No-Fault Case Law
Compas Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 50376(U))
March 17, 2016
The court considered the defendant's motion for summary judgment to dismiss the complaint on the basis that all claims were timely and properly denied due to the plaintiff's assignor's failure to attend scheduled independent medical examinations, as well as the argument that the fees sought exceeded the amounts permitted by the workers' compensation fee schedule. The main issue decided was whether the defendant had proper grounds to deny the claims and to reduce the amount of the claims based on the fee schedule. The court held that the defendant failed to establish its entitlement to judgment as a matter of law due to the lack of personal knowledge of the nonappearance of the plaintiff's assignor for the examinations, and that there was a triable issue of fact with respect to whether the reductions were proper based on the fee schedule. The court affirmed the denial of the defendant's motion for summary judgment.
Encompass Ins. Co. v Rockaway Family Med. Care, P.C. (2016 NY Slip Op 01922)
March 17, 2016
In this case, Encompass Insurance Company (respondent) sought to vacate the master arbitration decision of Frank G. Godson and reinstate the award of arbitrator Laura Yantsos. The main issue was whether petitioner's second follow-up request for an examination under oath was timely, as it was sent 11 days after the respondent failed to appear on the date set in the first request, with the 10th day falling on a Sunday. The court unanimously affirmed the order and judgment of Supreme Court, New York County, which vacated the master arbitration decision and reinstated the award of the arbitrator Laura Yantsos. The court held that plaintiff was entitled to an extension of time to send its second follow-up request, in accordance with General Construction Law § 25-a, and that the second request was therefore timely.
Encompass Ins. Co. v Rockaway Family Med. Care, P.C. (2016 NY Slip Op 01921)
March 17, 2016
The court in this case considered a motion for de novo review of a master arbitrator's findings and summary judgment by the plaintiff. The main issue decided was whether the plaintiff satisfied the requirements for a de novo adjudication of the dispute under Insurance Law §5106 (c). The holding of the court was that the plaintiff was entitled to a de novo review of the arbitrator's findings and an extension of time to send its second follow-up request for an examination under oath, based on General Construction Law §25-a. The court modified the lower court's decision to reinstate the complaint and grant the part of the motion seeking de novo review of the arbitrator's findings and affirmed the decision without costs.
Meridian Psychological Servs., P.C. v Allstate Ins. Co. (2016 NY Slip Op 50375(U))
March 16, 2016
The relevant facts considered by the court in Meridian Psychological Services, P.C. v Allstate Insurance Company included a nonjury trial of the action by a provider to recover assigned first-party no-fault benefits. The main issues decided in this case were the timeliness and proper mailing of defendant's letters scheduling examinations under oath (EUOs) and the proof that plaintiff's assignor had failed to appear for the EUOs. The holding of the court was that the defendant failed to establish that the EUO scheduling letters had been timely and properly mailed to plaintiff's assignor, and that the defendant also failed to prove that plaintiff's assignor had failed to appear for the two duly scheduled EUOs. As a result, the judgment awarding the plaintiff the principal sum of $1,365.21 was affirmed.
Great Health Care Chiropractic, P.C. v Unitrin Direct Ins. Co. (2016 NY Slip Op 50373(U))
March 16, 2016
The main issue in this case was whether the defendant was entitled to summary judgment dismissing the complaint filed by the plaintiff, who sought to recover assigned first-party no-fault benefits. The court considered whether the defendant had timely denied the claim in question and whether the plaintiff had demonstrated its entitlement to summary judgment. The court held that the defendant's motion for summary judgment dismissing the complaint was denied, as the defendant had failed to establish its entitlement to judgment as a matter of law. However, the court also held that the plaintiff had also failed to demonstrate its entitlement to summary judgment, as it did not establish that the claim had not been timely denied or that the defendant had issued a timely denial of the claim. Therefore, the court modified the order to deny the defendant's motion for summary judgment.
New Way Med. Supply Corp. v American Tr. Ins. Co. (2016 NY Slip Op 50370(U))
March 16, 2016
The relevant facts the court considered were related to a dispute between New Way Medical Supply Corp. and American Transit Insurance Co. regarding the payment of first-party no-fault benefits. The main issue decided was whether the plaintiff had failed to comply with a condition precedent to coverage by not appearing for scheduled examinations under oath (EUOs). The holding of the court was that the defendant had timely mailed the EUO scheduling letters and the plaintiff's assignor had failed to appear for the scheduled EUOs, thus failing to comply with a condition precedent to coverage. As a result, the defendant was entitled to summary judgment dismissing the complaint. The court affirmed the order, with the plaintiff having to pay $25 in costs.
Tam Med. Supply Corp. v American Tr. Ins. Co. (2016 NY Slip Op 50369(U))
March 16, 2016
The relevant facts in this case were that Tam Medical Supply Corp., as assignee of DOR GUY MARCEL, appealed from an order of the Civil Court of the City of New York, Queens County, which denied plaintiff's motion for summary judgment and granted defendant's cross motion for summary judgment dismissing the complaint. The main issue decided by the court was whether the action by the provider to recover assigned first-party no-fault benefits was premature due to the failure to provide requested verification. The holding of the court was that there is a triable issue of fact as to whether the action is premature because plaintiff had submitted an affidavit from the owner, which was sufficient to give rise to a presumption that the requested verification had been mailed to and received by defendant. Therefore, the court modified the order by providing that defendant's cross motion for summary judgment dismissing the complaint is denied.
Ultimate Health Prods., Inc. v Hereford Ins. Co. (2016 NY Slip Op 50367(U))
March 16, 2016
The relevant facts considered by the court in the case of Ultimate Health Prods., Inc. v Hereford Ins. Co. were that the plaintiff was seeking to recover first-party no-fault benefits as the assignee of an individual named Paul Luckner. The main issue decided in the case was whether the defendant, Hereford Insurance Co., had issued an automobile insurance policy covering the underlying accident. The court held that the defendant had established that there was no coverage for no-fault benefits because the policy being sued upon was a workers' compensation insurance policy which did not cover the plaintiff's claim for reimbursement of assigned first-party no-fault benefits. Therefore, the order denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint was affirmed.
Performance Plus Med., P.C. v Nationwide Ins. (2016 NY Slip Op 50366(U))
March 16, 2016
The court considered the appeal of Performance Plus Medical, P.C. from an order of the Civil Court of the City of New York, Kings County that granted defendant's motion for summary judgment dismissing the complaint. The main issues decided were whether the insurer's time to pay or deny a claim is tolled when a timely verification request has been provided, and whether the defendant had properly denied the claims for the services at issue. The holding of the court was that the insurer's time to pay or deny the entire claim is tolled if the provider has failed to respond to a request for verification, and that the defendant had established prima facie entitlement to summary judgment dismissing the second through tenth causes of action, as well as dismissing the first cause of action pursuant to the workers' compensation fee schedule. Therefore, the court affirmed the order of the Civil Court.
Matter of Singh v Allstate Ins. Co. (2016 NY Slip Op 01855)
March 16, 2016
The court considered a petition to vacate master arbitration awards that had denied the petitioner's no-fault claims for lost wages following an automobile accident. The petitioner appealed after the master arbitration awards were confirmed by a lower court. The main issue was whether there were sufficient grounds to vacate the master arbitration awards. The court held that the public policy in favor of arbitration meant that the grounds specified in CPLR 7511 for vacating or modifying a no-fault arbitration award were few and narrowly applied. In this case, the petitioner failed to demonstrate any ground for vacating the master arbitration awards, and the determinations of the master arbitrator were found to have evidentiary support and a rational basis. Therefore, the court affirmed the lower court's decision to deny the petition and confirm the master arbitration awards.