CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

Case Law Database

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

Case No. MISSING
Regular Panel Decision

Sexton v. Medicare

Plaintiff Kevin Sexton sued the Secretary of the United States Department of Health and Human Services (HHS) to prevent direct reimbursement for Medicare payments made after he was injured in an accident. Sexton argued that Medicare should pursue the primary insurer, American Transit Insurance Company, or the medical providers, rather than him. HHS moved to dismiss the case, asserting a lack of subject matter jurisdiction due to Sexton's failure to demonstrate an actual or imminent injury and to exhaust administrative remedies. The court granted HHS's motion, dismissing the complaint with prejudice. It ruled that Sexton lacked standing because Medicare had not yet formally demanded reimbursement from him, and its right to recover from a beneficiary only accrues after the beneficiary receives a primary payment, making his alleged injury purely speculative.

MedicareMedicare Secondary Payer ActMSP ActSubject Matter JurisdictionMotion to DismissStandingRipeness DoctrineConditional PaymentsReimbursement ClaimPrimary Payer
References
26
Case No. MISSING
Regular Panel Decision

Ferlazzo v. 18th Avenue Hardware, Inc.

Plaintiff Marie Ferlazzo moved to extinguish liens and subrogation rights asserted by Oxford Health Plan and The Rawlings Company, LLC against her personal injury settlement proceeds. Oxford, administering a Medicare Advantage plan, sought reimbursement for medical expenses. Ferlazzo contended that General Obligations Law § 5-335 (a) barred such claims as Oxford lacked a statutory right of reimbursement. The court examined the Medicare Secondary Payer Act and the Medicare Advantage Program, concluding that unlike Medicare, private Medicare Advantage insurers only have contractual, not statutory, rights to reimbursement. Citing federal precedents, the court ruled that Oxford's claim was subject to state law and not entitled to recovery from the settlement. Consequently, the court granted Ferlazzo's motion to extinguish the liens and subrogation rights.

Personal InjurySubrogationMedicare AdvantageHealth Insurance LienSettlement ProceedsGeneral Obligations LawStatutory InterpretationContractual RightsFederal PreemptionPrivate Insurer
References
4
Case No. MISSING
Regular Panel Decision

Tahir v. Progressive Casualty Insurance

This case addresses a no-fault health services provider's claims for compensation for current perception threshold (CPT) and sensory nerve conduction threshold (sNCT) testing. The defendant insurer argued these tests were not compensable under Medicare and constituted provider fraud. The court rejected the Medicare defense, clarifying that New York's no-fault statute relies on workers' compensation fee schedules, not Medicare standards. Furthermore, the court categorized the fraud defense as a medical necessity issue, requiring timely assertion with supporting evidence. Finding the insurer failed to meet its burden, the court ruled in favor of the plaintiff, entitling them to attorney fees and statutory interest.

No-fault insuranceCPT testingsNCT testingMedical necessityProvider fraudMedicare compensationWorkers' compensation fee schedulesElectrodiagnostic testSensory neuropathyChiropractic services
References
26
Case No. MISSING
Regular Panel Decision
Apr 19, 2004

Claim of Provoncha v. Anytime Home Care, Inc.

A 17-year-old certified nurses aid, identified as the claimant, sustained a back injury while employed by Anytime Home Care, Inc. The Workers' Compensation Board initiated proceedings to determine if her employment violated the Labor Law, which would entitle her to double compensation under Workers’ Compensation Law § 14-a. Despite requests, the employer failed to produce the required employment certificate at two hearings and its requests for further adjournments or to present alternative testimony were denied. Both the Workers’ Compensation Law Judge and the Board found the claimant was illegally employed due to the lack of an employment certificate. Consequently, the Board affirmed her entitlement to double compensation. The appellate court reviewed the employer's contentions and ultimately affirmed the Board's decision.

Workers' CompensationChild Labor LawIllegal EmploymentDouble CompensationEmployment CertificateAdministrative HearingAppellate ReviewEmployer ResponsibilityLabor Law ViolationWorkers' Compensation Board
References
5
Case No. ADJ4024660 (LAO 0887729)
Regular
Feb 03, 2017

ALFREDO COLLAZO vs. MECA NAG CORPORATION, EMPLOYERS COMPENSATION

The Appeals Board granted reconsideration, rescinded the prior order, and returned the case to the trial level for a new decision. The WCJ erred in determining the lien claimant's entitlement to payment solely on a multiplier of Medicare rates, rather than a reasonable cost basis. The Board clarified that while the facility's charges are not subject to the Official Medical Fee Schedule, their entitlement must be based on their actual costs plus a reasonable profit. Therefore, further proceedings are required to properly assess the reasonable cost basis for the services rendered.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderLien ClaimantReasonable Cost BasisMedicare ReimbursementOfficial Medical Fee ScheduleLong Term Care HospitalKunz StudyTapia
References
2
Case No. MISSING
Regular Panel Decision
Aug 07, 1984

Murtaugh v. Bankers Trust Co.

In November 1978, claimant Murtaugh filed a discrimination claim against Bankers Trust Company of Albany, N. A. following her 1977 dismissal, citing Workers’ Compensation Law § 241. The Workers’ Compensation Board affirmed a discrimination finding, which was subsequently upheld by the Appellate Division. An administrative law judge directed Murtaugh's reinstatement and awarded back wages from January 1, 1978, to October 19, 1982, with an offset for unemployment benefits. The Bank appealed this decision, contending the back pay award was unauthorized under Workers’ Compensation Law § 120, arguing Murtaugh failed to accept reemployment or mitigate damages. The court found substantial evidence that no bona fide reemployment offer was made and that the issue of mitigation of damages was not properly raised. Consequently, the court affirmed the Board's decision, upholding Murtaugh's entitlement to back pay.

Workers' Compensation LawDiscriminationBack Pay AwardReinstatementMitigation of DamagesUnemployment BenefitsOffer of ReemploymentAppellate DivisionNew York LawEmployer Liability
References
4
Case No. MISSING
Regular Panel Decision

In re the Claim of Warnock

The claimant was terminated after an altercation with a co-worker, but eyewitnesses testified that no threats or physical contact occurred, and the co-worker was the one who became angry. The Unemployment Insurance Appeal Board ruled that the claimant was entitled to receive unemployment insurance benefits, finding that the actions did not constitute misconduct. The appellate court affirmed this decision, holding that the Board's conclusion was supported by substantial evidence and that displaying bad judgment does not automatically disqualify a claimant from benefits.

Unemployment benefitsMisconductSubstantial evidenceAltercationCo-worker disputeAppellate reviewAppeal Board decisionEmployee terminationBad judgmentNo physical contact
References
2
Case No. MISSING
Regular Panel Decision

Coyle v. Intermagnetics Corp.

The Workers’ Compensation Board ruled that an unnamed claimant, who suffered work-related back injuries in 1985 and 1989, was entitled to reduced earnings benefits after taking a lower-paying job. The employer, Intermagnetics Corporation, and its workers’ compensation insurance carrier appealed, arguing the reduction in earnings was due to personal reasons, not disability. The court affirmed the Board's decision, finding substantial evidence that the claimant's permanent partial disability was a contributing factor to the wage reduction, despite conflicting evidence. The ruling highlighted that physical limitations from a permanent partial disability allow for an inference of causation for subsequent wage loss.

Permanent Partial DisabilityReduced EarningsBack InjuryChiropractic TreatmentCausal RelationshipSubstantial EvidenceAppellate ReviewWage LossEmployment ChangeMedical Testimony
References
4
Case No. WCB No. 6901 2052
Regular Panel Decision

Matter of Sunukjian v. Price Chopper

Claimant was awarded workers' compensation benefits for bilateral carpal tunnel syndrome and a shoulder injury in 2002, with a schedule loss of use award in 2004. In 2010, the schedule loss of use award was rescinded, and the claimant was classified with a permanent partial disability. The employer and its carrier sought credit for prior schedule loss of use payments. The Workers’ Compensation Board initially denied the credit but, upon reconsideration, ruled in favor of the employer. The claimant appealed this decision. The Appellate Division affirmed the Board's determination, holding that the employer was entitled to the credit and had not waived this right.

Workers' CompensationSchedule Loss of UsePermanent Partial DisabilityEmployer ReimbursementCreditWaiverStipulationAppellate ReviewBoard DecisionCarpal Tunnel Syndrome
References
6
Case No. MISSING
Regular Panel Decision
Mar 20, 2001

Claim of Derr v. VIP Structures

The claimant, who had a work-related permanent total disability, was convicted of assault in March 1999 and subsequently incarcerated. The Workers’ Compensation Board ruled that the claimant was not entitled to benefits during his incarceration after the conviction of a crime. The claimant appealed this decision, arguing for continued benefits due to his total disability and resulting lack of earning capacity, regardless of his incarceration status. The court affirmed the Board's decision, stating that the suspension of workers’ compensation benefits during incarceration after a criminal conviction is based on public policy, and this principle applies to both partial and total disabilities. The court concluded that suspending benefits in such circumstances does not conflict with the Workers’ Compensation Law's goals.

IncarcerationWorkers' Compensation BenefitsTotal DisabilityPublic PolicyAssault ConvictionBenefit SuspensionCriminal ConductAppellate ReviewDisability Benefits
References
5
Showing 1-10 of 1,927 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational