No-Fault Case Law
Acupuncture, Approach, P.C. v Allstate Ins. Co. (2015 NY Slip Op 50318(U))
March 16, 2015
The case involved Acupuncture, Approach, P.C. suing Allstate Insurance Company for recovery of assigned first-party no-fault benefits. Allstate appealed from an order entered by the Civil Court of the City of New York, which denied its motion for summary judgment dismissing the complaint. The main issue decided was whether the action was ripe for summary dismissal based on Allstate's claim that the assignor failed to appear for two scheduled independent medical examinations. The court held that the action was not ripe for summary dismissal because Allstate failed to establish "that it requested IMEs in accordance with the procedures and time frames set forth in the no-fault implementing regulations." Therefore, the order was affirmed and the case was allowed to proceed.
Top Choice Med., P.C. v Clarendon Natl. Ins. Co. (2015 NY Slip Op 50384(U))
March 12, 2015
The main issue in the case was whether the court should grant summary judgment dismissing the plaintiff's second cause of action. The court considered conflicting medical expert opinions regarding the medical necessity for the services at issue. The defendant had established the timely mailing of the denial of claim form, but the conflicting medical expert opinions presented by the parties demonstrated the existence of a triable issue of fact. As a result, the court held that the branch of the defendant's motion seeking summary judgment dismissing the plaintiff's second cause of action was properly denied. The court affirmed the order, ruling in favor of the plaintiff.
Metropolitan Diagnostic Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co. (2015 NY Slip Op 50383(U))
March 12, 2015
The court considered the case of Metropolitan Diagnostic Medical Care, P.C. as the assignee of Tareshe Allison, seeking to recover assigned first-party no-fault benefits from New York Central Mutual Fire Insurance Company. The main issue was whether the services provided were medically necessary. The court held that the physician's affirmation submitted by the plaintiff demonstrated the existence of a triable issue of fact as to the medical necessity of the services provided, and therefore, the defendant's motion for summary judgment dismissing the complaint should have been denied. Consequently, the order granting the defendant's motion for summary judgment was reversed, and the defendant's motion was denied.
Avicenna Med. Arts, PLLC v Unitrin Advantage Ins. Co. (2015 NY Slip Op 50382(U))
March 12, 2015
The court considered a case brought by Avicenna Medical Arts, PLLC as assignee of Samuel Darwa, seeking to recover assigned first-party no-fault benefits from Unitrin Advantage Insurance Company. Avicenna Medical Arts moved for summary judgment, and Unitrin Advantage Insurance Company cross-moved for summary judgment, arguing that the bills at issue had been timely and properly denied based on the assignor's failure to appear for scheduled examinations under oath (EUOs). The Civil Court granted the branches of Avicenna's motion, awarding them the principal sum of $2,903. The main issue decided was whether Avicenna demonstrated its prima facie entitlement to summary judgment, and the court held that Avicenna was properly granted judgment on its first six causes of action as the defendant's follow-up EUO requests were untimely, precluding them from asserting their defense. The judgment was affirmed by the court.
I.V. Med. Supply, Inc. v Praetorian Ins. Co. (2015 NY Slip Op 50380(U))
March 12, 2015
The court considered the motion for summary judgment brought by the defendant, who denied the claims at issue based on the failure of the plaintiff's assignor to appear for independent medical examinations (IMEs). The main issue decided was whether the IME scheduling letters had been timely and properly mailed, and whether the plaintiff's assignor had failed to appear for the IMEs. The court held that the defendant's denial of claim forms were timely and proper, and that the IME requests had been timely mailed. Affidavits from the chiropractors who were to perform the IMEs were also submitted and were found to be sufficient to establish that the plaintiff's assignor had failed to appear for the IMEs. Therefore, the court reversed the order and granted the defendant's motion for summary judgment dismissing the complaint.
Gutierrez v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 50379(U))
March 12, 2015
The court considered a case involving a provider seeking to recover assigned first-party no-fault benefits from an automobile insurance company. The main issue decided was whether the insurance company had properly reduced the billed amount for a medical procedure in accordance with the workers' compensation fee schedule. The court held that the insurance company's affidavits were sufficient to demonstrate that the fee schedule was appropriately applied, and that the company had mistakenly overpaid for the procedure. The court also found that the insurance company's defense was properly set forth in its denial of the claim, and that the provider had not rebutted the company's showing that it had overpaid. As a result, the court affirmed the lower court's decision to grant the insurance company's motion for summary judgment and to deny the provider's motion for summary judgment.
Ultimate Health Prods., Inc. v Travelers Ins. Co. (2015 NY Slip Op 50377(U))
March 12, 2015
The court considered the fact that the plaintiff, a healthcare provider, failed to appear at scheduled examinations under oath (EUOs) and that the denial of claim forms had been timely mailed by the insurer. The main issue decided was whether the failure to appear at the EUOs was a condition precedent to the insurer's liability on the policy. The court held that the appearance at an EUO is indeed a condition precedent to an insurer's liability on a policy, as established in prior case law. As a result, the court granted the insurer's motion for summary judgment dismissing the complaint and denied the plaintiff's cross motion for summary judgment. The order was affirmed by the court.
River Acupuncture, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 50271(U))
March 4, 2015
The court considered the defendant-insurer's motion for summary judgment to dismiss the complaint by the plaintiff-provider for first-party no-fault benefits. The main issue decided was whether the defendant made a prima facie showing of entitlement to summary judgment by establishing that it timely and properly mailed notices for independent medical examinations (IMEs) to the plaintiff's assignor, and that the assignor failed to appear. The holding of the court was that the defendant-insurer did make a prima facie showing of entitlement to summary judgment, and the plaintiff did not specifically deny the assignor's nonappearance or otherwise raise a triable issue with respect to the mailing or reasonableness of the underlying notices. Therefore, the defendant's motion for summary judgment dismissing the complaint was granted.
Auto One Ins. Co. v Hillside Chiropractic, P.C. (2015 NY Slip Op 01750)
March 3, 2015
The main issue in the case of Auto One Ins. Co. v Hillside Chiropractic, P.C. was whether the no-fault arbitrator erred in giving no weight to an independent medical examination (IME) report because it was not notarized, and whether the Master Arbitrator and IAS court were correct in deferring to the arbitrator's determination. The court considered the fact that the no-fault arbitrator's decision was based on CPLR 2106, which requires notarization for certain documents, but found that strict conformity to legal rules of evidence is not necessary in arbitration proceedings. The holding of the court was to reverse the denial of the petition seeking to vacate the arbitrator's determination, affirm the award of the lower arbitrator, vacate the arbitration award, and remand the matter for a new arbitration hearing before a different arbitrator.
Stracar Med. Servs., P.C. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 25079)
March 2, 2015
The court considered the issue of whether or not the plaintiff was obligated to submit to examinations under oath (EUOs) in order to recover assigned first-party no-fault benefits. The main issue was whether the recipient of an authorization to pay or an assignment of benefits was obligated to submit to an EUO and whether or not the defendant demonstrated that the plaintiff had failed to appear for these scheduled examinations under oath. The court held that both the recipient of a properly executed prescribed authorization and a properly executed prescribed assignment were required to submit to a duly scheduled EUO. They also held that the plaintiff was obligated to submit to an EUO whether viewed as the patient's assignee or as the patient's representative. The order was affirmed and the court found that the plaintiff's remaining argument, which was raised for the first time on appeal, was without merit.