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Case Law Database

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

Case No. 2019 NY Slip Op 08942 [178 AD3d 512]
Regular Panel Decision
Dec 12, 2019

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

This case addresses the appropriate fee schedule for licensed acupuncturists providing services to individuals injured in motor vehicle accidents under no-fault insurance. Plaintiff insurers moved for summary judgment, contending that acupuncturists should be reimbursed according to the workers' compensation fee schedule for chiropractors, not physicians. The Supreme Court denied this motion, and the Appellate Division, First Department, affirmed. The Appellate Division ruled that plaintiffs failed to make a prima facie showing of entitlement to judgment as a matter of law, noting the lack of a specific fee schedule for acupuncturists by the superintendent and prior rulings allowing flexibility in using either chiropractor or physician schedules based on consistency. The court also found an issue of fact raised by defendants regarding the physician fee schedule's applicability and deemed the motion for summary judgment on overbilling premature prior to discovery.

No-fault insuranceacupuncturefee scheduleworkers' compensationinsurance lawsummary judgmentappellate reviewmedical reimbursement11 NYCRR 68.5[b]judicial deference
References
11
Case No. MISSING
Regular Panel Decision
Jul 24, 2002

In re the Claim of Miller v. North Syracuse Central School District

This case involves an appeal from a Workers' Compensation Board decision concerning overlapping workers' compensation awards. The claimant, a food services worker, filed two separate claims: one for occupational disease to her shoulders, leading to a schedule loss of use award, and another for bilateral carpal tunnel syndrome, which resulted in a temporary total disability award for the period from December 13, 1999, to February 14, 2000. The State Insurance Fund argued that the schedule loss of use award should be suspended for this period to prevent an overlap. Initially, a Workers’ Compensation Law Judge disagreed, but the Workers’ Compensation Board reversed, ruling in favor of suspending the schedule award. On appeal, the court reversed the Board's decision, clarifying that a schedule award is not allocable to a specific period of disability and therefore does not overlap with a temporary total disability award covering a limited timeframe. The court distinguished this from cases involving permanent disability awards. The matter was remitted to the Workers’ Compensation Board for recalculation of the claimant’s award.

Workers' CompensationSchedule Loss of UseTemporary Total DisabilityOverlapping AwardsEarning CapacityOccupational DiseaseCarpal Tunnel SyndromeShoulder InjuryAppellate ReviewRecalculation of Award
References
7
Case No. MISSING
Regular Panel Decision

Matter of Terranova v. Lehr Construction Co.

In 2009, Claimant sustained a right knee injury at work, leading to workers' compensation benefits and a 10% schedule loss of use award. Concurrently, Claimant settled a third-party action for $173,500. A dispute arose concerning the carrier's credit and the apportionment of litigation expenses from the third-party settlement, specifically whether Burns v Varriale or Matter of Kelly v State Ins. Fund applied to a schedule loss of use award. The Workers’ Compensation Board ruled that Matter of Kelly controlled, denying Claimant ongoing payments for litigation expenses. The appellate court affirmed, clarifying that for schedule loss of use awards, future benefits are ascertainable, making Matter of Kelly applicable.

Schedule Loss of UseThird-Party SettlementWorkers’ Compensation BenefitsLitigation ExpensesCarrier CreditApportionment of Counsel FeesFuture BenefitsIndependent Medical ExaminationOrthopedist ReportCourt of Appeals Precedent
References
5
Case No. MISSING
Regular Panel Decision

Claim of Grugan v. The Record

Claimant sustained a work-related injury to her left hand in 2007, leading to a dispute over whether she should receive a permanent partial disability classification or a schedule loss of use award. The Workers’ Compensation Board ultimately issued a 15% schedule loss of use award, which the claimant appealed. The Appellate Division affirmed the Board's decision, finding that substantial evidence supported the determination. The court noted that claimant had reached maximum medical improvement and her condition was stable, factors supporting a schedule loss of use award. Conflicting medical opinions from the treating orthopedist and an independent medical examiner were resolved by the Board within its discretion.

Schedule Loss of UsePermanent Partial DisabilityWorkers' Compensation BoardMedical EvidenceIndependent Medical ExaminationTreating PhysicianAppellate ReviewBoard DiscretionMaximum Medical ImprovementConflicting Medical Opinions
References
3
Case No. MISSING
Regular Panel Decision

In Re Raggie

Severius Raggie, a debtor, filed for Chapter 13 bankruptcy in January 2006, which was subsequently dismissed in February 2006 due to his failure to comply with credit counseling requirements and other obligations. In January 2008, Raggie moved to amend his Schedule B and Statement of Financial Affairs to include a personal injury claim against CVP # 1, LLC et al. This motion was prompted by the defendants' attempt in state court to dismiss the personal injury action because it was not listed in Raggie's bankruptcy petition. The court addressed the core issue of whether a dismissed bankruptcy case, as opposed to a closed one, precludes a debtor's right to amend schedules under Bankruptcy Rule 1009(a). The court concluded that 'closed' under § 350 and Rule 1009 does not encompass 'dismissed,' thereby maintaining Raggie's right to amend. Finding no evidence of bad faith, fraud, or prejudice to creditors, the court granted Raggie's motion to amend his schedules, rendering the motion to vacate the dismissal order moot.

Bankruptcy LawChapter 13Schedule B AmendmentDismissed CaseClosed Case DistinctionPersonal Injury ClaimDebtor's RightsFederal Rules of Bankruptcy ProcedureBad FaithCreditor Prejudice
References
17
Case No. MISSING
Regular Panel Decision

Schmidt v. Falls Dodge, Inc.

The claimant was awarded a 21.43% schedule loss of use for binaural hearing loss in 2007. The Workers’ Compensation Law Judge and the Workers’ Compensation Board determined that this award was not subject to temporary disability benefits the claimant was already receiving from earlier workers' compensation cases. The employer and State Insurance Fund appealed, contending that a Court of Appeals decision overruled prior holdings regarding the overlap of schedule and nonschedule awards. The appellate court affirmed the Board's decision, distinguishing between schedule awards for future earnings loss and nonschedule awards for temporary disability during a limited time frame, concluding they do not overlap.

Workers' CompensationSchedule Loss of UseTemporary DisabilityBinaural Hearing LossAward OverlapAppellate DecisionInsurance FundEmployer LiabilityMedical BenefitsEarnings Loss
References
3
Case No. LAO 0805059 & LAO 0844230
Regular
Jan 07, 2008

JOSE TAPIA vs. RSS AERO INDUSTRIES, HIGHLANDS INSURANCE GROUP

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration, upholding the judge's award of 59% permanent disability. The employer argued the judge incorrectly used the 2004 permanent disability schedule instead of the 1997 schedule for injuries sustained in 2001 and 2004. The Board found the use of the 2004 schedule was proper as it applied to the date of the applicant's last industrial injury. The Board also noted that the employer waived any objections to combining the injuries into a single award by not raising them in their petition.

WilkinsonParkerNuellepermanent disabilityreconsiderationapportionmentcompensation scheduleindustrial injuryWCABLabor Code
References
16
Case No. 2013-1709 Q C
Regular Panel Decision
Jun 03, 2016

Renelique v. Tri State Consumers Ins. Co.

Pierre Jean Jacques Renelique, as Assignee of Yvon Delgado, initiated an action to recover assigned first-party no-fault benefits from Tri State Consumers Ins. Co. The defendant successfully moved for summary judgment in the Civil Court of the City of New York, Queens County, arguing that it had fully compensated the plaintiff in accordance with the workers' compensation fee schedule. On appeal, the plaintiff contended that the defendant was precluded from asserting its defense regarding the fee schedule due to insufficient particularity in the denial of claim form; however, this argument was deemed to lack merit by the Appellate Term. Furthermore, the plaintiff's attempt to challenge the calculation of the recoverable amount under the workers' compensation fee schedule was not considered by the appellate court, as it was raised for the first time on appeal. Consequently, the Appellate Term affirmed the Civil Court's order, finding no basis to disturb it.

no-fault insuranceworkers' compensationsummary judgmentappellate reviewclaim denialmedical billingfee scheduleassigneeassignorinsurance defense
References
3
Case No. MISSING
Regular Panel Decision

Yklik Medical Supply, Inc. v. Allstate Insurance

Plaintiff Yklik Medical Supply, Inc., a medical supply provider, sued Allstate Insurance Company to recover $317 in unpaid medical bills for equipment supplied to its assignor, Tammy Agosto. Yklik moved for summary judgment, asserting proper bill submission and Allstate's failure to timely pay or deny the claim. Allstate argued that the charges exceeded the Workers' Compensation fee schedule and that a partial payment had been made. The court found that Yklik established a prima facie case. The central issue was whether Allstate's fee schedule defense was precluded due to its failure to issue a timely denial within 30 days as mandated by Insurance Law § 5106 (a) and 11 NYCRR 65-3.5. The court ruled that since Allstate waited 56 days to send its denial, it was precluded from raising the fee schedule defense, and therefore, summary judgment was granted to the plaintiff.

No-fault insurancesummary judgmenttimely denialfee schedulepreclusion ruleinsurance lawmedical supplybilling practicespersonal injury protectionassignor
References
19
Case No. MISSING
Regular Panel Decision

Claim of Keselman v. New York City Transit Authority

Claimant, injured in 1986, initially established a right shoulder injury. The Workers’ Compensation Board affirmed this but denied a causally related neck injury in 1996. After another application in 1998 alleging a worsened neck condition, the Workers’ Compensation Law Judge found a causally related neck injury and permanent partial disability, awarding benefits from February 5, 1998, which the Board affirmed. Separately, the Board also ruled the employer was entitled to credit schedule payments against disability payments made after February 5, 1998. The court affirmed both decisions, finding substantial evidence supported the deterioration of the neck injury post-1996 and that schedule awards are independent of actual disability periods, thus allowing the employer's credit.

Workers' CompensationPermanent Partial DisabilitySchedule AwardDisability PaymentsNeck InjuryRight Shoulder InjuryCausally Related InjuryReopening CaseMedical EvidenceMRI
References
7
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