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

Case No. 2018 NY Slip Op 07432 [166 AD3d 621]
Regular Panel Decision
Nov 07, 2018

Matter of Progressive Advanced Ins. Co. v. New York City Tr. Auth.

This case involves an appeal by Progressive Advanced Insurance Company (Progressive) against the New York City Transit Authority (NYCTA) concerning an arbitration award. The dispute arose under Insurance Law § 5105 regarding a loss transfer claim, where NYCTA sought reimbursement from Progressive for workers' compensation benefits paid to its employee after a collision involving Progressive's insured. The central issue was whether a 20% no-fault offset applied to the workers' compensation wages, with the arbitrator ruling it did not, as a one-third offset had already been applied. Progressive's petition to vacate the award was denied by the Supreme Court, Queens County. The Appellate Division affirmed this denial, concluding that the arbitrator's determination was supported by a reasonable hypothesis and was not arbitrary or capricious.

Arbitration AwardLoss TransferInsurance LawWorkers' Compensation BenefitsNo-Fault OffsetAppellate ReviewStatutory InterpretationEvidentiary SupportArbitrary and CapriciousReasonable Hypothesis
References
9
Case No. MISSING
Regular Panel Decision

Volt Technical Services Corp. v. Immigration & Naturalization Service

Plaintiff Volt Technical Services Corp. applied for H-2 visas for nuclear start-up technicians, which the Immigration and Naturalization Service (INS) denied, asserting the need was permanent, not temporary. After the denial was affirmed on appeal, Volt filed suit, alleging the INS's decision was arbitrary and capricious. The court upheld the INS's interpretation of the Immigration and Nationality Act § 101(a)(15)(H)(ii), which requires the employer's need for services to be temporary, not just the individual assignments. Finding that Volt demonstrated a recurring need for such technicians over several years, the court granted the INS's motion for judgment on the pleadings and denied Volt's.

Immigration LawH-2 visasNonimmigrant WorkersTemporary EmploymentImmigration and Nationality ActAdministrative Procedures ActDeclaratory Judgment ActAgency InterpretationJudicial ReviewNuclear Industry
References
5
Case No. 2014-1124 K C
Regular Panel Decision
Jul 21, 2017

Natural Therapy Acupuncture, P.C. v. Nationwide Ins.

The Appellate Term, Second Department, affirmed an order of the Civil Court of the City of New York, Kings County, which had granted summary judgment to Nationwide Ins. The case involved Natural Therapy Acupuncture, P.C.'s action to recover assigned first-party no-fault benefits. Nationwide Ins. successfully argued that it properly reimbursed the plaintiff for acupuncture services using the workers' compensation fee schedule applicable to chiropractors providing similar services. The appellate court found sufficient proof of timely mailing of claim denials and full payment according to the fee schedule. A new contention raised by the plaintiff for the first time on appeal was not considered by the court.

no-fault insuranceacupuncture servicesworkers' compensation fee schedulesummary judgmentappellate reviewclaim denialtimely mailingreimbursementmedical servicesfirst-party benefits
References
4
Case No. MISSING
Regular Panel Decision

Progressive Casualty Insurance v. New York State Insurance Fund

Zimone Brown, a sanitation worker insured by the New York State Insurance Fund (NYSIF), was injured after being struck by an automobile insured by Progressive Casualty Insurance Company (Progressive). The NYSIF sought reimbursement of workers’ compensation benefits from Progressive through arbitration, citing Insurance Law § 5105. Progressive contended that the garbage truck was not 'involved' in the accident as statutorily required. Although the arbitration panel sided with NYSIF, the Supreme Court denied Progressive's petition to vacate the award. This appellate court reversed the Supreme Court's decision, finding no evidentiary support or rational basis for the arbitrators' determination, thus granting Progressive's petition and vacating the arbitration award.

Arbitration Award VacaturInsurance LawWorkers' Compensation BenefitsLoss Transfer ProvisionsStatutory InterpretationMotor Vehicle AccidentEvidentiary SupportArbitrary and CapriciousJudicial ScrutinyCPLR Article 75
References
15
Case No. 2017-635 K C
Regular Panel Decision
Aug 02, 2019

Natural Therapy Acupuncture, P.C. v. GEICO Ins. Co.

In this case, Natural Therapy Acupuncture, P.C., acting as assignee, sought to recover no-fault benefits from GEICO Ins. Co. The Civil Court initially denied GEICO's cross-motion for summary judgment to dismiss claims concerning unpaid benefits. On appeal, the Appellate Term, Second Department, reversed the lower court's decision. The Appellate Term found that GEICO had timely denied the claims and correctly applied the workers' compensation fee schedule for the services in question. Consequently, GEICO's cross-motion for summary judgment was granted, dismissing the plaintiff's claims.

No-Fault BenefitsSummary JudgmentWorkers' Compensation Fee ScheduleAppellate ReviewInsurance ClaimsTimely DenialAssigned ClaimsMedical Provider ReimbursementCivil CourtAppellate Term Decision
References
2
Case No. MISSING
Regular Panel Decision

Abraham Natural Foods Corp. v. Mount Vernon Fire Insurance

Plaintiff Abraham Natural Foods Corp. initiated an action seeking a declaration that Mount Vernon Fire Insurance Company was obligated to indemnify and defend it in a wrongful death suit. The case was removed to federal court based on diversity jurisdiction. Plaintiff later amended its complaint to add several non-diverse defendants, including Modern Insurance Agency and Ok Z. Kim. Defendants moved to dismiss for lack of subject matter jurisdiction, arguing that the joinder of non-diverse parties destroyed diversity. Plaintiff cross-moved to remand the case to state court. The Court denied the motion to dismiss and granted the motion to remand, finding that the joinder of Modern was permissible under Rule 20 and legitimate, thus requiring remand under 28 U.S.C. § 1447(e).

Diversity JurisdictionSubject Matter JurisdictionRemand to State CourtMotion to DismissJoinder of PartiesPermissive JoinderFederal Rules of Civil Procedure28 U.S.C. § 1447(e)Insurance LitigationBroker Malpractice
References
18
Case No. 2023 NY Slip Op 04372 [219 AD3d 819]
Regular Panel Decision
Aug 23, 2023

Iannaccone v. United Natural Foods, Inc.

The plaintiff, Louis Iannaccone, appealed an order from the Supreme Court, Rockland County, which had granted summary judgment dismissing his Labor Law § 240 (1) claim. Iannaccone alleged personal injuries suffered in October 2015 while installing camera systems for United Natural Foods, Inc., when an extension ladder he was on, resting on landscaping rocks, shifted and caused him to fall. The Supreme Court initially granted motions by the defendant and third-party defendants (Protection One Alarm Monitoring, Inc., and Protection One Systems, Inc.) to dismiss the Labor Law § 240 (1) cause of action. The Appellate Division, Second Department, reversed the Supreme Court's order, finding that the defendant and third-party defendants failed to establish, prima facie, that Iannaccone's actions were the sole proximate cause of his injuries. The Appellate Division noted Iannaccone's testimony about the unsafe alternative placement of the ladder and the lack of evidence that available safety ties, not at the job site, would have prevented the fall. Consequently, the motions for summary judgment dismissing the Labor Law § 240 (1) claim were denied.

Personal InjuryLadder SafetyLabor Law 240(1)Summary Judgment ReversalAppellate ReviewProximate CauseRecalcitrant WorkerSafety DevicesConstruction AccidentWorkplace Injury
References
16
Case No. 2014-769 Q C
Regular Panel Decision
Mar 18, 2016

Natural Therapy Acupuncture, P.C. v. American Tr. Ins. Co.

The plaintiff, Natural Therapy Acupuncture, P.C., acting as an assignee of Christopher Icheke, initiated an action to recover assigned first-party no-fault benefits from American Transit Ins. Co. The plaintiff moved for summary judgment, while the defendant cross-moved for summary judgment, asserting that all claims had been timely and properly paid in accordance with the workers' compensation fee schedule. The Civil Court denied the plaintiff's motion and granted the defendant's cross-motion, dismissing the complaint. On appeal, the Appellate Term affirmed the Civil Court's order, concluding that the defendant had successfully demonstrated full payment under the workers' compensation fee schedule, and the plaintiff failed to raise a triable issue of fact.

No-fault benefitsSummary judgmentWorkers' compensation fee scheduleAppellate reviewInsurance claimsAssignee rightsCivil Court decisionTimely paymentMedical servicesAcupuncture services
References
1
Case No. MISSING
Regular Panel Decision

Progressive Transportation Services, Inc. v. County of Essex

Progressive Transportation Services, Inc. sued Essex County, James Pierce, and Clifford Donaldson, asserting a 42 U.S.C. § 1983 civil rights claim for First Amendment retaliation and a state law claim for breach of contract. Progressive claimed the County retaliated against it by rejecting bids and withholding funds after Progressive combined transportation routes for efficiency, arguing this was a matter of public concern regarding taxpayer money and fuel usage. The Court determined that Progressive's speech, made in the context of contract negotiations to secure payment, was primarily an issue of economic self-interest and not a matter of public concern protected by the First Amendment. Consequently, the Court granted the defendants' motion for summary judgment, dismissing the federal claim with prejudice. The state law breach of contract claim was dismissed without prejudice, as the court declined to exercise supplemental jurisdiction after the dismissal of the federal claim.

42 U.S.C. Section 1983Civil RightsBreach of ContractFirst Amendment RetaliationSummary JudgmentGovernment ContractsFreedom of SpeechPublic Concern DoctrineSupplemental JurisdictionGovernmental Waste
References
16
Case No. MISSING
Regular Panel Decision

Progressive Northern Insurance Co. v. Sentry Insurance A Mutual Co.

Progressive Northern Insurance Company initiated an arbitration against Sentry Insurance A Mutual Company to recover first-party benefits paid to its insured following an automobile accident. After an initial arbitration claim (priority-of-payment) was denied, Progressive commenced a second arbitration based on a loss-transfer claim for the same reimbursement. Sentry raised the affirmative defense of res judicata, which the arbitrator upheld, denying Progressive's claim. Progressive then petitioned the Supreme Court, Nassau County, to vacate this arbitration award, but the petition was denied. The appellate court affirmed the Supreme Court's order, ruling that the arbitrator properly exercised its authority in applying res judicata, as both claims arose from the same transaction despite different legal theories.

Res JudicataArbitration Award VacaturInsurance ReimbursementAutomobile Accident ClaimLoss Transfer ClaimPriority-of-Payment ClaimAppellate ReviewSupreme Court NassauCPLR Article 75Arbitration Forum
References
24
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