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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
Jun 23, 1977

Milashouskas v. Mercy Hospital

Plaintiff Judith Milashouskas, a nurse, sustained injuries while working at Mercy Hospital and received medical treatment at the hospital's emergency room. She and her husband initiated a medical malpractice action, alleging damages from negligent treatment. Mercy Hospital asserted an affirmative defense under Workers’ Compensation Law § 29(6), arguing the action was barred. The Supreme Court, Nassau County, dismissed this defense, a decision affirmed on appeal. The appellate court found that Milashouskas sought treatment as a member of the public, and the hospital failed to provide evidence linking the medical treatment to her employment. The court emphasized that plaintiffs must still prove their injuries were proximately caused by the alleged negligence, not the underlying accident.

Medical MalpracticeWorkers' CompensationAffirmative DefenseNegligenceHospital LiabilityEmergency TreatmentCPLRAppellate ReviewEmployment InjuryCausation
References
1
Case No. CA 13-01105
Regular Panel Decision
Feb 14, 2014

KALEIDA HEALTH v. UNIVERA HEALTHCARE

This case concerns an appeal by Utica Mutual Insurance Company from a judgment that denied its motion for summary judgment and granted summary judgment to Kaleida Health and Univera Healthcare. The judgment declared Utica obligated to pay an outstanding hospital bill to Kaleida Health. Utica argued that collateral estoppel applied due to a Workers' Compensation Board determination, but the court found Kaleida Health and Univera Healthcare were not parties to that proceeding. Utica also contended the action was barred by arbitration, which was rejected as not compulsory. The Appellate Division affirmed the Supreme Court's decision, concluding Utica was responsible for the hospital bill as the patient's admission was a continuation of treatment for a work-related injury.

Workers' CompensationHospital BillCollateral EstoppelSummary JudgmentArbitrationPublic Health LawAppellate PracticeInsurance ObligationWork-Related InjuryHealth Care Provider
References
3
Case No. 2019 NY Slip Op 02599 [171 AD3d 1277]
Regular Panel Decision
Apr 04, 2019

New York State Workers' Compensation Bd. v. A&T Healthcare, Inc.

The New York State Workers' Compensation Board assumed administration of the insolvent Healthcare Providers Self-Insurance Trust, which had a deficit of $132.5 million. The Board initiated an action to recover the deficit from former employer-members, including Motherly Love Home Care Services Inc., who were jointly and severally liable. Motherly Love Home Care Services Inc. executed two settlement agreements but subsequently moved to vacate them, claiming a unilateral mistake by believing they had only signed duplicate copies of one agreement. The Supreme Court denied this motion. The Appellate Division, Third Department, affirmed the Supreme Court's decision, finding no basis for vacating the agreements given their distinct terms and the clear clarifications provided by the Board's counsel.

Workers' Compensation TrustInsolvencySettlement AgreementVacate AgreementUnilateral MistakeJoint and Several LiabilityAppellate ReviewContract PrinciplesHome Health CareEmployer Liability
References
5
Case No. 2018 NY Slip Op 07224 [165 AD3d 1558]
Regular Panel Decision
Oct 25, 2018

Healthcare Professionals Ins. Co. v. Parentis

This case involves an appeal regarding a declaratory judgment action initiated by Healthcare Professionals Insurance Company (HPI) against Michael A. Parentis and others. The dispute arises from a prior medical malpractice verdict against Parentis totaling $8.6 million, which exceeded his combined $2.3 million primary and excess insurance policies from Medical Liability Mutual Insurance Company (MLMIC) and HPI. Parentis alleged bad faith against both insurers for failing to settle the underlying action within policy limits. The Supreme Court initially granted summary judgment to HPI and MLMIC, dismissing Parentis' bad faith claim. The Appellate Division, Third Department, reversed this decision, finding that genuine issues of material fact exist concerning whether both HPI and MLMIC acted in bad faith during settlement negotiations, especially during jury deliberations.

Insurance LawBad Faith Insurance ClaimMedical MalpracticeSummary JudgmentAppellate ReviewSettlement NegotiationsExcess InsurancePrimary InsuranceJury DeliberationsDuty to Settle
References
16
Case No. MISSING
Regular Panel Decision

Quantum Maintenance Corp. v. Mercy College

Quantum entered into a maintenance contract with Mercy College which included a non-compete clause preventing Mercy from employing Quantum's personnel for two years post-termination. After Mercy terminated the contract, Aramark took over the maintenance services and subsequently hired Quantum's former employees. Quantum filed a lawsuit against Aramark, alleging tortious interference with contract, claiming Aramark induced Mercy to breach the non-compete clause. Aramark sought to dismiss the complaint, arguing the contract only restricted Mercy from direct hiring and that it could not be held liable as an agent. The court denied Aramark's motion, determining that the term 'engage' in the contract could be interpreted broadly to encompass hiring through a third-party contractor and that Aramark's alleged actions might have been for its self-interest, negating its agency defense.

tortious interference with contractnon-compete clausecontract interpretationmotion to dismissagency relationshipbreach of contractmaintenance servicespersonnel clauseemployer-employee relationsthird-party liability
References
33
Case No. 2013-1418 K C
Regular Panel Decision
Mar 11, 2016

Acupuncture Healthcare Plaza I, P.C. v. Truck Ins. Exch.

This case involves an appeal from an order of the Civil Court of the City of New York, Kings County. The Civil Court had granted the defendant's motion for summary judgment, dismissing the complaint. The plaintiff, a healthcare provider, sought to recover assigned first-party no-fault benefits. The defendant argued that it had properly reimbursed the plaintiff for acupuncture services using the workers' compensation fee schedule applicable to chiropractors. The Appellate Term affirmed the Civil Court's order, concluding that the defendant had timely mailed the denial of claim form and had fully paid the plaintiff in accordance with the workers' compensation fee schedule for acupuncture services.

No-fault benefitsAcupuncture servicesWorkers' compensation fee scheduleSummary judgmentAppellate reviewTimely mailingDenial of claimFirst-party benefitsInsuranceHealthcare provider
References
2
Case No. 2015-1243 K C
Regular Panel Decision
Feb 08, 2017

Acupuncture Healthcare Plaza I, P.C. v. Metlife Auto & Home

The case involves Acupuncture Healthcare Plaza I, P.C., as assignee of Boris Goldbaum, suing Metlife Auto & Home for first-party no-fault benefits. The defendant had paid a reduced sum, arguing the remaining amount exceeded the workers' compensation fee schedule and that one claim was subject to a policy deductible. During a nonjury trial, the parties stipulated to the plaintiff's prima facie case and timely denials. The defendant sought judicial notice of the workers' compensation fee schedule but failed to provide a witness to testify on its proper utilization or evidence for the deductible reduction. The Civil Court granted judgment to the plaintiff, which was subsequently affirmed by the Appellate Term, Second Department. The Appellate Term noted that while judicial notice of the fee schedule is permissible, the party seeking it must provide sufficient information and notice to the adverse party, and the fee schedule alone doesn't prove proper utilization of codes or reduction due to a deductible without supporting evidence.

No-fault insuranceMedical billing disputeAppellate reviewJudicial noticeBurden of proofFee schedule applicationPolicy deductibleAssigned claimsCivil procedureEvidence admissibility
References
5
Case No. MISSING
Regular Panel Decision

US Healthcare, Inc.(New York) v. O'BRIEN

This action concerns the interpretation of a right of recovery clause in a health benefits plan issued by U.S. Healthcare, Inc. of New York (USH), an ERISA-governed plan. USH sought a declaratory judgment to recover over $1 million in benefits paid for Michael O’Brien's care from a medical malpractice settlement. USH moved for summary judgment against the O’Briens and other defendants, arguing its right to recover from the settlement regardless of allocation. The defendants, including Michael O'Brien's parents and their law firm, contended that the settlement with Dr. Robbins was for pain and suffering, not medical services, and thus USH had no right of recovery under its plan's specific terms or unjust enrichment. The court denied USH's motion for summary judgment and granted the defendants' motions in part, finding that USH failed to prove the settlement included payment for medical services provided by USH, and dismissed claims for future declaratory relief as premature.

ERISAHealth Benefits PlanRight of Recovery ClauseSubrogationMedical Malpractice SettlementSummary JudgmentUnjust EnrichmentCollateral Source RuleDeclaratory JudgmentContract Interpretation
References
18
Case No. ADJ8094646
Regular
Jan 17, 2014

ALEJANDRINA BARRETO vs. OUT OF THE SHELL, SOUTHERN INSURANCE COMPANY, REPUBLIC INDEMNITY COMPANY, PHARMAFINANCE, LLC, HEALTHCARE FINANCE MANAGEMENT, LLC

This case involves lien claimants PharmaFinance and Healthcare Finance Management, and their representatives Landmark Medical Management and Brian Hall, who sought reconsideration of a decision disallowing their liens for medical treatment. The Appeals Board granted reconsideration solely to notice its intention to impose sanctions of up to $2,500 against the lien claimants and their representatives. This action is due to a pattern of allegedly filing petitions containing false statements about not receiving notices, which violates the Board's Rules of Practice and Procedure and Labor Code Section 5813. The Board found these claims not persuasive and indicative of a tactic to avoid responsibility.

Workers' Compensation Appeals BoardPetition for ReconsiderationSanctionsLien ClaimantsHearing RepresentativesIndustrial InjuryFindings and OrderCompromise and ReleaseNotice of IntentionLabor Code section 5813
References
0
Case No. 2017 NY Slip Op 01454
Regular Panel Decision
Feb 23, 2017

Sokolovic v. Throgs Neck Operating Co., Inc.

This case involves an appeal concerning hold harmless and indemnity agreements. The Supreme Court, Bronx County, initially granted Vision Healthcare Services' motion to enforce a hold harmless agreement and Throgs Neck Operating Company, Inc.'s motion for summary judgment on its contractual indemnity claim against Vision. The Appellate Division, First Department, affirmed these orders. The court held that the plaintiff was obligated to hold Vision harmless from Throgs Neck's indemnification claim due to a hold harmless agreement executed during settlement. It further clarified that a nurse provided by Vision to Throgs Neck remained Vision's general employee, thereby triggering Vision's contractual indemnity obligation, despite being considered a special employee of Throgs Neck for the purpose of Throgs Neck's liability to the plaintiff.

hold harmless agreementcontractual indemnityspecial employeegeneral employeestaffing agreementsettlement agreementsummary judgmentnegligenceagency liabilityappellate review
References
3
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