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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

Biscan v. Brown

The provided text is a concurring and dissenting opinion by Justice FRANK F. DROWOTA, III, C.J., in a case regarding the apportionment of fault in a comparative fault system. While agreeing with the majority on some points, Justice Drowota disagrees with the exclusion of Dana Biscan from fault apportionment, despite Tennessee Code Annotated section 57-10-101 precluding legal liability for furnishing alcohol. The opinion argues that disallowing fault to an "effectively immune" tortfeasor, like Dana Biscan, contradicts established Tennessee comparative fault jurisprudence, particularly McIntyre v. Balentine, Carroll v. Whitney, and Dotson v. Blake. Justice Drowota contends that the majority's approach undermines the principle of linking liability to fault, blinds the jury to relevant evidence, and imposes liability disproportionately, thereby injecting confusion into settled law.

Comparative FaultTort LawAlcohol LiabilityStatutory ImmunityProximate CauseApportionment of FaultJudicial DissentTennessee LawMcIntyre v. BalentineCarroll v. Whitney
References
8
Case No. MISSING
Regular Panel Decision

In re the Arbitration between Williams

Amoco Oil appealed two judgments from the Supreme Court, Nassau County, concerning arbitration for uninsured motorist and no-fault benefits. The first judgment, dated January 6, 1977, granted New Hampshire Insurance Company's application to stay arbitration, deeming Amoco Oil's coverage primary and New Hampshire's secondary for uninsured motorist benefits. The second judgment, dated March 30, 1977, permanently stayed arbitration for no-fault benefits under New Hampshire's policy. The Appellate Division affirmed both judgments, concluding that the claimant was "occupying" the Amoco Oil vehicle, making Amoco Oil primarily liable for uninsured motorist benefits. However, the claimant was precluded from receiving these benefits due to already receiving workers' compensation benefits in excess of the maximum, and was also ineligible for no-fault benefits under the New Hampshire policy.

Insurance DisputeArbitration ProceedingsUninsured Motorist CoverageNo-Fault InsuranceWorkers' CompensationPrimary vs Secondary LiabilityAppellate DivisionNassau County Supreme CourtVehicle OccupancyBenefit Eligibility
References
3
Case No. MISSING
Regular Panel Decision

Maxwell v. State Farm Mutual Automobile Insurance

This is an appeal concerning the award of counsel fees in a no-fault automobile accident case. The plaintiff appealed the Trial Term's decision denying an excess counsel fee award, which was initially granted at the statutory maximum. Plaintiff argued that the case involved novel issues related to an exclusion clause and the basis for disclaimer under No-Fault Law, warranting higher fees. The appellate court affirmed the Trial Term's decision, finding that the issues, while skillfully handled, were not sufficiently novel or unique to justify an excess fee under 11 NYCRR 65.16 (c) (8) (vii), as they relied on established contract law and statutory construction. The court also rejected the plaintiff's constitutional challenge regarding the impairment of contracts, clarifying that the fee limitation only applies to the insurer, not the client, and dismissed an ex parte communication claim as outside the record.

No-Fault BenefitsCounsel FeesExcess Fee AwardStatutory InterpretationContract Law PrinciplesConstitutional ChallengeImpairment ClauseAppellate DivisionInsurance RegulationsLegal Practice
References
8
Case No. MISSING
Regular Panel Decision
Oct 14, 2008

Westchester Medical Center v. Lincoln General Insurance

The plaintiff appealed an order from the Supreme Court, Nassau County, which denied its motion for summary judgment to recover no-fault medical benefits. The appellate court reversed the order, granting the plaintiff's motion. The plaintiff successfully demonstrated a prima facie case by showing that statutory billing forms were mailed and received, and the defendant failed to either pay or deny the claim within the 30-day period. The court rejected the defendant's arguments that letters advising of an investigation tolled the statutory period and that the period was tolled pending a no-fault application. Additionally, defenses related to Workers' Compensation benefits or the assignor's failure to appear at an examination under oath were found insufficient to defeat the medical provider's right to benefits.

no-fault insurancemedical benefitssummary judgmentinsurance contractstatutory periodtimely denialworkers' compensationpolicy conditionpreclusion remedyappellate review
References
19
Case No. MISSING
Regular Panel Decision
Jul 02, 2008

LMK Psychological Service, P.C. v. American Transit Insurance

The plaintiffs, as assignees of no-fault benefits, sought to recover for health services rendered to beneficiaries of the defendant’s no-fault insurance contracts. The Supreme Court initially denied the plaintiffs' motion for summary judgment and granted the defendant's cross-motion to dismiss several causes of action, citing Workers' Compensation Law § 11 because the injuries occurred during employment. Upon reargument, the court adhered to its original decision. The appellate court modified this determination, vacating the dismissal of those causes of action. The matter was remitted to the Supreme Court, Westchester County, for a new determination after the Workers’ Compensation Board makes a finding on the parties’ rights under the Workers’ Compensation Law, emphasizing the Board's primary jurisdiction over such factual issues.

Workers' CompensationNo-Fault InsuranceMedical PaymentsSummary JudgmentPrimary JurisdictionAppellate ReviewRemittalInsurance LawAutomobile AccidentJurisdictional Dispute
References
7
Case No. MISSING
Regular Panel Decision

Aetna Life & Casualty Co. v. Nelson

Plaintiff sued defendants, their insureds, to recoup first-party no-fault benefits. Both parties agreed there were no triable issues of fact, disputing only the timeliness of the action commenced on November 7, 1983. Plaintiff argued accrual on April 28, 1981, upon settlement of a Court of Claims action, while defendants claimed accrual on September 23, 1980, when the Court of Claims judgment was entered. Special Term initially applied a six-year limitation period (CPLR 213 [1]) but alternatively found the action timely under a three-year period (CPLR 214 [2]). The appellate court held the appropriate period of limitation is three years (CPLR 214 [2]) for actions upon a liability imposed by statute, such as enforcing a lien under Insurance Law § 5104 [b]. The court affirmed Special Term's alternative finding that the cause of action did not accrue until the underlying Court of Claims action was finally settled, entitling the plaintiff to summary judgment.

No-fault insuranceStatute of limitationsLien enforcementCause of action accrualSummary judgmentAppellate procedureInsurance LawCPLRCourt of ClaimsWorkers' Compensation Law
References
6
Case No. MISSING
Regular Panel Decision
Feb 21, 2006

Global Liberty Insurance v. Abdelhaq

The petitioner sought to permanently stay arbitration of its insured's no-fault claim, arguing the insured was entitled to workers' compensation benefits as primary coverage. The workers' compensation claim had been denied for self-employed cab drivers. The petitioner failed to provide evidence that Kenmore Cab Dispatch Service, Inc. was the insured's employer or that the insured violated their insurance contract. The Supreme Court, Nassau County, denied the petition. This appellate court affirmed the denial, finding no basis to permanently stay the arbitration.

No-fault insuranceArbitration stayWorkers' CompensationSelf-employedCab driverInsurance contract violationAppellate reviewDenial of petitionPrimary coverageNassau County Court
References
1
Case No. MISSING
Regular Panel Decision

Great Wall Acupuncture, P.C. v. GEICO Insurance

This case involves an action brought by a medical provider against an insurer to recover assigned first-party no-fault benefits. The insurer partially paid the claim but denied the remaining portion, arguing that charges for acupuncture treatments exceeded the maximum fees allowed under the applicable fee schedule. Following a nonjury trial, the Civil Court ruled in favor of the defendant, dismissing the complaint. The court held that an insurer may utilize the workers’ compensation fee schedule for acupuncture services rendered by chiropractors, even when the services are performed by a licensed acupuncturist. The appellate court affirmed this judgment, concluding that since the defendant reimbursed the plaintiff according to the workers’ compensation fee schedule for chiropractor-provided acupuncture services, no additional reimbursement was due.

Acupuncture ServicesChiropracticNo-Fault InsuranceFee ScheduleWorkers' Compensation Fee ScheduleLicensure RequirementsFirst-Party BenefitsAppellate ReviewInsurance ReimbursementCivil Court Decision
References
4
Case No. MISSING
Regular Panel Decision

Karmilowicz v. Allstate Insurance

The petitioner was injured in a 1977 motor vehicle accident, leading to a no-fault insurance claim. Following an arbitration award, the petitioner moved to confirm and the respondent cross-moved to vacate, arguing the arbitrator erred by not allowing a Social Security benefits setoff for the petitioner's wife and child. The Supreme Court confirmed the award. On appeal, the court found the Supreme Court applied an incorrect standard of review for compulsory arbitration. The appellate court concluded that the arbitrator's failure to apply the mandated Social Security offset, as per Insurance Law § 671 and 11 NYCRR Part 65, lacked a rational basis and would create an unintended windfall for the petitioner. Consequently, the judgment was modified, denying the confirmation of the arbitration award, partially granting the cross-application to vacate, and remanding the case for recomputation of the award, while affirming the attorney's fees.

No-Fault InsuranceArbitration Award ReviewCompulsory Arbitration StandardsSocial Security Benefits SetoffDependent BenefitsLost Earnings CalculationInsurance RegulationsCPLR Article 75Insurance LawAppellate Review Standard
References
6
Case No. M2001-02766-SC-R11-CV
Regular Panel Decision
Mar 30, 2005

Jennifer L. Biscan v. Franklin H. Brown - Concurring and Dissenting

Chief Justice Drowota pens a concurring in part and dissenting in part opinion regarding the apportionment of fault in a comparative fault case. He agrees with the majority on the exclusion of evidence of Jennifer Biscan's prior alcohol experiences and that Paul Worley owed a duty of care. However, he disagrees with the majority's analysis concerning the apportionment of fault to Dana Biscan, who is effectively immune from liability under Tennessee Code Annotated section 57-10-101 (furnishing alcohol). Drowota argues that fault should still be assigned to immune or effectively immune tortfeasors, citing precedents like Carroll v. Whitney and Dotson v. Blake, to uphold the principle of linking liability to fault. He contends that the majority's decision contradicts prior comparative fault jurisprudence and introduces unnecessary confusion.

Comparative FaultApportionment of FaultImmunity from LiabilityStatutory ImmunityTennessee Code Annotated 57-10-101Proximate CauseLinking Liability to FaultJudicial DissentLegal CausationTennessee Supreme Court
References
9
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