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Case Law Database

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

Case No. MISSING
Regular Panel Decision
Jun 09, 2011

In re the Certification as Qualified Adoptive Parents Pursuant to Domestic Relations Law § 115-d

This case concerns Joanna K. and Scottye K.'s application to waive the mandatory certification as qualified adoptive parents for Jeremiah B., the biological son of Careese B. The K.s received physical custody of Jeremiah shortly after his birth in March 2009, prior to obtaining the required judicial certification, thereby violating New York's adoption statute. The court reviewed the convoluted history, including Careese B.'s judicial consent to adoption and the K.s' temporary custody order. However, the court denied the waiver application, emphasizing the critical importance of pre-placement certification to protect children and prevent unregulated transfers of custody. The decision stated that the petitioners failed to show good cause for waiver and that a retroactive approval of non-compliance would undermine legislative intent, although the K.s retain legal and physical custody pending the adoption petition.

Adoption Law CompliancePrivate-Placement Adoption RequirementsPre-Placement CertificationWaiver Application DenialChild Welfare LegislationFamily Law ProcedureJudicial DiscretionStatutory InterpretationParental Fitness StandardsCustody Transfer
References
9
Case No. ADJ11423609
Regular
Sep 12, 2022

DANIEL SERVIN vs. CERRITOS LEXUS, ACE AMERICAN INSURANCE

This case concerns a defendant's petition for reconsideration of an order authorizing left shoulder surgery. The defendant argued a prior utilization review denial should prevent subsequent authorizations, citing Labor Code section 4610(k). However, the applicant's physician resubmitted the request with additional supporting documentation, triggering a new utilization review. This subsequent review certified the surgery as medically necessary, resolving the medical dispute. The Board denied reconsideration, holding that the defendant voluntarily submitted the resubmitted request, making the February 2, 2022 certification final and precluding further utilization review.

Utilization ReviewFindings and OrderPetition for ReconsiderationMedical NecessityReverse Total Shoulder ArthroplastyRequest for AuthorizationNon-certificationCertificationLabor Code Section 4610Resubmission
References
4
Case No. MISSING
Regular Panel Decision

Skyline Specialty, Inc. v. Gargano

Petitioner, a New York-incorporated distributor of specialized equipment, sought certification as a woman-owned business enterprise (WOBE). The application, submitted by sole shareholder Nancy Struzenski, was denied because petitioner failed to demonstrate independent operation as required by state regulations. Petitioner challenged this determination via a CPLR article 78 proceeding, arguing that the respondent agency misinterpreted its own regulations and that the decision lacked substantial evidence. The court upheld the respondent's interpretation of the regulations as reasonable and found ample evidence, including petitioner's deep financial and operational ties to Environmental Products and Services, Inc. (EPS), to support the finding of non-independence. The court further dismissed petitioner's claims of procedural flaws during the initial investigation. Consequently, the determination to deny WOBE certification was confirmed, and the petition was dismissed.

Woman-Owned Business EnterpriseCertification DenialIndependent OperationAdministrative LawCPLR Article 78Judicial ReviewRegulatory InterpretationSubstantial EvidenceBusiness InterdependenceCorporate Structure
References
6
Case No. MISSING
Regular Panel Decision
Dec 14, 2016

Brown v. Barnes & Noble, Inc.

Plaintiffs, Café Managers (CMs), sued Defendant Barnes & Noble, Inc. for alleged violations of the Fair Labor Standards Act (FLSA), claiming improper classification as exempt from overtime pay despite performing non-exempt duties. They sought conditional certification of a nationwide collective action under FLSA Section 216(b). The court reviewed the two-stage process for FLSA collective action certification, noting the modest factual showing required at the first stage but emphasizing that certification is not automatic. The motion was denied without prejudice, as the court found the plaintiffs' evidence insufficient to demonstrate a common policy or plan requiring all CMs nationwide to primarily perform non-exempt work. The court indicated that plaintiffs could renew their motion if further discovery revealed additional evidentiary support.

FLSAFair Labor Standards ActOvertime PayWage and Hour LawCollective ActionConditional CertificationExempt EmployeeNon-Exempt EmployeeCafé ManagersJob Classification
References
33
Case No. MISSING
Regular Panel Decision

J.A. Marshall Sheet Metal & Roofing, Inc. v. State of New York

This CPLR article 78 proceeding reviews a determination by the Department of Economic Development denying the petitioner's request for certification as a woman-owned business enterprise. The petitioner, a New York corporation involved in sheet metal construction, was deemed ineligible. The court found that the respondent misinterpreted its rules by focusing on when the owner, Eva Marshall, acquired her interest rather than at the time of the application. The determination was annulled, and the matter remitted to the respondent for reconsideration using the appropriate eligibility factors. A concurring and dissenting opinion argued for annulling the determination due to lack of substantial evidence and irrationality, without remittal.

woman-owned business enterpriseWBE certificationCPLR Article 78administrative revieweligibility criteriastandard of reviewremittalsubstantial evidenceNew York laweconomic development
References
4
Case No. MISSING
Regular Panel Decision

O'KEEFE v. Bowen

Josephine O’Keefe and Louis Scheibeler, patients at Belair Nursing Home, sought Medicare Part A benefits for post-hospital extended care, which were denied by the Secretary of Health and Human Services. They initiated a proceeding under 42 U.S.C. § 405(g) and 1395ff(b) to review these final determinations. The court determined that the absence of a physician's certification, a prerequisite for benefits under Medicare regulations, compelled the affirmance of the denial of benefits. The decision highlighted that neither the initial hospital physicians nor the Belair Nursing Home physicians provided the required daily skilled nursing care certification. The court also examined the role of DMS-1 forms, primarily used for Medicaid, and the challenges faced by Utilization Review Committees in New York due to the scarcity of appropriate intermediate care facilities.

Medicare BenefitsPost-Hospital Extended CareSkilled Nursing CarePhysician CertificationDenial of BenefitsUtilization Review CommitteeMedicaid ActCustodial CareHealth and Human ServicesRegulatory Compliance
References
3
Case No. ADJ13656596
Regular
Mar 04, 2025

CARLOS CARTAGENA vs. ORION ORNAMENTAL IRON, INC.; CYPRESS INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) denied the Petition for Reconsideration filed by Cypress Insurance Company. The petition challenged a Findings and Order from November 26, 2024, which found in favor of a lien claimant, DENTAL TRAUMA CENTER. The defendant argued that the lien claimant failed to timely submit billing and that there was insufficient evidence for the dental injury. Additionally, the defendant sought retrospective utilization review. The WCAB, adopting the WCJ's report, upheld the original decision, citing that the lien claimant's billing was timely served on a co-defendant, that exceptions to the 12-month billing rule apply when a claim is initially denied as non-industrial, and that the defendant failed to present medical evidence to rebut the applicant's medical opinions. The WCAB also denied retrospective utilization review due to the defendant's initial failure to medically investigate the disputed body part.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code section 5909Electronic Adjudication Management SystemEAMSTransmission to Appeals BoardAD Rule 9792.9Utilization ReviewURDeferral of Utilization Review
References
0
Case No. ADJ8458980
Regular
Dec 10, 2018

ELENA ESPINOZA vs. PLY GEM PACIFIC WINDOWS, ZURICH NORTH AMERICA

This case concerns a lien claimant seeking reimbursement for durable medical equipment (DME) provided to applicant Elena Espinoza. The Workers' Compensation Appeals Board (WCAB) affirmed the administrative law judge's decision disallowing the lien. The WCAB found that the lien claimant failed to submit proper Requests for Authorization (RFAs) from the applicant's treating physician for the DME. Furthermore, even after receiving a non-certification notice from the defendant, the lien claimant did not follow the proper statutory procedures to dispute the utilization review decision. Therefore, the WCAB concluded the lien claimant did not meet its burden of proof.

Workers' Compensation Appeals BoardPetition for ReconsiderationLien ClaimantDurable Medical Equipment (DME)Request for Authorization (RFA)Utilization Review (UR)Findings and Order (F&O)Compromise and ReleasePrimary Treating Physician's Progress Report (PR-2)Retro-authorization
References
3
Case No. MISSING
Regular Panel Decision

Claim of Coratti v. Jon Josef Hair & Colour Group

The Workers' Compensation Board denied a claimant's motion to preclude a workers’ compensation carrier’s consultant report, which was based solely on a review of medical records, not an independent medical examination (IME). The claimant argued non-compliance with Workers’ Compensation Law § 137 (1) (b), a provision requiring notice if an IME is performed. The Board concluded the statute does not apply to records-review-only reports. An appellate court affirmed, holding that the plain language of § 137 (1) (b) explicitly refers to practitioners who have performed or will perform an IME, thereby excluding those who solely review records. The court emphasized that statutory interpretation must adhere to plain language, leaving policy arguments to the Legislature.

IME reportsrecords reviewWorkers' Compensation Lawstatutory interpretationpreclusion motioncausationoccupational illnessdue processlegislative intent
References
3
Case No. MISSING
Regular Panel Decision

Incorporated Village of Nissequogue v. Suffolk County Department of Civil Service

The Village of Nissequogue initiated a special proceeding against the Suffolk County Department of Civil Service after the department refused to certify the payroll for police officers Dennis McHugh and Roger Leigh. The officers, appointed in 1982 and 1984, had served commendably despite not being appointed from an official eligibility list. The department, aware of the irregular appointments since 1986, did not act until 1989 when it blocked payroll certification, prompting this legal challenge. The court examined the applicability of a 1984 amendment to Civil Service Law § 100 (5), which presumes proper appointment after three years, even for initially irregular appointments. The court ruled that the department could not refuse payroll certification, denied the department's motion to dismiss, and granted the officers' cross-petition for payment, citing the department's inaction despite prior knowledge.

Civil Service LawPayroll CertificationPolice OfficersIllegal AppointmentConstitutional LawSpecial ProceedingSuffolk CountyMerit SystemProbationary PeriodStatutory Interpretation
References
5
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