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Case Law Database

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

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

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. ADJ5829433
Regular
Nov 08, 2017

JESSICA SENQUIZ vs. CITY OF FREMONT, YORK INSURANCE

In this workers' compensation case, the Workers' Compensation Appeals Board (WCAB) reconsidered a prior decision regarding payment for medical services. The defendant reduced payments for epidural steroid injections based on National Correct Coding Initiative (NCCI) edits, arguing this was a fee schedule dispute subject to Independent Bill Review (IBR). The WCAB ultimately rescinded the prior decision, finding that disputes over procedure coding, even if not explicitly adopted in the fee schedule, are considered disputes over the amount payable under the Official Medical Fee Schedule. Therefore, the WCAB concluded that such billing disputes are subject to IBR and not within the WCAB's jurisdiction.

WCABJessica SenquizCity of FremontYork InsuranceADJ5829433Opinion and Decision After Reconsiderationtransforaminal epidural steroid injectionsFremont Surgery CenterIndependent Bill Review (IBR)National Correct Coding Initiative (NCCI)
References
0
Case No. MISSING
Regular Panel Decision

L&L Painting Co. v. Contract Dispute Resolution Board

L&L and Odyssey, contractors for lead-based paint removal on the Queensboro Bridge, disputed a contract drawing's interpretation with the Department of Transportation (DOT) concerning scaffolding clearance. Petitioners sought additional compensation after DOT rejected their proposed platform design, claiming a latent ambiguity in the contract. The Contract Dispute Resolution Board (CDRB) denied their claim, finding a patent ambiguity requiring pre-bid clarification. The Supreme Court upheld CDRB's decision, and this appellate court affirmed, concluding that the ambiguity was indeed patent, contrasting 'all roadways' in the note with the drawing's specific references. A dissenting opinion argued against this, stating an engineer would find no ambiguity.

Contract DisputePublic Works ContractQueensboro BridgeConstruction LawContract InterpretationAmbiguityPatent AmbiguityLatent AmbiguityCPLR Article 78Administrative Law
References
0
Case No. ADJ10348591 ADJ10349019
Regular
Jan 07, 2019

MIGUEL VELAZQUEZ, SERVANDO VELAZQUEZ vs. ARTEMIO ARCE, SOLOMON MARTINEZ

The Workers' Compensation Appeals Board denied a defendant's petition for reconsideration, upholding a prior finding that liens for interpreting services were not barred by AD rule 9792.5.5. This rule, requiring a second review request for fee schedule disputes, did not apply because the interpreter services were not subject to an applicable fee schedule at the time of service. Therefore, the lien claimant's failure to request a second review did not preclude the WCAB from adjudicating the lien dispute. The Board reasoned that AD rule 9792.5.5 and associated statutes only mandate the second review process for disputes concerning amounts under an "applicable fee schedule."

Workers' Compensation Appeals BoardAD Rule 9792.5.5Official Medical Fee ScheduleIndependent Bill ReviewExplanation of ReviewLabor Code section 4603.2Senate Bill 863Threshold IssueFee Schedule DisputeInterpreter Services
References
0
Case No. 46885/05, 47943/05, 47945/05
Regular Panel Decision

Robert Physical Therapy, P.C. v. State Farm Mutual Automobile Insurance

This case involves three consolidated claims for first-party no-fault benefits related to physical therapy services. The plaintiff's assignors received physical therapy, and the defendant, an insurer, denied some claims due to disputes over billing codes. The central legal issues concerned whether a physical therapist could utilize billing codes from the medicine fee schedule when such services were not explicitly in the physical medicine schedule, and if range of motion and muscle testing could be billed separately from evaluation and management on the same day. The court determined that physical therapists are not confined to the physical medicine section and can use codes from any section of the medical fee schedule. Furthermore, the defendant failed to provide sufficient evidence to justify its denials regarding separate billing for range of motion and muscle testing. Consequently, the court ruled in favor of the plaintiff, awarding judgment for all disputed amounts.

Physical Therapy BillingNo-Fault BenefitsMedical Fee ScheduleCPT CodesWorkers' Compensation RegulationsEvaluation and Management ServicesRange of Motion TestingMuscle TestingProvider SpecialtyBilling Disputes
References
4
Case No. MISSING
Regular Panel Decision

In re the Arbitration between A.F.C.O. Metals, Inc. & Local Union 580 of International Ass'n of Bridge

This case concerns a dispute between Local Union 580 and AFCO Metals, Inc. regarding arbitration of pension fund contributions. Local 580 claimed AFCO underpaid contributions by assigning work to Carpenters Unions that should have been allocated to Local 580 members. AFCO sought to stay arbitration, arguing the dispute was jurisdictional and excluded from arbitration under their collective bargaining agreement. The Supreme Court initially dismissed AFCO's petition, but the Appellate Division reversed, finding the dispute jurisdictional. The Court of Appeals affirmed the Appellate Division's order, ruling that the underlying dispute is a jurisdictional matter, which the parties explicitly agreed to exclude from arbitration provisions in their collective bargaining agreement.

ArbitrationJurisdictional DisputeCollective Bargaining AgreementPension FundsUnion ContributionsWork AssignmentAppellate ReviewLabor LawContract InterpretationFund Delinquency
References
3
Case No. 2025 NY Slip Op 01159
Regular Panel Decision
Feb 27, 2025

Matter of American Bridge Co. v. Contract Dispute Resolution Bd. of the City of N.Y.

The Appellate Division, First Department, affirmed a lower court's decision denying American Bridge Company's (AB) petition to annul a determination by the Contract Dispute Resolution Board (CDRB). AB, a contractor for the New York City Department of Transportation (DOT), sought additional compensation for redesigning a protective shield on the Ed Koch Queensboro Bridge due to a discrepancy in vertical clearance measurements. However, the contract explicitly required AB to verify all existing dimensions, noting that DOT's figures were approximate. The court concluded that the contract unambiguously placed the responsibility for verifying dimensions on the contractor, and DOT had not made any bad faith misrepresentations, thereby affirming the denial of additional costs.

Contract DisputeConstruction ContractPublic WorksContract InterpretationRisk AllocationField MeasurementsBid DocumentsMisrepresentationAdministrative AppealArticle 78 Proceeding
References
4
Case No. MISSING
Regular Panel Decision

In re the Arbitration between Lane & Leather Workers' Union of the United States

The case involves an appeal by an employer against a Special Term order compelling arbitration of disputes with a petitioner (union) following the expiration of a collective bargaining agreement. Disputes originated in January 1947 over roller wages, leading to a work stoppage in March that was settled by an agreement to arbitrate. A second dispute arose over the discharge of three employees, also demanded for arbitration. After the contract expired on June 1, 1947, the employer contended its obligation to arbitrate ceased. The Special Term ruled that the duty to arbitrate disputes arising during the contract term survived its expiration. The Appellate Division affirmed this order, specifying that arbitration should be limited to grievances pending before the contract's expiry on May 31, 1947.

ArbitrationCollective Bargaining AgreementWage DisputeWork StoppageEmployee DischargeContract ExpirationArbitrabilityAppellate ReviewLabor LawPanel Decision
References
6
Case No. VNO 0495347
Regular
Jul 07, 2008

JOHN LIEBIG vs. LEXINGTON ACQUISITION, STATE COMPENSATION INSURANCE FUND

This case concerns an applicant who sustained admitted industrial injuries, and the central dispute is which permanent disability rating schedule applies. The defendant sought reconsideration, arguing the 2005 Schedule should apply instead of the 1997 Schedule used by the trial judge. The Appeals Board granted reconsideration, finding that pre-2005 reports did not sufficiently indicate permanent disability to trigger the exception allowing the 1997 Schedule. Consequently, the case was returned to the trial level for permanent disability determination under the 2005 Schedule.

Workers' Compensation Appeals BoardLexington AcquisitionState Compensation Insurance FundVNO 0495347Opinion and Order Granting ReconsiderationFindings and AwardWCJindustrial injuryneckback
References
0
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