No-Fault Case Law
Delta Diagnostic Radiology, P.C. v Kemper Ins. Co. (2016 NY Slip Op 50396(U))
March 23, 2016
The court considered the case of Delta Diagnostic Radiology, P.C. as Assignee of NOEL JUNIOR, appealing an order from the Civil Court of New York, which granted the defendant's motion for summary judgment and denied the plaintiff's cross motion for summary judgment. The main issue decided was whether the affidavits submitted by the defendant were sufficient to establish that the plaintiff's assignor had failed to appear for duly scheduled independent medical examinations (IMEs). The holding of the court was that since the assignor's appearance at an IME is a condition precedent to the insurer's liability on the policy, and in opposition to defendant's motion, the plaintiff did not raise a triable issue of fact, the order was affirmed.
Active Care Med. Supply Corp. v Hartford Ins. Co. (2016 NY Slip Op 50769(U))
March 22, 2016
The court considered the motion for summary judgment from the defendant, Hartford Insurance Company, in an action to recover assigned first-party no-fault benefits. The main issue was whether the defendant was the proper insurer for the claim. The defendant claimed it was not the proper insurer for the assignor's employer for no-fault claims, but the court found that the evidence provided was not sufficient to establish this for summary judgment. The court also denied the plaintiff's cross-motion for summary judgment and granted the plaintiff's motion to compel discovery, as the plaintiff contended that discovery was not complete. The holding of the case was that the defendant's motion for summary judgment was denied, the plaintiff's cross-motion for summary judgment was denied, and the plaintiff's motion to compel discovery was granted.
Big Apple Ortho Prods., Inc. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 50768(U))
March 22, 2016
The relevant facts considered by the court were that the plaintiff, Big Apple Ortho Products, Inc., was seeking to recover first-party no-fault benefits that had been denied by the defendant, State Farm Mutual Automobile Ins. Co., on the basis that the accident in question occurred in Georgia and therefore was not covered by New York State no-fault law. The defendant provided an affidavit from a claims representative and a police report to support their argument. The main issue decided by the court was whether the accident fell under the coverage provided by New York State no-fault law, given the location of the accident and the residency of the individual involved. The holding of the court was that the defendant's motion for summary judgment was denied without prejudice, as the evidence presented was found to be inadmissible and did not establish whether the individual involved was a New York State resident or if he was covered by another policy providing the required coverage.
PR Med., P.C. v Praetorian Ins. Co. (2016 NY Slip Op 50338(U))
March 21, 2016
In the case of PR Medical, P.C. v Praetorian Insurance Company, the court considered whether the defendant's motion for summary judgment to dismiss the complaint and the plaintiff's cross-motion for summary judgment on their claims amounting to $2,005.25 should be granted. The main issue decided was whether the plaintiff's claims were overdue, as they were not "denied or paid" within the prescribed 30-day period. The holding of the court was that the defendant's motion for summary judgment was denied, the complaint reinstated, and the plaintiff's cross-motion for summary judgment in the principal amount of $2,005.25 was granted. The court found that the defendant failed to raise a triable issue as to whether it had timely denied the claims and that the claims at issue were not timely denied, therefore the defendant was precluded from asserting its defense of lack of medical necessity.
Hu-Nam-Nam v Infinity Ins. Co. (2016 NY Slip Op 50391(U))
March 18, 2016
The court considered the fact that an automobile accident occurred in New York involving a vehicle insured by the defendant under a Florida automobile insurance policy. The defendant rescinded the policy retroactively based on a material misrepresentation in the insurance application. The main issue was whether the defendant had complied with the requirements of rescinding the policy under Florida law. The holding of the court was that the defendant had demonstrated, through documented evidence, that it had complied with the requirements for rescinding the policy under Florida law, and therefore, it was entitled to summary judgment to dismiss the complaint. The court reversed the lower court’s decision and granted the defendant’s motion for summary judgment, while denying the plaintiff’s cross motion for summary judgment.
Friedman v Allstate Ins. Co. (2016 NY Slip Op 50390(U))
March 18, 2016
The relevant facts that the court considered were that a medical provider was seeking to recover no-fault benefits for acupuncture services rendered to an assignor. The main issue was whether the acupuncture services were medically necessary. The court held that the services in question were, in fact, medically necessary, as the provider demonstrated, by a preponderance of the credible evidence, that the services at issue were medically necessary. The court also precluded the defendant from raising a defense that the assignor may have been eligible for workers' compensation benefits, as the defendant had not denied the claims based upon that eligibility. Therefore, the court affirmed the judgment in favor of the medical provider.
Natural Therapy Acupuncture, P.C. v American Tr. Ins. Co. (2016 NY Slip Op 50389(U))
March 18, 2016
The court considered the motion for summary judgment by the plaintiff to recover assigned first-party no-fault benefits, as well as the cross motion for summary judgment by the defendant to dismiss the complaint. The main issue decided was whether the defendant had timely and properly paid the plaintiff's claims in accordance with the workers' compensation fee schedule. The holding of the court was that the defendant had fully paid the plaintiff for the services at issue in accordance with the fee schedule, as established by the affidavit of the defendant's no-fault examiner and the exhibits annexed in support of the cross motion. Consequently, the Civil Court properly granted the defendant's cross motion and denied the plaintiff's motion, and the order was affirmed.
Alleviation Med. Servs., P.C. v A Cent. Ins. Co. (2016 NY Slip Op 50383(U))
March 17, 2016
The relevant facts considered by the court were that Alleviation Medical Services, P.C. was seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the letters scheduling the independent medical examinations had been timely and properly mailed to the assignor. The court held that the defendant's motion for summary judgment dismissing the complaint was denied because they failed to demonstrate that the IMEs had been properly scheduled and that the plaintiff's assignor had failed to comply with a condition precedent to an insurer's liability on a policy. Additionally, the court found that the affirmation of defendant's counsel was insufficient, and defendant could not establish its entitlement to judgment. Therefore, the order was reversed, and defendant's motion for summary judgment dismissing the complaint was denied.
Alleviation Med. Servs., P.C. v Truck Ins. Exch. (2016 NY Slip Op 50382(U))
March 17, 2016
The court considered the timely mailing of a denial of claim form by the defendant, which denied the claim on the grounds of lack of medical necessity. The defendant also submitted an affirmed peer review that provided a factual basis and medical rationale for the determination that there was a lack of medical necessity for the services at issue. In opposition, the plaintiff submitted an affidavit from a doctor that failed to sufficiently rebut the conclusions set forth in the peer review report. The main issue decided was whether the defendant sufficiently established the lack of medical necessity for the services at issue, and the court held that the defendant did establish its entitlement to summary judgment dismissing the complaint. Therefore, the order granting the defendant's motion for summary judgment and denying the plaintiff's cross motion for summary judgment was affirmed.
Vladenn Med. Supply Corp. v Travelers Ins. Co. (2016 NY Slip Op 50381(U))
March 17, 2016
The relevant facts the court considered in this case are that Vladenn Medical Supply Corp, as the assignee of Donald Audouis, appealed an order denying its motion for summary judgment and granting Travelers Insurance Company's cross motion for summary judgment dismissing the complaint. The main issue decided was whether plaintiff's action to recover assigned first-party no-fault benefits was premature due to failure to provide requested verification. The court held that defendant's cross motion for summary judgment dismissing the complaint was denied, as plaintiff had submitted an affidavit that gave rise to a presumption that the requested verification had been mailed to and received by defendant. Therefore, there was a triable issue of fact as to whether the action was premature.