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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

Maes ex rel. Maes v. El Paso Orthopaedic Surgery Group, P.A.

Vincent and Cynthia Maes, as next friend of their minor daughter Isabel, and The Insurance Company of the State of Pennsylvania (ICTSP), appealed a summary judgment granted in favor of El Paso Orthopaedic Surgery Group, P.A. (EPOSG). Isabel's claim was for loss of parental consortium due to her father Vincent Maes's alleged disabling injury following surgery performed by an EPOSG employee, Dr. Paul Cho, in 2001. Vincent Maes's initial lawsuit against EPOSG was dismissed with prejudice in 2004, and the two-year statute of limitations for his underlying claim expired in 2003. EPOSG moved for summary judgment, arguing Isabel's claims were time-barred and barred by the prior dismissal of her father's underlying claim. The appellate court affirmed the summary judgment, concluding that Isabel's derivative loss of parental consortium claims were extinguished by both the running of the statute of limitations on her father's claim and its prior dismissal with prejudice.

medical malpracticeloss of parental consortiumstatute of limitationssummary judgmentderivative claimshealthcare liabilityminor's claimsprior litigationdismissal with prejudiceTexas Civil Practice and Remedies Code
References
26
Case No. 08-06-00071-CV
Regular Panel Decision
Aug 30, 2007

Vincent Maes and Cynthia Maes and the Insurance Company of the State of Pennsylvania v. El Paso Orthopaedic Surgery Group

Vincent and Cynthia Maes and The Insurance Company of the State of Pennsylvania appealed the dismissal of a health care liability suit against El Paso Orthopaedic Surgery Group (EPOSG). The Maeses alleged negligence and vicarious liability against EPOSG after Vincent Maes suffered severe complications following back surgery by Dr. Paul Cho, an EPOSG neurosurgeon. The trial court dismissed all claims against EPOSG, finding the expert reports insufficient to address EPOSG's breach of the standard of care, even for vicarious liability claims. On appeal, the Court reviewed whether an expert report was necessary for vicarious liability claims and if the severance of claims against EPOSG was proper. The appellate court ultimately affirmed the trial court's judgment, upholding the dismissal of all claims against EPOSG and the severance.

Health Care LiabilityMedical MalpracticeExpert Report SufficiencyVicarious LiabilityRespondeat SuperiorDismissal with PrejudiceSeverance of ClaimsSpinal Surgery ComplicationsNeuroscienceOrthopedic Surgery Group Liability
References
17
Case No. 08-11-00331-CV
Regular Panel Decision
Oct 31, 2012

Vincent Maes and Cynthia Maes, as Next Friend of Isabel G. Maes, a Minor Child and the Insurance Company of the State of Pennsylvania v. El Paso Orthopaedic Surgery Group, P. A.

Vincent Maes sustained a spinal injury in 2000 from a motor vehicle accident, leading to a lumbar laminectomy in 2001 by Dr. Paul Cho, an employee of El Paso Orthopaedic Surgery Group, P.A. (EPOSG). Following the surgery, Mr. Maes allegedly experienced severe neurological issues. In 2010, Vincent and Cynthia Maes, acting as next friend for their minor daughter Isabel, along with The Insurance Company of the State of Pennsylvania (ICTSP), filed a lawsuit against EPOSG, asserting claims for Isabel's loss of parental consortium and alleging vicarious liability for Dr. Cho's negligence. EPOSG sought summary judgment, contending that Isabel's claims were time-barred by the two-year statute of limitations applicable to Mr. Maes's original claim and also by the prior dismissal of Mr. Maes's claim with prejudice in 2004. The trial court granted summary judgment in favor of EPOSG. The appellate court affirmed the trial court's decision, ruling that claims for loss of parental consortium are derivative in nature and are consequently extinguished when the statute of limitations on the injured parent's underlying claim expires or when that underlying claim is dismissed with prejudice.

Medical MalpracticeParental ConsortiumSummary JudgmentStatute of LimitationsDerivative ClaimsDismissal with PrejudiceTexas Civil Practice and Remedies CodeHealth Care LiabilityMinor's ClaimsAppellate Review
References
28
Case No. 03-05-00620-CV
Regular Panel Decision
Mar 14, 2008

Texas Orthopaedic Association, Texas Medical Association and Andrew M. Kant, M.D. v. Texas State Board of Podiatric Medical Examiners Texas Podiatric Medical Association And Bruce A. Scudday, D.P.M.

The Texas Orthopaedic Association and others challenged a rule by the Texas State Board of Podiatric Medical Examiners that defined 'foot' to include portions of the ankle and soft tissues extending into the leg. Appellants argued this rule impermissibly expanded the scope of podiatry beyond its statutory definition and intruded into the practice of medicine. The district court initially found the rule valid. However, the Court of Appeals reversed this decision, holding that the Board exceeded its authority. The appellate court concluded that the rule's expansive definition authorized podiatrists to treat anatomical features located well above the traditional foot and ankle, which is inconsistent with the occupations code and constitutes an unauthorized practice of medicine.

Podiatry ScopeRegulatory AuthorityStatutory InterpretationAdministrative Rule ValidityMedical Practice ActTexas Occupations CodeDeclaratory JudgmentAnkle TreatmentFoot DefinitionMedical Licensing Board
References
29
Case No. MISSING
Regular Panel Decision

Maes v. EL PASO ORTHOPAEDIC SURGERY GROUP

Vincent and Cynthia Maes, along with The Insurance Company of the State of Pennsylvania (ICTSP), appealed the dismissal of their health care liability suit against El Paso Orthopaedic Surgery Group (EPOSG). The lawsuit originated from complications Vincent Maes suffered following spinal surgery performed by Dr. Paul Cho, a neurosurgeon affiliated with EPOSG. The trial court dismissed claims against EPOSG because the expert reports submitted by Dr. James P. Bradley and Dr. Robert Wheeler Rand did not explicitly address EPOSG's breach of the standard of care or name its associated physicians. The appellate court affirmed this dismissal, concluding that the trial court did not abuse its discretion, emphasizing the necessity of specific expert reports for each health care provider. Additionally, the court upheld the severance of claims against EPOSG from the remaining claims against Dr. Cho.

Health Care LiabilityMedical MalpracticeExpert Report SufficiencyVicarious LiabilityRespondeat SuperiorDismissal With PrejudiceSeverance Of ClaimsSpinal Surgery ComplicationsNeurosurgical NegligenceStandard of Care Breach
References
8
Case No. 03-04-00253-CV
Regular Panel Decision

Texas Orthopaedic Ass'n v. Texas State Board of Podiatric Medical Examiners

The Texas State Board of Podiatric Medical Examiners (the "Board") promulgated a rule defining "foot" to include portions of the ankle and soft tissues extending into the leg. The Texas Orthopaedic Association, Texas Medical Association, and Andrew M. Kant, M.D. (appellants) challenged this rule, arguing it impermissibly expanded the scope of podiatry. The district court upheld the rule, but the appellate court reversed its judgment. The appellate court concluded that the Board exceeded its authority because the rule's definition authorized podiatrists to treat body parts outside the traditional scope of podiatry, such as nerves and veins along the leg, constituting unauthorized medical practice. The court rejected arguments regarding legislative acceptance and the rule's reasonableness, finding it inconsistent with existing statutes.

PodiatryScope of PracticeAdministrative RuleStatutory InterpretationMedical Practice ActAnkle TreatmentDeclaratory JudgmentAppellate ReviewTexas LawMedical Licensing
References
55
Case No. MISSING
Regular Panel Decision

UnitedHealthcare Services, Inc. v. Asprinio

UnitedHealthcare Services, Inc. sought a preliminary injunction to prevent out-of-network providers David Asprinio, M.D., and University Orthopaedics, P.C., from balance billing its members for amounts exceeding United's payments. The court denied the motion, finding that United failed to establish a likelihood of success on the merits, irreparable injury, or a favorable balance of equities. The court emphasized the absence of a contractual relationship between the insurer and providers and the lack of an applicable statute compelling providers to accept United's payments, reaffirming the common-law right of providers to seek reasonable fees from patients. United's claims of tortious interference and deceptive practices under General Business Law § 349 were also dismissed for lack of supporting evidence or standing.

Preliminary InjunctionBalance BillingOut-of-Network ProviderHealth Insurance DisputeTortious InterferenceGeneral Business Law 349Quantum MeruitMedical FeesFair Health DatabaseImplied Contract
References
37
Case No. 03-05-00620-CV
Regular Panel Decision
Mar 14, 2008

Janie Morales And Terrie Secaida, Community Administrator of the Estate of Edward Secaida v. Chard Richard Craig Wheaton Van Lines, Inc. And Johnnie P. Williams

This case addresses an appeal concerning the validity of an administrative rule promulgated by the Texas State Board of Podiatric Medical Examiners, which defined the term 'foot' to include portions of the ankle and soft tissues extending into the leg. The appellants, the Texas Orthopaedic Association, Texas Medical Association, and Andrew M. Kant, M.D., argued that this rule impermissibly expanded the statutory scope of podiatric practice. The district court initially upheld the rule's validity. However, the Court of Appeals reversed this decision, concluding that the Board exceeded its authority by adopting a definition that authorized podiatrists to treat anatomical features well above the ankle, thereby encroaching upon the unauthorized practice of medicine and exceeding the traditional scope of podiatry.

Scope of PracticePodiatryMedical LawAdministrative Rule ValidityStatutory InterpretationTexas Occupations CodeDeclaratory JudgmentMedical Board AuthorityAnkle TreatmentFoot Definition
References
22
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
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