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

Case No. CA 13-01105
Regular Panel Decision
Feb 14, 2014

KALEIDA HEALTH v. UNIVERA HEALTHCARE

This case concerns an appeal by Utica Mutual Insurance Company from a judgment that denied its motion for summary judgment and granted summary judgment to Kaleida Health and Univera Healthcare. The judgment declared Utica obligated to pay an outstanding hospital bill to Kaleida Health. Utica argued that collateral estoppel applied due to a Workers' Compensation Board determination, but the court found Kaleida Health and Univera Healthcare were not parties to that proceeding. Utica also contended the action was barred by arbitration, which was rejected as not compulsory. The Appellate Division affirmed the Supreme Court's decision, concluding Utica was responsible for the hospital bill as the patient's admission was a continuation of treatment for a work-related injury.

Workers' CompensationHospital BillCollateral EstoppelSummary JudgmentArbitrationPublic Health LawAppellate PracticeInsurance ObligationWork-Related InjuryHealth Care Provider
References
3
Case No. MISSING
Regular Panel Decision
Dec 27, 2001

MacRo v. Independent Health Ass'n, Inc.

Plaintiffs Cheryl Macro and Kim Zastrow, insured under a group health contract with Independent Health through the Tonawanda City School District, initiated a class action in state court to challenge Independent Health's modification of infertility treatment coverage. Defendant Independent Health removed the case to federal court, asserting ERISA preemption. Plaintiffs moved to remand, arguing that their claims fell under New York Insurance Law, which is exempt from ERISA preemption by the saving clause, and that their health plan qualified as a 'governmental plan' also exempt from ERISA. The District Court granted the plaintiffs' motion, concluding that the claims were indeed saved from ERISA preemption and that the plan was exempt, thus rendering federal subject matter jurisdiction absent. The court accordingly remanded the case back to New York State Supreme Court.

Infertility CoverageHealth Insurance DisputesERISA PreemptionSaving ClauseGovernmental PlansRemoval to Federal CourtSubject Matter JurisdictionNew York Insurance LawClass Action LitigationEmployee Benefits Plan
References
31
Case No. 99 Civ. 11886 WCC
Regular Panel Decision
Jul 11, 2000

Leonard v. DUTCHESS CTY. DEPT. OF HEALTH

Plaintiffs, including restaurant and bowling center owners and the National Smokers Alliance, challenged smoking regulations promulgated by the Dutchess County Department of Health and Board of Health. They alleged violations of equal protection, free speech, 42 U.S.C. § 1983, the New York State Constitution, and Article 78. The defendants moved to dismiss, arguing lack of subject matter jurisdiction, while plaintiffs moved for summary judgment and injunctive relief. The court, treating both as motions for summary judgment, found that the Board of Health exceeded its authority under the New York State separation of powers doctrine by enacting regulations that balanced economic, social, and privacy interests, rather than solely health concerns. Specifically, the court noted the Board's consideration of non-health factors, the non-interstitial nature of the regulations compared to state law, and the County Legislature's prior failure to pass similar legislation. Consequently, the court granted plaintiffs' motion for summary judgment and permanently enjoined the defendants from enforcing the challenged smoking regulations.

Smoking RegulationsPublic Health LawSeparation of PowersAdministrative Agency OverreachSummary JudgmentInjunctive ReliefDutchess CountyClean Indoor Air ActConstitutional LawArticle 78
References
12
Case No. MISSING
Regular Panel Decision

Washington Heights-West Harlem-Inwood Mental Health Council, Inc. v. District 1199, National Union of Hospital & Health Care Employees, RWDSU

This case involves a dispute between District 1199, National Union of Hospital and Health Care Employees, and Washington Heights-West Harlem-Inwood Mental Health Council, Inc. The union sought to enforce an arbitration award requiring the Council to rehire and provide back pay to an employee, Edward Lane. The Council cross-moved to vacate the award, arguing that no valid collective bargaining agreement with an arbitration clause existed between the parties. Although the parties had acted under the terms of a proposed agreement for a period, including processing some grievances and wage increases, no formal, signed contract had ever been executed. Citing recent appellate court decisions emphasizing contract formalism over implied intent, the District Court granted the Council's motion to vacate the arbitration award and denied the union's motion to enforce it, concluding that without a signed agreement, there was no contractual duty to arbitrate.

Arbitration AwardSummary JudgmentContract FormationCollective BargainingLabor DisputeContract FormalismVacation of AwardEnforcement of AwardMeeting of the MindsFederal Court
References
23
Case No. MISSING
Regular Panel Decision
May 14, 2013

Veneruso v. Mount Vernon Neighborhood Health Center

Plaintiff James J. Veneruso, on behalf of Community Choice Health Plan of Westchester Inc. (CCHP), sued Defendant Mount Vernon Neighborhood Health Center to recover 'Surplus Distributions' CCHP made to Mount Vernon. CCHP, a New York not-for-profit corporation, was directed by the New York State Department of Health to terminate operations and commence dissolution. Plaintiff, appointed temporary receiver, sought to recover payments made to Mount Vernon, arguing they were unlawful under New York's Not-for-Profit Corporation Law § 515(a). Defendant removed the case to federal court, asserting federal jurisdiction based on complete preemption, substantial federal question, its status as a federal corporation, and the involvement of federal funds. The court rejected all of Defendant's arguments for federal jurisdiction, finding that the claims were based purely on state law and that federal law was, at best, a potential defense. Consequently, the Plaintiff's motion to remand the case to state court was granted, while the request for attorneys' fees was denied.

MedicaidNon-Profit Corporation LawState Law ClaimsFederal JurisdictionRemoval StatuteComplete PreemptionSubstantial Federal QuestionDeclaratory JudgmentAttorneys' FeesCooperative Federalism
References
76
Case No. MISSING
Regular Panel Decision
May 27, 2014

Rumsey v. Northeast Health, Inc.

Plaintiff Ellen Rumsey, a former teacher, sued Northeast Health, Inc. and St. Peter's Health Partners alleging retaliatory termination in violation of Title VII and NYSHRL, and breach of contract. Rumsey claimed her employment was terminated after she supported a coworker's pregnancy discrimination claim and participated in a related internal investigation. Defendants moved for summary judgment, arguing a legitimate, non-retaliatory reason for termination based on Rumsey's repeated inappropriate behavior and a classroom incident. The court found that Rumsey failed to establish a causal connection between her protected activities and termination, citing intervening disciplinary events and her history of problematic working relationships. The motion for summary judgment was granted, and all claims were dismissed with prejudice.

RetaliationTitle VIINYSHRLPregnancy DiscriminationSummary JudgmentEmployment TerminationWorkplace DisputeAt-Will EmploymentBreach of ContractHuman Resources
References
50
Case No. 2022 NY Slip Op 07383 [211 AD3d 1616]
Regular Panel Decision
Dec 23, 2022

Williams v. Kaleida Health

Dr. Aston B. Williams, a physician with medical staff privileges at Kaleida Health, sought a medical exemption from a COVID-19 vaccine mandate, which was subsequently denied. As a result of noncompliance, his privileges at Buffalo General Medical Center were suspended. Williams initiated legal action, requesting injunctive relief to prevent the revocation of his privileges. Kaleida Health moved to dismiss the complaint. The Supreme Court denied Williams's motion for an injunction and partially granted Kaleida Health's motion, dismissing the complaint without prejudice. The Appellate Division, Fourth Department, affirmed this decision, determining that Public Health Law § 2801-c provides the exclusive remedy for alleged violations of § 2801-b (1), necessitating Williams to first pursue his claim before the Public Health and Health Planning Counsel.

COVID-19 vaccine mandatemedical staff privilegesinjunctionPublic Health Lawexclusive remedyPHHPCadministrative remediesdismissal without prejudicehealth care workersemployer-employee dispute
References
4
Case No. No. 11, No. 12
Regular Panel Decision
Mar 26, 2019

Lilya Andryeyeva v. New York Health Care , Adriana Moreno v. Future Care Health Services

The New York Court of Appeals addressed a common issue in two joint appeals: whether home health care aides on 24-hour shifts must be paid for each hour. The Department of Labor (DOL) interpreted its Wage Order (12 NYCRR part 142) to allow payment for at least 13 hours if the employee receives at least 8 hours for sleep (with 5 uninterrupted) and 3 hours for meals. The Appellate Division rejected this, but the Court of Appeals reversed, deferring to DOL's interpretation as rational and consistent with the Wage Order's plain language. The cases were remitted for lower courts to evaluate class certification issues in accordance with DOL's interpretation.

Home Health Care24-Hour ShiftsMinimum Wage ActWage OrderDepartment of Labor InterpretationClass CertificationAppellate ReviewLabor Law ViolationsSleep BreaksMeal Breaks
References
49
Case No. MISSING
Regular Panel Decision

Franzese v. United Health Care/Oxford

Plaintiffs Robert and Elizabeth Franzese, parents and legal guardians of disabled adult Robert Franzese Jr. ("Bobby"), sued United Health Care/Oxford under ERISA to recover medical benefits. Bobby, suffering from chronic lung disease, requires 24/7 in-home nursing care. Oxford denied preauthorization for private duty nursing, citing it as an exclusion, and denied home health care services. The court granted Oxford's summary judgment motion regarding private duty nursing and Xopenex preauthorization, finding private duty nursing not covered. However, the court denied Oxford's motion regarding home health care services, deeming Oxford's denial arbitrary and capricious due to lack of substantial evidence. The case is remanded to Oxford for reconsideration of home health care benefits.

Employee Retirement Income Security Act (ERISA)Medical BenefitsHealth Insurance DenialSummary JudgmentArbitrary and Capricious StandardHome Health CarePrivate Duty NursingPreauthorizationMedical NecessityChronic Lung Disease
References
37
Case No. MISSING
Regular Panel Decision

Government Employees Insurance v. Uptown Health Care Management, Inc.

Plaintiffs GEICO allege a scheme where defendants, including Uptown Health Care Management d/b/a East Tremont, Hisham Elzanaty, Alan Goldenberg, Dr. Hisham Ahmed, and Dr. Jadwiga Pawlowski, fraudulently billed GEICO for millions in services. GEICO contends East Tremont was ineligible for reimbursement under New York's no-fault insurance laws, operating without a legitimate medical director, violating its operating certificate, and paying kickbacks for referrals. The complaint raises six causes of action, including declaratory judgment, RICO violations (18 U.S.C. §§ 1962(c), 1962(d)), common law fraud, aiding and abetting fraud, and unjust enrichment. Defendants moved to dismiss under Rule 12(b)(1) for Burford abstention and Rule 12(b)(6) for failure to state a claim, arguing GEICO's claims would invalidate a DOH license and interfere with state oversight. Citing the similar Allstate Ins. v. Elzanaty action, the court denied defendants' motions, affirming that insurers can challenge fraudulent licensing and conduct under RICO and fraud claims, even if state authorities have approved the facility. The court concluded that such claims do not disrupt New York's regulatory scheme and need not be raised exclusively with the DOH or through an Article 78 proceeding.

Insurance FraudNo-Fault InsuranceRICO ActMedical LicensingHealthcare FraudAbstention DoctrineRule 12(b)(1) MotionRule 12(b)(6) MotionArticle 28 FacilitiesKickbacks
References
21
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