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

Case No. 2024 NY Slip Op 00599 [224 AD3d 428]
Regular Panel Decision
Feb 06, 2024

Matter of New Millennium Pain & Spine Medicine, P.C. v. Garrison Prop. & Cas. Ins. Co.

This case involves two appeals by New Millennium Pain & Spine Medicine, P.C. against Garrison Property & Casualty Insurance Company and GEICO Casualty Company. New Millennium sought to vacate master arbitration awards that denied its claims for no-fault benefits for medical services. The Supreme Court denied these applications. The Appellate Division, First Department, affirmed the Supreme Court's decisions, stating that an arbitrator's award will not be set aside unless it is irrational. The court also addressed the argument regarding a 20% wage offset in no-fault benefits, finding it unavailing under Insurance Law § 5102 (b). Ultimately, New Millennium was not entitled to attorneys' fees as it was not the prevailing party.

No-fault benefitsarbitration awardvacaturinsurance lawwage offsetappellate reviewmedical servicesno-fault policy exhaustionattorneys' feesCPLR Article 75
References
8
Case No. MISSING
Regular Panel Decision
Feb 15, 1990

Narine v. Handler

Oduth Narine, an employee of Protection Systems Specialists, Inc., was injured while inspecting a ventilation system. Narine and his wife initiated a negligence action against his employer and co-employee Howard Handler, alleging failure to provide a safe workplace. The defendants sought summary judgment, claiming the suit was barred by the Workers' Compensation Law, given Narine had already received benefits. The Supreme Court denied their motion. On appeal, the order was modified; summary judgment was granted to Protection Systems Specialists, Inc. due to the exclusivity of Workers' Compensation benefits. However, the denial of summary judgment for Handler was affirmed, as questions of fact remained regarding his employment relationship.

NegligencePersonal InjurySummary JudgmentWorkers' CompensationExclusive RemedyCo-employee LiabilityFactual QuestionsAppellate ReviewEmployer LiabilitySafe Place to Work
References
5
Case No. MISSING
Regular Panel Decision

Landon v. Kroll Laboratory Specialists, Inc.

This case addresses whether a drug testing laboratory can be held liable in tort to a non-contracting subject for negligent testing. The plaintiff, while on probation in Orange County, submitted an oral fluid sample that Kroll Laboratory Specialists, Inc., falsely reported as positive for marijuana. The lab allegedly used a lower cutoff level than recommended and failed to perform a confirmatory GC/MS test, leading to an extension of the plaintiff's probation. The Supreme Court initially dismissed the complaint, but the appellate court reversed, asserting that a duty of reasonable care exists due to the severe consequences of inaccurate drug test results on individuals' lives and the lack of market incentives for testing accuracy. The court concluded that the plaintiff's complaint adequately stated a cause of action for negligence.

Drug TestingNegligenceTort LiabilityForensic ToxicologyPrivity of ContractDuty of CareProbation ViolationFalse PositiveLaboratory StandardsCPLR 3211(a)(7)
References
101
Case No. MISSING
Regular Panel Decision

Claim of Steuber v. Home Properties, Inc.

Claimant applied for workers' compensation benefits after a March 2010 work fall, establishing injuries to his back, left knee, and left hip. After thoracic spine surgery in 2011, the employer and its workers' compensation carrier objected to coverage, arguing it was not causally connected to the initial claim. The Workers’ Compensation Board agreed, a decision which the appellate court affirmed. The court credited an independent medical examiner's opinion that the thoracic condition and subsequent falls were unrelated to the compensable accident, despite the claimant's orthopedic surgeon's testimony suggesting otherwise.

Workers' Compensation BenefitsCausal RelationThoracic Spine InjuryDegenerative ConditionIndependent Medical ExaminationSubsequent FallsBoard DecisionAppellate ReviewCredibility AssessmentSubstantial Evidence
References
3
Case No. ADJ7422993
Regular
Apr 06, 2015

SHIRLEY LESCALLETT vs. WAL-MART, ACE AMERICAN INSURANCE, YORK RISK SERVICES

In this workers' compensation case, the applicant sought to select a pain management specialist as her primary treating physician. The employer's Medical Provider Network (MPN) did not have any pain management specialists within the 15-mile/30-minute access standard for primary physicians, though it did have specialists within a 30-mile/60-minute radius. The Appeals Board affirmed the WCJ's decision, holding that if an applicant chooses a specialist for their primary care, the MPN must provide at least three physicians of that specialty within a 15-mile/30-minute radius. Since the defendant's MPN failed to meet this standard for pain management specialists, the applicant was permitted to choose one outside the MPN. A dissenting opinion argued that the 30-mile/60-minute standard for specialists should apply, allowing the applicant to select a physician within that broader radius from the MPN.

MPNMedical Provider NetworkPrimary Treating PhysicianSpecialistAccess StandardsAdministrative Director's RulePain Management PhysicianGeographic RadiusLabor CodeWorkers' Compensation Appeals Board
References
3
Case No. MISSING
Regular Panel Decision
Nov 05, 1990

In re New York Archaeological Council v. Town Board of Coxsackie

This case involves an appeal from a Supreme Court judgment that dismissed petitioners' application, in a CPLR article 78 proceeding, to review a determination by the Town Board of Coxsackie. Petitioners sought to annul Local Law No. 6 and a negative declaration, which rezoned a 155-acre parcel from residential/agricultural to industrial for a warehouse facility by J-Mark Company, Inc. and Distribution Specialist, Inc. The Town Board, as lead agency under SEQRA, failed to require an Environmental Impact Statement (EIS) despite identifying potentially significant environmental impacts on a recognized archaeological district. The appellate court found the Town Board acted arbitrarily and capriciously by not taking the "hard look" required by SEQRA and by having insufficient time for independent investigation. Consequently, the judgment was modified, the petition granted to the extent of annulling Local Law No. 6 and the negative declaration.

Environmental LawSEQRAZoningLand UseEnvironmental Impact Statement (EIS)Negative DeclarationArchaeological SiteType I ActionArbitrary and CapriciousCPLR Article 78
References
11
Case No. ADJ9145724
Regular
Jun 01, 2015

ARZAGA, JOSE vs. CROWN AUTOMOTIVE, INC., AMTRUST NORTH AMERICA

This case involves an applicant seeking to select a pain management specialist outside his employer's Medical Provider Network (MPN). The applicant argued the MPN failed to provide a qualifying specialist within the required 15-mile/30-minute access standard for a primary treating physician. The Board denied the employer's petition for reconsideration, affirming the applicant's right to choose an out-of-network physician and reimbursement for investigative costs. The majority reasoned that the MPN must meet the closer access standard for a primary treating physician, even if that physician is a specialist. A dissenting opinion argued that a specialist, when chosen as a primary treating physician, should fall under the 30-mile/60-minute access standard for specialists.

Medical Provider NetworkMPNprimary treating physicianpain management specialistaccess standardAdministrative Director's Rule 9767.5investigative costsLabor Code section 5703Lescallett v. Wal-MartMartinez v. New French Bakery
References
2
Case No. 2024 NYSlipOp 01325 [225 AD3d 723]
Regular Panel Decision
Mar 13, 2024

Samperi v. City Safety Compliance Corp.

Plaintiff Salvatore Samperi was injured at a construction site when an outward swinging access gate hit him. He sued multiple defendants, including Northeast Interior Specialists, LLC, alleging Labor Law § 200 violations and common-law negligence. Northeast moved for summary judgment to dismiss these claims, which the Supreme Court denied. The Appellate Division, Second Department, affirmed the denial, ruling that Northeast failed to establish prima facie that it did not create the dangerous condition of the gate.

Personal InjuryConstruction AccidentLabor LawCommon-law NegligenceSummary JudgmentAppellate ReviewSafe Place to WorkDangerous ConditionSubcontractor LiabilityProximate Cause
References
14
Case No. MISSING
Regular Panel Decision

Claim of Karatas v. Eastman Kodak Co.

The claimant appealed a decision by the Workers' Compensation Board, filed July 29, 1991, which denied her claim for workers' compensation benefits on the grounds that she did not sustain a causally related disability to her spine. Expert medical evidence, including testimony from an impartial specialist appointed by the Board, indicated that the claimant's disability was not casually related to her employment. This testimony provided substantial evidence to support the Board's finding. The appellate court noted that any conflicting medical opinion presented does not alter the result, as such conflicts are to be resolved by the Board. Consequently, the decision of the Workers' Compensation Board was affirmed without costs.

Causal RelationshipMedical EvidenceWorkers' Compensation BenefitsAppellate ReviewBoard FindingsConflicting Medical OpinionAffirmed DecisionSpinal Disability
References
4
Case No. ADJ11595561 ADJ11602485
Regular
Jun 27, 2019

CINTIA LEMUS vs. MOTEL 6/G6 HOSPITALITY, LIBERTY MUTUAL

In this case, the applicant sustained work-related injuries to her mid and low back. The defendant disputed the applicant's request for a chiropractic Qualified Medical Evaluator (QME) panel, arguing an orthopedic-spine specialist was more appropriate. The Medical Director initially agreed, citing the use of prescription medication outside a chiropractor's scope. However, the Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, finding that the Medical Director's rationale was insufficient. The Board affirmed the Workers' Compensation Judge's decision to overrule the Medical Director and allow a chiropractic QME, citing precedent that QMEs cannot provide treatment or opine on disputed treatment issues.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalFindings and OrderAdministrative Law Judge (WCJ)Qualified Medical Evaluator (QME)Medical DirectorQME Panel SpecialtyChiropracticOrthopedic-Spine
References
9
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