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Case Law Database

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

Case No. 2023 NY Slip Op 23398 [81 Misc 3d 21]
Regular Panel Decision
Nov 30, 2023

Associated Plastic Surgeons & Consultants, P.C. v. Global Commodities, Inc.

Plaintiff, Associated Plastic Surgeons & Consultants, P.C., filed a commercial claims action against Global Commodities, Inc. for $5,000 for unpaid medical services provided to an alleged employee. Plaintiff claimed defendant agreed to pay privately. The District Court dismissed the action after excluding a document detailing telephone conversations, which plaintiff argued was admissible under the business records exception or relaxed commercial claims evidence rules. The Appellate Term affirmed the dismissal, ruling that plaintiff failed to prove the patient was injured during employment or that the document was admissible as a business record, thus failing to establish defendant's liability for the medical bill. The court emphasized that while commercial claims courts are not bound by strict evidence rules, judgments cannot rest solely on hearsay.

Commercial claimsMedical servicesUnpaid billsBusiness records exceptionHearsayEvidence rulesEmploymentWorkers' Compensation LawAppellate reviewSubstantial justice
References
10
Case No. MISSING
Regular Panel Decision

Long Island Neurological Assocs., P.C. v. Highmark Blue Shield & Reed Smith LLP

Plaintiff Long Island Neurological Associates, P.C. sued Highmark Blue Shield and Reed Smith LLP for under-reimbursement of surgical services under ERISA. The case involved a 4-year-old patient who received complex out-of-network surgery from Dr. Schneider due to the unavailability of in-network providers. Highmark significantly under-reimbursed the billed amount and denied multiple appeals, failing to provide requested documentation. The patient's parents assigned their rights to the Plaintiff, leading Defendants to move for dismissal, asserting an anti-assignment provision in their Administrative Service Agreement (ASA). The Court denied the motion, ruling that the ASA is not an ERISA plan document and thus its anti-assignment clause is not binding on plan participants, confirming Plaintiff's standing. The Rule 12(b)(6) motion was also denied as abandoned.

ERISAMotion to DismissAnti-assignment clauseAdministrative Service Agreement (ASA)Plan DocumentSubject Matter JurisdictionStandingUnder-reimbursementOut-of-network providerHealth Insurance
References
27
Case No. MISSING
Regular Panel Decision

In re Anonymous

This case concerns an adoption proceeding in Nassau County for a neurologically handicapped child. The petitioners, an approved adoptive family, sought to finalize the adoption. Former foster parents, the intervenors, challenged this, claiming a statutory preference for adoption due to their long-term care of the child. The court found that the intervenors had previously declined to adopt the child and failed to take affirmative steps to gain statutory preference while the child was in their care. The decision emphasized that intervention rights apply to current foster parents in custody disputes, and ultimately, the court prioritized the child's best interests by granting the petitioners' adoption application.

AdoptionFoster CareChild WelfareNeurological HandicapBest Interests of ChildInterventionStatutory PreferenceSocial Services LawAgency Discretion
References
3
Case No. MISSING
Regular Panel Decision

Satalino v. Dan's Supreme Supermarket

This decision affirms the Workers' Compensation Board's determination that the claimant failed to establish a recognizable link between his occupational disease and employment. The claimant, diagnosed with disc herniation, arthritis, spondylolisthesis, and stenosis, presented testimony from two neurological surgeons. Dr. Stephen Burstein could not definitively link the conditions to employment, noting potential causes like chronic degeneration or age. Dr. Artem Vaynman, while performing surgeries, opined that heavy lifting accelerated degeneration but also acknowledged an initial view of no employment relation and a lack of scientific evidence for repetitive lifting causing spinal injury. The court found no abuse of discretion in the Board's conclusion, emphasizing the requirement for a probable and rationally based causal relationship.

Occupational DiseaseWorkers' Compensation LawCausal RelationshipMedical OpinionDisc HerniationArthritisSpondylolisthesisStenosisHeavy LiftingDegenerative Condition
References
5
Case No. 2017 NY Slip Op 03580 [150 AD3d 1349]
Regular Panel Decision
May 04, 2017

Claim of Richards v. Massena Central Schools

Mary Ann Richards, a cleaner, sustained neck injuries in March 2010 while working for Massena Central Schools, leading to an established workers' compensation claim and cervical surgery. In June 2013, she sought to amend her claim to include consequential neurological injuries, specifically scapulothoracic crepitation and mandibular dysesthesia. Both the Workers' Compensation Law Judge and the Workers' Compensation Board denied this amendment, concluding that Richards failed to demonstrate a causal relationship between her established work injury and the alleged consequential conditions. The Appellate Division, Third Department, affirmed the Board's decision, finding it supported by substantial evidence. Multiple medical professionals, including orthopedic surgeons and neurologists, provided opinions that either could not determine the etiology of Richards' symptoms or found no objective evidence linking them to her work injury or subsequent surgery.

Workers' CompensationNeurological InjuryCausationMedical EvidenceAppellate ReviewScapulothoracic CrepitationMandibular DysesthesiaCervical SurgeryIndependent Medical ExaminationBurden of Proof
References
5
Case No. 518081
Regular Panel Decision
Aug 07, 2014

MatterofWeldonvDiNapoli

Petitioner Michael X. Weldon, a State Police investigator, sought State Police disability retirement benefits due to permanent incapacitation from left shoulder injuries sustained in 2003 and 2008. His application was initially denied, and after a hearing, the Hearing Officer upheld the denial, a decision subsequently affirmed by the respondent, Thomas P. DiNapoli, as State Comptroller. Weldon then initiated a CPLR article 78 proceeding to challenge this determination. The Appellate Division confirmed the respondent's decision, noting that Weldon's medical records lacked a finding of permanency regarding his disability. Conversely, the New York State and Local Police and Fire Retirement System presented expert testimony from a neurologist and an orthopedic surgeon who found no objective evidence of permanent neurological disability and suggested that Weldon's chronic regional pain syndrome and temporary total disability could improve with aggressive physical therapy.

State PoliceDisability Retirement BenefitsPermanent IncapacitationShoulder InjuriesCPLR Article 78Medical EvidenceNeurological ConditionOrthopedic AssessmentChronic Regional Pain SyndromePhysical Therapy
References
5
Case No. ADJ3206000 (LAO 0877236)
Regular
Aug 10, 2012

JENNIFER HESTER vs. TECHNICOLOR, Permissibly Self-Insured

The applicant sought reconsideration of a decision limiting the defendant's payment for hip surgery to the Official Medical Fee Schedule, which the applicant's surgeon deemed insufficient. The Appeals Board granted reconsideration due to the complex fee dispute, noting that while extraordinary circumstances existed regarding the surgeon's qualifications, the reasonableness of his requested fee was unproven. To resolve this, the Board ordered the appointment of an agreed physician to investigate the surgeon's usual fee and its reasonableness compared to others with similar expertise.

ReconsiderationFindings of FactAgreed PhysicianMedical TreatmentFee ScheduleExtraordinary CircumstancesUsual FeeHip ArthroscopyOsteoplastyChondroplasty
References
1
Case No. ADJ9379623
Regular
May 18, 2018

ETHERY AMARI vs. CHILDREN'S HOSPITAL OF LOS ANGELES

The Workers' Compensation Appeals Board granted the applicant's petition for removal, rescinding a prior order that denied her request for an additional neurology Qualified Medical Evaluator (QME). The applicant sustained admitted injuries including to her spine and shoulder, and also claimed headaches. Her treating physician recommended a neurology consult twice, and the applicant testified about worsening headaches post-injury. The Board found that these factors constituted good cause and demonstrated significant prejudice, warranting the appointment of a neurology QME panel.

Petition for RemovalPanel Qualified Medical EvaluatorNeurology QMEWCABFindings and OrderIndustrial InjuryCervical SpineLumbar SpineHeadachesPrimary Treating Physician
References
1
Case No. ADJ3218661 (OAK 0339889)
Regular
Feb 07, 2011

CHANCE ROLLINS vs. JOHN MARTIN STABLES, INC.; AMERICAN HOME ASSURANCE administered by AIG, CLAIMS SERVICES

The Appeals Board vacated its prior order granting reconsideration and dismissed the defendant's petition for reconsideration, finding the WCJ's ruling was not a final order. However, the Board granted removal, rescinded the WCJ's order, and denied the applicant's request for a neurology consultation under Labor Code §4601(a). The matter was returned to the trial level with instructions to issue an order for a new QME panel in neurology, as Dr. Jamasbi's request for a consultative neurological evaluation constituted good cause for a new panel under 8 Cal. Code Regs. §31.7. Attorney fees for the ex parte communication were upheld.

WCABPetition for ReconsiderationPetition for RemovalLabor Code 4601(a)Labor Code 4062.3QMEAgreed Medical EvaluatorNeurological ConsultMedical DirectorSpecialty Panel
References
0
Case No. MISSING
Regular Panel Decision

Burger v. Bladt

The infant plaintiff suffered personal injuries resulting in serious learning disabilities and neurological problems following a collision. The defendant moved to compel additional medical examinations by a psychologist, psychiatrist, and a teacher of the neurologically handicapped, as well as a parent intake evaluation by a psychiatric social worker, after the plaintiffs refused to submit to more than a single examination. The Supreme Court partially denied this motion, deeming it overly burdensome. On appeal, the order was modified to grant the defendant's request for an examination by Annella Stevens, a teacher of the neurologically handicapped, and an interview by a psychiatric social worker to obtain the child's developmental history, affirming the order as modified.

Personal InjuryMedical ExaminationDiscoveryAppellate ProcedureInfant PlaintiffNeurological ProblemsLearning DisabilitiesSupreme CourtPre-Trial DiscoveryCourt Order Modification
References
4
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