No-Fault Case Law
Chapa Prods. Corp. v Nationwide Ins. (2017 NY Slip Op 51457(U))
October 27, 2017
The court considered the denial of the plaintiff's motion for summary judgment and the grant of the defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was the failure of the plaintiff to appear for duly scheduled examinations under oath (EUOs) and the sufficiency of proof submitted by the defendant in support of its cross motion. The court held that the proof submitted by the defendant was not sufficient to demonstrate proper mailing of the EUO scheduling letters and, therefore, the defendant's cross motion for summary judgment dismissing the complaint was denied. Additionally, the court held that the plaintiff failed to demonstrate its entitlement to summary judgment as the proof submitted failed to establish that the claim forms had not been timely denied or that the defendant had issued timely denial of claim forms. Therefore, the order was modified to deny the defendant's cross motion for summary judgment dismissing the complaint.
Professional Health Imaging, P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51456(U))
October 27, 2017
The case involves Professional Health Imaging, P.C. suing State Farm Mutual Automobile Insurance Co. as the assignee of Alaur Abdalla. State Farm moved for summary judgment, arguing that Professional Health Imaging failed to appear for scheduled examinations under oath. Professional Health Imaging cross-moved for summary judgment or, in the alternative, to strike State Farm's answer and to compel State Farm to respond to discovery demands. The Civil Court granted State Farm's motion and denied Professional Health Imaging's cross motion. On appeal, the Appellate Term affirmed the lower court's decision. The main issue decided was whether Professional Health Imaging failed to comply with the requirement of appearing for scheduled examinations under oath, and the holding was that the lower court's decision was affirmed.
Acupuncture Approach, P.C. v NY Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51455(U))
October 27, 2017
The court considered an action by a provider to recover assigned first-party no-fault benefits. The defendant moved for summary judgment claiming that it had timely paid the plaintiff for the services at issue in accordance with the workers' compensation fee schedule, and that the services at issue lacked medical necessity. The court found that there was a triable issue of fact as to the medical necessity of the services at issue, but reduced the amount in controversy on those claims to a total of $647.53. Plaintiff's cross motion for summary judgment was denied. The court held that the defendant did not demonstrate, as a matter of law, that it had timely denied the claims, and that the plaintiff failed to demonstrate its prima facie entitlement to summary judgment. Therefore, the court modified the order to provide that the branches of the defendant's motion seeking summary judgment are denied.
K.O. Med., P.C. v IDS Prop. Cas. Ins. Co. (2017 NY Slip Op 51454(U))
October 27, 2017
The main issue in the case was whether the plaintiff was entitled to recover assigned first-party no-fault benefits from the defendant, IDS Property Casualty Insurance Company. The defendant appealed from an order of the Civil Court that denied the branches of the defendant's motion seeking summary judgment dismissing the complaint. This was because the plaintiff had failed to appear for duly scheduled examinations under oath (EUOs). The defendant established that the plaintiff had failed to appear for the scheduled EUOs and that the claims had been timely denied on that ground. As the plaintiff failed to raise a triable issue of fact in opposition, the defendant was entitled to summary judgment dismissing the claims. The holding of the case was that the order denying the defendant's motion was reversed, and the defendant's motion seeking summary judgment to dismiss the claims was granted.
T & S Med. Supply Corp. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51453(U))
October 27, 2017
The court considered the circumstances of a lawsuit brought by T & S Medical Supply Corp. against New York Central Mutual Fire Insurance Company to recover assigned first-party no-fault benefits. The main issue decided was whether the action was premature due to the plaintiff's alleged failure to provide requested verification. The court held that there was a triable issue of fact as to whether the action was premature, as the plaintiff's affidavit in opposition to the defendant's motion was sufficient to create a presumption that the requested verification had been mailed to and received by the defendant. The court ultimately reversed the order granting the defendant's motion for summary judgment and denied the motion to dismiss the complaint.
Bronx Acupuncture Therapy, P.C. v Hereford Ins. Co. (2017 NY Slip Op 51452(U))
October 27, 2017
The court considered an action by a provider to recover first-party no-fault benefits, where the defendant had denied the plaintiff's claim for services billed under a specific CPT code. The main issue in this case was whether the provider was required to furnish additional documentation for the services billed and if the insurer properly requested additional verification before denying the claim. The court held that the insurer's denial of the claim was without merit as a matter of law because the insurer did not request the necessary documentation from the provider. As a result, the court reversed the lower court's decision, denied the insurer's motion for summary judgment, granted the provider's cross motion for summary judgment, and remitted the matter back to the Civil Court for the calculation of statutory interest and an assessment of attorney's fees.
Charles Deng Acupuncture, P.C. v Allstate Ins. Co. (2017 NY Slip Op 51451(U))
October 27, 2017
The court considered the fact that the defendant's cross motion for summary judgment was based on the plaintiff's assignor's failure to appear for scheduled independent medical examinations and on the ground that the amounts sought by the plaintiff exceeded the workers' compensation fee schedule. The main issue decided was whether the defendant's motion for summary judgment should be granted or denied, and whether the plaintiff's motion for summary judgment should be granted or denied. The holding of the case was that the order was modified by providing that the defendant's cross motion for summary judgment dismissing the complaint was denied, meaning that the defendant did not demonstrate its entitlement to summary judgment dismissing the complaint, and that the plaintiff's motion for summary judgment was properly denied.
Renelique v American Tr. Ins. Co. (2017 NY Slip Op 51450(U))
October 27, 2017
The court considered an action by a provider to recover assigned first-party no-fault benefits, as defendant moved for summary judgment dismissing the complaint on the ground that they had paid the plaintiff for the services at issue in accordance with the workers' compensation fee schedule. The main issue decided was whether the defendant's motion for leave to reargue should have been granted, as the Civil Court had denied their previous motion for summary judgment. The holding of the court was that the defendant's motion for leave to reargue should have been denied, as they did not provide any new matters of fact or law that were overlooked or misapprehended by the court in determining their previous motion. As a result, the court reversed the previous decision and reinstated the order denying defendant's motion for summary judgment dismissing the complaint.
Hurgada Physical Therapist, P.C. v NY Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51449(U))
October 27, 2017
The court considered the issue of whether the plaintiff, a provider seeking to recover assigned first-party no-fault benefits, had a reasonable excuse for failing to timely submit written opposition to the defendant's motion for summary judgment. The main issue was whether the plaintiff had an excusable default for their late submission, as required by CPLR 5015 (a) (1). The court held that the plaintiff failed to demonstrate a reasonable excuse for its default, as the excuse offered by the plaintiff's attorney was deemed mere neglect based on a heavy workload, which is not accepted as an excusable default. Therefore, the court affirmed the order entered on March 6, 2012, which denied the plaintiff's motion to vacate the prior order granting the defendant's motion for summary judgment.
Comprehensive Care Physical Therapy, P.C. v State-Wide Ins. Co. (2017 NY Slip Op 51448(U))
October 27, 2017
The court considered the plaintiff's motion for summary judgment and the defendant's cross motion for summary judgment to dismiss the complaint in an action to recover first-party no-fault benefits. The main issue decided was whether the plaintiff's failure to appear for scheduled examinations under oath (EUOs) justified the dismissal of certain causes of action. The court held that the defendant's affirmation was sufficient to establish the plaintiff's failure to appear for the EUOs, and therefore granted the defendant's cross motion for summary judgment and denied the plaintiff's motion for summary judgment on the second, third, fourth, eighth, and ninth causes of action. The court did not consider the plaintiff's argument regarding the first cause of action as it remained pending and undecided. The decision of the Civil Court was affirmed.