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

Case No. 2015-2337 Q C
Regular Panel Decision
May 18, 2018

Sama Physical Therapy, P.C. v. Hereford Ins. Co.

This case concerns an action by Sama Physical Therapy, P.C., as assignee, to recover first-party no-fault benefits from Hereford Insurance Co. The defendant argued that the plaintiff's assignor had been injured during the course of employment. The Civil Court conditionally granted defendant's cross-motion for summary judgment, ordering the plaintiff to file an application with the Workers' Compensation Board within 90 days. Plaintiff failed to comply with this order, and upon renewal, the Civil Court adhered to its prior determination. The Appellate Term, Second Department, affirmed the Civil Court's order, finding that the plaintiff did not demonstrate compliance with the order to make a proper application under the Workers' Compensation Law.

No-Fault BenefitsSummary JudgmentWorkers' Compensation BoardAppellate ReviewConditional GrantFailure to ComplyRenewal MotionInsurance LawAssigneeMedical Provider
References
1
Case No. 2015-608 Q C
Regular Panel Decision
Dec 19, 2017

Adelaida Physical Therapy, P.C. v. 21st Century Ins. Co.

In this case, Adelaida Physical Therapy, P.C., acting as an assignee, appealed an order from the Civil Court of the City of New York, Queens County. The original order had granted 21st Century Insurance Company's motion for summary judgment, dismissing parts of a complaint seeking first-party no-fault benefits for services billed under specific CPT codes (97010, 97110, and 97124). The Appellate Term, Second Department, reversed the lower court's decision. The appellate court found that 21st Century Insurance Company failed to demonstrate that it had used the correct conversion factor to calculate the reimbursement rate, thus not establishing its defense that the charged fees exceeded the workers' compensation fee schedule. As a result, the branches of the defendant's motion for summary judgment related to those CPT codes were denied.

No-Fault BenefitsCPT CodesSummary JudgmentWorkers' Compensation Fee ScheduleReimbursement RateAppellate ReviewInsurance DisputeCivil ProcedureConversion FactorMedical Billing
References
2
Case No. 2016-198 Q C
Regular Panel Decision
Jun 01, 2018

Comprehensive Care Physical Therapy, P.C. v. Allstate Ins. Co.

This case concerns a provider, Comprehensive Care Physical Therapy, P.C., seeking no-fault benefits from Allstate Insurance Company. The Civil Court initially denied the plaintiff's summary judgment motion and granted the defendant's cross-motion, dismissing the complaint based on the assignor's failure to appear for independent medical examinations (IMEs) and claims exceeding the fee schedule. On appeal, the Appellate Term modified this order, finding that Allstate failed to provide sufficient proof of timely denial form mailing, thereby precluding its defenses regarding IMEs and the fee schedule. Consequently, Allstate's cross-motion for summary judgment was denied, reversing that part of the lower court's decision. However, the Appellate Term affirmed the denial of the plaintiff's summary judgment motion, as the plaintiff also failed to establish their claims.

no-fault insurancesummary judgmentindependent medical examinationstimely denialinsurance defenseappellate reviewmedical billingassignee rightsprocedural requirementsfee schedule
References
5
Case No. 46885/05, 47943/05, 47945/05
Regular Panel Decision

Robert Physical Therapy, P.C. v. State Farm Mutual Automobile Insurance

This case involves three consolidated claims for first-party no-fault benefits related to physical therapy services. The plaintiff's assignors received physical therapy, and the defendant, an insurer, denied some claims due to disputes over billing codes. The central legal issues concerned whether a physical therapist could utilize billing codes from the medicine fee schedule when such services were not explicitly in the physical medicine schedule, and if range of motion and muscle testing could be billed separately from evaluation and management on the same day. The court determined that physical therapists are not confined to the physical medicine section and can use codes from any section of the medical fee schedule. Furthermore, the defendant failed to provide sufficient evidence to justify its denials regarding separate billing for range of motion and muscle testing. Consequently, the court ruled in favor of the plaintiff, awarding judgment for all disputed amounts.

Physical Therapy BillingNo-Fault BenefitsMedical Fee ScheduleCPT CodesWorkers' Compensation RegulationsEvaluation and Management ServicesRange of Motion TestingMuscle TestingProvider SpecialtyBilling Disputes
References
4
Case No. MISSING
Regular Panel Decision

New York City Human Resources Administration v. Carey

This case concerns a CPLR article 78 petition in the nature of a writ of prohibition. The petitioner, the City Human Resources Administration (HRA), sought to vacate a Supreme Court order regarding defendant Delgado, who was charged with arson. Delgado was found by two psychiatrists to be an incapacitated person unable to stand trial due to a severe hearing defect. The lower court, misinterpreting CPL article 730, ruled that Delgado's physical incapacity did not fall under the statute and ordered his placement with HRA and the Department of Social Services. The appellate court granted the writ of prohibition, vacating the lower court's order for exceeding its jurisdiction. The court declared Delgado incompetent to stand trial *nunc pro tunc* and committed him to the custody of the New York State Commissioner of Mental Health, clarifying that CPL 730.10 broadly applies to any mental defect causing incapacity, regardless of its source. The decision emphasized that the statute does not distinguish between different sources of disability once a finding of incapacity is made.

Incompetency to Stand TrialWrit of ProhibitionMental IncapacityCriminal Procedure LawJurisdiction DisputeArson Third DegreeDue ProcessCommitment OrderAppellate ReviewPhysical Impairment
References
1
Case No. MISSING
Regular Panel Decision
Nov 14, 1991

Pellach v. Pellach

The Supreme Court modified an earlier order denying plaintiff's motion to reopen a maintenance and support hearing and compel defendant's physical examination. The record before the Special Referee was reopened, allowing the plaintiff to subpoena defendant's bank account records due to alleged discovery of new information and previous attorney refusal. However, the court affirmed the denial of the physical examination request, noting the defendant's prior adjudication of permanent disability by the Workers’ Compensation Board. The delay in the divorce action, pending since 1988, was largely attributed to the defendant's frequent changes of attorneys.

DivorceMaintenanceSupportFinancial DisclosureBank AccountsPhysical ExaminationWorkers' CompensationJudicial DiscretionAppellate ReviewReopening Record
References
1
Case No. MISSING
Regular Panel Decision

Denise AA. v. David AA.

This case is an appeal from a Family Court order granting the petitioner primary physical custody of two children, Rebecca and Chelsea, while maintaining joint legal custody. The respondent, appealing pro se after an adjournment request was denied, argued that the Family Court abused its discretion in the custody award and in denying the adjournment. The appellate court affirmed the Family Court's decision, finding no abuse of discretion in denying the adjournment given the respondent's ample time to secure counsel. The court also found the custody award to the petitioner to be in the children's best interest, despite concerns about the petitioner's judgment regarding her older daughter's sexual activity and cohabitation plans. The decision emphasized the deference given to Family Court's factual findings and the desirability of keeping siblings together.

child custodyphysical custodyjoint legal custodyvisitation rightsFamily Court Act Article 6pro se representationadjournment denialbest interest of the childparental judgmentappellate review
References
7
Case No. 2018 NY Slip Op 03678 [161 AD3d 1074]
Regular Panel Decision
May 23, 2018

Matter of Greco v. Robert N. Greco

The mother, Susan Greco, appealed an order from the Family Court, Nassau County, which denied her petition to modify a prior physical access order and directed her to pay supervised physical access costs exceeding $100 per month. The Appellate Division, Second Department, affirmed the Family Court's order. The court found that the mother failed to demonstrate a change in circumstances warranting modification of the custody and physical access arrangement. It also determined that a more flexible physical access schedule was in the children's best interests and upheld the Family Court's financial determination regarding supervised physical access costs based on the parties' financial situation.

Child CustodyPhysical AccessFamily LawAppellate ReviewOrder ModificationSupervised VisitationBest Interests of the ChildParental Financial ObligationNassau CountyPro Se Representation
References
6
Case No. MISSING
Regular Panel Decision

the Claim of Brigandi v. Town & Country Linoleum & Carpet

This case involves an appeal by an employer and its compensation carrier against decisions made by the Workers’ Compensation Board. The decedent, a carpet layer, died from cardiac arrest during work, with an autopsy revealing underlying coronary atherosclerotic disease. His widow was awarded death benefits. The employer’s carrier sought reimbursement from the Special Disability Fund under Workers’ Compensation Law § 15 (8), asserting a preexisting permanent physical impairment. However, the Board determined that there was no evidence that the decedent’s heart condition hindered his job potential before his death, thus releasing the Special Disability Fund from liability and holding the compensation carrier responsible. The employer's subsequent application for reconsideration was denied by the Board, leading to these appeals. The appellate court affirmed the Board's decisions, concluding that the Board rationally found no proof that the decedent's heart disease impaired his job potential, a necessary condition for reimbursement under WCL § 15 (8) (d).

Special Disability FundPreexisting Permanent ImpairmentCardiac ArrestCoronary Atherosclerotic DiseaseDeath Benefits ClaimEmployer ReimbursementCarrier LiabilityBoard Decision ReviewAppellate AffirmationMedical Evidence Interpretation
References
2
Case No. MISSING
Regular Panel Decision
Nov 08, 1993

Thomas v. Abate

The Supreme Court, New York County, affirmed a judgment denying the petition of a probationary correction officer seeking to annul her termination and reinstatement with back pay. The petitioner was terminated due to extensive absenteeism, having accrued 376 sick days in 26 months, and departmental medical personnel deemed her medically unfit for full duty. The court found the termination was not arbitrary, capricious, or made in bad faith, and that the petitioner was not entitled to an evidentiary hearing. The appellate court upheld this decision, emphasizing that extensive absences and physical incapacity are valid, good-faith bases for terminating a probationary employee without a hearing.

Probationary employmentemployee terminationabsenteeismmedical unfitnessNew York City Department of Correctionadministrative appealjudicial reviewgood faithbad faithreinstatement
References
8
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