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

Case No. No. M2018-01696-COA-R3-CV; No. 15-4-IV
Regular Panel Decision
Dec 07, 2020

American Board of Craniofacial Pain v. American Board Of Orofacial Pain

This case involves an appeal concerning a failed merger between two professional dental associations, American Board of Craniofacial Pain (ABCP) and American Board of Orofacial Pain (ABOP). ABCP sued ABOP, alleging a breach of an agreement to merge formed through email exchanges and seeking specific performance and damages. The Chancery Court for Davidson County granted summary judgment to ABOP, finding no meeting of the minds and thus no enforceable contract. The Court of Appeals of Tennessee affirmed this decision, concluding that the parties’ objective manifestations showed a lack of mutual assent because an essential term (disposition of intellectual property) was not agreed upon and they intended to reduce the agreement to a formal Memorandum of Understanding, which was never finalized. The court also agreed that specific performance was not an available remedy due to the incompleteness of the purported contract.

Contract DisputeMerger NegotiationsCorporate MergerDental ProfessionMutual AssentSpecific Performance DenialSummary Judgment AffirmationTennessee Court of AppealsContract FormationLack of Agreement
References
26
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. 2014-02-0003
Regular Panel Decision
Feb 06, 2015

Russell, Angela v. Newport Health and Rehab

Angela Russell, a registered nurse for Newport Health & Rehab, filed a Request for Expedited Hearing seeking medical and temporary total disability benefits for alleged back pain, chest wall pain, a cystocele, and depression, claiming these arose from a lifting injury on July 29, 2014, and an abusive supervisor. The employer contended Ms. Russell failed to present sufficient evidence of a compensable physical or mental injury. The Court found that Ms. Russell's conditions, including chest pains from congestive heart failure and degenerative back problems, were not established by expert medical opinion to have arisen primarily out of and in the course and scope of her employment. Her mental injury claim was also denied, as her work stressors were deemed normal and not the result of a sudden or unusual stimulus. Consequently, the Court denied her request for medical and temporary total disability benefits.

Expedited HearingMedical Benefits DenialTemporary Total Disability DenialCompensability DisputeDegenerative Back ConditionMental Injury ClaimWork-Related StressorsCystoceleMedical Evidence InsufficiencyTennessee Workers' Compensation
References
2
Case No. MISSING
Regular Panel Decision
May 05, 2000

Pain Resource Center v. Travelers Insurance

This case addresses a dispute regarding the payment of first-party no-fault benefits to a health provider, Pain Resource Center, as the assignee of John Hiotis, who was injured in an auto accident. The defendant, Travelers Ins. Co., challenged the validity of the assignment and the necessity of the medical services provided. The court affirmed the validity of the assignment under New York's Insurance Law and related regulations. However, based on conflicting expert testimonies, the court limited the compensable medical services to six hours and awarded the plaintiff $566.10, along with statutory interest and attorney's fees.

No-Fault InsuranceFirst-Party BenefitsAssignment ValidityMedical ServicesPeer ReviewInsurance LawHealth Provider ClaimAutomobile AccidentDamagesStatutory Interpretation
References
5
Case No. MISSING
Regular Panel Decision

Universal Acupuncture Pain Services, P.C. v. Lumbermens Mutual Casualty Co.

The New York court addresses a motion for reargument by Universal Acupuncture Pain Services, P.C. against Lumbermens Mutual Casualty Company concerning no-fault insurance claims. The central legal question is whether an expert witness's peer review report, created after a timely denial of a no-fault claim, can be admitted at trial, specifically under the Cirucci precedent regarding the specificity of denial grounds. The court grants the motion for reargument but upholds its initial ruling, which granted partial summary judgment on one of five claims. It clarifies that the expert's testimony must be strictly limited to the "concurrent or excessive care" ground initially stated by the insurer, excluding any new grounds like "medical necessity" not specified in the original denial. The court emphasizes that the issue of whether different treatment modalities constitute concurrent care for the same condition requires a trial for factual determination.

No-Fault InsurancePeer ReviewExpert Witness TestimonySummary Judgment MotionInsurance Law InterpretationSpecificity of DenialConcurrent Medical CareAcupuncture TreatmentChiropractic TreatmentPhysical Therapy
References
7
Case No. MISSING
Regular Panel Decision

Claim of Cramer v. Barney's Clothing Store

A claimant appealed an award for disability due to a myocardial infarction. The board found that an argument with his supervisor about pay led to severe chest pain, and medical evidence supported that excitement from the argument, superimposed on a prior cardiac condition, caused the infarction. The claimant testified to a 20-minute argument with his assistant manager about overtime pay, during which he threatened to go home and experienced chest pains. The court, however, found no legally sufficient basis for the board's finding of an accident, stating the situation did not involve emotional tension greater than typical workplace irritations and was not exceptional enough to meet established legal tests for accident. Consequently, the decision and award were reversed, and the matter was remitted to the Workmen's Compensation Board.

myocardial infarctionworkplace argumentemotional stressworkers' compensationcardiac pathologydisability awardlegal precedentmedical evidenceappealboard finding
References
3
Case No. MISSING
Regular Panel Decision
May 15, 1970

Claim of Melillo v. La Sala Contracting Co.

The decedent, while engaged in strenuous work, complained of chest pain, collapsed, and died shortly after. His widow, Jean Melillo, filed a claim for death benefits, which was controverted by Annette Melillo, who also asserted to be the legal widow. The Workmen’s Compensation Board found that the decedent’s strenuous work activity, combined with continuing to work despite chest pains, constituted an accidental injury leading to his death. The Board also determined Jean Melillo to be the lawful widow entitled to benefits. Annette Melillo appealed this decision, but her appeal was considered abandoned due to failure to file a brief. The Appellate Division affirmed the Board’s findings, citing substantial medical evidence supporting the causal relationship between the decedent's continued work after the onset of symptoms and his death.

Worker's CompensationAccidental InjuryCausal RelationshipDeath BenefitsWidow DisputeStrenuous WorkMedical EvidenceAppeal AbandonedBoard FindingsChest Pain
References
3
Case No. MISSING
Regular Panel Decision
Apr 19, 1995

Claim of Tomlin v. Asplundh Tree Expert Co.

The claimant, a site manager for 23 years, began experiencing chest pains in February 1984. His employer granted him a medical leave and requested documentation. The claimant's treating physician, Patrick McAndrew, diagnosed essential hypertension, left ventricular hypertrophy, and chest pain of undetermined origin. The employer then used a disability claim form as a claim for a self-administered salary continuation plan, paying benefits under it. After an examination by the employer's physician, John Walters, who found no organic heart disease, the employer terminated the claimant, considering his absence a voluntary termination due to lack of a "bona fide" disability. The claimant subsequently filed for statutory disability benefits and a claim for discriminatory discharge with the Workers’ Compensation Board, alleging a violation of Workers’ Compensation Law § 241 for retaliation. The Board asserted jurisdiction, found discrimination, but reduced damages due to the claimant's failure to actively seek employment. The employer appealed, arguing lack of jurisdiction and insufficient evidence, but the decision was affirmed.

References
3
Case No. MISSING
Regular Panel Decision

DePoalo v. County of Schenectady

This case involves two correction officers, Philip DePoalo and Alfred Greenewald, employed by the County of Schenectady, who sought benefits under General Municipal Law § 207-c for work-related illnesses. DePoalo suffered chest pains due to a pre-existing heart condition, which his personal physician attributed to job-related stress. Greenewald experienced chest pains while on duty, diagnosed as a hiatal hernia, but lacked clear evidence connecting it to his employment. The County denied their applications, with DePoalo's denial partly due to his refusal of a county-scheduled medical examination. The Supreme Court initially granted the petitions, ruling against the county's authority to require a pre-determination medical examination for eligibility. However, the Appellate Division reversed, holding that General Municipal Law § 207-c authorizes municipalities to direct applicants to undergo medical examinations to establish a work-related disability before benefits are awarded, to prevent fraudulent claims. The Court of Appeals affirmed the Appellate Division's decision, emphasizing that the statute's plain wording and legislative history support the municipality's right to determine eligibility through a medical exam.

General Municipal Law § 207-cMedical Examination RequirementEligibility for BenefitsCorrection OfficersWork-Related IllnessPre-determination ExaminationMunicipal AuthorityStatutory InterpretationCardiac ConditionsHiatal Hernia
References
4
Case No. MISSING
Regular Panel Decision
Sep 04, 2013

Matter of Madigan v. ARR ELS

In 1994, the claimant sustained a low back injury during employment as a machinist, leading to workers' compensation benefits. Liability for the case was transferred to the Special Fund for Reopened Cases in 2003. Due to poor surgical outcomes, the claimant has been on pain medication, including oxycontin, since at least 2007, with doses escalating. A consultant for the Special Fund questioned the necessity of the increased medication, prompting a hearing. A Workers’ Compensation Law Judge ruled that the pain medications should continue, with the Special Fund covering the costs, until new Board guidelines or physician recommendations advised otherwise. The Workers’ Compensation Board affirmed this decision, citing that their Medical Treatment Guidelines for chronic pain were still in draft form at the time. The appellate court subsequently affirmed the Board's decision, noting that the guidelines were not yet in effect at the time of the Board's ruling and that the Board's interim guidance was rational.

Workers' CompensationPain ManagementOpioid PrescriptionsMedical Treatment GuidelinesSpecial FundReopened CasesLumbar InjuryOxycontinAppellate ReviewAdministrative Law
References
4
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