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

Case No. ADJ3823114 (MON 0252208)
Regular
Dec 03, 2015

ILANA BENLULU vs. BEVERLY SINAI TOWERS, SEDGWICK CLAIMS MANAGEMENT SERVICES, servicing facility for CIGA for RELIANCE INSURANCE COMPANY, in liquidation

This case concerns the proper transfer of an injured worker into a defendant's Medical Provider Network (MPN). The applicant contended she pre-designated her physician, avoiding MPN requirements, but provided no supporting evidence. The Board found that the defendant's prior attempts to transfer the applicant into the MPN were invalid due to insufficient notice or the MPN's failure to meet minimum access standards. Ultimately, the Board determined that a July 15, 2014 notice, properly served and containing all required information, effectively transferred the applicant into the MPN on August 14, 2014.

MPNMedical Provider NetworkReconsiderationFindings of FactWorkers' Compensation Appeals BoardLabor CodePre-designation of PhysicianContinuity of CareTransfer of CareMinimum Access Standards
References
0
Case No. 2014 NY Slip Op 06183 [120 AD3d 1315]
Regular Panel Decision
Sep 17, 2014

McDonald v. Winter Bros. Transfer Station Corp.

The plaintiff, Andrew McDonald, appealed from an order of the Supreme Court, Suffolk County, which granted the defendant Winter Bros. Transfer Station Corp.'s motion for summary judgment dismissing the complaint in an action to recover damages for personal injuries. The Appellate Division, Second Department, affirmed the order, holding that the defendant established a prima facie defense under the Workers' Compensation Law. The court found that the defendant and the plaintiff's employer, Winter Bros. Waste Systems, Inc., operate as a single integrated entity, thereby extending workers' compensation protection to the defendant as an alter ego of the employer. The plaintiff failed to raise a triable issue of fact in opposition to this defense, leading to the proper dismissal of the complaint.

Alter Ego DoctrineWorkers' Compensation DefenseSummary JudgmentPersonal InjuryEmployer LiabilityIntegrated EntityAppellate DivisionSuffolk CountyTriable Issue of FactRespondent
References
8
Case No. MISSING
Regular Panel Decision

Angulo v. City of New York

In a personal injury action, the defendant City of New York appealed an order from the Supreme Court, Queens County. The original order denied the City's motion to dismiss the complaint for failure to timely serve a notice of claim and granted the plaintiff's cross-motion to deem his notice of claim timely served nunc pro tunc. The plaintiff, injured in May 2005, served his notice of claim in August 2005, which the City rejected as untimely. The Appellate Division reversed the lower court's order, granting the City's motion to dismiss the complaint and denying the plaintiff's cross-motion. The court held that timely service of a notice of claim is a condition precedent to suing the City and that the plaintiff failed to make a timely application for leave to serve a late notice of claim. Furthermore, the court ruled that the plaintiff could not rely on the workers' compensation carrier's notice of claim.

Personal InjuryNotice of ClaimTimelinessCondition PrecedentCPLR 3211(a)(7)General Municipal Law § 50-eDismissal of ComplaintLate Notice of ClaimNunc Pro TuncWorkers' Compensation Carrier
References
7
Case No. MISSING
Regular Panel Decision

Isereau v. Brushton-Moira School District

This case concerns consolidated appeals from Supreme Court orders granting petitioners Darrell Isereau and Jason K. Houghton leave to file late notices of claim against Brushton-Moira School District. The petitioners, employees of Bette & Cring, LLC, were injured in a construction accident in August 2002, sustaining falls of approximately 15 feet. They sought to file late notices of claim based on alleged incapacitation and the District's actual knowledge of the accident. The respondent District argued prejudice due to late notice and a subsequent insurance disclaimer. The Appellate Division affirmed the Supreme Court's orders, finding no abuse of discretion as the District had actual notice of the essential facts, and the insurance disclaimer was attributed to the District Superintendent's failure, not the petitioners' delay.

Late Notice of ClaimGeneral Municipal LawLabor Law ViolationsPersonal InjurySchool District LiabilityConstruction AccidentFall AccidentActual KnowledgePrejudiceInsurance Disclaimer
References
5
Case No. ADJ5814563
Regular
Nov 19, 2012

MARIA VILLEGAS vs. BURKE WILLIAMS, INC., TRAVELERS SACRAMENTO

The Appeals Board dismissed the lien claimant's Petition for Reconsideration as untimely, unverified, and unserved. The Board also initiated removal and a notice of intention to impose a $250 sanction against the lien claimant and its representative for frivolous conduct, including filing a petition with willful misrepresentations of the record. The lien claimant failed to appear at a lien conference, leading to a Notice of Intention to Dismiss, which formed the basis of the dismissed petition. The Board found the lien claimant's assertion of lack of notice contradicted the record, which showed service of the conference notice.

Notice of Intention to Dismiss LienPetition for ReconsiderationLien claimantRemovalSanctionsLabor Code § 5813Due processVerificationServiceUntimely
References
9
Case No. MISSING
Regular Panel Decision

Pellegrini v. Reidy

Petitioner's application for medical assistance was denied due to the transfer of $30,000 to her daughters within 24 months of the application, which was presumed to be for the purpose of qualifying for assistance. The court rejected the petitioner's argument that the transfer was for care provided by her daughters, finding insufficient evidence to rebut the statutory presumption. The court also dismissed the petitioner's claim that the County Department failed its duty to protect her interests, noting this issue was not raised during the fair hearing. However, the court found merit in the petitioner's contention that the County Department failed to comply with the fair hearing determination requiring proper notice of ineligibility. Consequently, the determination was modified to mandate the Montgomery County Commissioner of Social Services provide the required notice, and as modified, confirmed.

medical assistancesocial services lawasset transfereligibilityCPLR article 78fair hearingadministrative reviewstatutory presumptionMontgomery Countydenial of benefits
References
4
Case No. MISSING
Regular Panel Decision
Jan 25, 1988

People v. Villanueva

The People moved for an order requiring Bellevue Hospital to provide 10 days' notice before releasing or transferring the defendant, who was committed as a civil psychiatric patient due to organic mental syndrome (dementia) making him incompetent to stand trial for manslaughter. The court had previously denied the People's application to commit the defendant under CPL 730.50 and the defendant's motion to dismiss the indictment. The court determined that granting the People's motion would subject the defendant to a more stringent standard of release than other civilly committed patients, violating equal protection. Instead, acknowledging the People's and court's interest in monitoring the defendant, the court ordered Bellevue (and subsequent facilities) to provide 10 days' prior written and telephonic notice of transfer or release to a court-appointed expert and personal representative, Hillel Bodek, MSW, CSW, who will monitor the defendant's condition and report to all parties.

Incapacity to Stand TrialCivil CommitmentMental Hygiene LawOrganic Mental SyndromeDementiaJackson v IndianaDue ProcessEqual ProtectionCriminal Procedure LawNotice of Release
References
15
Case No. MISSING
Regular Panel Decision

S & L BIRCHWOOD, LLC v. LFC Capital, Inc.

Plaintiffs, S & L Birchwood, LLC and S & L Birchwood Realty, LLC, filed a breach of contract action against LFC Capital, Inc., following a dispute over a medical equipment lease. LFC alleged default, and S&L initiated a declaratory judgment action in New York state court, which was subsequently removed to federal court. LFC moved to dismiss the complaint or, alternatively, to transfer the case to the United States District Court for the Northern District of Illinois, citing a forum-selection clause in their agreement. The court analyzed the enforceability of the clause, determining it to be mandatory due to language of 'irrevocable submission' to Illinois jurisdiction, despite not explicitly using 'must' or 'may'. Consequently, the court denied LFC's motion to dismiss but granted the request for transfer, concluding that venue was improper in the Eastern District of New York and that transfer to the Northern District of Illinois was warranted under 28 U.S.C. §§ 1404(a) or 1406(a).

Forum selection clauseBreach of contractDiversity jurisdictionTransfer of venueDismissal motionIllinois contract lawNew York jurisdictionMedical equipment leasingMandatory clause interpretationFederal Rules of Civil Procedure 12(b)(3)
References
14
Case No. MISSING
Regular Panel Decision

Claim of Miller v. North Shore University Hospital

Claimant, a registered nurse, allegedly exacerbated an abdominal injury in September 1994 while at work, but did not file a workers' compensation claim until May 1996, after undergoing surgery. The workers' compensation carrier subsequently controverted the claim, citing untimely notice. Both a Workers' Compensation Law Judge and the Workers' Compensation Board determined that the claimant failed to provide timely notice to the employer as mandated by Workers’ Compensation Law § 18. On appeal, the court affirmed the Board's decision, concluding that the emergency room report was insufficient to constitute proper notice. Furthermore, the claimant did not meet his burden of proving that the employer was not prejudiced by the delay in notice, as the delay prevented an investigation prior to his surgery.

Timely NoticeEmployer KnowledgePrejudiceAbdominal InjuryRegistered NurseAccident ReportEmergency RoomSurgeryAppellate ReviewWorkers' Compensation Law § 18
References
5
Case No. MISSING
Regular Panel Decision

In re Settlement Capital Corp.

Settlement Capital Corporation (SCC) sought court approval, under New York's Structured Settlement Protection Act (SSPA), to acquire $125,000 of a $225,000 annuity payment due to Richard C. Ballos on October 1, 2010. Ballos, a totally disabled father of two, agreed to transfer these rights for a net advance of $36,500, reflecting a 15.591% annual discount rate. The court, presided over by Justice Patricia E. Satterfield, denied the petition after a hearing on April 23, 2003. The decision hinged on a two-pronged test: whether the transfer was in Ballos's 'best interest' and if the transaction terms were 'fair and reasonable.' The court found that Ballos did not demonstrate 'true hardship' given his other income sources and previous transfer of structured settlement payments, concluding it was not in his or his dependents' best interest. Furthermore, the court deemed the 15.591% discount rate, resulting in Ballos receiving only 29% of the transferred amount, unconscionable and not 'fair and reasonable.'

Structured SettlementStructured Settlement Protection Act (SSPA)Annuity TransferDiscount RateBest Interest StandardFair and Reasonable StandardPayee ProtectionFinancial HardshipCourt ApprovalGeneral Obligations Law
References
12
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