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

Case No. ADJ8969504
Regular
Sep 12, 2016

GLADYS PAZ, vs. TECH FLEX; SEABRIGHT INSURANCE COMPANY, TRI-COUNTY MEDICAL GROUP

This case concerns the timeliness of a lien claim filed by Tri-County Medical Group for services rendered to applicant Gladys Paz. The lien was filed on October 19, 2015, more than 18 months after the last date of service on December 23, 2013. The Appeals Board affirmed the WCJ's decision that the lien is barred by the 18-month limitation period in Labor Code section 4903.5(a) for services provided on or after July 1, 2013. The Board found that the amended statute applied and lien claimant had a reasonable time to file within 18 months of their last service date.

Workers' Compensation Appeals BoardLien ClaimantLabor Code Section 4903.5(a)Statute of LimitationsReconsiderationFindings and OrderAdministrative Law JudgeContinuous ServicesEffective DateRetroactive Application
References
11
Case No. MISSING
Regular Panel Decision

Rechenberger v. Nassau County Medical Center

Edward Rechenberger suffered hip fractures and underwent two operations at Nassau County Medical Center in May 1982. Following a re-injury and later diagnosis, he learned the surgical hardware was improperly implanted, leading to further operations. Mr. Rechenberger sought leave to serve a late notice of claim against the medical center. The Supreme Court initially denied the motion, but the Appellate Division reversed this decision, finding that the hospital had actual knowledge of the essential facts of the claim within the statutory 90-day period through its own medical records. The court concluded that the delay in serving the notice of claim was not substantially prejudicial to the hospital, and thus, granted the petitioners leave to serve the late notice of claim.

Medical MalpracticeLate Notice of ClaimNassau CountyHip FractureSurgical ErrorContinuous Treatment DoctrineActual NoticePrejudiceAppellate ReviewMunicipal Corporation
References
11
Case No. MISSING
Regular Panel Decision

Berweger v. County of Orange

Plaintiffs Lurana M. Berweger and Susan E. Menon, nurses at the Orange County Correctional Facility, sued under 42 U.S.C. § 1983 for wrongful termination, alleging retaliation for criticizing the County’s Department of Mental Health's (DMH) inadequate inmate medical care. They also brought a state claim under New York State Labor Law § 740. The defendants included the County of Orange, County Executive Joseph G. Rampe, Commissioner of Mental Health Chris Ashman, County Attorney Richard Golden, and their private employer, Eastern Health Care Group, Inc. (EHG). The court granted summary judgment for Ashman and Golden on the § 1983 claims, citing lack of evidence, but denied it for Rampe, EHG, and the County due to remaining factual disputes regarding Rampe's involvement and EHG's potential state actor status. All state whistleblower claims were dismissed as plaintiffs complained about a third party (DMH), not their direct employer. EHG's motion for attorneys' fees and Rule 11 sanctions was denied, as Menon's claim was not deemed frivolous.

Civil Rights (42 U.S.C. § 1983)Whistleblower ProtectionWrongful TerminationSummary JudgmentFirst AmendmentMunicipal LiabilityState Actor DoctrineIndependent Contractor LiabilityCorrectional HealthcareOrange County
References
27
Case No. 2024 NY Slip Op 00069 [223 AD3d 660]
Regular Panel Decision
Jan 10, 2024

Matter of County of Nassau v. Nassau County Sheriff's Corr. Officers' Benevolent Assn.

The County of Nassau appealed an order denying its petition to vacate an arbitration award. The arbitration award had concluded that the County violated a collective bargaining agreement by denying General Municipal Law § 207-c benefits to correction officers who missed no work time but sought medical treatment for work-related injuries or illnesses. The Supreme Court initially denied the County's petition and granted the union's cross-petition to confirm the award. The Appellate Division, Second Department, reversed this order, finding the arbitration award to be irrational because the claimants neither sought payment of salary/wages nor reimbursement for out-of-pocket medical expenses, thus not requiring the benefits outlined in General Municipal Law § 207-c. Consequently, the County's petition to vacate the arbitration award was granted, and the cross-petition to confirm was denied.

Arbitration AwardVacaturCollective Bargaining AgreementGeneral Municipal Law § 207-cCorrection OfficersMedical BenefitsLost TimePublic Policy ExceptionIrrational AwardAppellate Review
References
9
Case No. MISSING
Regular Panel Decision

Rafiy v. Nassau County Medical Center

Dr. M. Pierre Rafiy and Dr. Philip Rafiy (the Rafiys) initiated a civil action against Nassau County Medical Center, Nassau County, Dr. Bruce Meinhard, and Dr. Anthony Angelo. Their claims, brought under 42 U.S.C. § 1983 and the Sherman Act, included deprivation of hospital privileges without due process, racial discrimination, and retaliation for exercising free speech rights. The Defendants sought summary judgment, arguing the revoked assignments were not protected property interests and the Rafiys failed to exhaust state remedies. They also contended that the Rafiys' speech was not protected under the First Amendment and that evidence for discrimination was lacking. The court granted the Defendants' motion for summary judgment on all counts, concluding that no constitutional violations occurred and that the Rafiys' antitrust claim had been withdrawn.

Civil RightsDue ProcessFirst AmendmentEqual ProtectionRacial DiscriminationRetaliationHospital PrivilegesSummary JudgmentSherman ActAntitrust
References
29
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. 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. 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. 2013-1427 K C
Regular Panel Decision
Jun 03, 2016

Harvard Med., P.C. v. Tri State Consumers Ins. Co.

This is an appeal by Harvard Medical, P.C., as assignee of Lenford Carty, against Tri State Consumers Ins. Co. The appeal is from an order of the Civil Court of the City of New York, Kings County, entered April 12, 2013, which granted the defendant's motion for summary judgment. The defendant argued that it had fully paid the plaintiff in accordance with the workers' compensation fee schedule for first-party no-fault benefits. The Appellate Term, Second Department, affirmed the Civil Court's order, citing a related case, Renelique, as Assignee of Yvon Delgado v Tri State Consumers Ins. Co.

No-fault benefitsSummary JudgmentAppellate ReviewWorkers' Compensation Fee ScheduleAssignee
References
1
Case No. 2011-192 K C
Regular Panel Decision
Dec 19, 2017

Jamaica Dedicated Med. Care, P.C. v. Tri State Consumer Ins. Co.

This case concerns an appeal from an order of the Civil Court of the City of New York, Kings County, which denied defendant Tri State Consumer Ins. Co.'s cross motion for summary judgment. Jamaica Dedicated Medical Care, P.C., as assignee, sought first-party no-fault benefits. Tri State Consumer Ins. Co. contended that it had either properly reimbursed services according to the workers' compensation fee schedule or timely denied others due to lack of medical necessity. The Appellate Term found a triable issue of fact regarding medical necessity and that the defendant failed to establish its workers' compensation fee schedule defense as a matter of law. Consequently, the order denying summary judgment was affirmed.

No-fault benefitsSummary judgmentMedical necessityWorkers' compensation fee scheduleAppellate reviewAssigneeInsurance claimCivil CourtAppellate TermKings County
References
2
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