No-Fault Case Law

The court considered an appeal from an order of the Civil Court that granted the defendant's motion for summary judgment dismissing the complaint and denied the plaintiff's cross motion for summary judgment. The main issue decided was whether the provider could recover assigned first-party no-fault benefits. The court held that the plaintiff's arguments in opposition to the defendant's motion for summary judgment were not properly before the court, as they were being raised for the first time on appeal, and therefore declined to consider them. Consequently, the court found that the plaintiff had demonstrated no basis to disturb the order granting the defendant's motion and denied the plaintiff's cross motion, affirming the original order.

The relevant facts considered by the court included a claim by Acuhealth Acupuncture, P.C. for first-party no-fault benefits from Hereford Ins. Co. Defendant argued that they had fully paid plaintiff in accordance with the workers' compensation fee schedule and moved for summary judgment dismissing the complaint. Plaintiff cross-moved for summary judgment. The main issue was whether the denial of plaintiff's claim for services billed under CPT code 97039 was justified and whether plaintiff had demonstrated their entitlement to judgment as a matter of law. The court held that the denial of the claim for services billed under CPT code 97039 was not justified, but also that the plaintiff had failed to demonstrate their entitlement to judgment as a matter of law. Therefore, the branch of defendant's motion seeking summary judgment dismissing so much of the complaint as sought to recover for services billed under CPT code 97039 was denied.

The main issue in this case was whether the defendant was entitled to summary judgment dismissing the complaint from the plaintiff, Bronx Acupuncture Therapy, P.C., for failure to comply with a condition precedent to coverage. The defendant had argued that the plaintiff's assignor had failed to appear for independently medical examinations (IMEs), which was a requirement under the insurance policy. The court considered the affidavit submitted by the operations manager of Transcion Medical, P.C., which had been retained by the defendant to schedule IMEs, establishing that the scheduling letters had been timely mailed. The court found that the defendant had demonstrated that the plaintiff had failed to comply with the condition precedent to coverage, and as there was no triable issue of fact raised by the plaintiff in opposition to the motion, the defendant was entitled to summary judgment. The holding of the case was that the order denying the defendant's motion for summary judgment was reversed, and the defendant's motion for summary judgment dismissing the complaint was granted.

The court considered the facts of a case where Village Medical Supply, Inc. was trying to recover first-party no-fault benefits as the assignee of Stephane Philogene. The main issue in this case was whether the plaintiff's assignor had failed to appear for scheduled independent medical examinations (IMEs). The court held that the affirmation submitted by the doctor who was to perform the IMEs was sufficient to establish that the plaintiff's assignor had indeed failed to appear for the scheduled IMEs. Additionally, the court found that the denial of claim forms which denied plaintiff's claims on that ground had been timely mailed. The court ultimately affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The court considered the fact that a provider was seeking to recover assigned first-party no-fault benefits, and that the complaint had been dismissed by the lower court following a motion for summary judgment by the defendant. The main issue decided was whether the defendant was entitled to summary judgment based on the plaintiff's failure to appear for examinations under oath (EUOs). The court held that the defendant failed to demonstrate that it was entitled to summary judgment, as the initial EUO request had been sent more than 30 days after the defendant had received the claims at issue, making the requests nullities as to those claims. Therefore, the judgment was reversed, the order was vacated, and the defendant's motion for summary judgment dismissing the complaint was denied.

The relevant facts of the case involved Healthy Way Acupuncture, P.C. seeking to recover no-fault benefits assigned to them from State Farm Mutual Automobile Insurance Co. The main issue decided in the case was whether State Farm's motion for summary judgment dismissing the complaint based on Healthy Way Acupuncture's failure to appear for scheduled examinations under oath was valid. The court held that State Farm had sufficiently established Healthy Way Acupuncture's failure to appear for scheduled examinations under oath, and therefore affirmed the order granting State Farm's motion for summary judgment dismissing the complaint.

The court considered a dispute between Z.M.S. & Y Acupuncture, P.C. and GEICO General Insurance Company regarding the reimbursement for medical services provided. Z.M.S. & Y Acupuncture, P.C. sought to recover first-party no-fault benefits, and GEICO General Insurance Company argued that they had fully paid for the services in accordance with the workers' compensation fee schedule. Specifically, the court focused on the claims for services billed under CPT codes 97810, 97811, 97813, and 97814. The main issues decided were whether the fee schedule was properly applied and whether GEICO General Insurance Company was required to reimburse Z.M.S. & Y Acupuncture, P.C. for the services. The holding of the case was that GEICO General Insurance Company's cross-motion for summary judgment to dismiss the claims for services billed under CPT codes 97811, 97813, and 97814 was granted. The decision was affirmed with modification.

The main issue in the case was whether the defendant had fully paid the plaintiff for acupuncture services billed under specific CPT codes in accordance with the workers' compensation fee schedule. The court considered the proof submitted by the defendant to show that the denial of claim forms had been timely mailed and that the plaintiff had been fully paid for the services in question. The court held that the defendant had demonstrated that they had fully paid the plaintiff for the services in accordance with the fee schedule, and the plaintiff had failed to raise a triable issue of fact in opposition. As a result, the court reversed the order and granted the branches of the defendant's cross motion seeking summary judgment dismissing the claims for services billed under the specific CPT codes.

The court considered a case in which a provider was seeking to recover first-party no-fault benefits and the defendant insurance company argued that it had already fully paid the provider in accordance with the workers' compensation fee schedule. The main issue decided was whether the defendant's cross motion for summary judgment dismissing the complaint on the grounds that it had already paid the provider in accordance with the fee schedule should be granted. The holding of the court was that the branches of the defendant's cross motion seeking summary judgment dismissing the claims for services billed under certain CPT codes were granted, affirming the order entered by the Civil Court with modifications.

The main issues in this case revolved around whether or not defendant's cross motion for summary judgment should be granted, seeking to dismiss the claims for services billed under specific CPT codes. The court considered whether the defendant had fully paid the plaintiff for the services at issue in accordance with the workers' compensation fee schedule. The Court found that the branches of defendant's cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims for services billed under CPT codes 97811, 97813 and 97814 are granted. Therefore, the order was affirmed, without costs. The main holding of the court was that the defendant's cross motion was granted in part, and denied in part, due to the proper application of the fee schedule.