No-Fault Case Law
Atlantic Chiropractic, P.C. v Geico Ins. Co. (2017 NY Slip Op 51253(U))
September 22, 2017
The Court considered the appeal from an order of the Civil Court of the City of New York, Kings County, granting summary judgment to the plaintiff, Atlantic Chiropractic, P.C., in their action to recover assigned first-party no-fault benefits from Geico Ins. Co. The main issues decided were whether defendant Geico had timely denied the claims at issue and whether there was medical necessity for the services provided. The court held that the proof submitted by Geico in opposition to the plaintiff's motion was sufficient to raise triable issues of fact regarding the timely denial of the claims and the medical necessity of the services, and therefore reversed the judgment, vacated the order, and denied the plaintiff's motion for summary judgment.
Charles Deng Acupuncture, P.C. v 21st Century Ins. Co. (2017 NY Slip Op 51252(U))
September 22, 2017
The relevant facts of this case revolve around a claim made by Charles Deng Acupuncture, P.C., as an assignee of Ambroisse Cassandra, against 21st Century Insurance Company. Charles Deng Acupuncture sought to recover first-party no-fault benefits and was appealing the denial of their motion for summary judgment by the Civil Court of the City of New York. The main issues decided were whether the claims at issue had been timely denied, the validity of the fee reductions by the insurance company, and the failure to object to the discovery demands within the prescribed time. The holding of the case was that the appellate term affirmed the decision of the Civil Court, ruling that the plaintiff had not established their prima facie entitlement to summary judgment, and had not objected to the discovery demands within the prescribed time, and thus were obligated to produce the information sought by the defendant.
TAM Med. Supply Corp. v Travelers Ins. Co. (2017 NY Slip Op 51251(U))
September 22, 2017
The relevant facts considered by the court in this case were that a medical supply company was seeking to recover no-fault benefits from an insurance company, and the insurance company had requested verification of the claim. The main issue decided by the court was whether the insurance company's motion for summary judgment dismissing the complaint should be granted on the grounds that the action was premature due to the provider's failure to provide the requested verification. The holding of the court was that there was a triable issue of fact as to whether the action was premature, as the provider's affidavit was sufficient to give rise to a presumption that the requested verification had been mailed to and received by the insurance company. Therefore, the court reversed the order and denied the insurance company's motion for summary judgment dismissing the complaint.
Laga v American Commerce Ins. Co. (2017 NY Slip Op 51250(U))
September 22, 2017
The court considered the denial of summary judgment by the Civil Court as well as the granting of defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was whether the plaintiff was entitled to summary judgment in an action to recover assigned first-party no-fault benefits, and whether the denial of the claim was timely. The court held that the defendant failed to establish that it had timely denied the claim underlying the sixth cause of action, so the branch of defendant's cross motion seeking summary judgment dismissing that cause of action should have been denied. The order was affirmed as to the remaining causes of action, and it was modified to provide that the branch of defendant's cross motion seeking summary judgment dismissing the sixth cause of action is denied.
AL Acupuncture, P.C. v Geico Ins. Co. (2017 NY Slip Op 51249(U))
September 22, 2017
The main issue in this case was whether plaintiff was entitled to recover first-party no-fault benefits for services rendered from July 8, 2008 to September 5, 2008, and from September 8, 2008 to September 25, 2008. The court held that defendant had timely denied the claims for services rendered from July 8, 2008 to September 5, 2008 and had fully paid plaintiff for the services at issue in those claims. As a result, the court granted defendant's cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon these claims. However, the court found that the defendant was not entitled to summary judgment on the claim for services rendered from September 8, 2008 to September 25, 2008 due to issues with the IME scheduling letters, and so the branch of plaintiff's motion seeking summary judgment on this claim was denied.
TAM Med. Supply Corp. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51248(U))
September 22, 2017
The court considered a case in which TAM Medical Supply Corp. appealed an order granting New York Central Mutual Fire Insurance Company's motion for summary judgment dismissing the complaint. The main issue decided was whether the action was premature due to the plaintiff's failure to provide requested verification for a no-fault benefits claim. The court held that there was a triable issue of fact as to whether the action was premature, as the plaintiff's affidavit gave rise to a presumption that the requested verification had been mailed to and received by the defendant. Therefore, the order granting the defendant's motion for summary judgment was reversed and the motion was denied.
TAM Med. Supply Corp. v Tri State Consumers Ins. Co. (2017 NY Slip Op 51247(U))
September 22, 2017
The relevant facts considered in this case involve an action by a provider to recover assigned first-party no-fault benefits. The court considered whether the defendant had timely and properly denied the claim based on the plaintiff's failure to provide requested verification within 120 days of the initial verification request. The main issue decided was whether the defendant had received the requested verification, as well as whether the affidavit submitted by the plaintiff in opposition to the defendant's motion was sufficient to give rise to a presumption that the requested verification had been mailed to and received by the defendant. The holding of the case was that there was a triable issue of fact as to whether the plaintiff provided the requested verification, and as a result, the court reversed the order and denied the defendant's motion for summary judgment dismissing the complaint.
Laga v Lancer Ins. Co. (2017 NY Slip Op 51244(U))
September 22, 2017
The court considered an appeal from an order of the Civil Court which granted the defendant's motion for summary judgment dismissing the complaint in this action by a provider to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant's proof sufficiently established proper mailing of the denials and verification requests and if the plaintiff had failed to appear for the scheduled examinations under oath (EUOs). The court held that the defendant's proof did establish proper mailing of the denials and verification requests and that the plaintiff had failed to appear for the scheduled EUOs, therefore affirming the order granting summary judgment in favor of the defendant.
Laga v Lancer Ins. Co. (2017 NY Slip Op 51243(U))
September 22, 2017
The court considered the fact that the plaintiff, an assignee of a provider, was seeking to recover first-party no-fault benefits from the defendant insurance company. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint on the grounds that the plaintiff had failed to appear for duly scheduled examinations under oath should be granted. The court held that the order granting the defendant's motion for summary judgment was affirmed, with $25 costs, based on the plaintiff's failure to appear for the examinations under oath. The court referenced a similar case, Laga, as Assignee of Mondestin, Liliane v Lancer Ins. Co., in which the same decision was made, in support of their holding.
T & S Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51240(U))
September 22, 2017
The court considered the fact that the plaintiff, T & S Medical Supply Corp., was seeking to recover assigned first-party no-fault benefits. The main issue that was decided was whether the defendant, State Farm Mutual Automobile Ins. Co., properly tolled its time to pay or deny the claim at issue through its initial and follow-up EUO (examinations under oath) scheduling letters. The court ultimately held that the defendant did properly toll its time to pay or deny the claim, and affirmed the order granting the defendant's motion for summary judgment dismissing the complaint. Therefore, the plaintiff's appeal was unsuccessful and the order to dismiss the complaint was affirmed by the court.