No-Fault Case Law
City Care Acupuncture, PC v New York Cent. Mut. Fire Ins. Co. (2013 NY Slip Op 50430(U))
March 27, 2013
The court considered the defendant-insurer's motion for summary judgment to dismiss a complaint regarding no-fault claims. The main issue decided was whether the insurer 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 court held that the defendant-insurer did make a prima facie showing of entitlement to summary judgment by establishing that it timely and properly mailed the IME notices to the plaintiff's assignor, and that the assignor failed to appear. As a result, the court reversed the previous order, granted the motion in its entirety, and dismissed the complaint.
Compas Med., P.C. v Mercury Ins. Co. (2013 NY Slip Op 50459(U))
March 21, 2013
The court considered a provider’s attempt to recover no-fault benefits, with the defendant appealing from an order denying its motion to dismiss the complaint on the grounds that it failed to establish the transactions giving rise to the cause of action. The main issue decided was whether the complaint gave sufficient notice of the transactions intended to be proved, and whether the requisite elements of any cause of action could be discerned from its averments. The holding of the court was that the complaint did state a cognizable cause of action and was sufficient to give the defendant notice of the transactions intended to be proved, and thus the order denying the motion to dismiss was affirmed.
Alrof, Inc. v Safeco Natl. Ins. Co. (2013 NY Slip Op 50458(U))
March 21, 2013
The court considered the case of Alrof, Inc. v Safeco Natl. Ins. Co., in which the plaintiff, Alrof, Inc., sought to recover first-party no-fault benefits from the defendant, Safeco National Insurance Company. The main issue before the court was whether the defendant's argument that the plaintiff failed to appear at a properly noticed examination under oath (EUO) was supported by admissible evidence. The court held that a conclusory statement from an attorney lacking personal knowledge was insufficient to support the defendant's cross motion for summary judgment. Additionally, the court found that an alleged noncompliance with an EUO must be established by admissible evidence. Ultimately, the court affirmed the order granting the plaintiff's motion for summary judgment and denying the defendant's cross motion.
Five Boro Psychological Servs., P.C. v GEICO Gen. Ins. Co. (2013 NY Slip Op 50454(U))
March 20, 2013
The court considered an action by a provider to recover assigned first-party no-fault benefits. Plaintiff appealed from an order of the Civil Court which denied its motion for summary judgment and granted defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant's denial of the claim was conclusory, vague, or without merit as a matter of law, and whether the denial was supported by a factual basis and medical rationale for the lack of medical necessity for the services rendered to the three assignors. The holding of the court was that the defendant was not entitled to summary judgment dismissing the claim for services rendered to Jeannette Lugaro, but that the branches of defendant's cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the claims of the other three assignors were properly granted.
Broad St. Acupuncture, P.C. v American Tr. Ins. Co. (2013 NY Slip Op 50453(U))
March 20, 2013
The court considered the provider's motion for summary judgment to recover first-party no-fault benefits and the insurer's cross motion for summary judgment to dismiss the complaint. The main issues decided were whether the insurer's partial denials of the provider's claims were proper and whether there was an issue of fact as to whether the provider was entitled to recover the unpaid portion of those claims. The holding of the case was that the branches of the provider's motion seeking summary judgment for certain claims were denied, and the insurer's cross motion seeking summary judgment to dismiss part of the complaint was granted to the extent of awarding partial summary judgment to the insurer for the paid portions of certain claims. The matter was remitted to the Civil Court for all further proceedings with respect to the unpaid portions of those claims and the remaining claim.
Coast Med. Diagnostic, PC v Praetorian Ins. Co. (2013 NY Slip Op 50381(U))
March 20, 2013
The court considered the defendant-insurer's motion for summary judgment dismissing the complaint, based on the insurer's claim that it had timely and properly mailed notices for independent medical examinations (IMEs) to the plaintiff's assignor, who failed to appear. The main issue decided was whether the insurer had made a prima facie showing of entitlement to summary judgment, which was ultimately upheld. The holding of the court was that the defendant's motion for summary judgment dismissing the complaint was granted, as the insurer had established that it had properly mailed the IME notices and the plaintiff did not raise a triable issue with respect to the assignor's nonappearance or the reasonableness of the notices. Therefore, the defendant's motion was granted and the judgment was entered accordingly.
A-Quality Med. Supply v GEICO Gen. Ins. Co. (2013 NY Slip Op 23088)
March 18, 2013
The relevant facts of the case centered around an insurance provider's refusal to pay for certain medical supplies, claiming that they were not medically necessary. When the provider took the insurance company to court, the defense produced a peer review report to support its position. However, the Civil Court found that some of the reports were not dated, signed, or notarized and ruled in favor of the medical supply company without considering the testimony of the defense's witness. The main issue before the court became whether the peer review reports were sufficient evidence for the insurance company's denial of the claim. The holding of the court was that the peer review reports should have been considered by the Civil Court, and the case was remitted for a new trial. The opinions of medical experts were determined to be applicable for the medical necessity claim, whereas peer review reports were not sufficient evidence and were considered impermissible bolstering.
New York Diagnostic Med. Care, P.C. v GEICO Gen. Ins. Co. (2013 NY Slip Op 50419(U))
March 15, 2013
The main issue in this case was whether the provider had established its prima facie case to recover assigned first-party no-fault benefits. The court considered the fact that the defendant had not paid the claim, but the plaintiff failed to show that the basis for the denial of the claim lacked merit as a matter of law. The Civil Court determined that the plaintiff had failed to establish its prima facie case. However, in opposition to the defendant's cross motion for summary judgment dismissing the complaint on the ground of lack of medical necessity, the plaintiff submitted an affidavit by its doctor which sufficiently demonstrated the existence of a question of fact as to medical necessity. Therefore, the court modified the order by denying the defendant's cross motion for summary judgment dismissing the complaint.
Apple Tree Acupuncture, P.C. v Allstate Ins. Co. (2013 NY Slip Op 50413(U))
March 15, 2013
The court considered whether an insurer may use the workers' compensation fee schedule for acupuncture services performed by chiropractors to determine the amount a licensed acupuncturist is entitled to receive, and whether the insurer had properly denied the remaining portion of each of the claims at issue. The main issue decided was whether the defendant had established, as a matter of law, that the amount it had paid the plaintiff was the maximum amount permitted by the workers' compensation fee schedule for acupuncture services rendered by a chiropractor. The holding of the case was that the defendant failed to demonstrate its prima facie entitlement to summary judgment, and therefore the judgment was reversed, with the order of summary judgment dismissing the complaint vacated and the defendant's cross motion for summary judgment dismissed.
American Ind. Ins. Co. v Art of Healing Medicine, P.C. (2013 NY Slip Op 01546)
March 13, 2013
The main facts of the case are that American Independent Insurance Company began a proceeding to permanently stay arbitration of Art of Healing Medicine, P.C.'s claims for no-fault benefits, arguing that they were not subject to personal jurisdiction in New York. Central to the decision is the rule that personal jurisdiction must first be obtained over a party before judgment may be entered upon an arbitration award. However, public policy favors arbitration courts interfere as little as possible with the freedom of parties to submit their disputes to arbitration. The courts held that the Supreme Court erred in granting the petition to permanently stay arbitration on the ground that there was no personal jurisdiction over AIIC and the counterclaims from the appellants were properly dismissed. Therefore, the order is modified, denying the petition to stay arbitration, but affirming the dismissal of the counterclaims.