No-Fault Case Law
Nova Chiropractic Servs., P.C. v GEICO Gen. Ins. Co. (2018 NY Slip Op 51689(U))
November 23, 2018
The court considered the issue of the medical necessity of the services in question in a nonjury trial of an action by a provider to recover assigned first-party no-fault benefits. The Civil Court precluded the testimony of defendant's expert witness and granted plaintiff's motion for a directed verdict, ultimately awarding the plaintiff the principal sum of $1,310.94. The main issue was whether the services in question were medically necessary, and the court held that the judgment is reversed, with $30 costs, and the matter is remitted to the Civil Court for a new trial. The decision was made based on the reasons stated in a previous case, Nova Chiropractic Servs., P.C., as Assignee of Miguel A. Vizcaino v GEICO Gen. Ins. Co., and was decided on November 23, 2018.
Nova Chiropractic Servs., P.C. v GEICO Gen. Ins. Co. (2018 NY Slip Op 51688(U))
November 23, 2018
The main issue in this case was the medical necessity of the services in question in a provider's action to recover assigned first-party no-fault benefits. The court considered the preclusion of the testimony of defendant's expert witness and the granting of plaintiff's motion for a directed verdict. The court found that defendant's expert medical witness should have been permitted to testify as to their opinion regarding the lack of medical necessity of the services at issue. However, the expert witness's testimony should be limited to the basis for the denial as set forth in the peer review report. The judgment was reversed, and the matter was remitted to the Civil Court for a new trial.
Nova Chiropractic Servs., P.C. v GEICO Gen. Ins. Co. (2018 NY Slip Op 51687(U))
November 23, 2018
The court considered a nonjury trial in an action by a provider to recover assigned first-party no-fault benefits. The main issue was the medical necessity of the services in question. The Civil Court precluded the testimony of defendant's expert witness and granted plaintiff's motion for a directed verdict, resulting in a judgment in favor of the plaintiff in the principal sum of $2,184.90. The Appellate Term reversed the judgment and remitted the matter to the Civil Court for a new trial. The holding of the case was that the judgment in favor of the plaintiff was reversed and remitted for a new trial.
Nova Chiropractic Servs., P.C. v GEICO Gen. Ins. Co. (2018 NY Slip Op 51685(U))
November 23, 2018
The court considered a nonjury trial of a provider's action to recover assigned first-party no-fault benefits, with the sole issue being the medical necessity of the services in question. The Civil Court precluded the testimony of the defendant's expert witness and granted the plaintiff's motion for a directed verdict, resulting in a judgment in favor of the plaintiff in the principal sum of $2,184.90. The main issue decided was the admissibility of the defendant's expert witness testimony, and whether the directed verdict was appropriate. The holding of the case was that the judgment was reversed and the matter was remitted to the Civil Court for a new trial, based on reasons stated in a related case.
Active Care Med. Supply Corp. v American Tr. Ins. Co. (2018 NY Slip Op 51683(U))
November 23, 2018
The court considered the fact that the defendant had established that the examination under oath (EUO) scheduling letters had been timely mailed and that the plaintiff had failed to appear for the duly scheduled EUOs. The main issue decided was whether the defendant had met the requirements for scheduling the EUOs and whether the plaintiff's failure to appear justified the dismissal of the complaint. The holding of the court was that the defendant had indeed met the requirements for scheduling the EUOs and that the plaintiff's failure to appear justified the dismissal of the complaint. Therefore, the court affirmed the order of the Civil Court, granting the defendant's motion for summary judgment dismissing the complaint.
Maiga Prods. Corp. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51682(U))
November 23, 2018
The main issue in this case was whether the defendant, State Farm Mutual Automobile Insurance Co., was entitled to summary judgment dismissing the complaint brought by Maiga Products Corp. as Assignee of Dorsinvil, Mireille, to recover assigned first-party no-fault benefits. State Farm argued that Maiga had failed to appear for duly scheduled examinations under oath (EUOs). The court found that State Farm had established the timely and proper mailing of the EUO scheduling letters and the denial of claim forms, as well as Maiga's failure to appear for the EUOs. The court also found that the only remaining issue for trial was "the nexus between where the bill is received and where the verification and denial is processed and mailed from Ballston Spa, when the bill was received in Atlanta, Georgia. The holding of the court was that State Farm was entitled to summary judgment dismissing the complaint, reversing the order of the Civil Court and granting State Farm's motion.
Maiga Prods. Corp. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51681(U))
November 23, 2018
The main issue in this case was whether an insurer was entitled to summary judgment dismissing a complaint on the basis that a provider failed to appear for examinations under oath (EUOs). The insurer argued that it had twice demanded an EUO from the provider, and that the provider had twice failed to appear, thus justifying their timely denial of the claims. The Civil Court found that the insurer had established the timely and proper mailing of the EUO scheduling letters and the denial of claim forms, as well as the provider's failure to appear for the EUOs. However, the provider challenged this finding and argued that the insurer's practices and procedures regarding the receipt of its mail were irrelevant. The Appellate Term ultimately reversed the order, granting the insurer's motion for summary judgment dismissing the complaint.
Big Apple Med. Supply, Inc. v Nationwide Affinity Ins. Co. of Am. (2018 NY Slip Op 51659(U))
November 21, 2018
The court considered a motion by the defendant to grant summary judgment and dismiss the complaint based on the plaintiff's failure to respond within 120 days to the initial request for verification. The main issue was whether the defendant could prove by admissible evidence that it did not receive the requested verification within the allotted 120-day period. The court held that defendant's conclusory denial of receipt was insufficient to make a prima facie showing of entitlement to summary judgment. Additionally, the court found that the defendant failed to produce an original "certificate of conformity" for two affidavits, rendering the affidavits inadmissible as a matter of law. As a result, the defendant failed to establish their entitlement to summary judgment by admissible evidence, and the motion for summary judgment was denied.
UGP Acupuncture, P.C. v 21st Century Ins. Co. (2018 NY Slip Op 51657(U))
November 16, 2018
The court considered the fact that UGP Acupuncture, P.C., as the assignee of Nicole Santana, was seeking to recover first-party no-fault benefits from 21st Century Insurance Company, but their amounts were in excess of the workers' compensation fee schedule. The main issue decided was whether the fee reductions made by the defendant were proper, as they were done in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors. The holding of the case was that the insurer may use the workers' compensation fee schedule for acupuncture services performed by chiropractors to determine the amount which a licensed acupuncturist is entitled to receive for such acupuncture services. The court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.
Restoration Chiropractic, P.C. v 21st Century Ins. Co. (2018 NY Slip Op 51656(U))
November 16, 2018
The court considered a case where Restoration Chiropractic, P.C. was seeking to recover no-fault benefits from 21st Century Insurance Company, as an assignee of Lopez, Candice. The main issue decided was whether the denial of plaintiff's motion for summary judgment and the granting of defendant's cross motion for summary judgment dismissing the complaint was proper, based on the fact that plaintiff's assignor had failed to appear for scheduled examinations under oath (EUOs). The court held that the proof submitted by the defendant was sufficient to establish the proper mailing of the EUO scheduling letters and that the remaining contentions raised by the plaintiff were either without merit or not considered because they were raised for the first time on appeal. Therefore, the court affirmed the order, with costs of $25.