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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

Yuhas v. Provident Life & Casualty Insurance

Deborah Yuhas sued Provident Life and Casualty Insurance Company under ERISA for long-term disability benefits, claiming physical disability. Yuhas, a graphic designer, initially received benefits for a mental condition, which ceased after 24 months due to policy limitations. She subsequently appealed, claiming physical disabilities from a car accident, leading to a retroactive award of benefits for a specific period (October 1991 through May 1993) but no further benefits. Provident repeatedly denied her claim for benefits beyond May 1993, citing lack of objective physical disability and the expiration of appeal periods. Yuhas filed suit in September 2000, but the court granted Provident's motion for summary judgment, ruling that her claim was barred by the three-year statute of limitations, which had accrued by December 13, 1993, at the latest.

ERISALong Term Disability BenefitsSummary JudgmentStatute of LimitationsAccrual of Cause of ActionDisability Insurance PolicyMental DisorderPhysical InjuryAppeals ProcessRepudiation of Claim
References
13
Case No. MISSING
Regular Panel Decision

Great Wall Acupuncture, P.C. v. GEICO Insurance

This case involves an action brought by a medical provider against an insurer to recover assigned first-party no-fault benefits. The insurer partially paid the claim but denied the remaining portion, arguing that charges for acupuncture treatments exceeded the maximum fees allowed under the applicable fee schedule. Following a nonjury trial, the Civil Court ruled in favor of the defendant, dismissing the complaint. The court held that an insurer may utilize the workers’ compensation fee schedule for acupuncture services rendered by chiropractors, even when the services are performed by a licensed acupuncturist. The appellate court affirmed this judgment, concluding that since the defendant reimbursed the plaintiff according to the workers’ compensation fee schedule for chiropractor-provided acupuncture services, no additional reimbursement was due.

Acupuncture ServicesChiropracticNo-Fault InsuranceFee ScheduleWorkers' Compensation Fee ScheduleLicensure RequirementsFirst-Party BenefitsAppellate ReviewInsurance ReimbursementCivil Court Decision
References
4
Case No. VNO 0435305
Regular
Dec 14, 2007

RENEE JACKSON vs. JEWISH FAMILY SERVICES OF LOS ANGELES, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board rescinded a prior award and returned the case to the trial level for further proceedings regarding the reasonable value of services provided by lien claimant Wilshire Surgicenter, Inc. The Board found that neither party presented sufficient evidence according to the precedent set in *Kunz v. Patterson Floor Coverings, Inc.* regarding usual fees accepted by providers. The case will be reheard to allow both parties to develop evidence regarding the usual fees accepted by providers in the geographic area for the services rendered.

Wilshire SurgicenterKunzComparative Study SummaryBill Review ExpertReasonable ValueOutpatient Surgery Facility FeesMedicare Reimbursement RatesLabor Code § 4903.1(c)Due ProcessRebuttal Evidence
References
6
Case No. MISSING
Regular Panel Decision

St. Vincent Medical Care, P.C. v. Country-Wide Insurance

The case concerns a provider's action to recover assigned first-party no-fault benefits from an insurer. The trial court initially granted the provider's summary judgment motion, but the appellate judgment modified the award, severing a $228.55 claim for February 22, 2006, services. This specific claim was denied summary judgment because it was timely denied by the insurer as exceeding the workers' compensation fee schedule. For the remaining claims, the appellate court affirmed summary judgment for the provider, determining that the insurer's follow-up verification requests were prematurely mailed and thus ineffective, precluding most defenses due to untimely denials. The insurer's cross-motion for summary judgment was consequently denied.

No-fault benefitsSummary judgmentVerification requestsTimely denialInsurance claimsWorkers' compensation fee scheduleAppellate reviewMedical servicesOverdue paymentsStatutory claim form
References
8
Case No. MISSING
Regular Panel Decision

Holland Laundry, Inc. v. Simon

This case concerns an action brought by the plaintiffs to enjoin the defendants from pursuing certain charges before the State Labor Board. The court considered the respondent's motion to dismiss the amended complaint. The order granting this motion was affirmed. No opinion was provided for this decision, with Presiding Justice Lazansky, along with Justices Carswell, Johnston, Taylor, and Close, concurring.

InjunctionLabor LawMotion to DismissAmended ComplaintAffirmedCourt OrderConcurring Justices
References
0
Case No. ADJ10013565
Regular
Nov 05, 2018

ANTONIO GUZMAN vs. KLEAN SWEEP PARKING LOT SERVICE, INC., STATE COMPENSATION INSURANCE FUND, INSURANCE COMPANY OF THE WEST

The Workers' Compensation Appeals Board (WCAB) granted Trucare Pharmacy's Petition for Reconsideration, rescinding the prior order to stay Trucare's lien. The WCAB found that the defendant failed to meet its burden of proof that Trucare was "controlled" by a criminally charged provider as defined by Labor Code section 139.21(a)(3). Specifically, there was no evidence that John Garbino, the criminally charged provider, was an officer, director, or 10% shareholder of Trucare Pharmacy. Therefore, Trucare's lien is not subject to a stay under Labor Code section 4615 and the case is returned for further proceedings.

Labor Code section 4615criminally charged providerjoint venturepartnershiplien claimantprovider statuscontrolled entitystatutory interpretationdue processadministrative director
References
13
Case No. 2025 NY Slip Op 02587 [237 AD3d 1196]
Regular Panel Decision
Apr 30, 2025

Matter of Correra v. Millwood Fire Dist.

The petitioner, a volunteer firefighter, was terminated from the Millwood Fire District after a disciplinary hearing. The District alleged he provided false information on a medical questionnaire in 2020 by not disclosing a "permanently, partially disabled" Workers' Compensation Board designation. He was also charged with misconduct and insubordination for improperly obtaining a physical examination while suspended. The hearing officer found him guilty of both charges, recommending termination, which the District adopted. The Appellate Division, Second Department, confirmed the District's determination, finding substantial evidence supported the misconduct and insubordination charges, and that the penalty of termination was not disproportionate.

MisconductInsubordinationVolunteer FirefighterTerminationCivil Service LawCPLR Article 78False StatementsMedical QuestionnaireWorkers' CompensationSubstantial Evidence
References
8
Case No. CA 13-00856
Regular Panel Decision
May 02, 2014

PIOTROWSKI, RICHARD v. MCGUIRE MANOR, INC.

Plaintiff Richard Piotrowski sued McGuire Manor, Inc. under Labor Law and common-law negligence after sustaining injuries from a fall off a wobbly ladder. A jury initially found in favor of the plaintiff and awarded damages. On appeal, the Appellate Division, Fourth Judicial Department, reversed the judgment and granted a new trial. The court determined that the trial court committed a reversible error by failing to give an expanded sole proximate cause charge to the jury, thereby prejudicing a substantial right of the defendant. Dissenting justices argued that the issue regarding the jury charge was not properly preserved for review or that the charge provided was sufficient.

Labor LawSole Proximate CauseJury ChargeAppellate ReviewNegligenceLadder AccidentReversalNew TrialPreservation of ErrorCPLR
References
29
Case No. MISSING
Regular Panel Decision

Action Electrical Contractors Co. v. Goldin

This appeal addresses a contractor's obligation to provide supplemental fringe benefits under Labor Law § 220 for public works projects. Petitioner, Action Electrical Contractors Co., Inc., was charged by the Comptroller of New York City for failing to provide prevailing supplemental benefits. The core issue was whether cash payments directly to employees could fulfill this obligation, rather than solely providing equivalent in-kind benefits. The Court of Appeals reversed the Appellate Division, ruling that the Comptroller's interpretation prohibiting cash substitutes was arbitrary. The court concluded that legislative intent focused on equalizing minimum labor costs, which is satisfied by cash payments equivalent to the cost of prevailing supplements, and thus, the petitioner had complied with the law.

Public Works ContractsPrevailing WageFringe BenefitsSupplemental BenefitsLabor Law § 220Cash EquivalentCollective Bargaining AgreementEmployer ComplianceStatutory InterpretationAdministrative Determination
References
3
Case No. MISSING
Regular Panel Decision
Apr 25, 2014

In re Pugliese

Louis M. Pugliese, an associate attorney, was charged with professional misconduct by the Grievance Committee for the Tenth Judicial District. The charges stemmed from his involvement in drafting a will and other legal documents for client Bernard Goldman, creating conflicts of interest and an appearance of undue influence, as Pugliese and his employer, John M. Bigler, were named beneficiaries and fiduciaries. Despite Goldman's intent to disinherit his children and provide for his sister, Fisher, Pugliese and Bigler prioritized their own interests, including settling with Goldman's children for $1.2 million and retitling an account to fund a trust from which they would benefit. The Special Referee sustained both charges, finding a deliberate pattern of self-serving conduct. The Court confirmed these findings, noting Pugliese's awareness of ethical concerns, and consequently suspended him from the practice of law for two years.

Professional MisconductAttorney DisciplineConflict of InterestUndue InfluenceWill DraftingEstate PlanningDisinheritanceBeneficiaryFiduciary DutySurrogate's Court
References
1
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