No-Fault Case Law
Professional Health Imaging, P.C. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 50700(U))
April 25, 2016
The court considered the fact that the plaintiff, Professional Health Imaging, P.C., was seeking to recover first-party no-fault benefits from the defendant, State Farm Mutual Automobile Ins. Co. Defendant moved for summary judgment to dismiss the complaint on the grounds that the plaintiff had failed to appear for scheduled examinations under oath. Plaintiff cross-moved for summary judgment or, in the alternative, to strike defendant's answer and affirmative defenses, and to compel the defendant to respond to discovery demands. The main issue decided was whether the trial court's order granting defendant's motion and denying plaintiff's cross motion should be affirmed. The holding of the case was that for the reasons stated in a related case, the appellate court affirmed the trial court's order.
Metropolitan Diagnostic Med. Care, P.C. v American Tr. Ins. Co. (2016 NY Slip Op 50699(U))
April 25, 2016
The court considered the facts presented in an action by a medical care provider to recover first-party no-fault benefits. The main issue decided was whether the provider's motion for summary judgment should have been granted. The holding of the case was that the provider failed to establish its entitlement to judgment as a matter of law, as it did not prove that the defendant had failed to deny the claim within the required 30-day period. As a result, the court affirmed the order denying the provider's motion for summary judgment.
Professional Health Imaging, P.C. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 50698(U))
April 25, 2016
The court considered whether the defendant had established the plaintiff's failure to appear for duly scheduled EUOs, whether the defendant had properly tolled its time to pay the claims, and whether the defendant's motion was premature in light of outstanding discovery.
The main issue was whether the defendant had established that the plaintiff had failed to appear for the two duly scheduled EUOs and whether the defendant had properly tolled its time to pay the two claims in question.
The court held that the defendant sufficiently established the plaintiff's failure to appear for the EUOs, and that the defendant had properly tolled its time to pay the claims in question. The court also rejected the plaintiff's contention that the defendant's motion was premature in light of outstanding discovery. Therefore, the order granting the defendant's motion for summary judgment and denying the plaintiff's cross motion for summary judgment was affirmed.
Great Health Care Chiropractic, P.C. v Unitrin Direct Ins. Co. (2016 NY Slip Op 50649(U))
April 19, 2016
The relevant facts the court considered were that plaintiff, Great Health Care Chiropractic, P.C., was suing defendant, Unitrin Direct Insurance Company, as the assignee of Junior Noel to recover first-party no-fault benefits. The main issue decided was whether defendant's motion for summary judgment dismissing the complaint should be granted on the ground that defendant never received the claim at issue. The holding of the court was that there was a triable issue of fact as to whether the claim at issue was timely submitted to defendant, and thus, the order was reversed and defendant's motion for summary judgment dismissing the complaint was denied.
Urban Well Acupuncture, P.C. v Hereford Ins. Co. (2016 NY Slip Op 50606(U))
April 18, 2016
The relevant facts of this case were that the plaintiff, Urban Well Acupuncture, P.C., was seeking first-party no-fault benefits from the defendant-insurer, Hereford Ins. Co., for acupuncture services rendered to an assignor. The defendant-insurer had timely denied certain claims on the ground that the fees charged by the plaintiff exceeded the amount permitted by the worker's compensation fee schedule. The remaining claims were paid by the defendant pursuant to a settlement agreement. The main issue decided was whether the defendant was entitled to summary judgment dismissing the plaintiff's claims. The holding of the court was that the defendant-insurer made a prima facie showing of entitlement to summary judgment by establishing the timely denial of claims and that the remaining claims were paid pursuant to a settlement agreement, and the plaintiff failed to raise a triable issue in opposition. Therefore, the defendant's motion for summary judgment was properly granted, and the plaintiff's remaining contentions were either without merit or abandoned on appeal.
MDJ Med. PC v Delos Ins. Co. (2016 NY Slip Op 50604(U))
April 18, 2016
The relevant facts the court considered were that the defendant-insurer timely and properly mailed notices for examinations under oath (EUOs) to the plaintiff's assignor, and the assignor failed to appear at two scheduled EUOs. The main issue decided was whether the insurer was entitled to summary judgment dismissing the action for first-party no-fault benefits. The holding of the case was that the defendant-insurer made a prima facie showing of entitlement to summary judgment by establishing the timely and proper mailing of the EUO notices, and the plaintiff did not raise a triable issue with respect to the assignor's nonappearance at the scheduled EUOs. Therefore, the appellate court reversed the order of the lower court and granted the defendant's motion for summary judgment dismissing the complaint.
Lotus Acupuncture PC v Unitrin Advantage Ins. Co. (2016 NY Slip Op 50603(U))
April 18, 2016
The court considered the defendant-insurer's motion for summary judgment dismissing a first-party no-fault action. The main issue decided was whether the peer review report provided by the defendant's acupuncturist was sufficient to establish that the services rendered were not medically necessary. The court held that while the defendant's documentary submissions were sufficient to establish the timely and properly mailed denial of claim forms, the peer review report failed to make a prima facie showing that the services rendered were not medically necessary. As a result, the court reversed the order of the Civil Court, denied the defendant's motion, and reinstated the complaint.
Lancer Acupuncture, P.C. v Amica Mut. Ins. Co. (2016 NY Slip Op 50537(U))
April 13, 2016
The court considered the fact that defendant's documentary submissions failed to eliminate all triable issues as to whether it properly denied plaintiff's no-fault claim for $54.74, billed under CPT code 99203. The main issues decided in this case were whether the plaintiff's claim for first-party no-fault benefits billed under CPT code 99302 should be reinstated, and whether the Civil Court properly exercised its discretion to allow the defendant to correct the defect in the form of the IME report of its acupuncturist/chiropractor. The holding of the case was that the order was modified by reinstating plaintiff's claim for first-party no-fault benefits billed under CPT code 99302, and as modified, the order was affirmed.
Flushing Traditional Acupuncture, P.C. v Auto Club Ins. Assn., AAA Mich. (2016 NY Slip Op 26125)
April 11, 2016
The court considered the appeal by a New York City provider to recover first-party no-fault benefits for services rendered to its assignor, who allegedly sustained injuries in a New York City motor vehicle accident. The main issues were whether personal jurisdiction over the defendant had been acquired, whether a conflict-of-law analysis required the application of Michigan law, and whether there was a lack of coverage for the vehicle involved in the accident. The holding of the court was that the service of process upon the Superintendent of Insurance established jurisdiction over the defendant, and the Michigan law could not be relied on to withhold payment of no-fault benefits to the plaintiff for the medical services it rendered to its assignor, who was an innocent third party. The court reversed the previous decision, denied the branch of the defendant's motion seeking summary judgment dismissing the complaint on the ground of lack of insurance coverage, and remitted the matter to the Civil Court for a determination of the remaining issue.
Pavlova v Allstate Ins. Co. (2016 NY Slip Op 26123)
April 11, 2016
The case involved a dispute over first-party no-fault benefits for medical services rendered to Cosby Reavis. The plaintiff submitted a claim form and invoice to the defendant for services related to three different codes under the Official New York Workers' Compensation Medical Fee Schedule. The defendant denied the claim based on a defense of lack of medical necessity and not billing services correctly. The court decided that the plaintiff failed to meet its burden for services related to code 20999 due to insufficient information provided for the amount charged for the services. However, the court granted the plaintiff's motion for summary judgment with regard to services related to codes 20553 and 99215, and the defendant's motion was granted with respect to services billed under code 20999. Therefore, the plaintiff was awarded $267.79 for the services related to codes 20553 and 99215, plus costs, fees, disbursements, and interest.