No-Fault Case Law
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.
525 EVM, Inc. v GEICO Gen. Ins. Co. (2017 NY Slip Op 51144(U))
September 8, 2017
The case involved a dispute between 525 EVM, Inc. and GEICO General Insurance Company regarding the recovery of first-party no-fault benefits that had been assigned to 525 EVM, Inc. The Civil Court denied both parties' motions for summary judgment, finding that there were triable issues of fact. 525 EVM, Inc. appealed, arguing that the Civil Court should have found, pursuant to CPLR 3212 (g), that certain facts had been established for all purposes in the action. The appellate court affirmed the lower court's decision, citing a similar case that had been decided with it. The holding of the case was that the appellate court affirmed the lower court's decision to deny both parties' motions for summary judgement.
GBI Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51143(U))
September 8, 2017
The main issues considered in this case were whether an insurer was allowed to use the workers' compensation fee schedule for acupuncture services performed by chiropractors to determine the amount a licensed acupuncturist is entitled to receive, and whether defendant's fee reductions were proper in accordance with the workers' compensation fee schedule. The court held that an insurer may use the workers' compensation fee schedule for acupuncture services performed by chiropractors to determine the amount which a licensed acupuncturist is entitled to receive for such acupuncture services. Therefore, the court affirmed the order granting defendant's motion for summary judgment dismissing the complaint.
Compas Med., P.C. v American Tr. Ins. Co. (2017 NY Slip Op 51142(U))
September 8, 2017
The court considered the denial of Compas Medical, P.C.'s motion for summary judgment and the granting of American Transit Ins. Co.'s cross motion for summary judgment, which sought to dismiss the first cause of action in a lawsuit involving the recovery of first-party no-fault benefits. The main issue decided was whether the defendant had fully paid the plaintiff for the claim underlying the first cause of action in accordance with the workers' compensation fee schedule, and whether the plaintiff had established its prima facie entitlement to summary judgment. The holding of the court was that the branch of the defendant's cross motion seeking summary judgment dismissing the first cause of action should have been denied, and that the plaintiff had failed to establish its entitlement to summary judgment. Therefore, the order was modified to deny the branch of the defendant's cross motion seeking summary judgment dismissing the first cause of action.
Renelique v Allstate Ins. Co. (2017 NY Slip Op 51141(U))
September 8, 2017
The relevant facts of the case were that the plaintiff, Pierre Jean Jacques Renelique, was seeking to recover assigned first-party no-fault benefits from Allstate Insurance Company. Plaintiff had moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint on the grounds that they had already paid the provider for the services at issue in accordance with the workers' compensation fee schedule. The main issue decided by the court was whether the defendant had properly applied the workers' compensation fee schedule to calculate the amount due for services billed, and whether the plaintiff's argument with respect to a specific CPT code was properly raised. The holding of the case was that the defendant had demonstrated that they had properly applied the workers' compensation fee schedule and the plaintiff had failed to rebut this showing. As a result, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.
JCC Med., P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51140(U))
September 8, 2017
The court considered a provider's attempt to recover assigned first-party no-fault benefits from an insurance company, with the insurance company seeking summary judgment to dismiss the complaint. The main issue decided was whether the insurance company had paid the underlying claims in full and whether the provider had provided sufficient verification of the claims. The court held that while the insurance company had demonstrated payment of some claims, there was a triable issue of fact as to whether the provider had provided sufficient verification for the second cause of action, and therefore, the motion for summary judgment on that cause of action should have been denied. Overall, the court modified the order by denying the motion to dismiss the second cause of action and affirmed the decision in all other respects.
Logic Chiropractic, P.C. v American Tr. Ins. Co. (2017 NY Slip Op 51139(U))
September 8, 2017
The court considered the case of Logic Chiropractic, P.C., as the assignee of Lambert Eva, appealing a decision from the Civil Court of the City of New York, Queens County. The issue at hand was the provider's attempt to recover assigned first-party no-fault benefits, with the defendant, American Transit Ins. Co., moving for summary judgment to dismiss the complaint. The main issue decided was whether the proof submitted by the defendant established that it had fully paid the plaintiff for the claims at issue. The court affirmed the order from the Civil Court, ruling in favor of the defendant and dismissing the complaint, with the justices concurring with the decision.
Compas Med., P.C. v American Tr. Ins. Co. (2017 NY Slip Op 51138(U))
September 8, 2017
The court considered a case where Compas Medical, P.C. was seeking to recover first-party no-fault benefits that had been assigned to them. American Transit Ins. Co. filed a motion for summary judgment to dismiss the complaint, which was granted by the Civil Court. Compas Medical, P.C. appealed the decision, and the Appellate Term, Second Department found that there was sufficient proof that American Transit Ins. Co. had not received the claim form for the first cause of action, so that part of the motion to dismiss was upheld. However, the Appellate Term found that American Transit Ins. Co. did not establish as a matter of law that the fees charged by Compas Medical, P.C. exceeded the amounts allowed by the workers' compensation fee schedule. Therefore, the branch of the motion seeking summary judgment dismissing the second cause of action was denied, and the order was modified accordingly.