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

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. 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. 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
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. MISSING
Regular Panel Decision
May 30, 1984

Aucompaugh v. General Electric

This case involves an appeal from a Workers' Compensation Board decision that found a claimant's injury compensable. The claimant was injured attempting a handstand on a swivel chair during a work break. The employer and its carrier argued this constituted horseplay and did not arise out of employment. However, the Board found that physical exercises, including push-ups and chin-ups, were regularly conducted by employees during breaks, and the employer was aware of and permitted these activities. The Board concluded that it is reasonable for young men with physically demanding jobs to engage in some activity during slack periods, and thus the risk was a risk of employment. The appellate court affirmed the Board's decision, holding that the "horseplay" was sufficiently related to employment to make the injury compensable, despite the employer's arguments regarding the isolated nature of the act and the claimant's initial misrepresentation.

Workers' CompensationHorseplayCompensable InjuryCourse of EmploymentArising Out of EmploymentPhysical ExercisesWork BreaksEmployer AwarenessAppellate ReviewAffirmed Decision
References
1
Case No. MISSING
Regular Panel Decision

O'BRIEN v. King World Productions, Inc.

The plaintiff, a former employee of King World Productions, Inc., alleged sexual harassment by King World and Stuart Hersch under Title VII of the Civil Rights Act and New York's Human Rights Law. She also claimed intentional and negligent physical and mental injury. The defendants moved to dismiss the second cause of action and to strike demands for a jury trial and damages. The court dismissed the intentional tort claim due to the one-year statute of limitations and the negligence claim under the Workers' Compensation Law's exclusive remedy provision. However, the claim under the New York Human Rights Law was allowed to proceed. The motion to strike compensatory and punitive damages was granted for the Title VII claim but denied for the Human Rights Law claim. The demand for a jury trial was also denied for the Title VII claim but permitted for the state Human Rights Law claim.

Sexual HarassmentTitle VII Civil Rights ActNew York Human Rights LawWorkers' Compensation LawIntentional TortNegligence ClaimJury Trial RightCompensatory DamagesPunitive DamagesExclusive Remedy
References
14
Case No. 2024 NY Slip Op 03080 [228 AD3d 426]
Regular Panel Decision
Jun 06, 2024

DiMaggio v. Port Auth. of N.Y. & N.J.

Plaintiffs Salvatore DiMaggio et al. alleged that Salvatore was struck in the face by a metal rod during a construction project, resulting in injuries to his face, head, and spine, as well as aggravation of prior asymptomatic conditions. Defendants Port Authority of New York and New Jersey et al. subsequently sought authorizations for records related to 19 prior incidents involving an individual named "Salvatore DiMaggio" and moved to compel discovery or dismiss the case. The Supreme Court initially granted defendants' motion to the extent of compelling plaintiffs to provide a Jackson affidavit and authorizations. However, the Appellate Division modified this order, ruling that the requirement for a Jackson affidavit was improper, as that procedure applies when documents are claimed to be missing, not when seeking authorizations from third parties, and CPLR 3130 prohibits interrogatories upon a party served with a demand for a bill of particulars. The Appellate Division affirmed the compulsion for plaintiffs to provide authorizations for records related to claims made by Salvatore and incidents in which he was involved, given his acknowledgement of involvement in some prior incidents and failure to timely object to the demands. The court further limited the scope of these authorizations to records relating to injuries to or treatment of Salvatore DiMaggio's face, mouth, head, cervical spine, and/or thoracolumbar spine, due to the nature of the alleged injuries and the principle that general anxiety/depression from physical injuries does not place entire mental health into contention, while allowing them to be unrestricted by date due to allegations of exacerbated preexisting injuries.

DiscoveryAuthorizationsMedical RecordsPreexisting InjuriesJackson AffidavitCPLR 3126CPLR 3130Waiver of ObjectionAppellate ProcedurePersonal Injury
References
11
Case No. MISSING
Regular Panel Decision

Eaton v. Chahal

This consolidated decision by Justice William H. Keniry addresses common discovery issues across six negligence actions in Rensselaer County Supreme Court. The primary focus is the requirement for a "good faith" effort to resolve discovery disputes, as mandated by section 202.7 of the Uniform Rules for Trial Courts (22 NYCRR). The court emphasizes that a "good faith" effort necessitates significant contact and negotiation between counsel. Due to a complete failure to comply with this rule, the motions and cross-motions in five cases (Eaton, Frament, Lindeman, Madsen, and Malave) are denied. In the Oathout case, the defendants' motion is conditionally granted, pending plaintiff's compliance with discovery demands. The court also outlines its position on substantive discovery issues like medical reports, collateral source information, statutory violations, age/date of birth, photographs, and authorizations for workers' compensation and no-fault insurance files.

Discovery disputesBill of particularsGood faith requirementCPLR Article 31Medical reportsCollateral source informationStatutory violationsWorkers' compensation filesNo-fault insurance filesJudicial discretion
References
19
Case No. 2024 NY Slip Op 05009 [231 AD3d 1257]
Regular Panel Decision
Oct 10, 2024

Matter of Miller v. Transdev Bus on Demand LLC

The case involves Candace Miller, whose husband, a paratransit operator, died from COVID-19 contracted during his employment in March 2020. His job required transporting often visibly ill passengers, presenting an elevated risk of exposure. The Workers' Compensation Board affirmed the claim for death benefits, finding a causal link between his employment and death. The Appellate Division, Third Department, upheld this decision, concluding that substantial evidence supported the Board's finding of increased exposure risk. The court noted that contracting COVID-19 in the workplace qualifies as an unusual hazard and is compensable.

COVID-19Workers' CompensationDeath BenefitsCausal ConnectionEmployment ExposureParatransit WorkerPublic ContactIncreased RiskAppellate AffirmationSubstantial Evidence
References
9
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