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

Claim of Perrin v. Builders Resource, Inc.

The case concerns an appeal from a Workers' Compensation Board decision regarding the reimbursement rate for home health aide services provided to a claimant by their sister. Initially, the carrier denied payment but was later directed to pay. The Workers’ Compensation Law Judge set the reimbursement rate at $12 per hour for services starting in 2011, which the Board affirmed. The claimant appealed, solely challenging this rate. The court dismissed the appeal, ruling that the claimant was not an aggrieved party concerning the reimbursement rate, as the dispute was between the care provider (the sister) and the carrier. The court affirmed that the claimant received the care sought and could not raise issues on behalf of the care provider.

Workers' CompensationHome Health Aide ServicesReimbursement RateAppeal DismissalAggrieved PartyCare ProviderWorkers' Compensation BoardAppellate ProcedureNew York LawCarrier Liability
References
4
Case No. MISSING
Regular Panel Decision

Anthony L. Jordan Health Corp. v. Axelrod

The Anthony L. Jordan Health Center, a not-for-profit corporation, challenged the New York State Department of Health's recalculation of its Medicaid reimbursement rates for the 1983-1984 and 1984-1985 periods. Following an appeal, the parties entered into a stipulation agreement. However, the Department, while recalculating the rates in accordance with the stipulation, unilaterally changed the group composition, resulting in a significant negative adjustment and recoupment from Jordan. The court determined that this regrouping constituted an 'error of judgment,' not a permissible correction for mathematical error or an audit finding. Consequently, the court found that the Department did not have the right to retroactively adjust the rates based on this discretionary change. The petition was granted.

Medicaid ReimbursementRate RecalculationAdministrative ReviewStipulation AgreementError of JudgmentGroup CompositionRetroactive AdjustmentHealth Care LawJudicial ReviewDepartment of Health
References
5
Case No. MISSING
Regular Panel Decision

Frances Schervier Home & Hospital Inc. v. Axelrod

This case concerns an appeal regarding Medicaid reimbursement rates for a residential health care facility. The Department of Health (DOH) disallowed certain costs from the petitioner's 1981 cost report, affecting 1983-1985 rates. Petitioner appealed, arguing it was a data error, not an alternative cost allocation method requiring prior approval. After DOH denied the appeal, the Supreme Court annulled DOH's determination, ruling in favor of the petitioner. The Appellate Division affirmed the Supreme Court's decision, finding DOH's interpretation of its regulations regarding data error corrections to be irrational.

Medicaid reimbursement ratescost reportDepartment of Healthresidential health care facilityCPLR article 78administrative lawdata errorcost allocationagency interpretationirrational interpretation
References
2
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. 03-09-00178-CV
Regular Panel Decision
Aug 26, 2010

Vista Healthcare, Inc. v. Texas Mutual Insurance Company Texas Department of Insurance, Division of Workers' Compensation Texas Association of School Boards Risk Management Fund And the Travelers Insurance Companies

This case involves Vista Healthcare, Inc.'s challenge to a district court judgment regarding a workers' compensation medical benefits reimbursement dispute. Vista, an ambulatory surgical center, argued for reimbursement of its "usual and customary" charges, while Texas Mutual Insurance Company applied a methodology based on Medicare rates. The dispute centered on the interpretation of Division rules governing reimbursement rates, specifically rule 134.1, in the absence of specific medical fee guidelines. The court affirmed the district court's judgment, deferring to the Division's interpretation that "fair and reasonable" reimbursement incorporates all standards from labor code section 413.011, including ensuring quality of medical care and achieving effective cost control, and found the rule not unconstitutionally vague.

Workers' CompensationMedical BenefitsReimbursement DisputeAmbulatory Surgical CenterFee GuidelinesRule InterpretationConstitutional VaguenessTexas Labor CodeAdministrative Procedure ActJudicial Review
References
21
Case No. MISSING
Regular Panel Decision
Jul 05, 2008

New Franklin Center for Rehabilitation & Nursing v. Novello

Six private residential health care facilities, including New Franklin Center for Rehabilitation & Nursing and the Bayview petitioners, appealed determinations by the Commissioner of Health. They challenged the removal of Medicaid reimbursement rate adjustments for recruitment and retention of nonsupervisory health care workers, which occurred after they reclassified nursing personnel expenses as 'fees' following a leasing arrangement with Budget Services, Inc. The Supreme Court dismissed one proceeding as untimely and affirmed the Commissioner's decision for the other, finding it consistent with Public Health Law § 2808 (18). The appellate court affirmed the Supreme Court's judgment, upholding the Commissioner's interpretation and emphasizing the statute's intent to ensure proper use of funds.

Medicaid ReimbursementHealth Care FacilitiesCPLR Article 78Recruitment and Retention FundsPublic Health LawStatutory InterpretationAdministrative AppealsTimeliness DoctrineStatute of LimitationsJudicial Deference
References
13
Case No. MISSING
Regular Panel Decision

People v. Young

An attorney representing an indigent defendant in Monroe County filed an application seeking reimbursement for legal services at a rate of $200 per hour, mirroring the rate charged by the Special Prosecutor, rather than the statutory rates under County Law § 722-b. The attorney argued that the significant disparity in hourly compensation violated the defendant's right to equal protection and that his qualifications justified the requested rate. The New York State Association of Criminal Defense Lawyers supported the application as amicus curiae, while Monroe County opposed it, arguing the request was untimely and lacked extraordinary circumstances. Presiding Judge Donald J. Mark, J., acknowledged the court's authority to grant compensation in excess of statutory limits under extraordinary circumstances but ultimately denied the application. The denial was based on the court's reasoning that an analogous argument was previously rejected, that linking assigned counsel rates to prosecutor rates would render County Law § 722-b ineffective, and that extraordinary circumstances could not be demonstrated prior to the conclusion of the criminal action. The court, however, reserved the right to reconsider an increased hourly fee upon the case's termination if such circumstances are then proven.

Assigned CounselLegal Aid CompensationCounty Law Section 722-bHourly Rate DisputeSpecial Prosecutor FeesIndigent RightsJudicial DiscretionExtraordinary CircumstancesMonroe County LawEqual Protection Challenge
References
16
Case No. MISSING
Regular Panel Decision
Sep 08, 1987

Richmond Memorial Hospital & Health Center v. Axelrod

The petitioner, a hospital not a member of the League of Voluntary Hospitals, sought to increase its 1983 third-party reimbursement rates from the Commissioner of the New York State Department of Health. This application was based on a 'trend factor' applicable to League members, stemming from a collective bargaining agreement which the petitioner also adopted. The Commissioner denied the request, citing the petitioner's non-membership in the League. The Supreme Court annulled this determination, directing the use of the League trend factor. On appeal, the judgment was modified: the annulment of the Commissioner's arbitrary determination was affirmed, but the direction to use the specific trend factor was deleted, and the case was remitted for recalculation based on permissible factors.

CPLR Article 78Third-Party Reimbursement RatesTrend FactorMedicaid RatesBlue Cross RatesWorkers' Compensation RatesNo-Fault RatesPublic Health LawArbitrary and CapriciousJudicial Review
References
5
Case No. MISSING
Regular Panel Decision

Vista Healthcare, Inc. v. Texas Mutual Insurance Co.

Vista Healthcare, Inc. (Vista) appealed a district court judgment concerning a workers' compensation medical benefits reimbursement dispute. Vista challenged the validity and interpretation of a rule by the Division of Workers’ Compensation, Texas Department of Insurance, regarding 'fair and reasonable' reimbursement rates for services not covered by specific fee guidelines. Vista argued that its 'usual and customary' charges should be deemed fair and reasonable, while Texas Mutual Insurance Company, the carrier, applied a methodology based on Medicare rates, considering factors like quality of care and cost control, as mandated by Labor Code section 413.011(d). The Administrative Law Judge and the district court sided with the Division's broader interpretation of 'fair and reasonable,' incorporating all statutory factors. The appellate court affirmed the district court's judgment, deferring to the agency's interpretation of its rules and finding that the rule was not unconstitutionally vague.

Workers' CompensationMedical ReimbursementFee GuidelinesAdministrative LawRule InterpretationConstitutional VaguenessJudicial ReviewTexas Labor CodeHealthcare FacilitiesAmbulatory Surgical Center
References
22
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
Showing 1-10 of 3,544 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