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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
Jul 22, 1987

Williams v. New York State Department of Health

The claimant was injured while rollerskating during her lunch hour on the Empire State Plaza mall. She sought workers' compensation benefits, asserting that her rollerskating was part of an employer-sponsored smoking cessation program that encouraged physical activity. The employer, State Department of Health, and its insurance carrier contested the claim, arguing it was a personal activity. The Workers’ Compensation Board denied benefits, concluding that the injuries did not arise out of and in the course of her employment. On appeal, the court affirmed the Board's decision, finding sufficient evidence that her rollerskating was a voluntary, personal act unrelated to her employment, as the cessation program had no physical exercise component.

Workers' CompensationLunch Break InjuryPersonal ActivitySmoking Cessation ProgramOff-Duty InjuryScope of EmploymentBoard DecisionAppellate ReviewVoluntary ActivityRoller Skating
References
3
Case No. 2023 NY Slip Op 00103 [212 AD3d 644]
Regular Panel Decision
Jan 11, 2023

Pecora v. Fitness Intl., LLC

Michael Pecora appealed from an order granting summary judgment to Fitness International, LLC, in a personal injury action. Pecora alleged he contracted infections, including MRSA, from using a sauna at the defendant's health club. The Appellate Division, Second Department, affirmed the lower court's decision. The court found that the defendants demonstrated the plaintiff could not prove the pathogen originated at their facility, noting MRSA's common transmission, regular cleaning, and lack of prior complaints. The plaintiff failed to raise a triable issue of fact, leading to the affirmation of the dismissal.

Personal InjurySummary JudgmentPremises LiabilityMRSAHealth ClubProximate CauseSpeculationDangerous ConditionInfectious DiseaseAppellate Review
References
17
Case No. MISSING
Regular Panel Decision

Brennan v. Bally Total Fitness

Kathryn Brennan filed a civil rights action against her former employer, Bally Total Fitness Corp., alleging sexual harassment under Title VII and disability discrimination under the ADA. Bally moved to dismiss the complaint as untimely and to compel arbitration based on its Employee Dispute Resolution Procedure (EDRP). The court denied Bally's motion to dismiss the Title VII claim, applying the 'continuing-violation exception' due to Brennan's allegations of ongoing harassment. The court also denied Bally's motion to compel arbitration, finding Bally's unilateral modifications to the EDRP invalid and raising questions of unconscionability regarding the original EDRP. The case is remanded for jurisdictional discovery and a possible hearing to determine the validity of the arbitration agreement.

Civil RightsSexual HarassmentDisability DiscriminationTitle VIIAmericans with Disabilities Act (ADA)Arbitration AgreementFederal Arbitration Act (FAA)Motion to DismissMotion to Compel ArbitrationContinuing Violation Exception
References
27
Case No. 2018 NY Slip Op 07391
Regular Panel Decision
Nov 01, 2018

Matter of Community Hous. Improvement Program v. Commissioner of Labor

The Appellate Division, Third Department, dismissed an appeal filed by the Community Housing Improvement Program against the Commissioner of Labor. The appeal sought to challenge a decision by the Industrial Board of Appeals regarding a minimum wage order for the building service industry. The court determined it lacked subject matter jurisdiction because the petitioner failed to properly file a notice of appeal with the court of original instance, which was the Industrial Board of Appeals, not the Appellate Division. Additionally, the petitioner failed to timely and correctly serve the notice of appeal on the respondent's counsel at the designated address. Consequently, due to the complete failure to comply with CPLR 5515, the appeal was dismissed.

JurisdictionAppeal ProcedureService of ProcessAppellate DivisionIndustrial Board of AppealsMinimum WageLabor LawCPLRNew York CourtsStatutory Interpretation
References
12
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. MISSING
Regular Panel Decision
Aug 30, 2001

Claim of Amicola v. New York Telephone Co.

Claimant, an employee of New York Telephone, sustained a low back injury in December 1992 and underwent disc repair surgery. After returning to light duty, he experienced increased back pain, and despite his physician's direction to stop working, he applied for an early retirement incentive program in May 1994, which was granted the following month. The Workers’ Compensation Board subsequently reversed a WCLJ decision, ruling that the claimant voluntarily withdrew from the labor market due to his early retirement. The Court affirmed the Board's determination, finding substantial evidence to support that the claimant elected to retire, influenced by a significant financial incentive, despite his injury. The decision emphasized that the availability of workers' compensation benefits would not cease with retirement, further supporting the voluntary nature of his withdrawal.

Workers' CompensationVoluntary WithdrawalLabor MarketEarly RetirementDisabilityBack InjuryAppealBoard DecisionSubstantial EvidenceFinancial Incentive
References
5
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. 142 SSM 33
Regular Panel Decision
Nov 16, 2017

The Matter of the Claim of Lidia Burgos v. Citywide Central Insurance Program

The New York Court of Appeals affirmed the order of the Appellate Division. The decision concerned the claim of Lidia Burgos against Citywide Central Insurance Program and the Workers' Compensation Board. The Appellate Division had concluded that substantial evidence supported the Workers' Compensation Board's determinations regarding the claimant's degree of impairment and loss of wage-earning capacity. The Court of Appeals found no reason to overturn this conclusion.

Workers' CompensationImpairmentWage-earning CapacitySubstantial EvidenceAppellate DivisionClaimantInsurance ProgramBoard DeterminationJudicial ReviewAffirmed Order
References
1
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
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