No-Fault Case Law
Infinity Health Prods. Ltd. v Liberty Mut. Fire Ins. Co. (2012 NY Slip Op 50774(U))
April 27, 2012
The court considered the fact that the defendant had timely mailed requests for verification and follow-up requests for first-party no-fault benefits, and that the plaintiff had failed to respond to those requests. The main issue decided was whether the 30-day period within which the defendant was required to pay or deny the plaintiff's claims had commenced to run, and whether the plaintiff's action was premature. The holding of the court was that the defendant's cross motion for summary judgment dismissing the complaint should have been granted, as the plaintiff's action was indeed premature. As a result, the judgment was reversed, the order granting the plaintiff's motion for summary judgment was vacated, and the defendant's cross motion for summary judgment was granted.
Eagle Surgical Supply, Inc. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 50772(U))
April 27, 2012
The main issue in this case was whether the provider, Eagle Surgical Supply, Inc., was entitled to recover assigned first-party no-fault benefits from New York Central Mutual Fire Insurance Co. Plaintiff's assignor failed to appear for examinations under oath (EUOs), which led to the dismissal of plaintiff's claims in the sums of $1,013.25, $549.18 and $844.13. The main argument on appeal was that the insurance policy did not contain a provision entitling the defendant to EUOs. However, the court found that this argument lacked merit based on previous legal precedents. The court also determined that plaintiff's remaining contention was not properly before the court since it was raised for the first time on appeal. As a result, the order granting the branches of defendant's motion seeking summary judgment dismissing plaintiff's claims was affirmed.
Ortho-Med Surgical Supply, Inc. v American Tr. Ins. Co. (2012 NY Slip Op 22119)
April 27, 2012
The main issues in the case dealt with medical expenses in a personal injury lawsuit. In this case, a provider sued an insurance company to recover first-party no-fault benefits. The insurance company agreed to provide responses to the provider's interrogatories within 60 days but did not fulfill this agreement. The court decided that the insurance company was precluded from offering evidence at trial due to their failure to comply with the stipulation. However, the court also found that the provider's motion for summary judgment was denied because it failed to establish a prima facie entitlement to it. Additionally, the insurance company was not allowed to use evidence in support of their cross motion for summary judgment that they were barred from introducing at trial. Therefore, the provider's motion for preclusion was granted, but their motion for summary judgment was denied, and the insurance company's cross-motion was also denied.
Neomy Med., P.C. v American Tr. Ins. Co. (2012 NY Slip Op 50769(U))
April 25, 2012
The main issues in this case involved a dispute over first-party no-fault benefits for medical services rendered. The court considered whether the defendant's timely denial of the claim based on lack of medical necessity was valid, and if so, whether the plaintiff had sufficiently rebutted this denial. The court held that the defendant's timely denial, supported by a peer review report and affidavit, demonstrated a lack of medical necessity, establishing their prima facie entitlement to summary judgment. The court found that the plaintiff's supervising physician's affidavit failed to justify with specificity the additional studies and did not rebut the conclusions set forth in the peer review report. Therefore, the court reversed the order, denied the plaintiff's motion for summary judgment, and granted the defendant's cross motion for summary judgment dismissing the complaint.
A.B. Med. Servs., PLLC v American Tr. Ins. Co. (2012 NY Slip Op 50764(U))
April 25, 2012
The relevant facts of the case involved a provider seeking to recover assigned first-party no-fault benefits. The provider moved for summary judgment, but the insurance company opposed the motion, arguing that it had timely denied the claims based on the assignor's eligibility for workers' compensation benefits. The main issue decided was whether the provider had complied with the court's order to make a proper application to the Workers' Compensation Board, pursuant to a previous court order. The holding of the case was that the provider had failed to demonstrate that a proper application for workers' compensation benefits had been made within the time provisions set forth in the court's order, and thus, the denial of summary judgment and the granting of the insurance company's cross motion for summary judgment were affirmed.
Alfa Med. Supplies v Geico Gen. Ins. Co. (2012 NY Slip Op 50762(U))
April 25, 2012
The court considered a case in which Alfa Medical Supplies, as the assignee of Teresa D. Cortez, appealed from an order dismissing the complaint against Geico General Insurance Company. The main issue was whether defendant had timely denied plaintiff's claims for first-party no-fault benefits. The court affirmed the judgment, holding that the affidavit of defendant's claim representative was sufficient to establish that the claims had been timely denied, and since this was the sole issue raised on appeal, the judgment was affirmed.
Small v Metropolitan Prop. & Cas. Ins. Co. (2012 NY Slip Op 50760(U))
April 25, 2012
The court considered the fact that the plaintiff had filed a breach of contract action in 1998 to recover no-fault benefits for medical treatments she had received as a result of a motor vehicle accident, and that the case was marked off the calendar in 1999. Plaintiff attempted to restore the case to the calendar in 2010, which was denied by the defendant. The main issue decided was whether the plaintiff's motion to restore the case to the calendar should have been denied and whether the defendant's cross motion to dismiss the complaint should have been granted. The holding was that plaintiff's motion to restore the case to the trial calendar was denied, and the defendant's cross motion to dismiss the complaint was also denied. Additionally, it was determined that the defendant's cross motion to dismiss the complaint invoked CPLR 3404, however, as CPLR 3404 applies solely to cases in the Supreme or County Courts, the Civil Court properly denied defendant's CPLR 3404 cross motion to dismiss.
W.H.O. Acupuncture, P.C. v AIG Auto Ins. (2012 NY Slip Op 50755(U))
April 25, 2012
The relevant facts considered by the court were that W.H.O. Acupuncture, P.C. was seeking to recover assigned first-party no-fault benefits, but their claim was partially denied by AIG Auto Insurance on the grounds that the unpaid portion exceeded the amount permitted by the workers' compensation fee schedule. The main issue decided was whether AIG's denial of claim forms and explanation of benefit forms were sufficient to apprise the plaintiff of the reasons for the denial. The court held that the denial forms were indeed sufficient, and affirmed the order granting AIG's motion for summary judgment and dismissing the complaint by W.H.O. Acupuncture, P.C. The judgment was subsequently entered, and the court deemed the appeal to have been taken from that judgment.
Axis Chiropractic, PLLC v Clarendon Natl. Ins. Co. (2012 NY Slip Op 50753(U))
April 25, 2012
The main issue in this case was the defendant's motion for summary judgment dismissing the complaint by a provider to recover assigned first-party no-fault benefits. The court considered affidavits from the company retained by the defendant to schedule independent medical examinations, which established that the IME scheduling letters had been timely mailed and that the plaintiff's assignors had failed to appear for the duly scheduled IMEs. The court also considered an affidavit demonstrating that the denial of claim forms had been timely mailed based on the assignors' nonappearance at the IMEs. The holding of the court was that since the appearance of an assignor at a duly scheduled IME is a condition precedent to the insurer's liability on the policy, the defendant's motion for summary judgment dismissing the complaint was properly granted. Therefore, the judgment to dismiss the complaint was affirmed.
Complete Radiology, P.C. v Geico Ins. Co. (2012 NY Slip Op 50752(U))
April 25, 2012
The court considered a motion for summary judgment and cross motion for summary judgment in a case involving a provider seeking to recover first-party no-fault benefits. Defendant's peer review reports were found to have a factual basis and medical rationale for determining a lack of medical necessity for the services rendered to plaintiff's assignors. Plaintiff's remaining contentions were found to lack merit. The main issue decided was whether the peer review reports provided a factual basis and medical rationale for determining the lack of medical necessity. The holding of the case was that the judgment denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment was affirmed.