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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
Jan 26, 1982

Hodge v. D'Elia

This case involves a proceeding under CPLR article 78 to review a determination by the State Commissioner of Social Services. The determination affirmed a local agency's decision to reduce the petitioner's public assistance grant. This reduction was for the recoupment of income tax refunds and workers' compensation benefits received by the petitioner. Although the court agreed that the petitioner willfully withheld information, it found that the respondents failed to evaluate if the recoupment rate would cause undue hardship. Consequently, the court annulled the determination and remitted the matter for further proceedings to assess undue hardship.

Public AssistanceRecoupmentIncome Tax RefundsWorkers' Compensation BenefitsUndue HardshipCPLR Article 78Administrative ReviewFair HearingAnnulmentRemittal
References
1
Case No. MISSING
Regular Panel Decision

Aetna Life & Casualty Co. v. Nelson

Plaintiff sued defendants, their insureds, to recoup first-party no-fault benefits. Both parties agreed there were no triable issues of fact, disputing only the timeliness of the action commenced on November 7, 1983. Plaintiff argued accrual on April 28, 1981, upon settlement of a Court of Claims action, while defendants claimed accrual on September 23, 1980, when the Court of Claims judgment was entered. Special Term initially applied a six-year limitation period (CPLR 213 [1]) but alternatively found the action timely under a three-year period (CPLR 214 [2]). The appellate court held the appropriate period of limitation is three years (CPLR 214 [2]) for actions upon a liability imposed by statute, such as enforcing a lien under Insurance Law § 5104 [b]. The court affirmed Special Term's alternative finding that the cause of action did not accrue until the underlying Court of Claims action was finally settled, entitling the plaintiff to summary judgment.

No-fault insuranceStatute of limitationsLien enforcementCause of action accrualSummary judgmentAppellate procedureInsurance LawCPLRCourt of ClaimsWorkers' Compensation Law
References
6
Case No. MISSING
Regular Panel Decision
May 19, 1980

Middleton v. D'Elia

A petitioner challenged a State Commissioner of Social Services' determination affirming a local agency's decision to budget income and recoup overpayments related to a lump-sum Social Security grant. The initial notice to the petitioner only indicated intent to discontinue public assistance, without mentioning recoupment or willful withholding of information. The court found that the agency never formally decided to recoup and that the notice provided to the petitioner failed to meet due process standards by specifying the wrong charge. Consequently, the State Commissioner's determination regarding recoupment was annulled because it lacked substantial evidence, and the petitioner's explanation for misunderstanding was deemed plausible. The court also denied the petitioner's request for attorney's fees.

Public AssistanceSocial Security BenefitsLump-Sum PaymentsOverpayment RecoupmentDue Process ViolationsNotice RequirementsAdministrative ReviewCPLR Article 78Annulment of DeterminationSubstantial Evidence
References
5
Case No. 23 NY3d 906
Regular Panel Decision

The Matter of Walter E. Carver v. State of New York

Petitioner Carver, a 69-year-old Vietnam War veteran, participated in the City of New York's Work Experience Program (WEP) from 1993 to 2000, performing tasks like sorting mail and sweeping floors in exchange for public assistance and food stamps. In 2007, after winning $10,000 in the New York State Lottery, the State, through OTDA, recouped $5,000 under Social Services Law § 131-r (1) to reimburse itself for past public assistance benefits. Carver initiated a CPLR article 78 proceeding, alleging this recoupment violated his rights under the federal Fair Labor Standards Act (FLSA) and the New York State Minimum Wage Act, arguing that the recoupment effectively reduced his compensation below minimum wage, as he was an "employee" under the FLSA. The Supreme Court initially dismissed his claim, but the Appellate Division reinstated the FLSA cause of action, applying the "economic reality test" and concluding that WEP participants are FLSA employees. The New York Court of Appeals affirmed the Appellate Division's decision, holding that the City should be considered Carver's employer under the FLSA's "economic reality test" due to factors like control over work, supervision, and maintenance of records, and that WEP workers are entitled to minimum wage protections, thus preventing the State from retroactively depriving Carver of minimum wage through benefit recoupment.

Fair Labor Standards Act (FLSA)Work Experience Program (WEP)Minimum WagePublic AssistanceWelfare ReformEconomic Reality TestEmployee StatusLottery WinningsRecoupment of BenefitsState Law Preemption
References
18
Case No. 2025 NY Slip Op 01026 [235 AD3d 1147]
Regular Panel Decision
Feb 20, 2025

Matter of Garden of Eden Home, LLC v. Bassett

Petitioners, licensed adult care facilities, challenged a Department of Health (DOH) determination to recoup Medicaid overpayments related to minimum wage increases for Assisted Living Program (ALP) providers. The DOH had disbursed funds subject to reconciliation, and later adjusted its calculation methodology, leading to recoupments. The Supreme Court dismissed petitioners' claims. On appeal, the Appellate Division, Third Department, affirmed DOH's right to recoup funds and its calculation methodology, finding it rational. However, the Appellate Division reversed the lower court's decision regarding petitioners' right to proper notice and a hearing concerning the overpayment amount, remitting the matter to DOH for further proceedings consistent with regulatory notice provisions.

Medicaid reimbursementMinimum wage lawOverpayment recoupmentDepartment of Health (DOH)Assisted Living ProgramsAdministrative reviewCPLR article 78Rational basis standardDue process rightsNotice and hearing
References
19
Case No. MISSING
Regular Panel Decision
Jul 24, 1985

Collier v. Simmonds Precision, Inc.

This case concerns an appeal from a Workers' Compensation Board decision regarding a carrier's failure to pay compensation at an awarded rate and its unauthorized recoupment of alleged overpayments. The carrier had deducted amounts from weekly payments without explicit Board direction, leading to a penalty imposed by the Board, reversing an initial finding by the Workers' Compensation Law Judge. The carrier argued that Workers' Compensation Law § 22 required specific Board rules or orders for recoupment. However, the court affirmed the Board's exclusive jurisdiction to direct the method and manner of recoupment, citing prior cases like Matter of Dovi v Grand Union Co. and Matter of Bales v Post Serv. Sta. The decision of the Board imposing the penalty was upheld.

Workers' CompensationPenalty ImpositionOverpayment RecoupmentBoard JurisdictionStatutory InterpretationAppellate ReviewDisability BenefitsCarrier ObligationsIndustrial AccidentExclusive Jurisdiction
References
2
Case No. 2019 NY Slip Op 05756 [175 AD3d 134]
Regular Panel Decision
Jul 23, 2019

Matter of People Care Inc. v. City of New York Human Resources Admin.

The New York Appellate Division, First Department, affirmed the Supreme Court's decision, which annulled the Human Resources Administration's (HRA) demand to recoup approximately $7 million in Health Care Reform Act (HCRA) funds from People Care Incorporated. The core issue was whether HRA possessed the authority to audit and recover these HCRA funds, established as a distinct Medicaid reimbursement program for worker recruitment and retention, from personal care service providers. The Court found that neither Public Health Law § 2807-v (1) (bb) nor the Memorandum of Understanding between the Department of Health (DOH) and HRA delegated such auditing and recoupment powers to HRA. It rejected HRA's arguments that HCRA funds were merely a subset of general Medicaid funds subject to its existing contractual audit authority, or that DOH's actions constituted ratification of HRA's authority. Consequently, the Court upheld the injunction preventing HRA from recouping the disputed HCRA funds from People Care.

Administrative LawMedicaid ReimbursementAuditing AuthorityStatutory ConstructionInter-agency AgreementsHealthcare Reform ActPersonal Care ServicesGovernment ContractsCPLR Article 78Delegation of Power
References
8
Case No. MISSING
Regular Panel Decision

KST Realty LLC v. Olatoye

KST Realty LLC, a landlord, filed an Article 78 petition against the New York City Housing Authority (NYCHA) challenging NYCHA's decision to deduct Section 8 subsidy payments intended for other tenants to recoup overpayments made for a former tenant, E.M. NYCHA had terminated E.M.'s subsidy effective August 31, 2011, after she was institutionalized, and subsequently recouped $11,630.05 from KST Realty LLC for alleged overpayments totaling $31,907.03. KST Realty LLC sought to vacate NYCHA's determination, recover reclaimed payments, and enjoin future deductions. NYCHA counterclaimed for the remaining overpayments. The court found that NYCHA had a rational basis for terminating E.M.'s subsidy and recouping overpayments according to federal regulations and their HAP contract. Consequently, the court denied KST Realty LLC's petition and ordered a framed issue hearing to determine the exact date E.M. vacated the apartment and the precise amount of overpayments owed by the petitioner to the respondents.

Article 78 PetitionLandlord-Tenant DisputeSection 8 Housing ProgramHousing SubsidyOverpayment RecoupmentAdministrative DiscretionRational Basis ReviewFederal Housing RegulationsHousing Assistance Payment ContractInstitutionalization
References
7
Case No. MISSING
Regular Panel Decision

Ins. Co. of North America v. S. E. Senior

The case concerns an appeal by the Chairman of the Workmen’s Compensation Board from an order that annulled two assessments made against an insurance carrier. The assessments were based on the carrier's total compensation payments, but the carrier argued for a deduction of recoupment payments received from other employers for apportioned liability in occupational disease cases under Workmen's Compensation Law section 44. The Chairman contended that no such statutory deduction existed. The court determined that the term “compensation” for assessment purposes did not intend for payments to be counted twice (by both payee and payor). Consequently, the insurance carrier is entitled to deduct these recoupment payments from its total compensation payments when calculating the assessments. The order and judgment granting the carrier's petition and annulling the assessments were affirmed.

Workers' Compensation AssessmentsRecoupment DeductionOccupational Disease LiabilityStatutory ConstructionInsurance Carrier ObligationsArticle 78 AppealCompensation ApportionmentAssessment Calculation MethodologyEmployer ReimbursementFiscal Year Assessments
References
2
Case No. MISSING
Regular Panel Decision

People Care Inc. v. City of New York Human Resources Administration

Petitioner, a provider of personal care services, appeals a lower court's dismissal of their petition challenging the Human Resources Administration's (HRA) determination to recoup nearly $7 million in funds. The lower court based its dismissal on the petitioner's alleged failure to comply with contractual dispute resolution procedures. The appellate court observes that HRA has not yet fully responded or provided transcripts. The case hinges on whether HRA is authorized to recoup these funds, as relevant statutes appear to grant this power to the state Commissioner of Health. The court also considers if the petitioner was excused from exhausting administrative remedies due to HRA's potentially unauthorized actions. Consequently, the court remands the case for further development of the record on these key issues.

Personal Care ServicesMedicaid ProgramRecoupment of FundsHRA DeterminationDispute Resolution ProceduresExhaustion of Administrative RemediesAgency AuthorityPublic Health LawDelegation of PowerRemand
References
6
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