CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

Case Law Database

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

Case No. 2019 NY Slip Op 08951 [178 AD3d 525]
Regular Panel Decision
Dec 12, 2019

Matter of Global Liberty Ins. Co. of N.Y. v. North Shore Family Chiropractic, PC

The Appellate Division, First Department, affirmed the dismissal of a petition by Global Liberty Insurance Company of New York, which sought to vacate an arbitration award denying their claim. Global Liberty had argued that workers' compensation benefits were available to the assignor, Ramon Martinez, and thus their denial of the no-fault insurance claim to North Shore Family Chiropractic, PC (Martinez's assignee) was proper. The court found that Global Liberty failed to prove Martinez was injured in the course of his employment. The order was modified to remand the matter for a determination of attorneys' fees owed to North Shore Family Chiropractic, PC, including those for the appeal.

Insurance DenialNo-Fault BenefitsArbitration AwardAttorneys' FeesWorkers' Compensation CoverageEmployment StatusAppellate ReviewRemandBurden of ProofAssignor
References
4
Case No. 2014-1527 Q C
Regular Panel Decision
Dec 08, 2017

AVM Chiropractic, P.C. v. American Tr. Ins. Co.

This case concerns an appeal from an order of the Civil Court of the City of New York regarding assigned first-party no-fault benefits. Plaintiff, AVM Chiropractic, P.C., sought to recover benefits from American Transit Ins. Co. The Civil Court initially granted some branches of the defendant's motion for summary judgment and reduced claims based on a fee schedule defense. The Appellate Term modified the order, denying summary judgment for the defendant on specific causes of action (second, third, and sixth through eighth) and vacating findings on others (ninth and tenth). The court found that the defendant did not adequately demonstrate appropriate reductions in accordance with workers' compensation Ground Rules for several claims.

No-Fault BenefitsSummary JudgmentWorkers' Compensation Fee ScheduleAppellate ReviewInsurance ClaimsAssigneeFirst-Party BenefitsCivil ProcedureGround RulesNew York Law
References
1
Case No. 2014-1568 S C
Regular Panel Decision
Jul 20, 2016

Chirocare Chiropractic Assoc. v. State Farm Mut. Auto. Ins. Co.

This case involves a provider, Chirocare Chiropractic Associates, as assignee of Antoneta Mertiri, seeking first-party no-fault benefits from State Farm Mutual Automobile Insurance Company. The District Court initially granted State Farm's motion for summary judgment, dismissing the complaint based on a workers' compensation fee schedule defense. The Appellate Term reversed this order, finding that the District Court erred by dismissing the entire complaint on this ground, as the fee schedule defense only applied to amounts in excess of the schedule. Furthermore, the District Court failed to address State Farm's primary defense of lack of medical necessity, which could have been dispositive of the whole action. The matter was remitted to the District Court for a new determination addressing the medical necessity defense first.

No-fault insuranceAutomobile insuranceSummary judgmentAppellate reversalRemittiturMedical necessity defenseWorkers' compensation fee scheduleFirst-party benefitsAssignee claimChiropractic care
References
2
Case No. 2015-1649 Q C
Regular Panel Decision
Jan 20, 2017

Flatbush Chiropractic, P.C. v. American Tr. Ins. Co.

Flatbush Chiropractic, P.C., as assignee of Pierre Luxio, appealed an order that granted American Transit Ins. Co.'s motion to dismiss the complaint and denied plaintiff's cross-motion for leave to renew its prior motion for summary judgment. The Civil Court initially denied plaintiff's summary judgment motion and granted defendant's cross-motion, requiring Workers' Compensation Board resolution within 90 days due to an issue of fact regarding the accident occurring in the course of employment. After 21 months, defendant moved to dismiss for non-compliance, and plaintiff cross-moved to renew, presenting an affidavit indicating no record of a workers' compensation application. The Appellate Term affirmed the Civil Court's decision, stating that the alleged 'new facts' would not change the prior determination and plaintiff failed to show good cause against dismissal.

No-Fault BenefitsWorkers' Compensation IssueSummary Judgment MotionMotion to DismissLeave to RenewAppellate ReviewProcedural ComplianceAssignor-AssigneeCivil CourtAppellate Term
References
1
Case No. 2016-329 S C
Regular Panel Decision
Apr 27, 2017

Spineisland for Chiropractic, P.C. v. 21st Century Advantage Ins. Co.

This case involves an appeal by Spineisland For Chiropractic, P.C., acting as an assignee, against 21st Century Advantage Insurance Company concerning first-party no-fault benefits. The plaintiff sought to recover for services billed under CPT code 95831. The District Court of Suffolk County had previously granted the defendant's motion for summary judgment, asserting that the defendant had appropriately paid the plaintiff based on the workers' compensation fee schedule. On appeal, the Appellate Term affirmed the lower court's decision. The Appellate Term found that the defendant had adequately demonstrated the proper application of CPT code 95833 for the services billed under CPT code 95831, and the plaintiff failed to present a triable issue of fact.

No-fault benefitsSummary judgmentCPT codeWorkers' compensation fee scheduleAppellate TermSuffolk CountyAssigneeInsurance disputeChiropractic servicesMedical billing
References
1
Case No. 2018 NY Slip Op 03093
Regular Panel Decision
May 01, 2018

Contact Chiropractic, P.C. v. New York City Tr. Auth.

This case addresses the applicable statute of limitations for no-fault claims against a self-insured entity. The Court of Appeals determined that the three-year statute of limitations under CPLR 214 (2) governs such claims, as the obligation to provide no-fault benefits by a self-insurer is statutory rather than contractual. This decision reversed the Appellate Division, which had applied a six-year statute of limitations based on a contractual nature. The Court clarified that in the absence of a private insurance contract, the self-insurer's liability for first-party benefits is wholly statutory. The ruling impacts procedural aspects without altering the substantive no-fault obligations of self-insurers.

Statute of LimitationsNo-Fault InsuranceSelf-Insurer LiabilityCPLR 214 (2)CPLR 213 (2)Statutory ObligationContractual ObligationFirst-Party BenefitsMotor Vehicle AccidentsAppellate Review
References
30
Case No. ADJ9040017, ADJ9040025
Regular
Jan 03, 2017

Superior Chiropractic Care vs. WES-LAR, INC.; TOWER GROUP COMPANIES administered by AMTRUST NORTH AMERICA

The Workers' Compensation Appeals Board denied reconsideration for lien claimant Superior Chiropractic Care's petition to reinstate its dismissed lien. The Board found that the lien claimant was properly served with notices for a lien conference and an intent to dismiss its lien, despite their claims of non-receipt. Evidence showed the lien claimant had notice of the proceedings and failed to appear or object timely. Consequently, the Board affirmed the administrative law judge's dismissal of the lien due to the claimant's lack of participation.

Lien claimantReconsiderationOrder Dismissing LienDue ProcessEvidentiary HearingNotice of Intent to DismissWCAB Rule 10562(d)WCAB Rule 10770.1(i)Declaration of Readiness to ProceedLien Conference
References
1
Case No. ADJ11446545
Regular
Dec 03, 2019

ROSA LOPEZ RODRIGUEZ vs. UNIVERSAL BUILDING SERVICES SUPPLY COMPANY, INSURANCE COMPANY OF THE WEST

This case concerns a dispute over the appropriate medical specialty for a Qualified Medical Evaluator (QME) panel. The applicant, Rosa Lopez Rodriguez, initially requested a chiropractic QME panel, which was issued first. The defendant objected, arguing that chiropractic was inappropriate due to the applicant's prior surgery and lack of full recovery. The Medical Unit then invalidated the chiropractic panel and issued an orthopedic surgery panel. The Workers' Compensation Appeals Board granted reconsideration, overturning the WCJ's decision. The Board held that the party who first requests a QME panel has the right to designate the specialty and that the defendant failed to provide sufficient grounds to invalidate the chiropractic panel. Therefore, the Board amended the findings to sustain the applicant's objection and affirm chiropractic as the appropriate panel specialty.

AD Rule 31.5(a)(10)AD Rule 31.5(a)(9)AD Rule 31.1(b)Labor Code section 4062Labor Code section 4062.2Qualified Medical Evaluator (QME)QME panel specialtyPetition for RemovalPetition for ReconsiderationMedical Unit determination
References
1
Case No. ADJ9796670
Regular
Aug 05, 2016

Virginia Lopez vs. California Pizza Kitchen, Travelers Insurance

Applicant Virginia Lopez sought removal after an administrative law judge (WCJ) invalidated a chiropractic QME panel, ordering an orthopedic replacement. The Workers' Compensation Appeals Board (WCAB) granted removal, finding the original chiropractic panel was properly issued and defendants waived their right to object by failing to follow proper procedures. The WCAB amended the WCJ's decision to affirm the chiropractic panel, deeming removal necessary to prevent substantial prejudice. The WCAB affirmed the WCJ's order to issue a replacement panel in the "specialty previously issued," which was chiropractic.

Petition for RemovalQualified Medical Evaluator (QME)Specialty DesignationCompensability ExamLabor Code § 4060Rule 30(b)Rule 31.1(b)Written ObjectionMedical Director ReviewWaiver of Objection
References
6
Case No. ADJ8472711
Regular
Jan 10, 2018

JOSE RAMON RAMIREZ vs. COASTAL GROWERS SUPPLY, INC., MEADOWBROOK INSURANCE

This case concerns a workers' compensation lien claim by Anderson Chiropractic, which was initially allowed only to the extent of $504.72 by an administrative law judge. Anderson Chiropractic petitioned for reconsideration, arguing for the full lien amount. Subsequently, Anderson Chiropractic and defendant Meadowbrook Insurance agreed to resolve the lien for $1,250.00 through mediation. The Workers' Compensation Appeals Board approved this agreement and amended the original order accordingly.

Workers' Compensation Appeals BoardLien claimantReconsiderationFindings and OrderWorkers' compensation administrative law judgePetition for reconsiderationMediationSettlement agreementPenaltyInterest
References
0
Showing 1-10 of 154 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational