No-Fault Case Law

The relevant facts considered in this case include that Ema Acupuncture, P.C. sought to recover assigned first-party no-fault benefits and moved for summary judgement. They were seeking to recover payment for acupuncture services rendered to Oralia Hernandez. Geico Insurance company cross-moved for summary judgement, arguing that they had properly used the workers' compensation fee schedule to reimburse Ema Acupuncture, P.C. for the services rendered, which was applicable to chiropractors who render the same services as acupuncturists. The main issue decided by the court was whether the fee schedule for chiropractors was the appropriate basis for reimbursing an acupuncturist. The holding of the case was that Ema Acupuncture, P.C. was entitled to summary judgment for the initial acupuncture visit on January 6, 2009 as billed under fee schedule treatment code 99205. However, Geico Insurance Company was granted summary judgement dismissing the remaining claims, as they had demonstrated that they had fully paid Ema Acupuncture, P.C. for those services in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors.

The relevant facts considered in this case were that Clinton Place Medical, P.C. was seeking to recover no-fault benefits from New York Central Mutual Fire Insurance Company. The main issue decided was whether the defendant had timely mailed proper independent medical examination scheduling letters to the plaintiff. The holding of the case was that the requirement to mail the scheduling letters to the plaintiff was not necessary, and the defendant was entitled to summary judgment dismissing plaintiff's first, second, and fifth causes of action. Additionally, the defendant failed to show that it had denied the underlying claims or otherwise raised a triable issue of fact, so there was no basis to disturb the judgment entered upon plaintiff's third, fourth, sixth, and seventh causes of action.

The court considered the provider's appeal from the granting of the defendant's motion for summary judgment in a case involving first-party no-fault benefits. The main issue was whether the defendant had the right to deny the plaintiff's claims either pursuant to the workers' compensation fee schedule or on the ground of lack of medical necessity. The holding of the court was that the defendant's motion for summary judgment was granted with respect to the unpaid portion of the claim for dates of service August 3, 2007 through August 25, 2007. The court found that the defendant had paid a portion of the claim, but had denied the remainder on the ground that the amount billed by the plaintiff exceeded the fees allowed by the workers' compensation fee schedule. Additionally, the court determined that the plaintiff had failed to raise a triable issue of fact regarding the unpaid portion of the claim for those specific dates, however, they did submit sufficient evidence to raise a triable issue of fact as to the medical necessity of the services rendered for other claims.

The court considered an order from the Civil Court of the City of New York, Queens County, which granted the defendant's motion for summary judgment dismissing the complaint. The main issue decided was whether the affidavits submitted by the defendant demonstrated that the denial of claim form had been timely mailed. The holding of the case was that the judgment was affirmed, with $25 costs. The court found that the plaintiff improperly raised the argument that the defendant's employees did not possess sufficient personal knowledge to demonstrate that the denial of claim form had been timely mailed. The court also found that the argument that one of the affidavits submitted by the defendant did not comply with CPLR 2309 (c) was waived.

The main issue in this case was the denial of plaintiff's motion for leave to enter a default judgment based on defendant's failure to appear in the action or answer the complaint. The court considered the fact that plaintiff's moving papers failed to establish that the defendant failed to pay or deny the claim within the requisite 30-day period, as well as the fact that plaintiff did not establish that the defendant issued a timely denial of claim that was conclusory, vague, or without merit as a matter of law. The court ultimately affirmed the denial of plaintiff's motion, finding that the plaintiff had not established its prima facie case. The holding of the case was that the order denying plaintiff's motion for leave to enter a default judgment was affirmed.

The main issue in this case was whether the court should grant the defendant's motion for summary judgment dismissing the complaint or grant the plaintiff's cross motion to compel the defendant to respond to the plaintiff's discovery demands. The court considered the fact that the plaintiff requested medical documentation underlying the defendant's decision to deny claims based on lack of medical necessity, but did not receive the requested information. The court held that the defendant's motion for summary judgment should be denied with leave to renew following discovery and that the plaintiff's cross motion to compel the defendant to respond to discovery demands should be granted. The defendant was directed to serve responses to plaintiff's discovery demands within 60 days of the date of the decision and order.

This case involved an action brought by a medical services company to recover monies for medical services provided to a New York resident injured in an automobile accident. The insurance policy at issue, obtained by the car's owner in Michigan, contained a provision that the insured vehicles were to be driven and principally garaged in Michigan. However, an investigation revealed that the insured vehicles were actually being operated as a commercial taxi/livery car service in New York, in violation of the insurance policy term requiring the vehicles to be garaged in Michigan. The main issue involved a conflict of law, as the defendant, Auto Club, argued that Michigan law applied, which allows for the retroactive voiding of an insurance policy due to fraud in procurement, whereas the plaintiff argued that New York law applied, which does not permit an insurance policy to be retroactively cancelled. The court held that Michigan law applied, as the policy was negotiated and issued in Michigan, with the insured risk primarily located in Michigan. The court also addressed the issue of the absence of a valid certificate of conformity for an out-of-state affidavit submitted by the defendant, ruling that the defect could be cured nunc pro tunc, and provided the defendant with 45 days to provide a proper certificate of conformity to grant the motion for summary judgment and dismiss the case.

The relevant facts considered by the court were that the plaintiff filed an action to recover assigned first-party no-fault benefits in 2001, based upon an accident that occurred in 1998. The case went without action for seven years until the plaintiff filed a notice of trial on August 7, 2008. The main issue decided was whether statutory prejudgment interest would begin to accumulate from the date the plaintiff filed his notice of trial. The court held that in this case, the Civil Court properly determined that the interest should be awarded from August 7, 2008. The holding of the court was that the judgment, insofar as appealed from, is affirmed, without costs.

The court considered the facts of a case where a provider sought to recover assigned first-party no-fault benefits, and the defendant moved for summary judgment on the ground of fraudulent procurement of the insurance policy due to misrepresentation of the state where the insured vehicle was garaged. The court also considered the plaintiff's separate motion for summary judgment. The main issue decided was whether the defendant had timely denied the plaintiff's claim, and whether the defendant could assert the defense of misrepresentation of the state where the insured vehicle was garaged. The holding of the case was that the plaintiff's motion for summary judgment was granted, defendant's motion for summary judgment dismissing the complaint was denied, and the matter was remitted to the Civil Court for a calculation of statutory interest and an assessment of attorney's fees.

The relevant facts of this case revolve around a dispute over first-party no-fault benefits, with the plaintiff, Clove Medical Supply, Inc., seeking to recover assigned benefits from Ameriprise Ins. Co. The main issue decided by the court was whether the defendant, Ameriprise, had the right to deny the claims on the basis that the plaintiff had failed to appear for an examination under oath (EUO). The court held that the defendant failed to demonstrate that it had timely mailed its initial and follow-up requests for EUOs, and therefore failed to toll its time to pay or deny the claims. As a result, the court affirmed the order of the Civil Court, denying the defendant's motion for summary judgment dismissing the complaint.