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

Case No. 2024 NY Slip Op 00599 [224 AD3d 428]
Regular Panel Decision
Feb 06, 2024

Matter of New Millennium Pain & Spine Medicine, P.C. v. Garrison Prop. & Cas. Ins. Co.

This case involves two appeals by New Millennium Pain & Spine Medicine, P.C. against Garrison Property & Casualty Insurance Company and GEICO Casualty Company. New Millennium sought to vacate master arbitration awards that denied its claims for no-fault benefits for medical services. The Supreme Court denied these applications. The Appellate Division, First Department, affirmed the Supreme Court's decisions, stating that an arbitrator's award will not be set aside unless it is irrational. The court also addressed the argument regarding a 20% wage offset in no-fault benefits, finding it unavailing under Insurance Law § 5102 (b). Ultimately, New Millennium was not entitled to attorneys' fees as it was not the prevailing party.

No-fault benefitsarbitration awardvacaturinsurance lawwage offsetappellate reviewmedical servicesno-fault policy exhaustionattorneys' feesCPLR Article 75
References
8
Case No. MISSING
Regular Panel Decision
May 14, 2014

Forest Rehabilitation Medicine PC v. Allstate Insurance

Plaintiff Forest Rehabilitation Medicine PC sued defendant Allstate to recover $3,490 for no-fault medical benefits provided to assignor Tracy Fertitta. The core issue was the medical necessity of "Calmare pain therapy" (scrambler therapy), a novel treatment. The court conducted a bench trial, hearing expert testimony from both sides. Dr. Ayman Hadhoud, for the defense, argued the treatment was not medically necessary, not cost-effective, and essentially a form of physical therapy. Dr. Jack D’Angelo, for the plaintiff, countered that the therapy, though new, had FDA approval, was used by the military, and reduced the assignor's pain levels. Applying the Frye standard, the court found the evidence regarding Calmare scrambler therapy reliable and ruled it was medically necessary for Ms. Fertitta's pain management. Consequently, judgment was awarded to the plaintiff, Forest Rehabilitation Medicine PC, for $3,490 plus attorney's fees and interest.

No-Fault InsuranceMedical NecessityCalmare Pain TherapyScrambler TherapyNovel TreatmentFrye StandardExpert TestimonyPain ManagementFDA ApprovalCervical Radiculopathy
References
14
Case No. MISSING
Regular Panel Decision

Wang v. Phoenix Satellite Television US, Inc.

Plaintiff Lihuan Wang, an unpaid intern, sued Phoenix Satellite Television US, Inc. for employment discrimination under the NYSHRL and NYCHRL. She alleged hostile work environment, quid pro quo sexual harassment, and retaliation by bureau chief Zhengzhu Liu, and a failure to hire her due to discriminatory animus. Phoenix moved to dismiss the Second Amended Complaint. The Court granted Phoenix's motion to dismiss Ms. Wang's hostile work environment claim, ruling that as an unpaid intern, she does not qualify as an 'employee' under the NYCHRL. However, the Court denied Phoenix's motion to dismiss Ms. Wang's remaining failure to hire claims, finding she plausibly alleged an informal application process for unposted vacancies.

Employment DiscriminationSexual HarassmentHostile Work EnvironmentFailure to HireUnpaid InternNYSHRLNYCHRLMotion to DismissEmployee DefinitionQuid Pro Quo
References
38
Case No. 2020 NY Slip Op 04896 [186 AD3d 1770]
Regular Panel Decision
Sep 03, 2020

Matter of Wen Liu v. Division of Gen. Internal Medicine, Mount Sinai Sch. of Medicine

Wen Liu, a data programming analyst, filed for workers' compensation benefits in May 2010, claiming a neck injury from a June 5, 2008 fall at work due to dizziness. The employer failed to timely file a notice of controversy, but a Workers' Compensation Law Judge (WCLJ) disallowed the claim, finding no causal connection between the injuries and employment. The Workers' Compensation Board upheld this decision, which the claimant appealed. The Appellate Division affirmed the Board's decision, emphasizing that the employer's procedural failure did not absolve the claimant of proving a causal relationship. Substantial evidence supported the Board's rejection of the claimant's medical proof, as emergency room records contradicted her later descriptions of the incident and indicated pre-existing conditions.

Workers' CompensationCausationMedical EvidenceTimely NoticeBurden of ProofInjuryFallDizzinessNeck InjuryCarpal Tunnel Syndrome
References
7
Case No. MISSING
Regular Panel Decision
Oct 20, 2016

Reyes v. Phoenix Beverages, Inc.

Plaintiff Eddy Reyes sued his former employer, Phoenix Beverages, Inc., alleging violations of the Family and Medical Leave Act (FMLA) and the New York City Human Rights Law (NYCHRL). Reyes claimed he was denied reinstatement to his sales representative position after taking FMLA leave due to a non-work-related injury. The court addressed Defendant's arguments regarding judicial estoppel and the Plaintiff's failure to provide a full-duty medical certification. The Court denied both parties' cross-motions for summary judgment, finding that Defendant failed to provide timely notice of fitness-for-duty requirements and that certain physical activities were not essential job functions. However, genuine factual disputes remain regarding whether Reyes was truly able to perform the essential functions of his job at the end of his FMLA leave, necessitating a trial.

FMLANYCHRLDisability DiscriminationSummary JudgmentJudicial EstoppelFitness-for-Duty CertificationEssential Job FunctionsReasonable AccommodationEmployee RightsEmployer Obligations
References
41
Case No. MISSING
Regular Panel Decision
May 05, 2000

Pain Resource Center v. Travelers Insurance

This case addresses a dispute regarding the payment of first-party no-fault benefits to a health provider, Pain Resource Center, as the assignee of John Hiotis, who was injured in an auto accident. The defendant, Travelers Ins. Co., challenged the validity of the assignment and the necessity of the medical services provided. The court affirmed the validity of the assignment under New York's Insurance Law and related regulations. However, based on conflicting expert testimonies, the court limited the compensable medical services to six hours and awarded the plaintiff $566.10, along with statutory interest and attorney's fees.

No-Fault InsuranceFirst-Party BenefitsAssignment ValidityMedical ServicesPeer ReviewInsurance LawHealth Provider ClaimAutomobile AccidentDamagesStatutory Interpretation
References
5
Case No. 2017 NY Slip Op 06635
Regular Panel Decision
Sep 26, 2017

Hamburg v. New York University School of Medicine

Plaintiff, Carole Hamburg, M.D., sued New York University School of Medicine for age discrimination under the New York City Human Rights Law and for breach of contract after her employment was not renewed. The Supreme Court granted NYU summary judgment on the age discrimination claim but denied it for the breach of contract claim. On appeal, the Appellate Division, First Department, affirmed the dismissal of the age discrimination claim, finding no evidence of discriminatory intent in NYU's restructuring and phase-out of the general radiology section. The court further modified the lower court's decision, granting summary judgment to NYU on the breach of contract claim, ruling that Dr. Hamburg was not contractually entitled to a year's notice of non-renewal as her non-tenure-eligible position automatically terminated unless renewed. Consequently, the entire complaint was dismissed.

Age DiscriminationEmployment ContractFaculty EmploymentUniversity AdministrationDepartment RestructuringSummary JudgmentAppellate ReviewContract InterpretationTenure-EligibleNon-Tenure Track
References
19
Case No. MISSING
Regular Panel Decision

Universal Acupuncture Pain Services, P.C. v. Lumbermens Mutual Casualty Co.

The New York court addresses a motion for reargument by Universal Acupuncture Pain Services, P.C. against Lumbermens Mutual Casualty Company concerning no-fault insurance claims. The central legal question is whether an expert witness's peer review report, created after a timely denial of a no-fault claim, can be admitted at trial, specifically under the Cirucci precedent regarding the specificity of denial grounds. The court grants the motion for reargument but upholds its initial ruling, which granted partial summary judgment on one of five claims. It clarifies that the expert's testimony must be strictly limited to the "concurrent or excessive care" ground initially stated by the insurer, excluding any new grounds like "medical necessity" not specified in the original denial. The court emphasizes that the issue of whether different treatment modalities constitute concurrent care for the same condition requires a trial for factual determination.

No-Fault InsurancePeer ReviewExpert Witness TestimonySummary Judgment MotionInsurance Law InterpretationSpecificity of DenialConcurrent Medical CareAcupuncture TreatmentChiropractic TreatmentPhysical Therapy
References
7
Case No. MISSING
Regular Panel Decision

Icahn School of Medicine at Mount Sinai v. Neurocrine Biosciences, Inc.

The plaintiff, Icahn School of Medicine at Mount Sinai, moved to strike several affirmative defenses and dismiss corresponding counterclaims brought by the defendant, Neurocrine Biosciences, Inc. The core dispute involves a patent license agreement and an alleged unlicensed sublicense by Neurocrine to AbbVie. The court granted Mt. Sinai's motion, striking Neurocrine's affirmative defenses for patent invalidity, non-infringement, and patent misuse. The decision emphasized that Neurocrine was estopped from challenging patent validity due to prior benefits from the license and clarified that Mt. Sinai's damages claim was for breach of contract, not future royalties. Consequently, Neurocrine's related declaratory judgment counterclaims were also dismissed.

Patent invalidityNon-infringementPatent misuseBreach of contractLicense agreementSublicenseDeclaratory judgmentMotion to strikeAffirmative defensesEstoppel
References
23
Case No. No. Civ. 8405(CM)(JCF)
Regular Panel Decision

Fleisher v. Phoenix Life Insurance

Plaintiffs Jonathan Berck and Martin Fleisher sued Phoenix Life Insurance Company for breach of contract regarding "premium-adjustable, universal life" (PAUL) insurance policies. Berck, a trustee, alleged two breaches by Phoenix: an improper 2010 cost of insurance (COI) rate increase and a concurrent interest rate decrease. Berck claimed the COI increase, based on impermissible factors and non-uniform application, forced him to invest an additional $700,000 to avoid higher charges, incurring a $35,000 sales fee. Phoenix moved to dismiss for lack of subject matter jurisdiction, asserting Berck lacked standing and that Class Action Fairness Act (CAFA) jurisdiction was lost post-class decertification, and for partial summary judgment on anticipatory repudiation and prejudgment interest. The court denied both motions, affirming Berck's standing due to economic harm and maintaining CAFA jurisdiction based on initial class allegations. The court also denied summary judgment regarding anticipatory repudiation and prejudgment interest as premature, allowing the case to proceed.

Breach of contractInsurance policiesUniversal life insuranceCost of insurance ratesInterest rate decreaseSubject matter jurisdictionStandingClass Action Fairness Act (CAFA)Motion to dismissMotion for partial summary judgment
References
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