No-Fault Case Law
Alleviation Med. Servs., P.C. v 21st Century Ins. Co. (2016 NY Slip Op 51347(U))
September 19, 2016
The court considered an appeal from an order of the Civil Court that denied a provider's motion for summary judgment and granted the insurance company's cross motion for summary judgment to dismiss the complaint. The main issue was whether the insurance company received the claim at issue and whether their time to pay or deny the claim began to run. The court held that there was an issue of fact as to whether the insurance company's time to pay or deny the claim ever began to run, as the affidavit from the provider's owner demonstrated that the claim form had been mailed to the insurance company. Therefore, neither party was entitled to summary judgment, and the court modified the order to deny the insurance company's cross motion for summary judgment dismissing the complaint.
Urban Well Acupuncture, P.C. v Erie Ins. Co. of N.Y. (2016 NY Slip Op 51302(U))
September 19, 2016
The court considered the fact that defendant timely denied plaintiff's no-fault claims on the grounds that the fees for the acupuncture services exceeded the amount permitted by the worker's compensation fee schedule. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint should be granted, and the court held that it should. The court found that the defendant's evidence established that they timely denied the claims, and plaintiff failed to raise a triable issue regarding the efficacy of the denial or the calculation of the fee. Therefore, the defendant's motion for summary judgment dismissing the claim was granted.
Urban Well Acupuncture, P.C. v Erie Ins. Co. of N.Y. (2016 NY Slip Op 51300(U))
September 19, 2016
The court considered the defendant's appeal from an order of the Civil Court, which denied its motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant was entitled to summary judgment dismissing the plaintiff's claim for first-party no-fault benefits billed under certain CPT codes. The holding of the court was that the defendant was entitled to partial summary judgment dismissing the plaintiff's claim for benefits billed under CPT codes 97813 and 97814, as they exceeded the fees set forth in the applicable worker's compensation fee schedule, and the defendant timely denied these claims. However, there were triable issues as to whether the defendant properly denied plaintiff's claim for $70 billed under CPT code 99202, thus precluding summary judgment dismissing this claim. The court concluded that the remaining arguments from the plaintiff were either unpreserved or lacking in merit.
GL Acupuncture, P.C. v Allstate Ins. Co. (2016 NY Slip Op 51328(U))
September 15, 2016
The main issue decided in this case was whether the defendant was entitled to summary judgment dismissing the complaint brought by the plaintiff, a provider seeking recovery of first-party no-fault benefits. The relevant facts considered by the court included the defendant's argument that it had fully paid the plaintiff for the services at issue in accordance with the workers' compensation fee schedule. On appeal, the plaintiff argued that the defendant had not sufficiently demonstrated that its denial of claim forms had been timely mailed. The court ultimately held that the defendant did not demonstrate its entitlement to summary judgment, reversed the lower court's order, and denied the defendant's motion for summary judgment dismissing the complaint.
TAM Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 51327(U))
September 15, 2016
The court considered the appeal from an order of the Civil Court granting the defendant's motion for summary judgment dismissing the complaint. The main issue decided was whether the provider, TAM Medical Supply Corp., could recover assigned first-party no-fault benefits. The holding of the court was that the order granting the defendant's motion for summary judgment was affirmed, with $25 costs, for the same reasons as stated in a previous case, Metro Health Prods., Inc. v State Farm Mut. Auto. Ins. Co. The decision was reached by Pesce, P.J., Aliotta and Solomon, JJ. on September 15, 2016.
Restoration Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 51325(U))
September 15, 2016
The facts of the case involved Restoration Chiropractic, P.C. seeking to recover assigned first-party no-fault benefits from New York Central Mutual Fire Insurance Company. The defendant had denied the plaintiff's claims on the basis that the assignor had failed to appear for independent medical examinations (IMEs) that were scheduled. The main issue decided by the court was whether the defendant's motion for summary judgment dismissing the complaint was justified based on the assignor's failure to appear for the scheduled IMEs. The court held that the proof submitted by the defendant was sufficient to establish that the IME scheduling letters and denial of claim forms had been properly mailed, and that the assignor had indeed failed to appear for the IMEs. As a result, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.
Dr. Ronda M. Bachenheimer/Meadowbrook Chiropractic v Allstate Ins. Co. (2016 NY Slip Op 51324(U))
September 15, 2016
The court considered the denial of a motion for summary judgment in a case where a chiropractic office sought to recover assigned first-party no-fault benefits from an insurance company. The main issue decided was whether there was a triable issue of fact regarding the medical necessity of the services at issue. The holding of the court was that there was, in fact, a triable issue of fact regarding the medical necessity of the services, and as a result, the order denying the motion for summary judgment was affirmed. The case was decided on September 15, 2016, by the Appellate Term, Second Department.
Daily Med. Equip. Distrib. Ctr., Inc. v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51323(U))
September 15, 2016
The court considered the fact that the plaintiff, a provider seeking to recover assigned first-party no-fault benefits, had moved for summary judgment, and the defendant had cross-moved for summary judgment dismissing the complaint on the ground that the plaintiff's assignor had failed to appear for independent medical examinations (IMEs). The main issue decided was whether the defendant had established the timely and proper mailing of the IME scheduling letters and the denial of claim forms. The holding of the case was that the Civil Court denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment, and the Appellate Term affirmed this decision, with costs. The court found that the defendant had submitted affidavits that established the timely and proper mailing of the IME scheduling letters and denial of claim forms, and as a result, there was no basis to disturb the order.
DAC Medical, P.C./Timothy Mosomillo, D.O. v Allstate Ins. Co. (2016 NY Slip Op 51322(U))
September 15, 2016
The relevant facts considered by the court were that DAC Medical, P.C./Timothy Mosomillo, D.O. was seeking to recover first-party no-fault benefits from Allstate Insurance Company. The main issue decided was whether there was a triable issue of fact regarding the medical necessity of the services at issue. The court held that there was a triable issue of fact regarding the medical necessity of the services at issue and affirmed the order denying plaintiff's motion for summary judgment. The decision was made by the Supreme Court, Appellate Term, Second Department, with Pesce, P.J., Aliotta and Solomon, JJ., concurring.
New Way Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 51321(U))
September 15, 2016
The court considered a case where New Way Medical Supply Corp, as the assignee of Kathleem Long, was seeking to recover first-party no-fault benefits from State Farm Mutual Automobile Insurance Co. The main issue decided in this case was whether the defendant's motion for summary judgment dismissing the complaint should be granted. The holding of the court was that the order granting the defendant's motion for summary judgment to dismiss the complaint was affirmed. The court cited a previous case, Metro Health Prods., Inc. v State Farm Mut. Auto. Ins. Co. to support their decision, and the judges Pesce, Aliotta, and Solomon all concurred with the decision.