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

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
Dec 21, 1995

In re Jordan Rehabilitation Service, Inc.

Jordan Rehabilitation Service, Inc., providing medical and vocational rehabilitative services, appealed a decision by the Unemployment Insurance Appeal Board. The Board assessed additional unemployment insurance contributions, finding that specialists hired by Jordan were employees, not independent contractors, between 1989 and 1991. The court reviewed whether there was substantial evidence to support the Board's conclusion of an employer-employee relationship. Key factors included Jordan's control over recruitment, screening, compensation, billing, and contractual restrictions on specialists. Ultimately, the court affirmed the Board's decision, determining that Jordan exercised sufficient overall control to establish an employer-employee relationship and thus was liable for the contributions.

Unemployment InsuranceEmployer-Employee RelationshipIndependent ContractorRehabilitation ServicesLabor LawSubstantial EvidenceControl TestJudicial ReviewAdministrative Law JudgeDepartment of Labor
References
8
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

Brentwood Pain & Rehabilitation Services, P.C. v. Allstate Insurance

This opinion addresses whether Magnetic Resonance Imaging (MRI) procedures are subject to the same fee limitations as X-rays under New York's no-fault auto insurance law. Plaintiffs, a group of MRI service providers ("Providers"), argued that applying x-ray fee schedules to MRIs is improper and violates insurance contracts. Defendants, numerous insurance companies ("Insurers"), along with the New York State Workers’ Compensation Board (WCB) and Department of Insurance (DOI), contended that the fee limitations for multiple diagnostic x-ray procedures (Ground Rule 3 of the WCB Fee Schedule) should also apply to MRIs. The court, deferring to the interpretations of the WCB and DOI, found their application of Ground Rule 3 to MRIs to be reasonable. Consequently, the court granted the Insurers' motion for summary judgment, denied the Providers' cross-motion for summary judgment, and denied the Providers' motion for class certification as moot.

MRIX-rayNo-Fault InsuranceFee ScheduleWorkers' Compensation BoardDepartment of InsuranceRegulatory InterpretationSummary JudgmentClass ActionDiagnostic Imaging
References
35
Case No. MISSING
Regular Panel Decision

Volt Technical Services Corp. v. Immigration & Naturalization Service

Plaintiff Volt Technical Services Corp. applied for H-2 visas for nuclear start-up technicians, which the Immigration and Naturalization Service (INS) denied, asserting the need was permanent, not temporary. After the denial was affirmed on appeal, Volt filed suit, alleging the INS's decision was arbitrary and capricious. The court upheld the INS's interpretation of the Immigration and Nationality Act § 101(a)(15)(H)(ii), which requires the employer's need for services to be temporary, not just the individual assignments. Finding that Volt demonstrated a recurring need for such technicians over several years, the court granted the INS's motion for judgment on the pleadings and denied Volt's.

Immigration LawH-2 visasNonimmigrant WorkersTemporary EmploymentImmigration and Nationality ActAdministrative Procedures ActDeclaratory Judgment ActAgency InterpretationJudicial ReviewNuclear Industry
References
5
Case No. MISSING
Regular Panel Decision

Americredit Financial Services, Inc. v. Oxford Management Services

AmeriCredit Financial Services, Inc. (AmeriCredit) commenced an action to confirm an arbitration award against Oxford Management Services (OMS). OMS cross-moved to vacate the award, alleging the arbitrator exceeded his powers by dismissing a counterclaim and manifestly disregarded the law. The arbitrator had dismissed OMS's counterclaim for spoilation of evidence. The Court affirmed the arbitrator's decision, finding he did not exceed his authority under the RSA by dismissing the counterclaim or by interpreting the contract terms regarding account termination. The Court also found no manifest disregard for the law, concluding the arbitrator's decision was rationally supported by the record. Consequently, AmeriCredit's motion to confirm the award was granted, and OMS's motion to vacate was denied.

Arbitration Award ConfirmationArbitration Award VacaturFederal Arbitration ActManifest Disregard of LawArbitrator PowersSpoilation of EvidenceContract InterpretationCollection Agency DisputeSummary ProceedingJudicial Review of Arbitration
References
41
Case No. 02-CV-6666L
Regular Panel Decision
Oct 29, 2008

Brown v. NEW YORK STATE DEPT. OF CORREC. SERVICES

Plaintiff, Curtis Brown, a Correction Officer, sued his employer, the New York State Department of Correctional Services (DOCS), and several individuals for racial discrimination and retaliation under Title VII, Sections 1981, 1983, and the New York Human Rights Law. Brown alleged a hostile work environment due to continuous harassment, verbal abuse, and physical violence by white coworkers at Elmira Correctional Facility since 2001, along with retaliatory discipline. Defendants sought summary judgment. The court dismissed claims against individual defendants under Title VII, all claims against Elmira, the State Comptroller, Civil Service, and all constructive discharge claims due to Eleventh Amendment immunity or other legal deficiencies. However, the court denied summary judgment on Brown's Title VII hostile work environment and retaliation claims against DOCS, finding sufficient evidence of fact disputes for these claims to proceed to trial.

Racial DiscriminationHostile Work EnvironmentRetaliationEmployment LawTitle VIICivil Rights ActSection 1981Section 1983Human Rights LawSummary Judgment Motion
References
83
Case No. MISSING
Regular Panel Decision

Doctor of Medicine in the House, P.C. v. Allstate Ins.

This case concerns a medical service provider plaintiff seeking $1,876.76 in no-fault claim benefits. The defendant insurance company denied the claim, citing that the fees were excessive under the workers’ compensation fee schedule and that prior reimbursements had exhausted the daily 8-unit limit for physical medicine procedures. The central legal question involved interpreting paragraph 11 of the Official New York Workers’ Compensation Medical Fee Schedule, Physical Medicine (2010), specifically whether the 8-unit limit applied per provider or cumulatively across all claimants. The court ruled in favor of the plaintiff, clarifying that the 8-unit rule is an individual provider fee limitation and not an exhaustion regulation for all claimants, distinguishing it from the $50,000 basic economic loss limit.

No-Fault BenefitsWorkers' Compensation Fee ScheduleMedical Reimbursement8-unit RuleFee Schedule InterpretationInsurance LawPhysical MedicineStatutory InterpretationClaim DenialExcessive Billing
References
9
Case No. MISSING
Regular Panel Decision

Valley Rehabilitation and Medical Offices, P.C. v. Cash

Plaintiff, Valley Rehabilitation, sought $10,010.56 from defendant Lynda Cash for physical therapy, claiming breach of contract and an account stated based on an agreement where Cash would be liable if her workers' compensation claim failed. However, Cash received a $12,500 workers' compensation settlement, fulfilling the conditions of the agreement. The court found that Valley Rehabilitation failed to comply with Workers’ Compensation Board rules, including obtaining authorization for services over $500 and properly filing documentation. Consequently, the court ruled that the medical provider must collect fees from the employer/carrier, not the claimant. Furthermore, the defendant's timely objections prevented the establishment of an account stated. Therefore, the plaintiff's claim was barred, and the action was dismissed with prejudice.

Workers' CompensationMedical BillingAccount StatedBreach of ContractStatutory ComplianceMedical ProviderInjured WorkerLump-Sum SettlementAuthorization RequirementsNew York Law
References
4
Case No. 06 Civ. 3994(DC)
Regular Panel Decision
Sep 14, 2007

BRENTWOOD PAIN & REHABILITATION SERV. v. Allstate Ins. Co.

The case examines whether Magnetic Resonance Imaging (MRI) charges fall under the same discounted fee schedule rules as x-rays for multiple body parts under New York's no-fault auto insurance law. Plaintiffs, MRI service providers, contested the application of Workers' Compensation Board (WCB) Radiology Ground Rule 3 to MRIs, arguing the rule specifically mentions only x-rays. Defendant insurance companies, supported by interpretations from the Department of Insurance (DOI) and WCB, asserted the rule's applicability to MRIs. The U.S. District Court for the Southern District of New York granted summary judgment to the insurers, deferring to the agencies' "rational" and "reasonable" interpretation. The court concluded that applying the discount rule to MRIs aligns with the No-Fault Law's objectives to control costs and prevent fraud, thus denying the providers' motions.

No-Fault InsuranceMRIX-rayFee ScheduleRadiologyWorkers' Compensation BoardDepartment of InsuranceAgency DeferenceStatutory InterpretationSummary Judgment
References
25
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