Appellate Division affirmed the denial of Wilder's request to proceed anonymously and seal records.

Dialysis TreatmentPatient DischargeTemporary Restraining OrderPreliminary InjunctionIrreparable HarmDisruptive Patient BehaviorFederal RegulationsRight to CareAppellate ReviewSealing Records
References
6
Case No. 2015-516 Q C
Regular Panel Decision
Dec 19, 2017

Healthway Med. Care, P.C. v. Global Liberty Ins.

The case "Healthway Med. Care, P.C. v Global Liberty Ins." involved an appeal by Healthway Medical Care, P.C. against Global Liberty Insurance concerning assigned first-party no-fault benefits. The plaintiff appealed an order from the Civil Court, Queens County, which denied the plaintiff's motion for summary judgment on certain causes of action (third through tenth) and granted the defendant's cross-motion to dismiss those same causes of action. The Appellate Term, Second Department, modified the Civil Court's order by denying the branches of the defendant's cross-motion seeking summary judgment to dismiss the third through tenth causes of action. The court found the defendant failed to establish that fees exceeded workers' compensation schedules or that independent medical examinations (IMEs) were properly scheduled. However, the plaintiff was not granted summary judgment either, as they failed to demonstrate that the claims were not timely denied or that the denials were without merit. The order was affirmed as modified.

No-fault benefitssummary judgmentindependent medical examinationIME schedulingfee scheduleworkers' compensationappellate reviewcivil proceduremedical billingassigned claims
References
6
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
Case No. 2017-2088 K C
Regular Panel Decision
Oct 25, 2019

Quality Comprehensive Med. Care, P.C. v. New York Cent. Mut. Fire Ins. Co.

The Appellate Term, Second Department, reviewed an appeal concerning assigned first-party no-fault benefits. The plaintiff, Quality Comprehensive Medical Care, P.C., appealed a Civil Court order that granted summary judgment to the defendant, New York Central Mutual Fire Insurance Company, dismissing the complaint. The defendant had denied claims asserting a lack of medical necessity and excessive fees. The appellate court determined that the defendant did not establish a lack of medical necessity. However, it agreed that fees exceeding $425.88 per claim surpassed the allowed amount under the workers' compensation fee schedule. Therefore, the Civil Court's order was modified to dismiss only the portion of the complaint seeking recovery in excess of $425.88 per claim, and the order was affirmed as modified.

No-fault benefitsMedical necessityWorkers' compensation fee scheduleSummary judgmentAppellate reviewInsurance claimsFee disputeAssigned benefitsCivil CourtKings County
References
4
Case No. MISSING
Regular Panel Decision
Apr 27, 2012

China Auto Care, LLC v. China Auto Care (Caymans)

Plaintiffs China Auto Care, LLC and China Auto Care Holdings, LLC brought an action against China Auto Care (Caymans), Digisec Corporation, and the estate of Chander Oberoi, alleging various causes of action stemming from the 2011 sale of Digisec's assets. Defendants sought to dismiss the complaint and compel arbitration, citing an arbitration clause in the parties' "Business Relationship and Shareholder Agreement." The court analyzed the scope of the arbitration clause under the Federal Arbitration Act. Finding the clause to be broad, the court concluded that the plaintiffs' claims were within its scope, as they "touch matters" governed by the Shareholder Agreement. Consequently, the court granted the defendants' motion, staying the litigation and compelling arbitration.

ArbitrationShareholder AgreementCorporate DisputeMotion to CompelFederal Arbitration ActSecond Circuit PrecedentFraudulent InducementCorporate GovernanceCayman Islands LawStay of Proceedings
References
25
Case No. MISSING
Regular Panel Decision
Sep 15, 1997

Mushatt v. Cayuga Medical Center

Plaintiff appealed a judgment favoring defendants Cayuga Medical Center and the estate of her obstetrician, Frank Flacco, in a medical malpractice case. Plaintiff alleged that negligent care during her son Quandale's birth on August 15, 1990, led to his severe spastic cerebral palsy, mental retardation, and seizure disorder, attributing it to oxygen deprivation caused by a delayed Cesarean section. Defendants argued the oxygen deprivation occurred prior to delivery due to an acute event and chronic condition, and their care met standards. The jury sided with defendants. On appeal, plaintiff challenged the verdict's weight, the application of CPLR 4519 (Dead Man's Statute), the admission of testimony regarding her drug and alcohol use, and a missing witness charge. The Supreme Court Appellate Division affirmed the judgment, finding no errors warranting reversal.

Medical MalpracticeBirth InjuryCerebral PalsyOxygen DeprivationCesarean SectionExpert WitnessDead Man's StatuteCPLR 4519Appellate ReviewNegligence
References
4
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. 2016-1618 K C
Regular Panel Decision
Mar 22, 2019

Active Care Med. Supply Corp. v. American Tr. Ins. Co.

This case concerns an appeal by Active Care Medical Supply Corp. against American Transit Ins. Co. regarding first-party no-fault benefits. The plaintiff, an assignee of Luciano Ernesto, sought summary judgment, while the defendant cross-moved to either dismiss the complaint or hold the action in abeyance. The defendant argued that Luciano Ernesto might be eligible for workers' compensation benefits, thus requiring a determination from the Workers' Compensation Board. The Civil Court granted the defendant's cross-motion to hold the action in abeyance. The Appellate Term affirmed this decision, reiterating that the Workers' Compensation Board has primary jurisdiction over the applicability of the Workers' Compensation Law and that courts should defer to the Board's determination.

No-Fault BenefitsWorkers' Compensation LawPrimary JurisdictionAbeyanceAppellate TermSummary JudgmentEligibility DisputeFirst-Party BenefitsInsurance CoverageAssignor-Assignee
References
9
Case No. 2016-318 S C
Regular Panel Decision
Apr 27, 2017

Dynasty Med. Care, P.C. v. 21st Century Advantage Ins. Co.

This case involves an appeal by Dynasty Medical Care, P.C., as an assignee, seeking first-party no-fault benefits from 21st Century Advantage Insurance Company. The District Court of Suffolk County initially granted the defendant's motion for summary judgment, agreeing that payments were made in accordance with the workers' compensation fee schedule. The Appellate Term, Second Department, reviewed and subsequently affirmed this amended order. The court determined that the defendant had sufficiently demonstrated the proper application of the fee schedule, and the plaintiff failed to present a triable issue of fact to dispute this claim.

No-fault benefitsSummary judgmentWorkers' compensation fee scheduleAppellate reviewInsurance disputeMedical providerAssigneeProcedural lawFactual disputeDistrict Court
References
2
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