No-Fault Case Law
Radiology Today, P.C. v Geico Ins. Co. (2017 NY Slip Op 51768(U))
December 15, 2017
The case involves Radiology Today, P.C. suing Geico Ins. Co. to recover assigned first-party no-fault benefits for services provided to its assignor. The main issue was whether the peer review report could be admitted into evidence at trial to prove the insurer's defense of lack of medical necessity. The court held that an insurer cannot use a peer review report at trial for its "truth" to prove the defense and that this would be impermissible bolstering of the expert's testimony. The court directed a verdict in favor of plaintiff, but the Appellate Term reversed and remitted the matter for a new trial on the first cause of action, indicating that a new trial is required to determine whether the services at issue were medically necessary.
Greenway Med. Supply Corp. v Travelers Ins. Co. (2017 NY Slip Op 51766(U))
December 15, 2017
The relevant facts considered by the court were that Greenway Medical Supply Corp. was seeking to recover first-party no-fault benefits as an assignee of Castillo Teofilo from Travelers Insurance Company. The issue decided was whether the lower court had erred in granting the defendant's motion for summary judgment dismissing the complaint on the grounds that the plaintiff had failed to appear for scheduled examinations under oath. The holding of the case was that the lower court's decision to grant the defendant's motion for summary judgment was affirmed, and the plaintiff's complaint was dismissed. The court based its decision on a similar case involving the same plaintiff and defendant, wherein it reached the same conclusion.
Greenway Med. Supply Corp. v Travelers Ins. Co. (2017 NY Slip Op 51765(U))
December 15, 2017
The court considered whether the provider had failed to appear for scheduled examinations under oath (EUOs) and whether the denial of claim form had been timely mailed. The main issue was whether the provider had failed to appear for the EUOs as required, and whether the denial of claim form had been timely mailed. The court held that the provider had failed to appear for the EUOs, as evidenced by the affirmation submitted by the defendant's attorney. The court also held that the denial of claim form had been timely mailed, as established by the affidavits submitted by the defendant. As a result, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.
Charles Deng Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51764(U))
December 15, 2017
The court considered the fact that the plaintiff, Charles Deng Acupuncture, P.C., was seeking to recover assigned first-party no-fault benefits from State Farm Mutual Automobile Ins. Co. The main issue decided was whether the plaintiff had failed to appear for duly scheduled examinations under oath (EUOs) as required by the insurance company. The court held that the affirmation submitted by defendant's attorney was sufficient to establish that the plaintiff had indeed failed to appear for the EUOs. The court also found that the plaintiff's attempt to reschedule the EUOs was not valid, as the person called and the phone number used did not match the information provided by the insurance company's EUO scheduling letter. Therefore, the court affirmed the order granting defendant's motion for summary judgment dismissing the complaint.
Renelique v American Tr. Ins. Co. (2017 NY Slip Op 51759(U))
December 15, 2017
The court considered a case involving a provider seeking to recover assigned first-party no-fault benefits in the amount of $3,748.69 for services rendered. The defendant denied the claim in full on September 11, 2012, but subsequently paid the sum of $256.34 on December 13, 2012. The defendant admitted that it should have paid the plaintiff $267.79 and agreed to pay the difference of $11.45 with appropriate interest. The main issue decided was whether the defendant demonstrated that the sum of $267.79 would fully compensate the plaintiff for the services in accordance with the workers' compensation fee schedule. The holding of the court was that the defendant's cross motion should have been denied, but the plaintiff failed to establish its prima facie entitlement to summary judgment on any amount in excess of $11.45. Therefore, the judgment was reversed, the order granting the defendant's cross motion was vacated, and the defendant's cross motion was denied.
Maxford, Inc. v Utica Mut. Ins. Co. (2017 NY Slip Op 51756(U))
December 15, 2017
The court considered a case brought by Maxford, Inc. as the assignee of Reynolds Gregory against Utica Mutual Insurance Company. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint, which was granted by the Civil Court, was appropriate. The court held that the defendant had demonstrated prima facie that its denial of claim form had been issued within 30 days of receiving the bills at issue, and that the plaintiff had failed to rebut that showing. Additionally, the court found that the plaintiff had failed to appear for scheduled examinations under oath as required, and as the plaintiff raised no other issue on appeal with respect to this defense, the order for summary judgment dismissing the complaint was affirmed.
Logic Chiropractic, P.C. v Hereford Ins. Co. (2017 NY Slip Op 51754(U))
December 15, 2017
The relevant facts in this case were that Logic Chiropractic, P.C. was seeking to recover first-party no-fault benefits and moved for summary judgment, while the defendant, Hereford Insurance Co., cross-moved for summary judgment dismissing the complaint. The issues decided were whether plaintiff's assignor had failed to appear for duly scheduled independent medical examinations (IMEs) and whether the claims underlying the causes of action had been timely denied. The holding of the case was that the court modified the order by striking the findings that defendant had properly and timely mailed the IME scheduling letters, and that the sole issue for trial was whether the claimant failed to appear for the scheduled IMEs. The court also found that plaintiff had failed to establish entitlement to summary judgment on the third through sixth causes of action.
Stracar Med. Servs., P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51753(U))
December 15, 2017
The court considered the fact that the plaintiff had failed to appear for scheduled examinations under oath (EUOs) as required for the recovery of assigned first-party no-fault benefits. The main issue decided was whether the affirmation submitted by the defendant's attorney, who was present in her office to conduct the EUOs on the scheduled dates, was sufficient to establish that the plaintiff had failed to appear for the EUOs. The court held that the affirmation submitted by the defendant's attorney was indeed sufficient to establish that the plaintiff had failed to appear for the EUOs, and therefore affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.
Brown v Government Empls. Ins. Co. (2017 NY Slip Op 08774)
December 14, 2017
The relevant facts the court considered were that the plaintiff was alleging that she became permanently disabled as a result of injuries sustained in an automobile accident, but the defendant's insurance company denied her claims for benefits. The main issues decided by the court were whether the plaintiff adequately stated a claim for General Business Law violations, whether she could seek damages for emotional distress in her breach of contract claim, and whether punitive damages were recoverable for breach of contract. The holding of the case was that the plaintiff did state a claim for violation of General Business Law and that she could seek consequential damages, but not emotional distress or punitive damages, in her breach of contract claim. Therefore, the court modified the order to reverse the dismissal of the General Business Law § 349 cause of action, deny the motion to that extent, and affirmed the decision as modified.
Accelerated Chiropractic Care P.C. v Progressive Ins. (2017 NY Slip Op 51967(U))
December 13, 2017
The court considered an action by a provider to recover assigned first-party no-fault benefits for chiropractic manipulation under anesthesia. The main issues remaining for trial were the defenses of medical necessity and whether the plaintiff was properly reimbursed by the defendant pursuant to the fee schedule and calculations applied. The court determined that the defendant did not present sufficient evidence to establish that the manipulation under anesthesia was inconsistent with generally accepted professional practice based on the assignor's medical treatment and condition at the time. Therefore, the evidence was insufficient to carry the defendant's burden of proving that the services were not medically necessary. However, the court found that the defendant had met its burden of showing that the appropriate amount for the invoices at issue was $1,462.47 instead of $3,572.91, and awarded judgment in favor of the plaintiff for that amount.