No-Fault Case Law
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.
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.