No-Fault Case Law
Alleviation Med. Servs., P.C. v Allstate Ins. Co. (2015 NY Slip Op 51591(U))
October 30, 2015
The court considered the denial of a provider's motion for summary judgment and the granting of the defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant had established its entitlement to summary judgment dismissing the complaint based on the nonappearance of the plaintiff's assignor for independent medical examinations (IMEs). The court held that the defendant had failed to establish its entitlement to summary judgment because the affirmation from the doctor who was to perform the IMEs did not demonstrate the nonappearance of the assignor. However, the court also held that the plaintiff had failed to demonstrate its entitlement to summary judgment as the affidavit submitted by plaintiff failed to establish that the claim at issue had not been timely denied or that the defendant had issued a timely denial of claim that was conclusory, vague, or without merit as a matter of law. Therefore, the court modified the order to provide that the defendant's cross motion for summary judgment dismissing the complaint is denied.
Compas Med., P.C. v Geico Ins. Co. (2015 NY Slip Op 51590(U))
October 30, 2015
The court considered an action by a provider to recover assigned first-party no-fault benefits. The plaintiff moved for summary judgment, and the defendant cross-moved for summary judgment dismissing the complaint. The main issues decided were whether the defendant's cross-motion seeking summary judgment dismissing the third cause of action should have been denied, and whether the plaintiff was entitled to summary judgment upon its third cause of action. The holding of the case was that the branch of defendant's cross motion seeking summary judgment dismissing the third cause of action was denied and the branch of plaintiff's motion seeking summary judgment upon its third cause of action was properly denied.
Linden Equip., Inc. v Praetorian Ins. Co. (2015 NY Slip Op 51545(U))
October 27, 2015
The court considered the plaintiff's failure to move for entry of a default judgment within one year, as required by CPLR 3215(a). However, the court exercised its discretion to deny the defendant's motion to dismiss the complaint as abandoned pursuant to CPLR 3215(c). The main issue decided was whether the plaintiff demonstrated a meritorious cause of action for assigned first-party no-fault benefits and if the defendant was prejudiced by the plaintiff's delay. The holding of the case was that the court affirmed the order denying the defendant's motion to dismiss the complaint as abandoned, as the plaintiff demonstrated a meritorious cause of action and the defendant was not prejudiced by the plaintiff's delay.
Compas Med., P.C. v Travelers Ins. Co. (2015 NY Slip Op 51568(U))
October 26, 2015
The relevant facts the court considered were that the plaintiff was seeking to recover assigned first-party no-fault benefits from the defendant insurance company. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint based on the plaintiff's alleged failure to appear for scheduled examinations under oath (EUOs). The court held that the defendant failed to establish its entitlement to summary judgment as a matter of law because it did not provide sufficient evidence that the plaintiff had failed to appear for both EUOs. As a result, the court reversed the order granting the defendant's motion for summary judgment and denied the motion, with costs.
Downtown Acupuncture PC v State Wide Ins. Co. (2015 NY Slip Op25371)
October 22, 2015
The court considered whether defendant state wide insurance company could proactively invoke collateral estoppel to bar a medical service provider from recovering no-fault benefits due to a finding of fraudulent incorporation. In the previous trial, after it was found out that the corporations were not owned or controlled by licensed acupuncturists and their services were performed by independent contractors in violation of New York law, the plaintiff had a full and fair opportunity to contest the prior issue. The holding of the the case was that the plaintiff party could invoke the common-law doctrine of collateral estoppel to preclude the defendants from relitigating in a subsequent proceeding an issue clearly raised in a prior action and decided against the party or those in privity. This is significant in a subsequent proceeding whether or not the causes of action are the same, provided that the cause of action is similar.
Easy Care Acupuncture P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51524(U))
October 20, 2015
In the case above, the main issue was whether the defendant made a showing of entitlement to summary judgment dismissing the action for first-party no-fault benefits. The court found that the defendant-insurer had properly mailed the notices for chiropractic/acupuncture independent medical examinations (IMEs) to plaintiff's assignor and that the assignor failed to appear. The plaintiff had claimed that the defendant was not entitled to request the IMEs prior to its receipt of plaintiff's claim forms, but the court found that was not the case. As a result, the court ruled in favor of the defendant, reversing the lower court's order and granting the motion for summary judgment, thereby dismissing the complaint.
Acupuncture Pain Mgt., P.C. v Kemper Cas. Ins. Co. (2015 NY Slip Op 51522(U))
October 20, 2015
The court considered the defendant-insurer's motion for summary judgment to dismiss the complaint regarding first-party no-fault benefits and the assignor's failure to appear for independent medical examinations (IMEs). The main issue was whether the defendant had established a prima facie showing of entitlement to summary judgment by proving timely and proper mailing of the IME notices and the assignor's nonappearance, and whether the plaintiff raised a triable issue in opposition. The holding was that the defendant had indeed made a prima facie showing and the plaintiff did not specifically deny the assignor's nonappearance or raise a triable issue, therefore the defendant's motion for summary judgment was granted and the complaint was dismissed.
Walden-Bailey Chiropractic v Erie Ins. Co. (2015 NY Slip Op25353)
October 19, 2015
The case involved a dispute between a chiropractic provider and an insurance company over assigned first-party no-fault benefits. The provider requested a discontinuance without prejudice in the Civil Court, which was granted. The insurance company subsequently moved to vacate or modify the order of discontinuance and sought attorney's fees and sanctions. The Civil Court denied the motion to vacate or modify the discontinuance, but also implicitly denied the insurance company's request for attorney's fees and sanctions. The Appellate Term modified the order to grant the insurance company's motion for attorney's fees, stating that the provider did not indirectly seek to change venue by requesting discontinuance and filing elsewhere, and that the insurance company was entitled to recover the reasonable attorney's fees incurred in its defense of the action. The matter was remitted to the Civil Court for a determination of the reasonable amount of attorney's fees incurred by the insurance company up to the date of discontinuance.
Cliffside Park Imaging & Diagnostic v Travelers Ins. Co. (2015 NY Slip Op 51489(U))
October 8, 2015
The court considered the defendant's motion for partial summary judgment in a case involving a dispute over the reimbursement of health services rendered in New Jersey. The main issue decided was whether the defendant could rely on the New Jersey fee schedule to establish the "prevailing fee" for the purposes of the plaintiff's no-fault claim. The court held that the defendant could properly rely on the New Jersey fee schedule, and therefore sustained the grant of defendant's motion for partial summary judgment. The court also noted that the plaintiff's objections to the sufficiency of the defendant's proof pertaining to the calculation of the fees under the New Jersey fee schedule were premature, as the Civil Court had not made a determination on the amount reimbursable under that fee schedule. The decision was affirmed, with costs.
Surgicare Surgical Assoc. v National Interstate Ins. Co. (2015 NY Slip Op25338)
October 8, 2015
The legal case is about a first-party no-fault action arising from health services rendered at a New Jersey location. The insurer only paid a portion of the amount billed by the health service provider according to the New Jersey fee schedule, which plaintiff argues was not permissible. Plaintiff seeks the difference between the amount charged and payment made by the defendant pursuant to the New Jersey fee schedule. The court decided that insurers may properly rely on such fee schedule to establish the prevailing fee and demonstrate compliance therewith by payment within that fee schedule. The Superintendent of Insurance had issued an opinion letter stating that the reimbursement amount is determined by the permissible cost in the out-of-state location. The ruling is affirmed to apply the permissible rate authorized in New Jersey for the services rendered by plaintiff at a rate significantly higher than the permissible charges in the New Jersey fee schedule, which would undermine the purpose of Insurance Law §5108.