No-Fault Case Law
Metro Psychological Servs., P.C. v Travelers Prop. & Cas. Ins. Co. (2017 NY Slip Op 51804(U))
December 19, 2017
The case involved an action by a provider to recover assigned first-party no-fault benefits. The defendant argued that the plaintiff's assignor had been injured during the course of his employment, and therefore workers' compensation benefits might be available. The Civil Court denied the defendant's motion and granted the plaintiff's cross motion for summary judgment. However, the Appellate Term held that there was a sufficient issue as to whether the plaintiff's assignor had been acting in the course of his employment at the time of the accident and therefore the matter should be determined by the Workers' Compensation Board. The Appellate Term reversed the lower court's order and remitted the case back to the Civil Court to be held in abeyance pending a determination by the Workers' Compensation Board of the parties' rights under the Workers' Compensation Law.
Precious Acupuncture Care, P.C. v GEICO Gen. Ins. Co. (2017 NY Slip Op 51803(U))
December 19, 2017
The court considered a case in which Precious Acupuncture Care, P.C. was attempting to recover first-party no-fault benefits from GEICO General Insurance Company. Precious Acupuncture Care sought summary judgment, while GEICO cross-moved to dismiss part of the complaint. The issue at hand was whether GEICO had fully paid for the services in accordance with the workers' compensation fee schedule, and if the claims for services rendered on certain dates had been untimely submitted. The court found that GEICO had indeed paid in accordance with the fee schedule and that the claims for services on specific dates had been untimely submitted. Therefore, the court held in favor of GEICO and granted the branches of their cross motion seeking summary judgment dismissing the portion of the complaint related to those claims.
Gentlecare Ambulatory Anesthesia Servs. v Travelers Ins. Co. (2017 NY Slip Op 51802(U))
December 19, 2017
The relevant facts considered by the court in this case were that the defendant, an insurance company, had denied a provider's claim for first-party no-fault benefits based on the provider's alleged failure to provide requested verification. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint. The holding of the court was that the denial of the defendant's motion for summary judgment was affirmed because the plaintiff had submitted an affidavit in opposition to the motion that was sufficient to create a presumption that the requested verification had been mailed to and received by the defendant, thus creating a triable issue of fact as to whether the action was premature. Therefore, the court held that the denial of the defendant's motion for summary judgment was appropriate.
Lynbrook PT & OT, PLLC v Ameriprise Ins. Co. (2017 NY Slip Op 51801(U))
December 19, 2017
The court considered the defendant's motion for summary judgment dismissing the complaint and the plaintiff's cross-motion for summary judgment. The issue before the court was whether the plaintiff had failed to appear for examinations under oath (EUOs) and whether the EUO scheduling letters and the denial of claim form were timely mailed. The court held that while the plaintiff had failed to appear for scheduled EUOs, the defendant failed to establish that the first EUO scheduling letter had been timely, and did not demonstrate that the claims were timely denied. As a result, the court denied the branches of the defendant's motion seeking summary judgment dismissing the claims for $72.92, $397.30, $208.30, and $540.15, and granted the branches of the plaintiff's cross-motion seeking summary judgment upon those claims.
JYW Med., P.C. v IDS Prop. Ins. Co. (2017 NY Slip Op 51800(U))
December 19, 2017
The Court considered the appeal of an order of the Civil Court grant for summary judgment for the plaintiff in an action by a provider to recover assigned first-party no-fault benefits. The defendant carrier had denied the claim from plaintiff Vital Function Physician Services, P.C. for failing to appear for scheduled examinations under oath (EUOs). At issue was whether the defendant’s denial of claim forms were improper since they did not set forth the dates of the EUOs for which plaintiffs had failed to appear. The Court found that the branch of plaintiffs' motion seeking summary judgment upon so much of the complaint as sought to recover upon the claims submitted by plaintiff Vital Function Physician Services, P.C. is denied and the branch of defendant's cross-motion seeking summary judgment dismissing that portion of the complaint is granted.
Queens Vil. Med. Care, P.C. v Government Employees Ins. Co. (2017 NY Slip Op 51799(U))
December 19, 2017
The main issue in this case was the medical necessity of the services in dispute in a claim for first-party no-fault benefits. The court considered the testimony of expert medical witnesses, with the plaintiff moving to preclude the defendant's expert witness from testifying on the grounds of his specialty being physical medicine and rehabilitation, rather than orthopedic surgery. The court granted the plaintiff's application for a directed verdict, precluding the witness, and awarded judgment in favor of the plaintiff in the amount of $2,671. However, the Appellate Term held that an expert medical witness's specialty goes to the weight to be given to the testimony and not to the witness's competency to testify, and therefore the defendant's witness should have been permitted to testify. The Appellate Term reversed the judgment and remitted the matter to the Civil Court for a new trial.
Masigla v Travelers Ins. Co. (2017 NY Slip Op 51798(U))
December 19, 2017
The court considered an appeal from an order of the Civil Court of the City of New York that granted a defendant's cross motion seeking summary judgment dismissing the first through eighth causes of action in a case regarding the recovery of assigned first-party no-fault benefits. The main issue decided was whether the plaintiff had failed to appear for examinations under oath and the court held that the order, insofar as appealed from, is affirmed. The court affirmed the decision based on the reasons stated in another case, Masigla, as Assignee of Brumaire, Shimaine v Travelers Ins. Co. The decision was made on December 19, 2017 by the Appellate Term, Second Department.
Masigla v Travelers Ins. Co. (2017 NY Slip Op 51797(U))
December 19, 2017
The court considered a case in which a provider was seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the plaintiff had failed to appear for examinations under oath, leading to the granting of the defendant's cross motion for summary judgment dismissing several causes of action. The holding of the case was that the order, insofar as appealed from, was affirmed, with the court referring to a similar case for the reasons behind their decision.
Masigla v Travelers Ins. Co. (2017 NY Slip Op 51796(U))
December 19, 2017
The main issue in this case was whether the plaintiff, a provider seeking to recover assigned first-party no-fault benefits, had failed to appear for examinations under oath. The court considered the fact that the defendant had cross-moved for summary judgment dismissing the complaint, and the plaintiff had appealed from the order granting the defendant's cross motion. The holding of the court was that the order, insofar as appealed from, was affirmed, with the plaintiff being required to pay $25 in costs. This decision was based on the fact that the plaintiff had failed to appear for examinations under oath, as determined in a related case.
Masigla v Travelers Ins. Co. (2017 NY Slip Op 51795(U))
December 19, 2017
The court considered the facts of a case in which a provider was seeking to recover assigned first-party no-fault benefits. The plaintiff had moved for summary judgment, while the defendant cross-moved for summary judgment dismissing the complaint on the basis that the plaintiff had failed to appear for examinations under oath. The main issue decided was whether the defendant's cross motion for summary judgment was valid based on the plaintiff's failure to appear for examinations under oath. The holding of the case was that the order granting the defendant's cross motion for summary judgment was affirmed. The court's decision was based on the plaintiff's failure to appear for the required examinations under oath, as established in the previous case of Masigla, as Assignee of Brumaire, Shimaine v Travelers Ins. Co.