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Case Law Database

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

Case No. MISSING
Regular Panel Decision

Spherenomics Global Contact Centers v. Vcustomer Corp.

Plaintiff Spherenomics Global Contact Centers sued defendant vCustomer Corporation for breach of a non-solicitation agreement, breach of implied covenant of good faith and fair dealing, promissory estoppel, and unjust enrichment. Spherenomics, a provider of outsourced call-center services, alleged that VCC, its subcontractor, improperly solicited and secured a long-term contract with their mutual client, Fingerhut, in violation of their November 2002 agreement. While the court found that VCC indeed breached the non-solicitation provision, it ultimately ruled in favor of VCC. The court concluded that Spherenomics failed to prove by a preponderance of the evidence that VCC's breach directly caused Spherenomics to suffer damages, specifically lost profits, deeming such claims too speculative to be recoverable under New York contract law or equitable theories.

Breach of ContractNon-Solicitation AgreementLost ProfitsDamagesCausationPromissory EstoppelUnjust EnrichmentContract LawNew York LawFederal Jurisdiction
References
32
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. ADJ10762593
Regular
Feb 06, 2023

NICHOLAS KOBE vs. CITY OF LOS ANGELES, AIMS

The Workers' Compensation Appeals Board denied the City of Los Angeles' petition for reconsideration, upholding the finding that firefighter Nicholas Kobe's TMJ/myofascial pain injury was compensable. The Board adopted the judge's report, which determined that the applicant was not the initial physical aggressor in an altercation with a fellow firefighter, as the initial physical contact was initiated by the other firefighter. Therefore, Labor Code §3600(a)(7) did not bar the claim, and the applicant was awarded temporary and permanent disability benefits. The defense exclusively argued the initial physical aggressor defense, which the Board found inapplicable based on the facts.

Initial physical aggressor defenseLabor Code §3600(a)(7)TMJ/myofascial painPanel Qualified Medical EvaluatorNina Nattiv DDSfirefighter injurytemporary disabilitypermanent disabilitywage calculationattorney fees
References
11
Case No. MISSING
Regular Panel Decision

Claim of Capon v. Grumman Corp.

William Capon sustained compensable injuries to his left leg in 1970 and 1983. In the latter incident, he fractured his femur, requiring surgery. Following his hospital discharge, Capon began physical therapy with Louis Cress. On April 8, 1983, after a reportedly strenuous therapy session, Capon suffered a fatal heart attack approximately one hour after returning home. His wife, the claimant, applied for workers' compensation benefits. The Workers’ Compensation Board sustained the claim, based on Dr. Irwin Friedman's testimony that the heart attack was causally related to the stress of the physical therapy. The employer appealed, contending that Friedman's testimony lacked substantial evidence. The court found adequate evidentiary support in the physical therapist's report and the claimant's testimony regarding Capon's condition, affirming the Board's decision.

Workers' Compensation BenefitsCausal ConnectionFatal Heart AttackStress-Induced InjuryPhysical Therapy ComplicationsMedical Expert TestimonyAppellate Court ReviewSubstantial Evidence RuleEmployer AppealDecedent's Claim
References
2
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. ADJ1132942 (LAO 0875472)
Regular
Aug 20, 2009

James Lewis vs. COMPTON UNIFIED SCHOOL DISTRICT, HAZELRIGG RISK MANAGEMENT SERVICES

The Workers' Compensation Appeals Board denied James Lewis's petition for reconsideration of its prior decision that his injury arose from an altercation where he was the initial physical aggressor. The Board found applicant initiated a confrontation with a co-worker over a parking space, culminating in physical contact with the co-worker while attempting to move a truck. Applicant's arguments regarding evidence review and the Board exceeding its powers were rejected, as the Board can independently reweigh evidence and found applicant's conduct barred his claim under Labor Code section 3600(a)(7).

Initial physical aggressorLabor Code section 3600(a)(7)Petition for reconsiderationWorkers' Compensation Appeals BoardOpinion and OrderGranting ReconsiderationDecision After ReconsiderationFindings of FactAdministrative law judgeReconsideration of evidence
References
0
Case No. MISSING
Regular Panel Decision

John R. v. State of New York Office of Children and Family Services

Petitioners Patricia R. and John R. were 'indicated' for child maltreatment after their children had continued contact with an uncle who had sexually abused their oldest daughter. Despite being explicitly instructed by a child protective services caseworker to prevent any contact, the children reported seeing and greeting the uncle. Patricia R. even sent the youngest child to the uncle's apartment. The petitioners challenged this determination in a CPLR article 78 proceeding, requesting the report be amended to unfounded. However, the court confirmed the determination, finding substantial evidence that the children's physical, mental, or emotional condition was impaired or in imminent danger due to the petitioners' failure to exercise a minimum degree of care in supervision.

Child MaltreatmentChild AbuseSexual AbuseParental NeglectFailure to SuperviseCPLR Article 78Administrative ReviewSubstantial EvidenceFamily LawChild Protection
References
5
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