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

Case No. 2024 NY Slip Op 00069 [223 AD3d 660]
Regular Panel Decision
Jan 10, 2024

Matter of County of Nassau v. Nassau County Sheriff's Corr. Officers' Benevolent Assn.

The County of Nassau appealed an order denying its petition to vacate an arbitration award. The arbitration award had concluded that the County violated a collective bargaining agreement by denying General Municipal Law § 207-c benefits to correction officers who missed no work time but sought medical treatment for work-related injuries or illnesses. The Supreme Court initially denied the County's petition and granted the union's cross-petition to confirm the award. The Appellate Division, Second Department, reversed this order, finding the arbitration award to be irrational because the claimants neither sought payment of salary/wages nor reimbursement for out-of-pocket medical expenses, thus not requiring the benefits outlined in General Municipal Law § 207-c. Consequently, the County's petition to vacate the arbitration award was granted, and the cross-petition to confirm was denied.

Arbitration AwardVacaturCollective Bargaining AgreementGeneral Municipal Law § 207-cCorrection OfficersMedical BenefitsLost TimePublic Policy ExceptionIrrational AwardAppellate Review
References
9
Case No. 2016 NY Slip Op 02096
Regular Panel Decision
Mar 23, 2016

Matter of Nassau County Sheriff's Correction Officers Benevolent Assn., Inc. v. Nassau County

John Thomas, a correction officer, sustained a back injury in 1998 and subsequently received General Municipal Law § 207-c benefits. After periods of restricted duty and military service, medical evaluations in 2009 determined he was unfit for any duty, reinstating his benefits. However, in February 2010, a County-appointed doctor deemed him fit for light-duty work, leading the Nassau County Sheriff's Department to discontinue his benefits. Thomas and his labor union challenged this decision, arguing a due process violation due to the hearing officer placing the burden of proof on Thomas to demonstrate his unfitness. The Appellate Division, Second Department, affirmed the lower court's dismissal, concluding that Thomas was afforded due process as he had the opportunity to present evidence and requiring him to support his claim of continued total disability was permissible.

CPLR Article 78 ProceedingGeneral Municipal Law § 207-c BenefitsDue Process RightsBurden of ProofLight-Duty AssignmentCorrection Officer InjuryDiscontinuation of BenefitsAppellate ReviewProperty InterestCollective Bargaining Agreement
References
6
Case No. ADJ7735518 ADJ7735519 ADJ7735513 ADJ7735501 ADJ7735502 ADJ7736429 ADJ7736449 ADJ7735498 ADJ7098593 ADJ7735514
Regular
Jul 29, 2014

Marialaine Tabak vs. SAN DIEGO UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration regarding a dispute over medical treatment authorization. The core issue was whether a Medical Provider Network (MPN) could restrict treatment to specific office locations of a listed physician. The Board affirmed the WCJ's finding that the defendant school district properly denied authorization for treatment at an unauthorized location of an MPN physician. The MPN's explicit listing stated providers were in-network only at designated locations, and this contractual limitation was upheld. Therefore, treatment outside the approved location was at the applicant's own expense.

Medical Provider NetworkMPNPhysician locationAuthorizationSelf-procureGeographic limitExclusive rightContractual limitationsEmployer's obligationAdministrative Director's Rule
References
2
Case No. MISSING
Regular Panel Decision

Main Evaluations, Inc. v. State

The claimant, Main Medical Evaluations, entered into contracts with the New York State Office of Temporary and Disability Assistance (OTDA) to perform consultative medical evaluations. OTDA terminated these contracts, alleging the claimant failed to disclose professional disciplinary proceedings against its chief medical officer, Arvinder Sachdev, and submitted false information during the bidding process. Following the dismissal of its claim in the Court of Claims, the claimant appealed. The appellate court affirmed the lower court's judgment, concluding that OTDA had legitimate grounds for termination due to the claimant's misrepresentations and failure to report substantial contract-related issues concerning Sachdev's integral role. Additionally, the court rejected the claimant's equal protection argument, finding no evidence of selective enforcement based on impermissible considerations.

Contract TerminationProfessional MisconductFalse RepresentationEqual ProtectionGovernment ContractsAppellate ReviewBreach of ContractMedical LicensingAdministrative ProceedingsDue Diligence
References
5
Case No. MISSING
Regular Panel Decision

Lapir v. Maimonides Medical Center

Olga Lapir sued her former employer, Maimonides Medical Center (MMC), and her union, Local 1199, under the Labor Management Relations Act. She alleged that MMC breached their collective bargaining agreement by terminating her employment without good cause and that the union failed to process her grievance, breaching its duty of fair representation. Lapir was fired as a blood bank technician after an incident where she assisted a doctor in locating special blood, violating hospital confidentiality and blood segregation policies. The court found that the union's investigation and defense were not arbitrary or in bad faith, and its decision not to pursue arbitration was rational, especially given Lapir's admitted misconduct. Consequently, the defendants' motions for summary judgment were granted, dismissing Lapir's complaint.

Labor RelationsDuty of Fair RepresentationSummary Judgment MotionWrongful Termination ClaimCollective BargainingGrievance ArbitrationHospital Blood Bank PolicyEmployee ConfidentialityUnion Due DiligenceFederal District Court
References
15
Case No. MISSING
Regular Panel Decision

Queens Blvd. Medical, P.C. v. Travelers Indemnity Co.

The plaintiff, Queens Blvd. Medical, P.C., sought $950 in first-party no-fault benefits for biofeedback medical services provided to its assignor for lower back and chronic pain syndrome. The central issue at trial was the medical necessity of these services under Insurance Law § 5102 (a) (1). The plaintiff established a prima facie case with expert testimony from a board-certified neurologist affirming the medical appropriateness of biofeedback. The defendant insurance company failed to present admissible evidence to disprove medical necessity, as its expert was deemed incompetent to testify on biofeedback for back pain. Consequently, the court granted the plaintiff's motion for a directed verdict, awarding judgment for $950 along with statutory costs, interest, and attorney's fees.

No-fault benefitsMedical necessityBiofeedback treatmentExpert testimonyDirected verdictInsurance lawChronic pain syndromeBack injuryCPT codesBurden of proof
References
9
Case No. MISSING
Regular Panel Decision

Sheriff Officers Ass'n v. Nassau County

The Sheriff Officers Association, Inc., representing Kathryn Ranieri, grieved Nassau County's decision to send Ranieri to an Independent Medical Examiner (IME) for an opinion on her ability to return to work. An arbitrator upheld the County's action, but the Supreme Court vacated this arbitration award, finding the arbitrator exceeded his authority. This appellate court reversed the Supreme Court's decision, determining that the arbitrator did not exceed his power. The court emphasized the limited scope of judicial review for arbitration awards, stating that an award must be upheld if it offers even a 'barely colorable justification' for the outcome and does not give a 'completely irrational construction' to the contract provisions. Thus, the arbitrator's original determination, upholding the County's actions, was reinstated.

Collective Bargaining AgreementArbitration AwardCPLR Article 75Judicial ReviewArbitrator AuthorityIndependent Medical ExaminationGrievancePublic Sector EmploymentScope of ReviewLabor Dispute
References
13
Case No. 25 NY3d 907
Regular Panel Decision
2015-XX-XX

Government Employees Insurance v. Avanguard Medical Group, PLLC

This case addresses whether no-fault insurance carriers are obligated to pay facility fees to New York State-accredited office-based surgery (OBS) centers for the use of their premises and support services. The court concluded that neither existing statutes nor regulations mandate such payments. Plaintiffs, a group of GEICO insurers, successfully sought a declaratory judgment that they are not legally required to reimburse Avanguard Medical Group, PLLC, for OBS facility fees, totaling over $1.3 million. The decision affirmed the Appellate Division's ruling, emphasizing that OBS facility fees are not explicitly covered by statute or fee schedules, nor do they fall under reimbursable "professional health services" as per 11 NYCRR 68.5. The court highlighted the distinct regulatory frameworks for OBS centers compared to hospitals and ambulatory surgery centers, declining to mandate policy changes best left to the legislature.

No-Fault InsuranceOffice-Based Surgery (OBS)Facility FeesInsurance LawBasic Economic LossFee SchedulesWorkers' Compensation BoardDepartment of Financial ServicesStatutory InterpretationRegulatory Framework
References
16
Case No. MISSING
Regular Panel Decision

Claim of Cummins v. North Medical Family Physicians

A claimant sustained a work-related back injury and sought continued medical treatment, which was initially authorized. Disputes over authorization led the claimant to retain an attorney. A Workers’ Compensation Law Judge authorized continued medical treatment but denied counsel fees, stating no "money passing" occurred. The Workers' Compensation Board upheld this decision. The claimant appealed, arguing the Board unconstitutionally applied Workers’ Compensation Law § 24, misinterpreted the statute regarding fee payment from medical benefits, and abused its discretion. The appellate court affirmed the Board's decision, ruling that counsel fees must be paid from "compensation," defined as a money allowance, and medical benefits are not considered "compensation" for this purpose, thus finding no abuse of discretion.

Workers' CompensationCounsel FeesAttorney FeesMedical TreatmentStatutory InterpretationConstitutional LawLienCompensation DefinitionAppellate ReviewBoard Decision
References
3
Case No. 2015 NY Slip Op 07262
Regular Panel Decision
Oct 07, 2015

Westchester County Correction Superior Officers Ass'n v. County of Westchester

The case involves an action brought by the Westchester County Correction Superior Officers Association and several retired correction officers against the County of Westchester. The plaintiffs sought damages for an alleged breach of a collective bargaining agreement, claiming the county failed to provide benefits equivalent to Workers' Compensation Law for permanent disability. The Supreme Court, Westchester County, initially denied the defendants' motion to dismiss but later granted their motion for summary judgment, dismissing the complaint. The Supreme Court also denied the plaintiffs' cross-motion to amend their complaint. On appeal, the Appellate Division, Second Department, affirmed the Supreme Court's decision, concluding that no provision in the collective bargaining agreement mandated such payments and that the proposed amendment to the complaint lacked merit.

Collective Bargaining AgreementBreach of ContractSummary JudgmentWorkers' Compensation BenefitsLoss of Earning CapacityPermanent DisabilityLeave to Amend ComplaintAppellate ReviewAffirmationJudiciary Law
References
2
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