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Case Law Database

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

Case No. ADJ8606940
Regular
Apr 18, 2013

ANGELICA PEREZ vs. PERMANENTE MEDICAL GROUP, INC.

The Workers' Compensation Appeals Board denied defendant's petition for removal or reconsideration regarding the applicant's entitlement to multiple Panel Qualified Medical Examiners (PQMEs). The defendant contested the procedural validity of the applicant's PQME requests, while the applicant asserted proper procedure was followed due to the defendant's lack of response to an Agreed Medical Examiner offer. The Board found that the February 4, 2013 notation was not a final order, as PQME requests remained pending with the Medical Unit. Therefore, the petition was denied without prejudice to the Medical Unit's future determination on the propriety of the PQME requests.

Panel Qualified Medical ExaminersPQMEPetition for RemovalPetition for ReconsiderationIndustrial InjuryCumulative InjuryAgreed Medical ExaminerAMEMedical UnitAdministrative Law Judge
References
0
Case No. MISSING
Regular Panel Decision

Gartenbaum v. Beth Israel Medical Center

Plaintiff Ilona Gartenbaum, a white employee, filed a Title VII racial discrimination lawsuit against Beth Israel Medical Center and three supervisors, alleging she was denied promotions in favor of less qualified black employees. The court, sua sponte, questioned her counsel, Bart Nason's, pre-filing investigation under Rule 11, noting prior union grievance procedures and an arbitration, where race was not an issue, had not supported Gartenbaum's claims. While Mr. Nason's investigation was found to be inadequate, relying on the client's assertions and an unsupported affidavit from a union representative, the court acknowledged that Gartenbaum could make out a prima facie case for racial discrimination concerning at least two denied promotions. Consequently, the court denied Rule 11 sanctions at this juncture and allowed the Title VII claim to proceed to discovery. Additionally, the court ordered the consolidation of this action with a separate pro se retaliation lawsuit filed by Gartenbaum against the same defendants.

Title VIIRacial DiscriminationEmployment DiscriminationRule 11 SanctionsPre-Filing InvestigationPrima Facie CaseGrievance ProcedureArbitrationEEOC InvestigationNLRB
References
6
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

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. MISSING
Regular Panel Decision

Martinez v. Downstate Medical Center of State University of New York

The petitioner, an associate professor and director of a Joint Respiratory and Surgical Intensive Care Unit, was reassigned and later terminated following a leave of absence for a heart attack. He initiated a CPLR article 78 proceeding to challenge his reassignment, the transfer of the ICU, and his termination from a tenured position. The Supreme Court's initial judgment was appealed. The appellate court modified the judgment by granting the petitioner's request for reinstatement to a comparable ICU director position. It also remitted the issue of reinstatement as a tenured associate professor to Downstate for review under its medical staff bylaws, displacing a prior referral to the UUP agreement. However, the court affirmed the dismissal of the claim concerning the ICU transfer and found the promotion issue time-barred under the UUP grievance procedure.

ReinstatementTenurePromotion DisputeCPLR Article 78Administrative ReviewMedical Staff BylawsCollective Bargaining AgreementJudicial Review ScopeHospital AdministrationAcademic Appointment
References
6
Case No. MISSING
Regular Panel Decision

Rechenberger v. Nassau County Medical Center

Edward Rechenberger suffered hip fractures and underwent two operations at Nassau County Medical Center in May 1982. Following a re-injury and later diagnosis, he learned the surgical hardware was improperly implanted, leading to further operations. Mr. Rechenberger sought leave to serve a late notice of claim against the medical center. The Supreme Court initially denied the motion, but the Appellate Division reversed this decision, finding that the hospital had actual knowledge of the essential facts of the claim within the statutory 90-day period through its own medical records. The court concluded that the delay in serving the notice of claim was not substantially prejudicial to the hospital, and thus, granted the petitioners leave to serve the late notice of claim.

Medical MalpracticeLate Notice of ClaimNassau CountyHip FractureSurgical ErrorContinuous Treatment DoctrineActual NoticePrejudiceAppellate ReviewMunicipal Corporation
References
11
Case No. MISSING
Regular Panel Decision
Feb 10, 2017

Mitchell v. SUNY Upstate Medical University

Plaintiff Robbie Mitchell sued SUNY Upstate Medical Center for alleged Title VII violations, including race discrimination and retaliation, after experiencing a series of adverse employment actions. These actions included reassignment, disciplinary notices (NODs), a mandatory medical examination, a formal counseling memorandum, a verbal dispute, and eventual termination. The defendant moved for summary judgment, arguing the plaintiff failed to establish a prima facie case for most claims and that their actions were based on legitimate, non-discriminatory reasons. The court granted summary judgment in favor of SUNY Upstate Medical Center, concluding that the plaintiff failed to provide sufficient evidence of discrimination or that retaliation was the but-for cause of the challenged employment actions, and consequently, the case was closed.

Title VIICivil Rights ActEmployment DiscriminationRetaliationSummary JudgmentAdverse Employment ActionMcDonnell Douglas FrameworkWorkplace ConductDisciplinary ActionPaid Administrative Leave
References
49
Case No. MISSING
Regular Panel Decision

Yklik Medical Supply, Inc. v. Allstate Insurance

Plaintiff Yklik Medical Supply, Inc., a medical supply provider, sued Allstate Insurance Company to recover $317 in unpaid medical bills for equipment supplied to its assignor, Tammy Agosto. Yklik moved for summary judgment, asserting proper bill submission and Allstate's failure to timely pay or deny the claim. Allstate argued that the charges exceeded the Workers' Compensation fee schedule and that a partial payment had been made. The court found that Yklik established a prima facie case. The central issue was whether Allstate's fee schedule defense was precluded due to its failure to issue a timely denial within 30 days as mandated by Insurance Law § 5106 (a) and 11 NYCRR 65-3.5. The court ruled that since Allstate waited 56 days to send its denial, it was precluded from raising the fee schedule defense, and therefore, summary judgment was granted to the plaintiff.

No-fault insurancesummary judgmenttimely denialfee schedulepreclusion ruleinsurance lawmedical supplybilling practicespersonal injury protectionassignor
References
19
Case No. MISSING
Regular Panel Decision

Fraser v. Brunswick Hospital Medical Center, Inc.

In this medical malpractice action, the defendant The Brunswick Hospital Medical Center, Inc. appealed an order that granted the plaintiff’s motion to strike its workers’ compensation coverage defense. Concurrently, the plaintiff cross-appealed the dismissal of the complaint against defendant S. Fong. The appellate court affirmed the decision to strike the workers’ compensation defense for The Brunswick Hospital Medical Center, Inc., citing its participation and lack of appeal in the prior Workers’ Compensation Board hearing. However, the dismissal of the complaint against S. Fong was reversed, as S. Fong was not present at the Board hearing, thus preclusion did not apply, and a triable issue of fact existed regarding whether the injury was employment-related. The court also rejected S. Fong's argument regarding the absence of a doctor-patient relationship.

Medical MalpracticeWorkers' CompensationAffirmative DefenseSpecial EmployeeCoemployeePreclusive EffectTriable Issue of FactDoctor-Patient RelationshipAppellate ReviewHospital Liability
References
7
Case No. MISSING
Regular Panel Decision

ABC Medical Management, Inc. v. GEICO General Insurance

The case addresses whether a plaintiff-assignee medical equipment supplier can recover no-fault first-party benefits when a chiropractor, rather than a physician, issued the prescription. Defendant GEICO General Insurance Company moved for summary judgment, arguing that Education Law § 6551 prohibits chiropractors from prescribing such items. The court denied GEICO's motion, ruling that chiropractors are permitted to prescribe TENS units, thermophore devices, and similar medical supplies, as these do not constitute 'drugs or medicines' under the Education Law. Furthermore, the court found that GEICO failed to properly present its medical necessity defense and that the contested issues should be determined by a trier of fact.

No-Fault BenefitsChiropractic PrescriptionMedical EquipmentEducation Law § 6551Summary JudgmentMedical NecessityTENS UnitThermophoreCervical CollarLumbar Support
References
29
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