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Case Law Database

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

Case No. 2014-1124 K C
Regular Panel Decision
Jul 21, 2017

Natural Therapy Acupuncture, P.C. v. Nationwide Ins.

The Appellate Term, Second Department, affirmed an order of the Civil Court of the City of New York, Kings County, which had granted summary judgment to Nationwide Ins. The case involved Natural Therapy Acupuncture, P.C.'s action to recover assigned first-party no-fault benefits. Nationwide Ins. successfully argued that it properly reimbursed the plaintiff for acupuncture services using the workers' compensation fee schedule applicable to chiropractors providing similar services. The appellate court found sufficient proof of timely mailing of claim denials and full payment according to the fee schedule. A new contention raised by the plaintiff for the first time on appeal was not considered by the court.

no-fault insuranceacupuncture servicesworkers' compensation fee schedulesummary judgmentappellate reviewclaim denialtimely mailingreimbursementmedical servicesfirst-party benefits
References
4
Case No. 2017-635 K C
Regular Panel Decision
Aug 02, 2019

Natural Therapy Acupuncture, P.C. v. GEICO Ins. Co.

In this case, Natural Therapy Acupuncture, P.C., acting as assignee, sought to recover no-fault benefits from GEICO Ins. Co. The Civil Court initially denied GEICO's cross-motion for summary judgment to dismiss claims concerning unpaid benefits. On appeal, the Appellate Term, Second Department, reversed the lower court's decision. The Appellate Term found that GEICO had timely denied the claims and correctly applied the workers' compensation fee schedule for the services in question. Consequently, GEICO's cross-motion for summary judgment was granted, dismissing the plaintiff's claims.

No-Fault BenefitsSummary JudgmentWorkers' Compensation Fee ScheduleAppellate ReviewInsurance ClaimsTimely DenialAssigned ClaimsMedical Provider ReimbursementCivil CourtAppellate Term Decision
References
2
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. 2017-407 K C
Regular Panel Decision
Jul 12, 2019

Apple Massage Therapy, P.C. v. 21st Century Ins. Co.

This case concerns an appeal by Apple Massage Therapy, P.C., as an assignee, against 21st Century Ins. Co. The plaintiff sought to recover assigned first-party no-fault benefits. The appeal challenged an order from the Civil Court of the City of New York, Kings County, which had granted the defendant's motion for summary judgment, thereby dismissing the complaint. The appellate court found that the defendant adequately demonstrated the proper mailing of denial of claim forms and the correct application of the workers' compensation fee schedule for determining benefits. Consequently, the appellate court affirmed the Civil Court's order.

No-Fault BenefitsSummary JudgmentAppellate ReviewDenial of ClaimWorkers' Compensation Fee ScheduleInsurance LawCivil ProcedureAssignee ClaimMailing PresumptionMedical Provider
References
1
Case No. 2014-769 Q C
Regular Panel Decision
Mar 18, 2016

Natural Therapy Acupuncture, P.C. v. American Tr. Ins. Co.

The plaintiff, Natural Therapy Acupuncture, P.C., acting as an assignee of Christopher Icheke, initiated an action to recover assigned first-party no-fault benefits from American Transit Ins. Co. The plaintiff moved for summary judgment, while the defendant cross-moved for summary judgment, asserting that all claims had been timely and properly paid in accordance with the workers' compensation fee schedule. The Civil Court denied the plaintiff's motion and granted the defendant's cross-motion, dismissing the complaint. On appeal, the Appellate Term affirmed the Civil Court's order, concluding that the defendant had successfully demonstrated full payment under the workers' compensation fee schedule, and the plaintiff failed to raise a triable issue of fact.

No-fault benefitsSummary judgmentWorkers' compensation fee scheduleAppellate reviewInsurance claimsAssignee rightsCivil Court decisionTimely paymentMedical servicesAcupuncture services
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. 2015-1078 K C
Regular Panel Decision
Jan 20, 2017

Bronx Acupuncture Therapy, P.C. v. Hereford Ins. Co.

This case involves Bronx Acupuncture Therapy, P.C., as assignee of Niurka Mejia, appealing an order from the Civil Court of the City of New York, Kings County. The defendant, Hereford Ins. Co., had moved for summary judgment, arguing full payment according to workers' compensation fee schedules. The Civil Court granted the motion, dismissing claims for services billed under codes 97039 (unlisted modality) and 99199 (unlisted special service). The Appellate Term reversed this decision, finding that the defendant failed to request additional verification within 15 business days for these "By Report" designated codes, as required by 11 NYCRR 65-3.5 (b). Therefore, the defendant was not entitled to summary judgment.

No-Fault BenefitsSummary JudgmentAppellate TermWorkers' Compensation Fee ScheduleUnlisted Medical CodesVerification of ClaimsMoxibustionAcupressureInsurance DisputeHealthcare Provider Reimbursement
References
2
Case No. MISSING
Regular Panel Decision
Nov 05, 2014

Shoshanah B. v. Lela G.

This case involves an appeal from a Family Court order concerning child therapy and visitation. The original order, entered on November 5, 2014, permitted the respondent (custodial parent) to enroll the parties' child in therapy and temporarily suspended the petitioner's Wednesday overnight visits. The Appellate Division modified the order, affirming the respondent's right to enroll the child in therapy but vacating the suspension of the petitioner's Wednesday overnight visits. The court found that while the respondent acted appropriately in seeking therapy for the child due to emotional distress, the Family Court erred in modifying the visitation schedule without a proper hearing, as there was no showing of an immediate emergency. The ruling underscores the requirement for a hearing when modifying custody or visitation orders, even on a temporary basis.

Family LawChild CustodyVisitation RightsChild TherapyParental RightsCustody Agreement ModificationJudicial Hearing OfficerAppellate ReviewDue ProcessEmergency Order
References
8
Case No. MISSING
Regular Panel Decision
Mar 01, 2011

Tptcc Ny, Inc. v. Radiation Therapy Services, Inc.

Plaintiffs TPTCC NY, Inc., The Proton Institute of New York, LLC, and N.Y. Medscan LLC sued defendants Norton Travis, Radiation Therapy Services Inc. (RTSI), Oppenheimer & Co., Inc., Cicero Consulting Associates VCC, Inc., New York Proton Management LLC (NYPC), Radiation Therapy Services Holdings, Inc., and 21st Century Oncology, LLC. Plaintiffs alleged federal antitrust, federal copyright, and various New York state law claims, contending a conspiracy to exclude them from the New York City market for Proton Beam Therapy (PBT) services and misappropriation of their business plan. The court dismissed the antitrust claims, applying the Noerr-Pennington doctrine and finding a lack of antitrust injury. Copyright claims were dismissed because the business plan lacked creativity for copyright protection and was jointly authored. State law claims, including breach of joint venture, unjust enrichment, misappropriation of trade secrets, unfair competition, tortious interference, breach of fiduciary duty, and breach of contract, were also dismissed due to various legal deficiencies, such as the absence of a joint venture, the public disclosure of alleged trade secrets, and the lack of a fiduciary relationship. The court reaffirmed its order granting defendants' motions and dismissed the Amended Complaint in its entirety with prejudice, directing entry of final judgment for the defendants.

Antitrust LawCopyright LawTrade SecretsUnfair CompetitionFiduciary DutyBreach of ContractJoint VentureNoerr-Pennington DoctrineSherman ActNew York Common Law
References
57
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