No-Fault Case Law
Chiroworks Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51159(U))
September 8, 2017
The court considered a provider's action to recover assigned first-party no-fault benefits and the defendant's motion for summary judgment dismissing the complaint. The main issue was whether the defendant had submitted sufficient evidence to establish that the plaintiff's assignor had failed to appear for independent medical examinations. The court held that there was no merit to the plaintiff's arguments regarding the sufficiency of the proof submitted by the defendant. Additionally, the court found that the plaintiff's remaining contention lacked merit. Therefore, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.
Island Life Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51157(U))
September 8, 2017
The court considered the motion by defendant State Farm Mutual Automobile Insurance Company for summary judgment to dismiss the complaint filed by Island Life Chiropractic, P.C., as assignee of Blake Brenderline, in an action to recover assigned first-party no-fault benefits. The main issue decided was whether the fees charged by the plaintiff exceeded the amounts permitted by the workers' compensation fee schedule. The court held that the defendant's motion papers failed to establish, as a matter of law, that the fees charged by the plaintiff exceeded the amounts permitted by the workers' compensation fee schedule. As a result, the court reversed the order granting defendant's motion for summary judgment and denied the motion to dismiss the complaint. The decision was made by Judges Pesce, Aliotta, and Solomon, and the order was reversed with costs.
Charles Deng Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51156(U))
September 8, 2017
The court considered the fact that the provider, Charles Deng Acupuncture, P.C., was seeking to recover first-party no-fault benefits from State Farm Mutual Automobile Insurance Co. The main issue decided was whether the defendant's motion for summary judgment to dismiss the complaint should be granted. The court held that the proof submitted by defendant demonstrated that the plaintiff's assignor had failed to appear for examinations under oath, and therefore affirmed the order granting defendant's motion for summary judgment.
Laga v Country Wide Ins. Co. (2017 NY Slip Op 51155(U))
September 8, 2017
The main issue in this case was whether the denial of claim forms had been properly mailed by the defendant insurance company. The court considered the proof submitted by the defendant in support of its cross-motion, which was found to be sufficient to give rise to a presumption that the denial of claim forms had been properly mailed. The plaintiff's argument with respect to the defendant's cross-motion was also considered, but ultimately not properly before the court as it was being raised for the first time on appeal. As a result, the court affirmed the order, denying the plaintiff's motion for summary judgment and granting the defendant's cross-motion for summary judgment dismissing the complaint.
Acupuncture Now, P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51154(U))
September 8, 2017
The court considered the plaintiff's appeal from an order by the Civil Court granting the defendant's motion for summary judgment dismissing the first through fifth causes of action and compelling the plaintiff to appear for a deposition. The main issue decided was whether the defendant's fee reductions, according to the workers' compensation fee schedule for acupuncture services performed by chiropractors, were proper. The court held that it is legal for an insurer to use the workers' compensation fee schedule to determine the amount a licensed acupuncturist is entitled to receive for acupuncture services. Furthermore, since the defendant was defending the remaining cause of action on the grounds that the services rendered lacked medical necessity, the Civil Court properly granted the defendant's motion to compel the plaintiff to appear for a deposition. Thus, the order was affirmed.
525 EVM, Inc. v GEICO Gen. Ins. Co. (2017 NY Slip Op 51153(U))
September 8, 2017
The relevant facts the court considered were that 525 EVM, Inc., as the assignee of Dzianis Haiduk, was seeking to recover assigned first-party no-fault benefits from GEICO General Insurance Company. The main issue was whether there were triable issues of fact regarding the summary judgment motion and cross-motion for summary judgment. The holding of the court was that the Civil Court properly denied both motions and found that there were triable issues of fact. The Appellate Term affirmed the decision, declining the plaintiff's request to limit the issues for trial. Therefore, the order was affirmed, and the case was allowed to proceed to trial.
Gentlecare Ambulatory Anesthesia Servs. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51152(U))
September 8, 2017
The court considered the facts that the plaintiff, Gentlecare Ambulatory Anesthesia Services, was seeking to recover assigned first-party no-fault benefits from the defendant, State Farm Mutual Automobile Insurance Company. The defendant had moved for summary judgment to dismiss the complaint on the grounds that the plaintiff’s assignor had failed to appear for duly scheduled examinations under oath (EUOs). The main issue decided was whether the defendant’s proof that the EUO scheduling letters and denial of claim forms had been timely and properly mailed was sufficient. The court ultimately held that there was no merit to the plaintiff’s arguments regarding the sufficiency of the defendant’s proof, and affirmed the order granting the defendant’s motion for summary judgment. The decision was made by Judges Pesce, Aliotta, and Solomon.
Compas Med., P.C. v American Tr. Ins. Co. (2017 NY Slip Op 51147(U))
September 8, 2017
The court considered the facts that Compas Medical, P.C. was seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant received timely notice of the accident, as required by 11 NYCRR § 65-1.1. The holding of the case was that the Civil Court correctly granted the defendant's cross motion for summary judgment dismissing the complaint, as the proof submitted by the defendant established that it had not received timely notice of the accident. Therefore, the order denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment dismissing the complaint was affirmed. No other issues were reached in the decision.
Lynbrook Pt & Ot, PLLC v Foremost Ins. Co. (2017 NY Slip Op 51146(U))
September 8, 2017
The court considered an action by a medical provider to recover assigned first-party no-fault benefits. The plaintiff appealed an order from the Civil Court that granted the defendant's motion for summary judgment, which dismissed part of the complaint seeking to recover certain claims, and denied the plaintiff's cross motion seeking summary judgment on those same claims. The main issue decided was whether there was a triable issue of fact with respect to the defendant's application of Ground Rule 11 of the workers' compensation fee schedule to the claims at issue. The holding was that the branches of the defendant's motion seeking summary judgment dismissing the claims for specific dates of service were denied, and the order was modified to reflect this decision.
Culex Acupuncture, P.C. v 21st Century Indem. Ins. Co. (2017 NY Slip Op 51145(U))
September 8, 2017
The Court considered a case involving Culex Acupuncture, P.C. as the appellant and 21st Century Indemnity Ins. Co. as the respondent. The issue at hand was the recovery of assigned first-party no-fault benefits. Plaintiff appealed from an order of the Civil Court that granted the respondent’s motion seeking summary judgment to dismiss claims for specific dates of service. The plaintiff’s argument on appeal was that the respondent had paid the claims at issue at the rate for acupuncture services performed by a chiropractor, while paying other claims at the rate for acupuncture services performed by a medical doctor. The Court held that the plaintiff’s argument lacked merit and affirmed the order, finding in favor of the respondent.