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

Case No. 2017 NY Slip Op 01454
Regular Panel Decision
Feb 23, 2017

Sokolovic v. Throgs Neck Operating Co., Inc.

This case involves an appeal concerning hold harmless and indemnity agreements. The Supreme Court, Bronx County, initially granted Vision Healthcare Services' motion to enforce a hold harmless agreement and Throgs Neck Operating Company, Inc.'s motion for summary judgment on its contractual indemnity claim against Vision. The Appellate Division, First Department, affirmed these orders. The court held that the plaintiff was obligated to hold Vision harmless from Throgs Neck's indemnification claim due to a hold harmless agreement executed during settlement. It further clarified that a nurse provided by Vision to Throgs Neck remained Vision's general employee, thereby triggering Vision's contractual indemnity obligation, despite being considered a special employee of Throgs Neck for the purpose of Throgs Neck's liability to the plaintiff.

hold harmless agreementcontractual indemnityspecial employeegeneral employeestaffing agreementsettlement agreementsummary judgmentnegligenceagency liabilityappellate review
References
3
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. ADJ1088522 (RIV 0015524)
Regular
Jan 03, 2013

SAMANTHA VAN DUINHOVEN vs. SPA HOTEL & CASINO, CALIFORNIA CASUALTY, Administered by GAB ROBINS NORTH AMERICA

This case involved an applicant who claimed industrial injury to her neck, back, left shoulder, psyche, and associated chronic pain syndrome, resulting in a finding of permanent total disability. The defendant sought reconsideration, arguing the medical evidence did not support injury to the low back or a diagnosis of chronic pain syndrome. The Appeals Board reversed the findings on the low back and chronic pain syndrome, finding no substantial evidence to support them. Consequently, the applicant's permanent disability award was amended to 70%, based on ratings for her neck, left shoulder, and psyche.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPermanent Total DisabilityChronic Pain SyndromeAgreed Medical EvaluatorQualified Medical EvaluatorMedical Record ReviewIndustrial InjuryPermanent Disability Indemnity
References
0
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

Gaston v. Great Neck Union Free School District

Luis Gaston, an employee of Bay Welding, Inc., was injured while working at a school owned by Great Neck Union Free School District. Gaston initiated a negligence action against the School District, which subsequently filed a third-party complaint against Bay Welding, Inc., seeking indemnification for allegedly failing to procure general liability insurance as per their contract. The Supreme Court granted partial summary judgment to the School District, finding Bay Welding, Inc., had not provided proof of the required insurance. However, the Appellate Division reversed this decision, ruling that the contract regarding insurance coverage was ambiguous and necessitated a trial to determine the parties' intent.

Personal InjuryNegligenceContract DisputeIndemnificationSummary JudgmentAppellate ReviewInsurance CoverageContract AmbiguityThird-Party Action
References
0
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. 2025 NY Slip Op 02902 [238 AD3d 836]
Regular Panel Decision
May 14, 2025

Canales v. Rye Neck Union Free Sch. Dist.

The plaintiff, Osman Canales, an employee of Sea Breeze General Construction, Inc., sustained injuries after slipping and falling approximately five feet from a truck step at a construction site at Daniel Warren Elementary School. He initiated an action against Rye Neck Union Free School District and Daniel Warren Elementary School, alleging violations of Labor Law §§ 240 (1) and 241 (6). The Supreme Court granted the defendants' motion for summary judgment, dismissing the Labor Law § 240 (1) claim and parts of the Labor Law § 241 (6) claim, while denying the plaintiff's cross-motion. The Appellate Division affirmed the Supreme Court's order, ruling that the five-foot descent was not an elevation-related risk under Labor Law § 240 (1) and that Industrial Code provisions 12 NYCRR 23-1.7 (d) and (e) (2) were inapplicable because truck steps are not considered 'elevated working surfaces' and the injury resulted from a slip, not a trip.

Labor Law § 240 (1)Labor Law § 241 (6)Industrial Code 12 NYCRR 23-1.7Elevation-related riskSafe place to workSummary judgmentSlip and fallConstruction accidentTruck egressAppellate Division Second Department
References
13
Case No. CV-23-0766
Regular Panel Decision
Nov 07, 2024

In the Matter of the Claim of Mary Daniels

Claimant Mary Daniels appealed a Workers' Compensation Board decision denying a causally-related neck injury. Daniels, a train conductor, initially claimed work-related injuries to her right shoulder, elbow, and hand. A Workers' Compensation Law Judge (WCLJ) established claims for the shoulder and elbow but not the neck. The Board affirmed, noting Daniels did not report neck pain in her initial claim or during a hearing, despite medical experts opining on a causally-related neck injury based on her later complaints. The Appellate Division affirmed the Board's decision, deferring to its credibility determinations and finding substantial evidence supported the finding that the medical opinions lacked a proper factual basis regarding the neck injury.

CausationNeck InjuryRight Shoulder InjuryRight Elbow InjuryMedical EvidenceCredibility DeterminationSubstantial EvidenceAppellate ReviewTreating PhysicianOrthopedic Surgeon
References
5
Case No. MISSING
Regular Panel Decision

Claim of Knisell v. Treasure Chest Advertising Co.

Claimant sustained a work-related injury on October 12, 1999. Initially reporting an injury to her left arm, she later experienced neck pain and sought workers' compensation benefits for injury to her left arm, shoulder, and neck. A Workers’ Compensation Law Judge initially barred the neck injury claim due to a failure to provide timely notice to the employer under Workers’ Compensation Law § 18. However, the Workers’ Compensation Board reversed this decision, concluding that the employer was aware of the neck, arm, and shoulder injury on the date of the accident. The employer appealed the Board's reversal. The Appellate Division affirmed the Board's decision, finding that the Board's conclusion of employer awareness was supported by substantial evidence in the record.

Workers' CompensationNotice RequirementCausally Related InjuryNeck InjuryShoulder InjuryArm InjurySubstantial EvidenceAppellate ReviewBoard ReversalEmployer Knowledge
References
1
Case No. 2024 NY Slip Op 05517
Regular Panel Decision
Nov 07, 2024

Matter of Daniels v. New York City Tr. Auth.

Mary Daniels, a train conductor, filed a claim for workers' compensation benefits alleging work-related injuries to her right shoulder, right elbow, and right hand from a March 4, 2022 incident. A Workers' Compensation Law Judge (WCLJ) found prima facie medical evidence for injuries including her neck, but ultimately established the claim only for the shoulder and elbow, finding no causally-related neck injury. The Workers' Compensation Board affirmed this determination. On appeal, the Appellate Division, Third Department, affirmed the Board's decision, concluding it was supported by substantial evidence. The court noted that while treating physicians opined on a causally-related neck injury, the claimant herself did not report neck pain in her initial claim or job injury report and denied it during the hearing, thereby undermining the factual basis for the medical opinions.

Workers' CompensationCausationNeck InjuryShoulder InjuryElbow InjuryCredibility DeterminationSubstantial EvidenceAppellate ReviewTreating PhysicianOrthopedic Surgeon
References
5
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