No-Fault Case Law
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.
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.