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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
Nov 14, 1991

Pellach v. Pellach

The Supreme Court modified an earlier order denying plaintiff's motion to reopen a maintenance and support hearing and compel defendant's physical examination. The record before the Special Referee was reopened, allowing the plaintiff to subpoena defendant's bank account records due to alleged discovery of new information and previous attorney refusal. However, the court affirmed the denial of the physical examination request, noting the defendant's prior adjudication of permanent disability by the Workers’ Compensation Board. The delay in the divorce action, pending since 1988, was largely attributed to the defendant's frequent changes of attorneys.

DivorceMaintenanceSupportFinancial DisclosureBank AccountsPhysical ExaminationWorkers' CompensationJudicial DiscretionAppellate ReviewReopening Record
References
1
Case No. 2016-198 Q C
Regular Panel Decision
Jun 01, 2018

Comprehensive Care Physical Therapy, P.C. v. Allstate Ins. Co.

This case concerns a provider, Comprehensive Care Physical Therapy, P.C., seeking no-fault benefits from Allstate Insurance Company. The Civil Court initially denied the plaintiff's summary judgment motion and granted the defendant's cross-motion, dismissing the complaint based on the assignor's failure to appear for independent medical examinations (IMEs) and claims exceeding the fee schedule. On appeal, the Appellate Term modified this order, finding that Allstate failed to provide sufficient proof of timely denial form mailing, thereby precluding its defenses regarding IMEs and the fee schedule. Consequently, Allstate's cross-motion for summary judgment was denied, reversing that part of the lower court's decision. However, the Appellate Term affirmed the denial of the plaintiff's summary judgment motion, as the plaintiff also failed to establish their claims.

no-fault insurancesummary judgmentindependent medical examinationstimely denialinsurance defenseappellate reviewmedical billingassignee rightsprocedural requirementsfee schedule
References
5
Case No. MISSING
Regular Panel Decision
Jan 05, 1989

In re Jessica R.

The Law Guardian appealed an order from Family Court, Westchester County, which granted the father's motion to compel medical and psychological examinations of his daughter, Jessica R., in a child protective proceeding. This proceeding, initiated by the Westchester County Department of Social Services, alleged sexual abuse by the father. The appellate court reviewed the Family Court Act provisions concerning court-appointed versus party-selected examiners and the amended Family Court Act § 1038 (c). While affirming the right to a psychiatric or psychological evaluation by a party-selected professional to aid in defense, the court found it an improvident exercise of discretion to order a second physical examination. This decision was based on Jessica R.'s prior traumatic experience and anxiety during a previous attempt. Consequently, the order was modified to deny the physical examination and affirmed as modified.

Child protective proceedingFamily Court ActMedical examinationPsychological evaluationPsychiatric evaluationSexual abuseDiscoveryAppellate reviewDiscretionary powerPotential harm to child
References
13
Case No. MISSING
Regular Panel Decision
Apr 22, 1980

Rastaetter v. Charles S. Wilson Memorial Hospital

The case concerns a medical malpractice action where the plaintiff appealed a summary judgment granted to defendants Porits and Kim. The complaint was dismissed for lack of subject matter jurisdiction regarding alleged malpractice during an October 1975 physical examination. The central legal question was whether an individual undergoing a pre-employment physical should be considered an employee under the Workers' Compensation Law concerning injuries from that examination. The court determined that such an individual is not an employee in this context. The judgment was modified to grant summary judgment and dismiss the complaint only for malpractice related to the pre-employment physical, and as modified, the judgment was affirmed.

Medical MalpracticePre-employment PhysicalWorkers' Compensation LawEmployer-Employee RelationshipSummary JudgmentSubject Matter JurisdictionAppellate ReviewInjury during Examination
References
4
Case No. MISSING
Regular Panel Decision
Nov 03, 1967

Holloway v. Board of Examiners

The petitioner, a school social worker, initiated an Article 78 proceeding to compel the respondent to provide copies of medical and other reports that led to an unsatisfactory rating in an examination for a Supervisor of School Social Workers license. The Supreme Court, Kings County, initially dismissed the petition. However, the appellate court reversed this judgment, granting the petition to the extent of directing the respondent to furnish the reports to a physician designated by the petitioner, rather than directly to the petitioner. The case was remanded to the Special Term for further proceedings, including a determination on allowing the petitioner more time to appeal the unsatisfactory rating.

Article 78 CPLRLicense ExaminationSchool Social WorkerMedical ReportsDisclosureAdministrative AppealUnsatisfactory RatingAppellate ReversalRemandPhysician Disclosure
References
3
Case No. MISSING
Regular Panel Decision

Miller v. Loblaw, Inc.

Plaintiff Marie Miller initiated a personal injury lawsuit in Chemung County against Loblaw, Inc., and Pasyl Corp., alleging negligence related to a fall in a parking lot. Defendant Loblaw, Inc. filed a motion under CPLR 3121 and 3124 to compel Miller to appear for a physical examination by Dr. Bruce Stewart in Ithaca. Plaintiff's counsel objected to the location, arguing it was too distant from his Elmira office and requested compensation for travel. The court, after considering similar statutes and cases, determined that the 33-mile distance to Ithaca was not unreasonable for the examination. Consequently, the court granted Loblaw's motion, directing Marie Miller to appear for the physical examination without obligating the defendants to cover the plaintiff's attorney's travel expenses or fees.

Physical ExaminationMotion to CompelCPLR 3121CPLR 3124Attorney FeesTravel ExpensesChemung CountyIthacaNegligencePersonal Injury
References
2
Case No. MISSING
Regular Panel Decision

Claim of Brian VV. v. Chenango Forks Central School District

Petitioners filed a notice of claim after their six-year-old daughter was allegedly sexually assaulted on a school bus. The respondent, a school district, subsequently served a notice to orally examine the infant and petitioners. While petitioners submitted to examination, they refused to produce their child. The Supreme Court initially granted petitioners’ motion to strike the notice to examine the infant, deeming prior informal interviews with the child as substantial compliance. However, the appellate court reversed this decision, emphasizing that General Municipal Law § 50-h mandates a pre-action examination as a condition precedent. The court ruled that the prior interviews did not fulfill the statutory purpose and that the child's submission to an examination is required. Due to the child's young age, the matter was remitted to the Supreme Court to conduct a hearing to determine the child's competency to testify under oath before the examination takes place.

General Municipal Law § 50-hEducation Law § 3813Infant examinationSexual assault claimCondition precedentAppellate procedureCompetency hearingSchool district liabilityPre-action discoveryOath requirement
References
13
Case No. 2015-2337 Q C
Regular Panel Decision
May 18, 2018

Sama Physical Therapy, P.C. v. Hereford Ins. Co.

This case concerns an action by Sama Physical Therapy, P.C., as assignee, to recover first-party no-fault benefits from Hereford Insurance Co. The defendant argued that the plaintiff's assignor had been injured during the course of employment. The Civil Court conditionally granted defendant's cross-motion for summary judgment, ordering the plaintiff to file an application with the Workers' Compensation Board within 90 days. Plaintiff failed to comply with this order, and upon renewal, the Civil Court adhered to its prior determination. The Appellate Term, Second Department, affirmed the Civil Court's order, finding that the plaintiff did not demonstrate compliance with the order to make a proper application under the Workers' Compensation Law.

No-Fault BenefitsSummary JudgmentWorkers' Compensation BoardAppellate ReviewConditional GrantFailure to ComplyRenewal MotionInsurance LawAssigneeMedical Provider
References
1
Case No. 2015-608 Q C
Regular Panel Decision
Dec 19, 2017

Adelaida Physical Therapy, P.C. v. 21st Century Ins. Co.

In this case, Adelaida Physical Therapy, P.C., acting as an assignee, appealed an order from the Civil Court of the City of New York, Queens County. The original order had granted 21st Century Insurance Company's motion for summary judgment, dismissing parts of a complaint seeking first-party no-fault benefits for services billed under specific CPT codes (97010, 97110, and 97124). The Appellate Term, Second Department, reversed the lower court's decision. The appellate court found that 21st Century Insurance Company failed to demonstrate that it had used the correct conversion factor to calculate the reimbursement rate, thus not establishing its defense that the charged fees exceeded the workers' compensation fee schedule. As a result, the branches of the defendant's motion for summary judgment related to those CPT codes were denied.

No-Fault BenefitsCPT CodesSummary JudgmentWorkers' Compensation Fee ScheduleReimbursement RateAppellate ReviewInsurance DisputeCivil ProcedureConversion FactorMedical Billing
References
2
Case No. 46885/05, 47943/05, 47945/05
Regular Panel Decision

Robert Physical Therapy, P.C. v. State Farm Mutual Automobile Insurance

This case involves three consolidated claims for first-party no-fault benefits related to physical therapy services. The plaintiff's assignors received physical therapy, and the defendant, an insurer, denied some claims due to disputes over billing codes. The central legal issues concerned whether a physical therapist could utilize billing codes from the medicine fee schedule when such services were not explicitly in the physical medicine schedule, and if range of motion and muscle testing could be billed separately from evaluation and management on the same day. The court determined that physical therapists are not confined to the physical medicine section and can use codes from any section of the medical fee schedule. Furthermore, the defendant failed to provide sufficient evidence to justify its denials regarding separate billing for range of motion and muscle testing. Consequently, the court ruled in favor of the plaintiff, awarding judgment for all disputed amounts.

Physical Therapy BillingNo-Fault BenefitsMedical Fee ScheduleCPT CodesWorkers' Compensation RegulationsEvaluation and Management ServicesRange of Motion TestingMuscle TestingProvider SpecialtyBilling Disputes
References
4
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