CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

Case Law Database

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

Case No. 2025 NY Slip Op 02248 [237 AD3d 1379]
Regular Panel Decision
Apr 17, 2025

Matter of Jehle v. DOCCS Coxsackie Corr. Facility

William Jehle, a correction officer, sustained a work-related injury, prompting his employer, DOCCS Coxsackie Correctional Facility, to continue paying his full wages. The employer sought reimbursement, and Jehle's attorney filed for counsel fees. The Workers' Compensation Law Judge (WCLJ) established the claim, found a temporary total disability, awarded a credit to the employer for wage reimbursement, and granted counsel fees of $4,300 as a lien against this reimbursement. The Workers' Compensation Board affirmed the WCLJ's decision, deeming the lien proper under Workers' Compensation Law § 24 (2) (b). The Appellate Division, Third Department, further affirmed the Board's decision, holding that an award for previously unawarded benefits constitutes an 'increase' under the law, and that counsel fees are appropriately a lien against the employer's reimbursement, dismissing arguments of the employer subsidizing fees.

Counsel FeesLien on AwardEmployer ReimbursementTemporary Total DisabilityWorkers' Compensation LawAppellate ReviewCorrection OfficerWage ReimbursementStatutory InterpretationClaimant Attorney Fees
References
3
Case No. FRE 0222651
Regular
Jul 15, 2008

CHRISTOPHER HUNT vs. MADERA COUNTY ROAD DEPARTMENT

The Appeals Board granted reconsideration of a WCJ's decision that limited a lien claimant's facility fees to the Official Medical Fee Schedule. The Board found the WCJ erred by not applying the correct *Kunz* standard for determining the reasonableness of outpatient surgery facility fees, which considers factors beyond the fee schedule. The case is remanded for further proceedings to properly develop the record according to *Kunz*.

KunzOfficial Medical Fee Scheduleoutpatient surgery facility feeslien claimantreconsiderationen banc decisionreasonableness of feesusual feegeographical areacontractually negotiated fees
References
5
Case No. MISSING
Regular Panel Decision
Aug 24, 1999

Town of Hempstead v. Inc. Village of Atlantic Beach

This case involves two related actions arising from inter-municipal agreements for waste disposal services. The defendants appealed from initial court orders concerning their obligations to pay minimum waste commitment tonnage fees and their entitlement to various credits, including those for private carters, recyclable materials, and yard waste. The plaintiffs cross-appealed regarding the methodology for calculating yard waste credits and the fees for using the Town's transfer facility. The Supreme Court, Nassau County, issued an initial order and a subsequent amended order upon reargument, clarifying several points. The Appellate Division affirmed the amended order, holding that the agreements unambiguously required villages to pay minimum tonnage fees regardless of actual waste delivered. The court also determined that the villages were only obligated to pay transfer facility fees based on actual waste delivered and that any ambiguities regarding yard waste credits should be interpreted against the Town as the drafter of the agreements.

Inter-municipal agreementsWaste disposalSummary judgmentContract interpretationMinimum commitment feesYard waste creditTransfer facility feesUnambiguous agreementsExtrinsic evidenceAmbiguity construction
References
10
Case No. 2019 NY Slip Op 09078 [178 AD3d 1268]
Regular Panel Decision
Dec 19, 2019

Matter of Donovan v. DOCCS Coxsackie Corr. Facility

Danl D. Donovan, a correction sergeant, sustained a work-related hip injury. His employer, DOCCS Coxsackie Correctional Facility, advanced his wages and sought reimbursement. Following an award for a schedule loss of use, a dispute arose regarding the deduction of attorney fees from the claimant's payment, which the Workers' Compensation Board upheld. While Donovan's appeal was pending before the Appellate Division, the Board issued an amended decision based on a new legal rationale. Consequently, the Appellate Division, Third Department, dismissed the initial appeal as moot.

Workers' CompensationSchedule Loss of UseAttorney Fee DeductionReimbursement DisputeMoot AppealAppellate DivisionWork-related InjuryWage ReimbursementIndependent Medical ExaminerAdministrative Review
References
2
Case No. RIV 0032677
Regular
Jan 23, 2008

LUIS VALENCIA vs. VILLA AMALFIRISTORANTE, CALIFORNIA INDEMNITY INSURANCE

The Workers' Compensation Appeals Board denied reconsideration, affirming the administrative law judge's decision regarding the reasonableness of an outpatient surgery center's facility fees. The Board reiterated that the lien claimant bears the burden of proving their charges are reasonable and that the defendant presented credible evidence rebutting the billed amount. The decision also clarified that reasonableness considers various factors beyond just the facility's usual accepted fees, and inadmissible evidence from the lien claimant was appropriately excluded.

Workers' Compensation Appeals BoardLien ClaimantFacility FeeReasonablenessBurden of ProofOutpatient Surgery CenterMedical Treatment ExpenseReconsiderationEvidenceAdministrative Law Judge
References
5
Case No. OAK 0293725
Regular
May 22, 2008

MARGARITA CHAVEZ vs. WESTERN NATIONAL PROPERTIES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded the initial denial of the lien claim by Bay Surgery Center (BSC). BSC's claim for facility fees was initially denied because it allegedly failed to prove it operated as an "outpatient setting" and thus was exempt from needing a fictitious business name permit. The Board found that BSC presented sufficient evidence of its "surgical clinic" license to meet its initial burden, thereby establishing it as an "outpatient setting" for purposes of the lien claim, and remanded the case for further proceedings on the reasonableness of the fees.

Workers' Compensation Appeals BoardLien claimantOutpatient settingFictitious Business Name permitSurgical clinic licenseDepartment of Health ServicesFacility feeMedical BoardLicensed physicianReasonable fee
References
9
Case No. SBR 0315782
Regular
Jul 30, 2007

GORDON ADAMS vs. SOUTHLAND DRYWALL COMPANY, STATE COMPENSATION INSURANCE FUND

This case concerns a lien claimant, Premier Outpatient Surgery Center, Inc., whose lien was denied because it allegedly did not use its full corporate name or have a fictitious business name permit. The Appeals Board rescinded the denial and returned the case for further proceedings, finding that Premier was properly licensed as an outpatient facility and that the defendant did not timely raise the fictitious business name statement issue. The Board clarified that a facility fee lien claimant is not required to have a Medical Board fictitious-name permit, but may need to file a fictitious business name statement if operating under a name other than its legal corporate name.

Workers Compensation Appeals BoardLien ClaimantFictitious Business Name StatementFictitious-Name PermitBusiness & Professions Code Section 17910Business & Professions Code Section 2415(a)Medical Board of CaliforniaOutpatient SettingFacility FeeCompromise and Release
References
13
Case No. 531543
Regular Panel Decision
Jan 07, 2021

Matter of Gilliam v. Doccs Wende Corr. Facility

Claimant Wanda Gilliam, a correction officer, sustained work-related injuries to her right hip and left shoulder in May 2017. Following various medical evaluations, including conflicting opinions from orthopedist Michael Grant and independent examiner Louis Nunez regarding schedule loss of use (SLU), a Workers' Compensation Law Judge initially awarded a 60% SLU of her left arm and 57.5% SLU of her right leg. Upon administrative review, the Workers' Compensation Board modified this decision, crediting Nunez's evaluation, and awarded a 30% SLU for her left arm while making no SLU award for her right leg, and also reduced the attorney's fee. The Appellate Division, Third Department, affirmed the Board's decision, determining that it was supported by substantial evidence, particularly in resolving conflicting medical opinions and exercising discretion regarding counsel fees. The court found no abuse of discretion in the reduction of attorney's fees, noting the limited period of representation.

Workers' CompensationSchedule Loss of Use (SLU)Left Arm InjuryRight Leg InjuryOrthopedic ExaminationMedical Opinion ConflictAppellate ReviewAttorney FeesDiscretionary AwardSubstantial Evidence
References
17
Case No. 2022 NY Slip Op 05964 [209 AD3d 596]
Regular Panel Decision
Oct 25, 2022

Pirozzo v. Laight St. Fee Owner LLC

Plaintiff Paul Pirozzo sought summary judgment on his Labor Law § 240 (1) claim against defendants Laight Street Fee Owner LLC, Laight Street Fee Owner II LLC, and Sciame Construction, LLC, which was granted by the Supreme Court. The Appellate Division, First Department, affirmed this decision. The plaintiff established a prima facie case by demonstrating that the scaffold he was working on collapsed without an apparent reason. The defendants' arguments that the plaintiff was the sole proximate cause, either by failing to lock scaffold pins or remaining on the scaffold while it was moved, were deemed unavailing. The court noted that these actions, even if proven, would amount to comparative negligence, which is not a defense to a Labor Law § 240 (1) claim, and there was no evidence of specific instructions to the plaintiff that were disobeyed.

Summary judgmentLabor Law § 240 (1)Scaffold collapseSole proximate causeComparative negligenceWorkers' compensation Form C-2Hearsay objectionPersonal knowledgeRecalcitranceAppellate Division
References
9
Case No. 25 NY3d 907
Regular Panel Decision
2015-XX-XX

Government Employees Insurance v. Avanguard Medical Group, PLLC

This case addresses whether no-fault insurance carriers are obligated to pay facility fees to New York State-accredited office-based surgery (OBS) centers for the use of their premises and support services. The court concluded that neither existing statutes nor regulations mandate such payments. Plaintiffs, a group of GEICO insurers, successfully sought a declaratory judgment that they are not legally required to reimburse Avanguard Medical Group, PLLC, for OBS facility fees, totaling over $1.3 million. The decision affirmed the Appellate Division's ruling, emphasizing that OBS facility fees are not explicitly covered by statute or fee schedules, nor do they fall under reimbursable "professional health services" as per 11 NYCRR 68.5. The court highlighted the distinct regulatory frameworks for OBS centers compared to hospitals and ambulatory surgery centers, declining to mandate policy changes best left to the legislature.

No-Fault InsuranceOffice-Based Surgery (OBS)Facility FeesInsurance LawBasic Economic LossFee SchedulesWorkers' Compensation BoardDepartment of Financial ServicesStatutory InterpretationRegulatory Framework
References
16
Showing 1-10 of 3,206 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational