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

Case No. MISSING
Regular Panel Decision

Fernandez v. North Shore Orthopedic Surgery & Sports Medicine, P.C.

Frank Fernandez, an x-ray technician, sued his former employer, North Shore Orthopedic Surgery & Sports Medicine, P.C., for retaliation under Title VII after filing a national origin discrimination complaint. A jury found in favor of Fernandez, awarding back pay, front pay, and punitive damages. North Shore subsequently moved for judgment as a matter of law, a new trial, and to modify the damage awards. The court denied North Shore's motions for judgment and a new trial, affirmed the jury's back pay award, but vacated and reduced the front pay award from $160,000 to $50,000, and the punitive damages award from $100,000 to $50,000.

RetaliationTitle VIIEmployment DiscriminationBack PayFront PayPunitive DamagesMitigation of DamagesFederal Rules of Civil ProcedureJudicial DiscretionEquitable Relief
References
27
Case No. MISSING
Regular Panel Decision
May 14, 2014

Forest Rehabilitation Medicine PC v. Allstate Insurance

Plaintiff Forest Rehabilitation Medicine PC sued defendant Allstate to recover $3,490 for no-fault medical benefits provided to assignor Tracy Fertitta. The core issue was the medical necessity of "Calmare pain therapy" (scrambler therapy), a novel treatment. The court conducted a bench trial, hearing expert testimony from both sides. Dr. Ayman Hadhoud, for the defense, argued the treatment was not medically necessary, not cost-effective, and essentially a form of physical therapy. Dr. Jack D’Angelo, for the plaintiff, countered that the therapy, though new, had FDA approval, was used by the military, and reduced the assignor's pain levels. Applying the Frye standard, the court found the evidence regarding Calmare scrambler therapy reliable and ruled it was medically necessary for Ms. Fertitta's pain management. Consequently, judgment was awarded to the plaintiff, Forest Rehabilitation Medicine PC, for $3,490 plus attorney's fees and interest.

No-Fault InsuranceMedical NecessityCalmare Pain TherapyScrambler TherapyNovel TreatmentFrye StandardExpert TestimonyPain ManagementFDA ApprovalCervical Radiculopathy
References
14
Case No. MISSING
Regular Panel Decision

Doctor of Medicine in the House, P.C. v. Allstate Ins.

This case concerns a medical service provider plaintiff seeking $1,876.76 in no-fault claim benefits. The defendant insurance company denied the claim, citing that the fees were excessive under the workers’ compensation fee schedule and that prior reimbursements had exhausted the daily 8-unit limit for physical medicine procedures. The central legal question involved interpreting paragraph 11 of the Official New York Workers’ Compensation Medical Fee Schedule, Physical Medicine (2010), specifically whether the 8-unit limit applied per provider or cumulatively across all claimants. The court ruled in favor of the plaintiff, clarifying that the 8-unit rule is an individual provider fee limitation and not an exhaustion regulation for all claimants, distinguishing it from the $50,000 basic economic loss limit.

No-Fault BenefitsWorkers' Compensation Fee ScheduleMedical Reimbursement8-unit RuleFee Schedule InterpretationInsurance LawPhysical MedicineStatutory InterpretationClaim DenialExcessive Billing
References
9
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. 2020 NY Slip Op 04896 [186 AD3d 1770]
Regular Panel Decision
Sep 03, 2020

Matter of Wen Liu v. Division of Gen. Internal Medicine, Mount Sinai Sch. of Medicine

Wen Liu, a data programming analyst, filed for workers' compensation benefits in May 2010, claiming a neck injury from a June 5, 2008 fall at work due to dizziness. The employer failed to timely file a notice of controversy, but a Workers' Compensation Law Judge (WCLJ) disallowed the claim, finding no causal connection between the injuries and employment. The Workers' Compensation Board upheld this decision, which the claimant appealed. The Appellate Division affirmed the Board's decision, emphasizing that the employer's procedural failure did not absolve the claimant of proving a causal relationship. Substantial evidence supported the Board's rejection of the claimant's medical proof, as emergency room records contradicted her later descriptions of the incident and indicated pre-existing conditions.

Workers' CompensationCausationMedical EvidenceTimely NoticeBurden of ProofInjuryFallDizzinessNeck InjuryCarpal Tunnel Syndrome
References
7
Case No. 2017 NY Slip Op 06635
Regular Panel Decision
Sep 26, 2017

Hamburg v. New York University School of Medicine

Plaintiff, Carole Hamburg, M.D., sued New York University School of Medicine for age discrimination under the New York City Human Rights Law and for breach of contract after her employment was not renewed. The Supreme Court granted NYU summary judgment on the age discrimination claim but denied it for the breach of contract claim. On appeal, the Appellate Division, First Department, affirmed the dismissal of the age discrimination claim, finding no evidence of discriminatory intent in NYU's restructuring and phase-out of the general radiology section. The court further modified the lower court's decision, granting summary judgment to NYU on the breach of contract claim, ruling that Dr. Hamburg was not contractually entitled to a year's notice of non-renewal as her non-tenure-eligible position automatically terminated unless renewed. Consequently, the entire complaint was dismissed.

Age DiscriminationEmployment ContractFaculty EmploymentUniversity AdministrationDepartment RestructuringSummary JudgmentAppellate ReviewContract InterpretationTenure-EligibleNon-Tenure Track
References
19
Case No. MISSING
Regular Panel Decision

Icahn School of Medicine at Mount Sinai v. Neurocrine Biosciences, Inc.

The plaintiff, Icahn School of Medicine at Mount Sinai, moved to strike several affirmative defenses and dismiss corresponding counterclaims brought by the defendant, Neurocrine Biosciences, Inc. The core dispute involves a patent license agreement and an alleged unlicensed sublicense by Neurocrine to AbbVie. The court granted Mt. Sinai's motion, striking Neurocrine's affirmative defenses for patent invalidity, non-infringement, and patent misuse. The decision emphasized that Neurocrine was estopped from challenging patent validity due to prior benefits from the license and clarified that Mt. Sinai's damages claim was for breach of contract, not future royalties. Consequently, Neurocrine's related declaratory judgment counterclaims were also dismissed.

Patent invalidityNon-infringementPatent misuseBreach of contractLicense agreementSublicenseDeclaratory judgmentMotion to strikeAffirmative defensesEstoppel
References
23
Case No. MISSING
Regular Panel Decision
Jul 27, 2018

Popat v. Levy

Plaintiff Saurin Popat, M.D., a doctor of African and Southeast Asian origin, filed a lawsuit alleging race and national origin discrimination, hostile work environment, and retaliation under Title VII, § 1981, § 1983, and the NYSHRL, along with tortious interference claims. The defendants include Elad Levy, M.D., The State University of New York at Buffalo, University at Buffalo School of Medicine and Biomedical Sciences, Kaleida Health, and University at Buffalo Neurosurgery, Inc. The plaintiff alleges Dr. Levy, who held multiple positions across these entities, created a hostile work environment through racially charged comments and retaliated against him by terminating his faculty position after a discrimination complaint. The court addressed motions to dismiss filed by the defendants. It found that UBNS and Kaleida could be considered 'joint employers' or acting 'under color of state law' for Title VII and § 1983 purposes, respectively, and that Dr. Levy could be liable under the NYSHRL as an aider and abettor. However, the University and the Medical School were granted dismissal of all claims due to Eleventh Amendment immunity, and certain tortious interference claims against UBNS and Kaleida were also dismissed due to insufficient pleading of an actual breach or injury.

Employment DiscriminationRace & National Origin DiscriminationHostile Work EnvironmentRetaliationTitle VII ClaimsSection 1981 ClaimsSection 1983 ClaimsNew York State Human Rights Law (NYSHRL)Tortious Interference with ContractTortious Interference with Business Relations
References
146
Case No. SAL 96100; 96096
Regular
Jul 03, 2007

JEANNE LAWRENCE vs. CYPRESS URGENT CARE and PREFERRED EMPLOYERS INSURANCE, TENET/DOCTORS HOSPITAL OF MANTECA

This case involves a worker who sustained two industrial injuries, the first in 2001 with Cypress Urgent Care and the second in 2001 with Tenet/Doctors Hospital of Manteca. The defendant, Tenet/Doctors Hospital, sought reconsideration of a joint findings and award that attributed 25% of the worker's temporary disability and vocational rehabilitation costs to their injury. The WCAB granted reconsideration, finding that while the second injury occurred after the first, evidence indicated the first injury contributed to the worker's need for benefits, thus supporting the apportionment.

WCABReconsiderationJoint Findings and AwardPetition for ReconsiderationTemporary Total Disability (TTD)Vocational RehabilitationApportionmentConsecutive InjuriesMedical TreatmentSelf-Insured
References
0
Case No. ADJ9501859
Regular
May 13, 2015

, Jose Chavez, vs. , Miracle Farms, d/b/a Golden Valley Farms; Star Insurance Company, Administered By Meadowbrook Insurance Group,

The applicant suffered a low back injury and claims additional injuries, with a Physical Medicine and Rehabilitation physician as his primary treating doctor. The WCJ incorrectly ordered a Spine-MNB QME panel, overriding the parties' requests and the primary physician's specialty. The Appeals Board dismissed the applicant's reconsideration petition as untimely for a non-final order. They granted removal, rescinded the WCJ's order, and substituted their own, directing the Medical Unit to issue a QME panel in Physical Medicine and Rehabilitation.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalFindings and OrderQualified Medical EvaluatorQME PanelPhysical Medicine and RehabilitationSpine-MNBOrthopedic PanelPrimary Treating Physician
References
5
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