No-Fault Case Law
Darlington Med. Diagnostic, P.C. v Praetorian Ins. Co. (2012 NY Slip Op 51756(U))
September 11, 2012
The court considered the fact that the plaintiff's third-party biller acknowledged receipt of the defendant's follow-up verification demand, but failed to explain why it took no responsive action. In addition, the plaintiff neither claimed nor showed that it responded in any way to the defendant's properly issued verification demands. The main issue decided was whether the defendant-insurer's motion for summary judgment dismissing the first-party no-fault action should be granted. The holding was that the defendant's motion for summary judgment dismissing the complaint was granted, and the complaint was dismissed.
Cliffside Park Imaging v Preferred Mut. Ins. Co. (2012 NY Slip Op 51754(U))
September 11, 2012
The court considered the residence of the insured and his family as the relevant facts in this case. The main issue decided was whether the insured fraudulently procured insurance coverage by falsely listing a different residence on the insurance application. The court held that the standard for determining residency for insurance coverage requires some degree of permanence and intention to remain, and that the insured's mere intention to reside at a certain premises was not sufficient. The court found that the insured fraudulently listed a different residence on the insurance application, and that the plaintiff, as the assignee standing in the shoes of the insured, failed to raise a triable issue of fact. Therefore, the court reversed the lower court's order denying the defendant's motion for summary judgment and granted the motion, dismissing the complaint.
All Boro Psychological Servs., P.C. v Allstate Ins. Co. (2012 NY Slip Op 51775(U))
September 6, 2012
The court considered an appeal from an order of the Civil Court of the City of New York denying the plaintiff's motion for summary judgment and granting the defendant's cross motion to compel discovery pursuant to CPLR 3124. The main issue decided in this case was whether the defendant properly substantiated its allegations of fraudulent incorporation in order to warrant disclosure. The holding of the court was that the defendant did properly substantiate its allegations, and therefore, the Civil Court did not improvidently exercise its discretion in denying the plaintiff's motion for summary judgment and granting the defendant's cross motion to compel disclosure. The order was affirmed by the court, and the plaintiff's remaining contentions on appeal were found to lack merit.
AIM Acupuncture, P.C. v Travelers Ins. Co. (2012 NY Slip Op 51773(U))
September 5, 2012
The court considered the fact that the defendant had timely mailed requests and follow-up requests for verification for the first-party no-fault benefits. The main issue decided was whether the defendant had received the requested verification, and if the 30-day period within which the defendant was required to pay or deny the claims had begun to run. The holding of the case was that the defendant demonstrated it had not received the requested verification, and the plaintiff did not show that such verification had been provided to the defendant prior to the commencement of the action. Consequently, the court held that the plaintiff's action was premature, and the defendant's motion for summary judgment dismissing the complaint was granted.
Flushing Traditional Acupuncture, P.C. v GEICO Ins. Co. (2012 NY Slip Op 51772(U))
September 5, 2012
The court considered the denial of first-party no-fault benefits by GEICO Insurance to Flushing Traditional Acupuncture. The main issue in the case was whether GEICO had timely mailed denial of claim forms and whether they had fully paid for the services in accordance with the workers' compensation fee schedule. The holding of the court was that the denial of the claims for services rendered from March 31, 2009 to September 24, 2009 was valid and that GEICO had fully paid plaintiff for those services in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors. Additionally, the court held that the claims for services rendered on September 25, 2009 were also validly denied based on an independent medical examination, and that GEICO's cross motion for summary judgment was granted, reversing the judgment in favor of Flushing Traditional Acupuncture.
BLR Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51770(U))
September 5, 2012
The court considered the fact that in an action by a provider to recover assigned first-party no-fault benefits, the defendant moved for summary judgment dismissing the complaint and the plaintiff cross-moved for summary judgment. The main issue decided was whether the defendant's denial of claim form had been timely mailed, and if so, whether the plaintiff was otherwise entitled to judgment. The holding of the court was that the defendant's motion for summary judgment dismissing the complaint was granted, as the affidavit executed by the defendant's litigation examiner demonstrated that the denial of claim form had indeed been timely mailed, and the plaintiff did not challenge the finding that the defendant was otherwise entitled to judgment. Therefore, the defendant's motion was granted and the plaintiff's complaint was dismissed.
Hollis Med. Servs., P.C. v GEICO Ins. Co. (2012 NY Slip Op 51768(U))
September 5, 2012
The relevant facts considered by the court in Hollis Med. Servs., P.C. v GEICO Ins. Co. included an action by a medical services provider to recover assigned first-party no-fault benefits. The main issue decided was whether the affidavit by defendant's employee was sufficient to establish that the denial of claim forms had been timely mailed. The holding of the case was that the affidavit by the defendant's employee was indeed sufficient to establish that the denial of claim forms had been timely mailed, and that the defendant had submitted enough evidence to support their position. As a result, the court granted the defendant's cross motion for summary judgment and dismissed the complaint, reversing the judgment and vacating the previous order.
Alfa Med. Supplies v GEICO Gen. Ins. Co. (2012 NY Slip Op 51765(U))
September 5, 2012
The court considered an appeal from an order denying a provider's motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was whether the denial of claim forms were timely mailed and whether the peer review reports were admissible. The court held that the denial of claim forms were timely mailed and that the peer review reports were admissible, as they contained the electronic stamped facsimiles of the peer reviewers' signatures. As a result, plaintiff's motion for summary judgment was properly denied and defendant's cross motion for summary judgment dismissing the complaint was properly granted, and the judgment was affirmed.
Royal Med. Supply, Inc. v Progressive Northeastern Ins. Co. (2012 NY Slip Op 51727(U))
August 31, 2012
The court considered the facts of the case, where Royal Medical Supply, Inc. was seeking to recover assigned first-party no-fault benefits. The main issue was whether the defendant had demonstrated that Royal Medical Supply's assignor had failed to appear for two duly scheduled examinations under oath (EUOs). The court found that the defendant had submitted sufficient proof that the assignor had failed to appear for the EUOs, which had been timely scheduled after the defendant's receipt of the plaintiff's claim forms. As a result, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.
Atlantic Radiology Imaging, P.C. v NY Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51725(U))
August 31, 2012
The main issue in this case was whether the insurer was liable to pay the first-party no-fault benefits to the provider, Atlantic Radiology Imaging, P.C., as assignee of Emanuel Malayev. The court considered the evidence submitted by the defendant, including an affidavit from an employee of the company responsible for scheduling independent medical examinations (IMEs), affirmations from licensed healthcare professionals who were to perform the IMEs, and an affidavit demonstrating the timely mailing of denial of claim forms. The court held that the appearance of an assignor at a duly scheduled IME is a condition precedent to the insurer's liability on the policy, and since Malayev failed to appear for the IMEs, the insurer was not liable to pay the benefits. Therefore, the court reversed the lower court's order and granted the defendant's motion for summary judgment dismissing the complaint.