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

Case No. 2019 NY Slip Op 08951 [178 AD3d 525]
Regular Panel Decision
Dec 12, 2019

Matter of Global Liberty Ins. Co. of N.Y. v. North Shore Family Chiropractic, PC

The Appellate Division, First Department, affirmed the dismissal of a petition by Global Liberty Insurance Company of New York, which sought to vacate an arbitration award denying their claim. Global Liberty had argued that workers' compensation benefits were available to the assignor, Ramon Martinez, and thus their denial of the no-fault insurance claim to North Shore Family Chiropractic, PC (Martinez's assignee) was proper. The court found that Global Liberty failed to prove Martinez was injured in the course of his employment. The order was modified to remand the matter for a determination of attorneys' fees owed to North Shore Family Chiropractic, PC, including those for the appeal.

Insurance DenialNo-Fault BenefitsArbitration AwardAttorneys' FeesWorkers' Compensation CoverageEmployment StatusAppellate ReviewRemandBurden of ProofAssignor
References
4
Case No. 2014-1527 Q C
Regular Panel Decision
Dec 08, 2017

AVM Chiropractic, P.C. v. American Tr. Ins. Co.

This case concerns an appeal from an order of the Civil Court of the City of New York regarding assigned first-party no-fault benefits. Plaintiff, AVM Chiropractic, P.C., sought to recover benefits from American Transit Ins. Co. The Civil Court initially granted some branches of the defendant's motion for summary judgment and reduced claims based on a fee schedule defense. The Appellate Term modified the order, denying summary judgment for the defendant on specific causes of action (second, third, and sixth through eighth) and vacating findings on others (ninth and tenth). The court found that the defendant did not adequately demonstrate appropriate reductions in accordance with workers' compensation Ground Rules for several claims.

No-Fault BenefitsSummary JudgmentWorkers' Compensation Fee ScheduleAppellate ReviewInsurance ClaimsAssigneeFirst-Party BenefitsCivil ProcedureGround RulesNew York Law
References
1
Case No. 2014-1568 S C
Regular Panel Decision
Jul 20, 2016

Chirocare Chiropractic Assoc. v. State Farm Mut. Auto. Ins. Co.

This case involves a provider, Chirocare Chiropractic Associates, as assignee of Antoneta Mertiri, seeking first-party no-fault benefits from State Farm Mutual Automobile Insurance Company. The District Court initially granted State Farm's motion for summary judgment, dismissing the complaint based on a workers' compensation fee schedule defense. The Appellate Term reversed this order, finding that the District Court erred by dismissing the entire complaint on this ground, as the fee schedule defense only applied to amounts in excess of the schedule. Furthermore, the District Court failed to address State Farm's primary defense of lack of medical necessity, which could have been dispositive of the whole action. The matter was remitted to the District Court for a new determination addressing the medical necessity defense first.

No-fault insuranceAutomobile insuranceSummary judgmentAppellate reversalRemittiturMedical necessity defenseWorkers' compensation fee scheduleFirst-party benefitsAssignee claimChiropractic care
References
2
Case No. 2015-1649 Q C
Regular Panel Decision
Jan 20, 2017

Flatbush Chiropractic, P.C. v. American Tr. Ins. Co.

Flatbush Chiropractic, P.C., as assignee of Pierre Luxio, appealed an order that granted American Transit Ins. Co.'s motion to dismiss the complaint and denied plaintiff's cross-motion for leave to renew its prior motion for summary judgment. The Civil Court initially denied plaintiff's summary judgment motion and granted defendant's cross-motion, requiring Workers' Compensation Board resolution within 90 days due to an issue of fact regarding the accident occurring in the course of employment. After 21 months, defendant moved to dismiss for non-compliance, and plaintiff cross-moved to renew, presenting an affidavit indicating no record of a workers' compensation application. The Appellate Term affirmed the Civil Court's decision, stating that the alleged 'new facts' would not change the prior determination and plaintiff failed to show good cause against dismissal.

No-Fault BenefitsWorkers' Compensation IssueSummary Judgment MotionMotion to DismissLeave to RenewAppellate ReviewProcedural ComplianceAssignor-AssigneeCivil CourtAppellate Term
References
1
Case No. 2016-329 S C
Regular Panel Decision
Apr 27, 2017

Spineisland for Chiropractic, P.C. v. 21st Century Advantage Ins. Co.

This case involves an appeal by Spineisland For Chiropractic, P.C., acting as an assignee, against 21st Century Advantage Insurance Company concerning first-party no-fault benefits. The plaintiff sought to recover for services billed under CPT code 95831. The District Court of Suffolk County had previously granted the defendant's motion for summary judgment, asserting that the defendant had appropriately paid the plaintiff based on the workers' compensation fee schedule. On appeal, the Appellate Term affirmed the lower court's decision. The Appellate Term found that the defendant had adequately demonstrated the proper application of CPT code 95833 for the services billed under CPT code 95831, and the plaintiff failed to present a triable issue of fact.

No-fault benefitsSummary judgmentCPT codeWorkers' compensation fee scheduleAppellate TermSuffolk CountyAssigneeInsurance disputeChiropractic servicesMedical billing
References
1
Case No. MISSING
Regular Panel Decision

NYSA-ILA Medical & Clinical Services Fund Ex Rel. Capo v. Catucci

The NYSA-ILA Medical & Clinical Services Fund, an employee medical services fund, sued Sabato Catucci and his three sons for allegedly withholding payments from Saleo Trucking Corporation to the fund. This action followed a prior judgment against the corporation for delinquent contributions. The plaintiff sought to hold the defendants personally liable under alter ego, breach of ERISA fiduciary duty, and embezzlement theories. The court granted summary judgment to the plaintiff on the breach of ERISA fiduciary duty claim against Sabato Catucci, finding him to be a fiduciary who misused plan assets. However, claims against his sons were dismissed due to lack of sufficient control over the corporation. The alter ego claim against Sabato Catucci will proceed to trial, and the embezzlement claim was dismissed for not supporting a private civil cause of action.

ERISA Fiduciary DutyAlter Ego LiabilityCorporate Veil PiercingDelinquent ContributionsSummary JudgmentEmployee Benefit PlanMultiemployer FundSelf-DealingCorporate ControlLabor Law
References
32
Case No. LAO 0774175, LAO 0777678, LAO 0778097
Regular
Feb 26, 2008

FRANCISCO ARAU MEZA vs. PLATINUM DYEING & FINISHING, REDLAND INSURANCE COMPANY, RELIANCE NATIONAL INSURANCE COMPANY/CIGA

This case involves Redland Insurance Company's petition for reconsideration of an arbitrator's decision awarding contribution from Redland to CIGA for medical and rehabilitation expenses. Redland argued a prior decision settled all contribution rights, but the Board found that the earlier decision did not address CIGA's contribution rights and therefore CIGA did not waive them. The Board denied Redland's petition, allowing the arbitrator to determine the proper remedy for CIGA's contribution claim.

WCABRedland Insurance CompanyCIGAcontributionarbitrationCompromise & Releaseindustrial injuryback injuryneck injurycumulative trauma
References
0
Case No. 2018 NY Slip Op 03093
Regular Panel Decision
May 01, 2018

Contact Chiropractic, P.C. v. New York City Tr. Auth.

This case addresses the applicable statute of limitations for no-fault claims against a self-insured entity. The Court of Appeals determined that the three-year statute of limitations under CPLR 214 (2) governs such claims, as the obligation to provide no-fault benefits by a self-insurer is statutory rather than contractual. This decision reversed the Appellate Division, which had applied a six-year statute of limitations based on a contractual nature. The Court clarified that in the absence of a private insurance contract, the self-insurer's liability for first-party benefits is wholly statutory. The ruling impacts procedural aspects without altering the substantive no-fault obligations of self-insurers.

Statute of LimitationsNo-Fault InsuranceSelf-Insurer LiabilityCPLR 214 (2)CPLR 213 (2)Statutory ObligationContractual ObligationFirst-Party BenefitsMotor Vehicle AccidentsAppellate Review
References
30
Case No. MISSING
Regular Panel Decision
Jul 29, 1996

Ray v. County of Delaware

The plaintiff sued Delaware County Mental Health Clinic for negligence, alleging failure to properly hire and supervise employee Brian Hart, a social worker who engaged in a sexual relationship with the plaintiff. Defendants moved for summary judgment, arguing proper procedures, lack of foreseeability, and plaintiff's culpable conduct. The Supreme Court granted the motion, determining the plaintiff failed to provide credible evidence for recovery. The appellate court affirmed this decision, finding that the plaintiff did not present affirmative proof to establish genuine issues of fact regarding the defendants' negligence in hiring and supervising their employee.

NegligenceSummary JudgmentAppealSupervisionEmployee MisconductSocial WorkerMental Health ClinicForeseeabilityEthical ConductProximate Cause
References
4
Case No. ADJ7962227
Regular
May 09, 2014

ANDREA REYNOSO vs. SANSUM CLINIC, EMPLOYERS COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding the initial finding that she did not sustain a cumulative injury during her employment. The applicant claimed new evidence, including EMG testing for wrist issues and diagnoses of pulmonary embolism and blood clots affecting her psyche, should have been considered. However, the Board found this evidence was not "newly discovered" and could have been discovered through due diligence prior to the settlement conference or trial. Even if admitted, the new evidence would not alter the conclusion that any industrial injury occurred in 1999, not during her employment with Sansum Clinic.

Workers' Compensation Appeals BoardCumulative InjuryAgreed Medical EvaluatorPetition for ReconsiderationFindings of Fact and OrderAOE/COECarpal Tunnel SyndromePulmonary EmbolismPsyche InjuryNew Evidence
References
1
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