No-Fault Case Law
Best Touch PT, P.C. v American Tr. Ins. Co. (2015 NY Slip Op 51789(U))
December 2, 2015
The main issue in this case was whether the defendant, American Transit Ins. Co. (ATIC), was obligated to pay first-party no-fault benefits for services provided by the plaintiff, Best Touch PT, P.C., to their assignor, Emely Cordero, after she failed to appear at independent medical examinations. The court considered the fact that ATIC had obtained a declaratory judgment against Cordero and various providers, including the plaintiff, stating that they were not obligated to pay any claims for no-fault benefits submitted by the providers who treated Cordero. The court held that this action was barred under the doctrine of res judicata, based on the Supreme Court's order, and reversing the Civil Court's decision to grant plaintiff's motion for summary judgment, denied it, and granted defendant's cross motion for summary judgment dismissing the complaint. Therefore, the holding of the case was that ATIC was not obligated to pay the first-party no-fault benefits to the plaintiff.
Performance Plus Med., P.C. v Kemper Ins. Co. (2015 NY Slip Op 51777(U))
December 2, 2015
The court considered an appeal from an order granting the defendant's motion to dismiss the complaint in an action by a provider to recover assigned first-party no-fault benefits. The main issue was whether the appeal from the order entered upon the default of the appealing party was allowed. The court held that as no appeal lies from an order entered upon the default of the appealing party, the appeal was dismissed. The decision was made by a unanimous decision of the judges.
Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51776(U))
December 2, 2015
The case involved an action by a medical provider to recover assigned first-party no-fault benefits. The provider moved for summary judgment, and the insurance company cross-moved for summary judgment to dismiss the complaint. The Civil Court denied the provider's motion and granted the insurance company's cross-motion, dismissing the complaint. The main issues decided were whether the insurance company had timely mailed verification requests, and whether the medical provider's assignor had failed to comply with conditions precedent to coverage, such as appearing for independent medical examinations. The holding of the case was that the insurance company was entitled to summary judgment dismissing the remaining causes of action, except for the third cause of action, as there was a triable issue of fact as to whether it was premature. Therefore, the order was modified to deny the insurance company's motion seeking summary judgment dismissing the third cause of action.
GLM Med., P.C. v Geico Gen. Ins. Co. (2015 NY Slip Op 25405)
December 2, 2015
The main issue in this case was whether or not to grant the plaintiff's motion to restore the action to the trial calendar after it had been mistakenly marked as "settled." The court considered the fact that the case had been marked as "settled" on the New York State Unified Court System eCourts public website, but also noted that this notation did not constitute sufficient memorialization of the terms of the alleged settlement to satisfy the open-court requirement of CPLR 2104. As a result, the court held that, since there was no indication that an enforceable settlement was reached, the plaintiff's motion to restore the action should have been granted. The holding of the case was that the order was reversed, and the plaintiff's motion to restore the action to the trial calendar was granted.
Stracar Med. Servs. v Nationwide Mut. Ins. Co. (2015 NY Slip Op 51761(U))
December 1, 2015
The court considered the circumstances of an automobile accident and the subsequent assignment of first-party no-fault benefits to the plaintiff. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint based on an order from a Virginia court voiding the insurance policy ab initio. The holding of the case was that the plaintiff was not bound by the Virginia court's order because it was not a party to, nor in privity with a party to, the Virginia action. Therefore, the defendant was not entitled to judgment as a matter of law, and the motion for summary judgment dismissing the complaint was denied.
V.S. Med. Servs., P.C. v Travelers Ins. Co. (2015 NY Slip Op 51760(U))
December 1, 2015
In this case, V.S. Medical Services, P.C. (plaintiff) sought to recover first-party no-fault benefits for medical services rendered. The Civil Court awarded the plaintiff $10,859.64 plus statutory interest, with an exception for a period when interest accrual was stayed pursuant to parties' stipulation. The defendant, Travelers Insurance Co., challenged the proof of mailing of the claims and whether the claims remained unpaid at the time of trial. The defendant also argued that the accrual of statutory interest should be further stayed due to plaintiff's inaction after the dismissal of the action had been vacated. The Appellate Court found that plaintiff had proved its case at trial and was entitled to judgment, but modified the judgment to further stay the accrual of statutory interest to February 27, 2009, due to the plaintiff's years of inaction. The matter was remitted to the Civil Court for recalculation of the interest and entry of an amended judgment.
Throgs Neck Multicare, P.C. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 51756(U))
November 30, 2015
The main issue in the case was whether the defendant's denial of the plaintiff's claims for medical services was justified. The defendant argued that the claims were denied based on lack of medical necessity and also on the grounds that some of the services were in excess of the workers' compensation fee schedule. The court considered the plaintiff's challenge to the denial of the claims and found that they had failed to rebut the conclusions set forth in the independent medical examination (IME) report. As a result, the court held that the plaintiff had not raised a triable issue of fact as to the medical necessity of the services and affirmed the order granting the defendant's motion for summary judgment. Ultimately, the decision of the court favored the defendant, as it was found that the denial of the claims based on lack of medical necessity was justified.
Dayan v Allstate Ins. Co. (2015 NY Slip Op 51751(U))
November 30, 2015
The court evaluated a case where the plaintiff, as the assignee of Zaur Yevdeyev, sought to recover first-party no-fault benefits from the defendant. The trial court found that the plaintiff had established a prima facie case and that the burden shifted to the defendant to show the lack of medical necessity for the services in question. The trial court ultimately ruled in favor of the plaintiff and awarded a specific sum of money. However, the appellate court determined that the trial court erred in ruling that the defendant bore the ultimate burden of proof. As a result of this error, the appellate court reversed the judgment and remitted the matter to the Civil Court for a new trial. In summary, the main issue in this case was which party bears the burden of proving the medical necessity or lack of medical necessity of the assignor's right-shoulder surgery, and the holding of the court was that the trial court erred in placing the ultimate burden of proof on the defendant, leading to the need for a new trial.
Weinberg v Auto One Ins. Co. (2015 NY Slip Op 51746(U))
November 30, 2015
The main issue in this case was whether the attorney's complaint stated a cause of action for recovery of contingent attorney's fees, and whether the attorney was entitled to collect attorney's fees in excess of the limitations set forth in the statutes. The relevant facts included the provider and defendant settling some first-party no-fault actions in 2012, the subsequent claim by the IRS which led to the settlement monies, including the attorney's fee, being forwarded to the IRS, and the plaintiff's assertion that his lien on the principal settlement was superior to the IRS claim. The court held that the attorney's complaint failed to state a cause of action for the recovery of contingent attorney's fees beyond those authorized by statute, as there were no factual allegations in the complaint to support such a claim. Therefore, the court affirmed the order granting the defendant's motion to dismiss the complaint.
Acupuncture Healthcare Plaza I, P.C. v 21st Century Ins. Co. (2015 NY Slip Op 51716(U))
November 20, 2015
The court considered a dispute over medical fees and appointments between Acupuncture Healthcare Plaza I, P.C. and 21st Century Insurance Company. Defendant denied the underlying claims, stating that the amounts sought exceeded the amounts permitted by the workers' compensation fee schedule, and had also timely denied the appointments due to plaintiff's assignor's failure to attend scheduled examinations. The court granted defendant's motion to dismiss the first, second, fifth, and seventh causes of action, as well as part of the third and fourth causes of action. The court found that defendant had demonstrated that it had fully paid plaintiff for the services in accordance with the workers' compensation fee schedule. However, there was a triable issue of fact regarding the addresses to which the examination scheduling letters were sent, so the court denied the motion to dismiss the fifth and seventh causes of action. Ultimately, the court modified the order by denying the dismissal of the fifth and seventh causes of action, and affirmed the remainder of the order.