No-Fault Case Law
Promed Durable Equip., Inc. v GEICO Ins. (2013 NY Slip Op 51375(U))
August 16, 2013
The case involved a dispute between Promed Durable Equipment, Inc. and GEICO Insurance over the reimbursement of medical supplies provided, with the main issue being whether the supplies were medically necessary. The court found that the submission of bills and the fact and amount of the loss had been established for all purposes in the action. The court determined that plaintiff had raised a triable issue of fact as to whether certain supplies were medically necessary, and denied defendant's motion for summary judgment on those supplies. However, the court granted defendant's motion for summary judgment on claims for supplies furnished on December 24, 2008, as the plaintiff did not refute the peer review report's determination of lack of medical necessity. The court also directed the defendant's counsel to show cause as to why sanctions and costs should not be imposed for engaging in frivolous conduct in the appeal. Ultimately, the court affirmed in part and modified in part the lower court's order, and directed the parties to file affidavits or affirmations regarding potential sanctions and costs.
Promed Durable Equip., Inc. v GEICO Ins. (2013 NY Slip Op 51374(U))
August 16, 2013
The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, which denied the defendant's cross motion for summary judgment dismissing the complaint and found that the only issue for trial was the medical necessity of the supplies at issue. The relevant facts include the plaintiff establishing the submission of the bills and the fact and amount of the loss sustained, as well as the defendant submitting a sworn peer review report and an affirmed peer review report. The main issue decided was whether the supplies at issue were medically necessary, and the court held that there was sufficient evidence to establish this issue for trial. The court also directed certain individuals to show cause why sanctions and costs should not be imposed against them for their conduct in the case.
Promed Durable Equip., Inc. v GEICO Ins. (2013 NY Slip Op 51373(U))
August 16, 2013
The court considered the denial of the defendant's cross motion for summary judgment dismissing the complaint and the issue of whether the medical necessity of the supplies at issue should be determined at trial. The main issue decided was whether the plaintiff had established the submission of the bills and the fact and amount of the loss sustained, and whether the defendant had issued a claim denial that was conclusory, vague, or without merit as a matter of law. The holding of the case was that the plaintiff had established the submission of the bills and the fact and amount of the loss sustained, and that the branch of the defendant's cross motion seeking summary judgment to dismiss the complaint for specific supplies furnished on October 8, 2008 was granted. Additionally, the Court directed the attorneys for the defendant to show cause why sanctions and costs should not be imposed against them.
Promed Durable Equip., Inc. v GEICO Ins. (2013 NY Slip Op 51372(U))
August 16, 2013
The main issue in the case was whether the defendant, GEICO Insurance, was entitled to summary judgment dismissing the complaint brought by Promed Durable Equipment, Inc., as the assignee of Roberto Martinez, seeking first-party no-fault benefits. The court considered the submission of the bills and the fact and amount of the loss sustained by plaintiff, as well as the medical necessity of the supplies at issue. The court held that plaintiff had established the submission of the bills and the fact and amount of the loss sustained, therefore denying the defendant's cross motion for summary judgment. However, the court also found that there was a lack of medical necessity for certain supplies furnished on specific dates, and granted the defendant's motion to dismiss those specific claims. In addition, the court directed the attorneys for both parties to show cause why sanctions and costs should not be imposed against them for their conduct in the case.
Promed Durable Equip., Inc. v GEICO Ins. (2013 NY Slip Op 51371(U))
August 16, 2013
The court considered an appeal from an order of the Civil Court denying the defendant's cross motion for summary judgment in a case involving the recovery of first-party no-fault benefits. The main issue decided was whether the plaintiff had established the submission of bills and the fact and amount of the loss sustained, and whether a trial was necessary on the issue of medical necessity. The court held that plaintiff had indeed established the submission of bills and the fact and amount of the loss sustained, and found that a trial should be held specifically on the issue of medical necessity. The court also directed the attorneys for the defendant to show cause why sanctions and costs should not be imposed against them for engaging in frivolous conduct in their appellate brief. In conclusion, the court affirmed the order from the Civil Court and directed the attorneys to show cause regarding potential sanctions and costs.
Promed Durable Equip., Inc. v GEICO Ins. (2013 NY Slip Op 23283)
August 16, 2013
In this case, Promed Durable Equipment, Inc. v GEICO Insurance, the appellant appealed the denial of a motion for summary judgment dismissing the complaint and sought a trial to decide the medical necessity of the supplies in question. The appellant also argued that a peer review report submitted showed a lack of medical necessity for the supplies, leading them to seek summary judgment to dismiss the complaint for supplies furnished. The court found that plaintiff established the submission of the bills and the loss sustained and affirmed the denial of the branch of the cross-motion for supplies furnished on October 23, 2008. However, the court granted the motion to dismiss the claim for supplies furnished on December 16, 2008, and directed counsel to show cause for sanctions and costs to be imposed against the respondent's counsel.
South Nassau Community Hosp. v Kemper Independence Ins. Co. (2013 NY Slip Op 51384(U))
August 8, 2013
The relevant facts of this case involve a provider, South Nassau Community Hospital, seeking to recover assigned first-party no-fault benefits from Kemper Independence Insurance Company. The issue decided by the court was whether the plaintiff's assignor had failed to appear for duly scheduled independent medical examinations (IMEs). The holding of the case was that the defendant's motion for summary judgment dismissing the fourth and sixth causes of action was granted. The court found that the defendant had established its prima facie entitlement to summary judgment as a matter of law, and the plaintiff had failed to demonstrate the existence of a triable issue of fact. Therefore, the order denying the motion for summary judgment was reversed and the branches of defendant's motion seeking summary judgment were granted.
Westchester Med. Ctr. v Allstate Ins. Co. (2013 NY Slip Op 51383(U))
August 8, 2013
The relevant facts the court considered in this case were that Westchester Medical Center and other hospitals were seeking to recover first-party no-fault benefits from Allstate Insurance Company. The main issue decided was whether the plaintiffs were entitled to summary judgment, and the court held that the District Court properly denied the motion for summary judgment in favor of The New York Hospital Medical Center of Queens because it had not demonstrated its entitlement to judgment as a matter of law. The court affirmed the order in this regard, while dismissing the appeal by other plaintiffs who were not aggrieved by the order. The decision was made on August 8, 2013 by the Supreme Court, Appellate Term, Second Department.
Wexford Med., P.C. v Commerce Ins. Co. (2013 NY Slip Op 51193(U))
July 19, 2013
The court considered the fact that the plaintiff had appealed from an order of the Civil Court of the City of New York, New York County, which denied its motion to dismiss the action as time-barred. The main issue decided was whether the action for assigned first-party no-fault benefits was time-barred. The court held that even though the plaintiff's allegations were accepted as true and given the benefit of every favorable inference, the action for assigned first-party no-fault benefits was time-barred and the complaint was dismissed. The court pointed out that the action, commenced on September 18, 2009, was barred by the governing six-year statute of limitations.
Parkview Med. & Surgical, P.C. v Commerce Ins. Co. (2013 NY Slip Op 51239(U))
July 17, 2013
The main issue in this case was whether the defendant, a Massachusetts-based insurance company, was obligated to pay first-party no-fault benefits to a medical provider for services provided to a patient injured in a motor vehicle accident in New York. The court considered the conflicting interests in tort cases with multi-state contacts and ultimately decided to apply Massachusetts law as dispositive factors weighed in favor of applying Massachusetts law.
The court held that the defendant did not sufficiently prove that the insured breached the duty to cooperate or that the insurer suffered actual prejudice due to lack of cooperation. Additionally, the court found that the insurer's reservation of rights letter was vague and ambiguous and that there was no evidence of the insurer's diligence and good faith in obtaining the insured's cooperation. Therefore, the plaintiff's motion and the defendant's cross motion were both denied.