No-Fault Case Law
Axis Chiropractic, PLLC v Geico Gen. Ins. Co. (2013 NY Slip Op 50067(U))
January 14, 2013
The relevant facts considered by the court were that plaintiff, as an assignee of an individual, was seeking to recover first-party no-fault benefits from defendant. Plaintiff's motion for summary judgment was denied and defendant's cross motion for summary judgment was granted, resulting in the dismissal of the complaint. The main issue decided by the court was whether defendant timely mailed denial of claim forms and whether there was a lack of medical necessity for the services rendered. The holding of the court was that defendant had timely mailed the denial of claim forms and had provided an affirmed independent medical examination report setting forth a basis and medical rationale for the determination of lack of medical necessity. In addition, the court held that plaintiff failed to raise a triable issue of fact by not submitting evidence rebutting the conclusions set forth in the independent medical examination report, and therefore the denial of plaintiff's motion for summary judgment and the granting of defendant's cross motion for summary judgment was proper.
Axis Chiropractic, PLLC v Geico Gen. Ins. Co. (2013 NY Slip Op 50066(U))
January 14, 2013
The relevant facts considered by the court were that defendant had timely mailed denial of claim forms which denied the claims on the ground of lack of medical necessity, and had submitted an independent medical examination (IME) report which provided a factual basis and medical rationale for the determination by defendant's chiropractor that there was a lack of medical necessity for the services rendered. The main issue decided by the court was whether plaintiff raised a triable issue of fact in opposition to defendant's cross motion for summary judgment dismissing the complaint. The holding of the court was that in opposition to defendant's motion, plaintiff failed to raise a triable issue of fact, as it did not submit an affirmation or an affidavit from a medical professional rebutting the conclusions set forth in the IME report, so the Civil Court's grant of defendant's cross motion for summary judgment dismissing the complaint was proper.
Parsons Med. Supply, Inc. v Progressive Northeastern Ins. Co. (2013 NY Slip Op 50065(U))
January 14, 2013
The relevant facts of this case include an action by a medical supply company to recover assigned first-party no-fault benefits. The defendant insurance company had timely denied the claim on the ground of lack of medical necessity and supported their motion for summary judgment with an affirmed independent medical examination (IME) report. The main issue decided was whether the plaintiff had raised a triable issue of fact to rebut the conclusions set forth in the IME report, and the court held that they had not. The court affirmed the judgment of the Civil Court, granting the defendant's motion for summary judgment and dismissing the complaint. The decision was made on January 14, 2013.
Alfa Med. Supplies v GEICO Gen. Ins. Co. (2013 NY Slip Op 50064(U))
January 14, 2013
The relevant facts considered by the court were that Alfa Medical Supplies was seeking to recover assigned first-party no-fault benefits from GEICO General Insurance Company. GEICO had timely mailed the denial of claim form and provided a sworn peer review report which indicated a lack of medical necessity for the supplies provided. The main issue decided was whether Alfa Medical Supplies had provided enough evidence to rebut GEICO's prima facie showing of lack of medical necessity for the supplies. The court held that Alfa Medical Supplies had provided an affidavit from its doctor which demonstrated the existence of a question of fact as to the medical necessity of the supplies, and therefore, GEICO's motion for summary judgment should have been denied. As a result, the judgment was reversed, and GEICO's cross motion for summary judgment was denied.
Quality Psychological Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2013 NY Slip Op 50063(U))
January 14, 2013
The relevant facts the court considered in this case were whether the defendant's NF-10 form denying the plaintiff's no-fault benefits claim based on lack of medical necessity had been timely mailed, and whether the peer review report submitted by the defendant was admissible. The main issue was whether defendant's motion for summary judgment should be granted and plaintiff's cross motion for summary judgment denied. The holding of the court was that the defendant's motion for summary judgment dismissing the complaint was denied and the plaintiff's cross motion for summary judgment was also denied. The court found that the peer review report submitted by the defendant was not in admissible form, and while the plaintiff demonstrated that the claim had not been paid, it failed to demonstrate that the defendant had issued a legally insufficient denial of claim form. Therefore, the order was modified by providing that plaintiff's cross motion for summary judgment is denied.
Fu Kun Wu, L..Ac. v Tri State Consumer Ins. Co (2013 NY Slip Op 50062(U))
January 14, 2013
The court considered the appeal of a provider seeking to recover first-party no-fault benefits, which was dismissed by the Civil Court. The main issue was whether the plaintiff's release of all claims related to the instant case, including the claims in the complaint, voluntarily relinquished their right to recover upon those claims. The court held that the plaintiff's execution of a release bearing the caption of the case and its index number, which stated that the plaintiff released all claims ever had, now have, or hereafter can, shall, or may have for, upon, or by reason of, an assignment of rights from its assignor, effectively relinquished their right to recover upon the claims forming the object of the instant action. As a result, the court dismissed the appeal.
Eastern Star Acupuncture, P.C. v American Tr. Ins. Co. (2013 NY Slip Op 50059(U))
January 14, 2013
The court in this case considered an appeal from an order of the Civil Court of the City of New York, Kings County, which granted summary judgment in favor of the plaintiff, Eastern Star Acupuncture, P.C., in their action to recover assigned first-party no-fault benefits from the defendant, American Transit Insurance Company. The main issue decided was whether the defendant was entitled to summary judgment dismissing the plaintiff's complaint. The court held that the defendant was entitled to summary judgment dismissing the plaintiff's claim for $612.59 and a claim for $167.07 for services rendered on September 8, 2006 through September 19, 2006, as the defendant had established that these claims had been timely denied on the grounds that the assignor had failed to appear at independent medical examinations. However, the court did not disturb the part of the order that awarded the plaintiff summary judgment with respect to a claim for $167.07 for services rendered on August 15, 2006 and other claims totaling $668.28 and $222.76, as the defendant had failed to establish timeliness of denial for these claims.
Craigg v Infinity Select Ins. Co. (2013 NY Slip Op 23014)
January 14, 2013
This case involved a provider of first-party no-fault benefits seeking to recover assigned first-party no-fault benefits. After a nonjury trial, it was established that the insurance company had issued letters rescinding the plaintiff's assignor's insurance policy on the grounds of material misrepresentations during the application process. The main issue before the court was determining whether the insurance company had to prove the reason for its rescission of the policy. The court held that the Florida law applied in this case. According to Florida law, a carrier is not required to establish a good faith basis for the termination of the insurance policy and only needs to demonstrate that it complied with the requisite notice of the rescission to the insured and returned or tendered all premiums paid within a reasonable time after the discovery of the grounds for avoiding the policy. The judgment was reversed and the complaint was dismissed.
Stanley Liebowitz, M.D., P.C. v Unitrin Preferred Ins. Co. (2012 NY Slip Op 52363(U))
December 27, 2012
The court considered the fact that the defendant-insurer had timely and properly mailed notices for independent medical examinations (IMEs) to the assignor and his attorney, and that the assignor failed to appear. The main issue was whether the defendant-insurer was entitled to summary judgment dismissing the action for first-party no-fault benefits. The holding of the court was that the defendant-insurer made a prima facie showing of entitlement to summary judgment dismissing the complaint, and therefore the motion was granted and the complaint was dismissed. The plaintiff did not deny the assignor's nonappearance or raise a triable issue with respect to the mailing or reasonableness of the underlying notices.
GBI Acupuncture, P.C. v Esurance Ins. Co. (2012 NY Slip Op 52423(U))
December 26, 2012
The court considered the procedural history of the case, including the Defendant's motion for summary judgment and the Plaintiff's opposition to the motion. The main issue decided was whether the Plaintiff was entitled to first-party No-Fault benefits as a result of an alleged automobile accident, despite the Defendant's argument that the Plaintiff failed to provide additional verification by not appearing for an examination under oath (EUO). The court held that the Plaintiff's motion for summary judgment was denied, and the Defendant's motion for summary judgment was granted in its entirety, resulting in the dismissal of the complaint with prejudice. The court cited statutory provisions and case law to support its decision and emphasized the failure of the Plaintiff to raise any triable issues of fact.