No-Fault Case Law
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.
Masigla v Travelers Ins. Co. (2017 NY Slip Op 51794(U))
December 19, 2017
The relevant facts in this case involved a provider seeking to recover assigned first-party no-fault benefits. The plaintiff moved for summary judgment, and the defendant cross-moved for summary judgment dismissing the complaint. The main issue decided was whether plaintiff had failed to appear for examinations under oath (EUOs) and whether the denial of claim forms had been properly mailed. The court held that the affirmations submitted by defendant's attorneys established that plaintiff had failed to appear for the EUOs, and the proof submitted by defendant gave rise to a presumption that the denial of claim forms had been properly mailed. As a result, the order was affirmed in favor of the defendant.
Easy Care Acupuncture, P.C. v 21 Century Advantage Ins. Co. (2017 NY Slip Op 51792(U))
December 19, 2017
The court considered the fact that the defendant had fully paid the plaintiff for the services at issue in accordance with the workers' compensation fee schedule. The main issue decided was whether the proof submitted by the defendant in support of its motion was sufficient to give rise to a presumption that the denial of claim form had been properly mailed and to demonstrate that it had properly used the workers' compensation fee schedule to determine the amount the plaintiff was entitled to receive for the services at issue. The holding of the case was that the order granting the defendant's motion for summary judgment dismissing the complaint was affirmed, with the court stating that the proof submitted by the defendant was sufficient to demonstrate that it had properly used the workers' compensation fee schedule to determine the amount the plaintiff was entitled to receive for the services at issue.
Big Apple Ortho Prods., Inc. v Allstate Ins. Co. (2017 NY Slip Op 51791(U))
December 19, 2017
The court considered the fact that the plaintiff, Big Apple Ortho Products, Inc., was seeking to recover assigned first-party no-fault benefits, and that the defendant, Allstate Insurance Company, had filed a motion for summary judgment to dismiss the complaint based on the plaintiff's failure to appear for scheduled examinations under oath. The main issue decided in the case was whether the defendant had demonstrated its entitlement to summary judgment by showing that the denial of claim form had been timely mailed, and whether the affidavits submitted by the defendant sufficiently set forth a standard office practice or procedure to ensure this. The holding of the case was that the defendant did not demonstrate its entitlement to summary judgment dismissing the complaint, and as a result, the order granting the defendant's motion for summary judgment was reversed and the motion was denied.