CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

Case Law Database

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

Case No. 25 NY3d 907
Regular Panel Decision
2015-XX-XX

Government Employees Insurance v. Avanguard Medical Group, PLLC

This case addresses whether no-fault insurance carriers are obligated to pay facility fees to New York State-accredited office-based surgery (OBS) centers for the use of their premises and support services. The court concluded that neither existing statutes nor regulations mandate such payments. Plaintiffs, a group of GEICO insurers, successfully sought a declaratory judgment that they are not legally required to reimburse Avanguard Medical Group, PLLC, for OBS facility fees, totaling over $1.3 million. The decision affirmed the Appellate Division's ruling, emphasizing that OBS facility fees are not explicitly covered by statute or fee schedules, nor do they fall under reimbursable "professional health services" as per 11 NYCRR 68.5. The court highlighted the distinct regulatory frameworks for OBS centers compared to hospitals and ambulatory surgery centers, declining to mandate policy changes best left to the legislature.

No-Fault InsuranceOffice-Based Surgery (OBS)Facility FeesInsurance LawBasic Economic LossFee SchedulesWorkers' Compensation BoardDepartment of Financial ServicesStatutory InterpretationRegulatory Framework
References
16
Case No. 2014-1081 K C
Regular Panel Decision
Oct 05, 2016

High Quality Med. Supplies, Inc. v. Mercury Ins. Group

This case involves an appeal concerning assigned first-party no-fault benefits sought by High Quality Medical Supplies, Inc., as assignee of Charles Botwee. The defendant, Mercury Ins. Group, appealed an order from the Civil Court that denied its motion for summary judgment to dismiss the complaint. Mercury Ins. Group contended that billing for durable medical equipment not listed in a fee schedule is not compensable. However, the Appellate Term affirmed the lower court's decision, citing 11 NYCRR 68.5, which specifically permits reimbursement for healthcare services not explicitly covered by fee schedules, thereby rejecting the defendant's argument.

No-Fault BenefitsFirst-Party BenefitsDurable Medical EquipmentFee ScheduleSummary JudgmentAppellate TermAssigned BenefitsInsurance LawReimbursementCivil Court
References
3
Case No. ADJ7418888 ADJ6523182
Regular
May 07, 2014

Frances Evans vs. San Joaquin Regional Transit District, York Risk Services Group, Inc.

This case involves Frances Evans' claim for workers' compensation benefits due to cumulative trauma to her back and spine and a subsequent motor vehicle accident. The Appeals Board denied reconsideration, affirming its prior decision that Evans failed to prove her cumulative trauma injury arose from her employment. Because no industrial injury was established, the motor vehicle accident sustained while en route to a medical evaluation was also deemed non-compensable. The Board found the Agreed Medical Examiner's conflicting opinions on causation insufficient to meet the applicant's burden of proof.

Workers' Compensation Appeals BoardPetition for ReconsiderationCumulative Trauma InjuryIndustrial InjuryCompensable Consequence InjuryAgreed Medical Examiner (AME)Substantial Medical EvidenceIndustrial CausationBurden of ProofPermanent Disability
References
1
Case No. MISSING
Regular Panel Decision
Sep 16, 1992

Pica v. Montefiore Medical Group

The Supreme Court, Bronx County, dismissed a personal injury action brought by an employee of Montefiore Hospital and Medical Center against Montefiore Medical Group. The dismissal was based on the affirmative defense of Workers' Compensation. The plaintiff failed to demonstrate that Montefiore Medical Group was a separate legal entity from Montefiore Hospital and Medical Center, whose employee controlled her work. Consequently, the court found recovery barred under Workers' Compensation Law § 11. The appellate court unanimously affirmed the dismissal.

Workers' CompensationPersonal InjuryEmployer LiabilityCorporate VeilExclusive RemedyAffirmative DefenseAppellate DecisionMotion to DismissSummary JudgmentBronx County
References
3
Case No. ADJ3425466 (FRE 0244904)
Regular
Mar 21, 2013

IMELDA SANCHEZ vs. COUNTY OF FRESNO

The Workers' Compensation Appeals Board affirmed the WCJ's finding that the County of Fresno neglected to provide adequate notice of the applicant's rights under its Medical Provider Network (MPN). This failure resulted in liability for the applicant's self-procured medical treatment from San Joaquin Accident and Medical Group. The Board found the defendant failed to prove proper initial MPN notification and subsequent transfer of care into the MPN. Therefore, the defendant is responsible for the reasonable costs of that treatment.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNSelf-procured medical treatmentNeglect or refusalReasonable medical treatmentLabor Code section 4600Administrative Director Rule 9767.6Knight v. United Parcel ServiceBabbitt v. Ow Jing
References
4
Case No. 2022 NY Slip Op 02801 [204 AD3d 1016]
Regular Panel Decision
Apr 27, 2022

Matter of Panos v. Mid Hudson Med. Group, P.C.

Spyros Panos was terminated from Mid-Hudson Medical Group (MHMG) for submitting fraudulent medical bills and subsequently pleaded guilty to healthcare fraud. Panos initiated an action for breach of contract against MHMG, which proceeded to arbitration. The arbitrator applied the faithless servant doctrine and granted MHMG's motion for summary judgment, dismissing Panos's claims. Panos then sought to vacate the arbitration award in the Supreme Court, Dutchess County, but the court denied his petition and dismissed the proceeding. On appeal, the Appellate Division affirmed the lower court's judgment, concluding that Panos failed to demonstrate that the arbitrator manifestly disregarded the law.

Arbitration awardVacaturFaithless servant doctrineBreach of contractSummary judgmentHealth care fraudAppellate reviewJudicial reviewEmployment agreementFiduciary duty
References
18
Case No. ADJ7418888, ADJ6523182
Regular
Feb 21, 2014

Frances Evans vs. San Joaquin Regional Transit District, York Risk Services Group, Inc.

The Workers' Compensation Appeals Board overturned the original award finding that applicant Frances Evans sustained a cumulative trauma injury to her back and spine by October 1, 2008. The Board determined the Agreed Medical Examiner's opinions on causation were conflicting and ultimately concluded she did not sustain a cumulative trauma injury. Furthermore, the Board found that a subsequent motor vehicle accident occurring while applicant was traveling to a medical-legal examination for her disputed claim was not a compensable consequence of an industrial injury, as no such underlying injury was established. Therefore, the applicant was awarded nothing for both claimed injuries.

Workers' Compensation Appeals BoardSan Joaquin Regional Transit DistrictPermissibly Self-InsuredYork Risk Services GroupInc.Frances EvansCumulative Trauma InjuryBack InjurySpine InjuryBus Driver
References
3
Case No. ADJ3362574
Regular
Oct 18, 2012

LAURA BIGGS vs. SAN BERNARDINO COUNTY MEDICAL CENTER, SAN BERNARDINO COUNTY

The Workers' Compensation Appeals Board (WCAB) dismissed Laura Biggs' Petition for Reconsideration in this case against San Bernardino County Medical Center and San Bernardino County. The dismissal was based on the WCAB's review of the record and adoption of the administrative law judge's report and recommendation. The report provided the reasoning for the dismissal, which the WCAB incorporated by reference. Therefore, the petition for reconsideration was officially dismissed.

Petition for ReconsiderationWorkers' Compensation Appeals BoardDismissalReport and RecommendationAdministrative Law JudgeSan Bernardino County Medical CenterLaura BiggsWorkers' Compensation CaseLegal DocumentCase Number
References
0
Case No. ADJ3871980 (SBR 0332495) ADJ1578450 (SBR 0333829) ADJ7125261
Regular
Nov 05, 2010

ANITA BAKER vs. SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP, PSI, Adjusted and Administered By KAISER PERMANENTE MEDICAL GROUP

This case involves Anita Baker's workers' compensation claim against Southern California Permanente Medical Group. The Workers' Compensation Appeals Board denied reconsideration of the judge's decision. The primary dispute centered on the calculation of diminished future earning capacity, with the applicant arguing for a calculation based on actual lost earnings and the defendant relying on statutory guidelines and expert testimony. The Board adopted the judge's report, which found in favor of the applicant regarding the calculation of permanent disability, incorporating aspects of both expert opinions and considering the applicant's specific circumstances.

Workers Compensation Appeals BoardSouthern California Permanente Medical GroupKaiser Permanente Medical GroupPetition for ReconsiderationWorkers' Compensation Administrative Law JudgeOgilvie v. City and County of San Franciscodiminished future earning capacityFindings and Awardcontinuous traumabilateral upper extremities
References
1
Case No. ADJ10477247
Regular
Oct 31, 2017

ESTELA WALLE vs. THE PERMANENTE MEDICAL GROUP

Here's a summary of the two cases for a lawyer, in max four sentences each: **Case 1: Estela Walle vs. The Permanente Medical Group (ADJ10477247)** The Workers' Compensation Appeals Board denied reconsideration, affirming the WCJ's finding that the applicant did not sustain a back injury arising out of and in the course of employment. The Board gave significant weight to the WCJ's credibility determination, finding no substantial evidence to warrant overturning it. Therefore, the applicant was awarded nothing on her claim. **Case 2: Estela Walle vs. The Permanente Medical Group (ADJ8620015, ADJ9183471)** The Appeals Board rescinded the WCJ's award for psychiatric injury and returned the case to the trial level for further proceedings. The Board found the analysis of whether the injury was predominantly caused by employment events, and specifically by lawful, good faith personnel actions, to be inadequate under *Rolda*. Further development of the record is required to clarify the events of May 21, 2012, and to determine the precise causal contribution of employment-related factors versus good faith personnel actions.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderApplicantInjury Arising Out of and In the Course of EmploymentAOE/COEBack InjuryWCJCredibility DeterminationGarza v. Workmen's Comp. Appeals Bd.
References
1
Showing 1-10 of 12,123 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational