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

Case No. 2013-2706 Q C
Regular Panel Decision
Sep 19, 2016

NYS Acupuncture, P.C. v. State Farm Mut. Auto. Ins. Co.

This case, NYS Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co., concerned an appeal from an order of the Civil Court of the City of New York, Queens County. The plaintiff, NYS Acupuncture, P.C., sought assigned first-party no-fault benefits from State Farm, which had moved for summary judgment arguing full payment according to the workers' compensation fee schedule. The Civil Court initially granted State Farm's motion. On appeal, NYS Acupuncture, P.C. contended that the fee schedule reductions were improper. The Appellate Term, Second Department, affirmed the prior ruling, finding that State Farm adequately demonstrated it had fully compensated the plaintiff for acupuncture services based on the applicable workers' compensation fee schedule for services performed by chiropractors, referencing Great Wall Acupuncture, P.C. v Geico Ins. Co.

Workers' Compensation Fee ScheduleNo-Fault BenefitsAcupuncture ServicesChiropractorsSummary JudgmentAppellate ReviewInsurance DisputeFee Schedule ReductionAssigned BenefitsMedical Billing
References
1
Case No. 26 NY3d 107 (2016)
Regular Panel Decision
Jun 09, 2016

S.B. v. A.C.C.

This case addresses the definition of "parent" under Domestic Relations Law § 70 (a) for purposes of custody and visitation for unmarried couples. The New York Court of Appeals overrules its 1991 decision in Matter of Alison D. v Virginia M., which had limited parental standing to biological or adoptive parents. The Court now holds that a non-biological, non-adoptive partner has standing if they can show by clear and convincing evidence that the parties agreed to conceive and raise a child together. In Matter of Brooke S.B. v Elizabeth A.C.C., the Appellate Division's order is reversed and the matter remitted for further proceedings under this new standard. In Matter of Estrellita A. v Jennifer L.D., the Appellate Division's order is affirmed, upholding standing based on judicial estoppel. This decision aims to address the unworkability of the Alison D. rule in light of evolving familial relationships, particularly for same-sex couples, and to protect the best interests of children.

Parental RightsCustodyVisitationSame-Sex CouplesNontraditional FamiliesEquitable EstoppelJudicial EstoppelPre-Conception AgreementDomestic Relations LawOverruling Precedent
References
28
Case No. MISSING
Regular Panel Decision
Jul 10, 2013

Christopher C. v. Bonnie C.

This divorce action between Christopher C. and Bonnie C. addresses equitable distribution, spousal maintenance, and counsel fees. The defendant, Bonnie C., who has a court-appointed guardian due to mental and emotional difficulties, had separated from the plaintiff in 2003 and informally divided marital assets. The court ratified this prior asset division, noting the defendant had dissipated her share. Finding the defendant unable to work and self-support, and the plaintiff capable of employment despite his claims of disability, the court awarded the defendant non-durational permanent maintenance of $2,500 per month and substantial attorney's fees. The plaintiff's motion to suspend or refund temporary maintenance was denied.

DivorceSpousal MaintenanceEquitable DistributionGuardianshipMental Health IssuesAsset DissipationAttorney's FeesFinancial CapacityPermanent MaintenanceMarital Property
References
12
Case No. 2013-1461 K C
Regular Panel Decision
Mar 16, 2016

Performance Plus Med., P.C. v. Nationwide Ins.

This case involves an appeal by Performance Plus Medical, P.C., acting as an assignee, against Nationwide Ins. The plaintiff sought to recover assigned first-party no-fault benefits. The Civil Court had previously granted the defendant's motion for summary judgment, leading to the dismissal of the complaint. The Appellate Term affirmed this order, ruling that the defendant's timely verification request tolled the insurer's time to pay or deny the claim, thus rendering the plaintiff's action premature due to a failure to respond to the request. Additionally, the court found that the defendant had successfully demonstrated a prima facie case for denying claims related to the first cause of action based on the workers' compensation fee schedule, which the plaintiff failed to rebut.

No-fault benefitsSummary judgmentVerification requestInsurer's time to payPremature actionWorkers' compensation fee scheduleAppellate reviewCivil Court orderFirst-party benefitsAssigned claims
References
2
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. 2016-910 K C
Regular Panel Decision
Jan 12, 2018

Precious Acupuncture Care, P.C. v. Hereford Ins. Co.

This case concerns an action by Precious Acupuncture Care, P.C., as assignee of James Hough, against Hereford Insurance Company to recover assigned first-party no-fault benefits. Plaintiff sought the unpaid balance of five claims for services rendered between December 2013 and April 2014. Defendant cross-moved for summary judgment, asserting that the amounts claimed exceeded the workers' compensation fee schedule. The Civil Court initially granted plaintiff's motion, ruling that defendant was precluded from the defense due to untimely denial. However, the Appellate Term reversed this decision, clarifying that under 11 NYCRR 65-3.8 (g) (1) (ii); (2), for services rendered after April 1, 2013, payment is not due for fees exceeding permissible charges, irrespective of timely denial. Consequently, the Appellate Term vacated the prior order, denied plaintiff's motion, and granted defendant's cross-motion for summary judgment dismissing the complaint.

No-Fault BenefitsSummary JudgmentFee Schedule DefenseAppellate ReviewTimely DenialWorkers' Compensation Fee ScheduleMedical BillingInsurance LawCivil CourtAppellate Term
References
5
Case No. 2016-263 Q C
Regular Panel Decision
May 25, 2018

Mind & Body Acupuncture, P.C. v. Allstate Ins. Co.

Mind & Body Acupuncture, P.C., as assignee, appealed an order denying its summary judgment motion and granting Allstate Insurance Company's cross-motion to dismiss the complaint regarding first-party no-fault benefits. The Appellate Term, Second Department, modified the Civil Court's order, affirming the denial of the plaintiff's motion but reversing the grant of the defendant's cross-motion. The court ruled that Allstate failed to establish timely mailing of its denial of claim forms, thus precluding its defense. However, the plaintiff also failed to prove that the claims were not timely denied or that the denials were without merit, leading to the proper denial of its summary judgment motion.

No-Fault BenefitsSummary Judgment MotionAppellate TermInsurance DefenseDenial of ClaimTimely MailingWorkers' Compensation Fee ScheduleAssignee ClaimCivil Court OrderAffidavit Sufficiency
References
4
Case No. 2015-1339 K C
Regular Panel Decision
Dec 19, 2017

GBI Acupuncture, P.C. v. State Farm Mut. Auto. Ins. Co.

This case concerns an appeal by GBI Acupuncture, P.C. from a Civil Court order granting State Farm Mutual Automobile Ins. Co.'s motion for summary judgment. The Appellate Term found that State Farm's denial of claim forms for the first four causes of action were untimely, thus reversing that portion of the lower court's decision. However, with respect to the fifth through eighth causes of action, the court affirmed State Farm's practice of using the workers' compensation fee schedule for acupuncture services performed by chiropractors to determine payment for licensed acupuncturists. The order was therefore modified by denying summary judgment for the first four causes of action, and otherwise affirmed. The case cites previous rulings on timely verification requests and the application of workers' compensation fee schedules.

No-fault benefitsSummary judgmentTimely denialVerification requestsFee scheduleAcupuncture servicesChiropractorsWorkers' compensation fee scheduleAppellate reviewCivil Court order
References
2
Case No. 2024 NY Slip Op 00798 [224 AD3d 495]
Regular Panel Decision
Feb 15, 2024

Matter of Camrem C. (Lydia C.)

Lydia C. appealed a Family Court order that found she neglected her child, Camrem C., by inflicting or allowing physical harm. The Family Court's finding was based on extensive medical evidence showing the child had multiple welts, lacerations, and bruises in various stages of healing, indicating a pattern of corporal punishment. This medical evidence corroborated out-of-court statements made by the child to a paraprofessional, the Child Advocacy Center, and an ACS caseworker. The appellant's testimony, which attributed the injuries to a single incident, was deemed insufficient to account for the variety of injuries observed. The Appellate Division, First Department, affirmed the neglect finding, concluding that the record supported the Family Court's decision and that the appellant, at a minimum, should have been aware of the injuries and acted to protect the child.

Child NeglectFamily LawAppellate ReviewPhysical HarmCorporal PunishmentMedical EvidenceOut-of-court StatementsCredibility FindingsParental ResponsibilityChild Protection
References
4
Case No. 2025 NY Slip Op 05500 [242 AD3d 829]
Regular Panel Decision
Oct 08, 2025

DeMarco v. C.A.C. Indus., Inc.

The plaintiff, Peter DeMarco, suffered personal injuries when excavation walls collapsed at a Queens work site. He sued C.A.C. Industries, Inc., a contractor that provided a backhoe and operating engineer to his employer, the City of New York Department of Environmental Protection (DEP). The Supreme Court, Queens County, partially granted the defendant's motion for summary judgment, dismissing claims under Labor Law § 200 and certain Labor Law § 241 (6) violations, while denying dismissal of the common-law negligence claim. The plaintiff's cross-motion for summary judgment was denied. On appeal, the Appellate Division, Second Department, affirmed the Supreme Court's order, finding that the defendant lacked authority to supervise for the Labor Law claims but failed to demonstrate a special employment relationship, leaving triable issues of fact regarding the common-law negligence claim and whether the defendant's excavation created or exacerbated the dangerous condition.

Excavation CollapseTrench SafetyLabor Law 200Labor Law 241(6)Industrial Code ViolationsSpecial EmploymentContractor NegligencePremises LiabilitySummary Judgment AppealDuty of Care
References
21
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