No-Fault Case Law
Arce Med. & Diagnostic Svce v American Tr. Ins. Co. (2013 NY Slip Op 50531(U))
April 8, 2013
The court considered the motion to stay the case pending a determination of the Workers' Compensation Board of the parties' rights under the Workers' Compensation Law. The relevant facts considered were whether the plaintiff's assignor had been acting as an employee at the time of the accident, and whether workers' compensation benefits might be available. The main issue decided was whether the defendant proffered sufficient evidence that workers' compensation benefits might be available to warrant a stay of the action. The holding of the court was that the defendant did proffer sufficient evidence in admissible form of the alleged facts, and therefore the Civil Court properly granted the motion for a stay pending the Board's determination of the parties' rights under the Workers' Compensation Law.
Parkway Pain Mgt., PLLC v American Tr. Ins. Co. (2013 NY Slip Op 50521(U))
April 4, 2013
The court considered a motion to stay the action pending a determination by the Workers' Compensation Board of the parties' rights under the Workers' Compensation Law. The main issue was whether the plaintiff's assignor had been acting as an employee at the time of the accident, which needed to be resolved by the Workers' Compensation Board. The court held that the defendant's proof, including a police accident report, was sufficient to raise a question of fact on the issue, and therefore, the action was stayed pending a determination by the Workers' Compensation Board. The order was affirmed by the court.
Valley Psychological, P.C. v Government Empls. Ins. Co. (2013 NY Slip Op 02302)
April 4, 2013
The main issues decided in this case were whether the defendant was entitled to a credit against a judgment and whether the plaintiff was entitled to counsel fees. The court considered the fact that the plaintiff had been awarded partial summary judgment and secured a judgment in its favor, whereas the defendant sought to recover a credit of $825.55 against the judgment. The holding of the case was that the Supreme Court properly granted the plaintiff's request for a turnover order and directed the defendant to pay the plaintiff $5,254.02 in full satisfaction of the underlying judgment. The court also found the defendant's pursuit of the appeal to be frivolous and granted the plaintiff's request for counsel fees incurred in responding to the appeal. The matter was remitted to the Supreme Court for a determination of the amount of reasonable counsel fees incurred.
Allstate Ins. Co. v Natural Healing Acupuncture, P.C. (2013 NY Slip Op 50645(U))
April 3, 2013
The relevant facts considered by the court included a dispute over an arbitration award between Allstate Insurance Company and Natural Healing Acupuncture, P.C. The main issue decided was whether the master arbitrator's confirmation of the original arbitrator's decision, which awarded $927.99 to Natural Healing Acupuncture, was arbitrary, capricious, or contrary to well-settled law. The holding of the court was that the master arbitrator's award was vacated because it was not in accordance with well-established precedent and was contrary to the law. The court directed the arbitrator to recalculate the fees owed to Natural Healing Acupuncture in accordance with the fee schedule for licensed chiropractors who perform acupuncture.
Jamaica Med. Plaza, P.C. v Interboro Ins. Co. (2013 NY Slip Op 50475(U))
March 29, 2013
The main issues in the case involved a provider seeking to recover assigned first-party no-fault benefits. The defendant insurance company had moved for summary judgment dismissing the complaint or, alternatively, for a finding that certain correspondence was timely and valid. They also sought an order compelling the plaintiff to appear for an examination before trial. The Civil Court granted both motions to the extent that the only remaining issues for trial were related to the medical necessity of the services provided and whether the billing was in accordance with the New York State Workers' Compensation Fee Schedule. The court found that the plaintiff had established its prima facie case, and the defendant's motion for summary judgment was properly denied. However, the defendant's motion for an order compelling the plaintiff to appear for an examination before trial was granted, with the examination to be held within 60 days. The Appellate Court affirmed this decision.
City Dental Servs., P.C. v Country Wide Ins. Co. (2013 NY Slip Op 50474(U))
March 29, 2013
The relevant facts that the court considered were that the plaintiff, City Dental Services, P.C., sought to recover first-party no-fault benefits that were assigned to them. The defendant, Country Wide Insurance Company, attempted to file opposing papers almost two months after the stipulated due date, and the court rejected them, granting the plaintiff's motion on default. The main issue decided by the court was whether the defendant should be allowed to "renew and reargue" its opposition to the plaintiff's motion for summary judgment, and whether the previous default order should be vacated. The holding of the court was that the branch of the defendant's motion seeking leave to "renew" its opposition to plaintiff's motion for summary judgment was proper, as the defendant had defaulted in opposing the motion, and their remedy was to seek to vacate the default order. The court also noted that the branch of the plaintiff's motion seeking to vacate the previous order remained pending and undecided.
Crotona Hgts. Med., P.C. v Clarendon Natl. Ins. Co. (2013 NY Slip Op 50473(U))
March 29, 2013
The court considered the issue of a provider's right to recover assigned first-party no-fault benefits in this case. The main issues decided were whether the denial of claim forms and verification requests had been timely mailed by the defendant, and whether the plaintiff had failed to respond to defendant's verification requests. The court held that the denial of claim forms and verification requests had been timely mailed and that the plaintiff had failed to respond to defendant's requests, entitling the defendant to summary judgment dismissing the complaint. Additionally, the court found that the plaintiff's treating doctor had failed to rebut the conclusions set forth in the peer review reports submitted by the defendant, leading to the granting of summary judgment dismissing plaintiff's first, second and fourth causes of action.
Lancer Ins. Co. v Saravia (2013 NY Slip Op 23095)
March 29, 2013
This case involves a motion for summary judgment by Lancer Insurance Company against the insured participants for a motor vehicle accident that the company claims was staged. Lancer sought a default judgment against defendants Torres and Duran, as well as the dismissal of Utopia Equipment's counterclaims for no-fault benefits and attorneys' fees. The court denied Lancer's motion for a default judgment against Torres and Duran because the publication order for serving them did not comply with the requirements of the law. The court also denied Lancer's motion for a declaratory judgment that the accident was staged, stating that the circumstantial evidence presented was not sufficient to meet the burden for summary judgment. Additionally, the court ruled that Utopia had the right to recover attorneys' fees in defending against Lancer's declaratory judgment action, as it had been assigned the right to payment from Torres and Duran prior to the initiation of the action. Therefore, Lancer's motion was denied in its entirety.
Lotus Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2013 NY Slip Op 23098)
March 28, 2013
The case involved an insurance dispute between Lotus Acupuncture, P.C. and State Farm Mutual Automobile Insurance Company over an examination under oath (EUO). State Farm sent an initial and follow-up EUO request that Lotus failed to comply with. The issue before the court was whether the follow-up request by State Farm was timely. The court interpreted two state regulations, 11 NYCRR 65-3.6 and 65-3.8, which govern the timing of verification requests. While State Farm submitted that other judges had decided the issue contrary to the original determination by the court, the court disregarded these determinations. The court also considered an opinion by the New York State Department of Financial Services, which supported the original conclusion of the court that a follow-up EUO notice must be sent within 10 calendar days of the missed EUO. Therefore, the court adhered to its original determination granting Lotus summary judgment.
AR Med. Rehabilitation, P.C. v GEICO Gen. Ins. Co. (2013 NY Slip Op 50510(U))
March 27, 2013
The court considered whether the defendant's motion in limine should be granted and if the plaintiff met its prima facie case of entitlement to no-fault benefits at trial. The main issue decided was whether AR Medical Rehabilitation could pursue no fault benefits in a civil action, based on the defendant's contention that the company was a Mallela corporation and its true owners were unauthorized to collect no fault benefits under New York law. The court held that the defendant's motion in limine was denied and that the plaintiff's evidence was insufficient to establish its prima facie case, ultimately awarding a verdict in favor of the defendant. The court found that the defendant failed to demonstrate that AR Medical Rehabilitation was a fruit of a fraudulent scheme and that the plaintiff's witness's testimony was inconsistent and insufficient to lay the foundation necessary to establish the plaintiff's billing documents as business records.