No-Fault Case Law
Bath Ortho Supply, Inc. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 50271(U))
February 22, 2012
The court considered the fact that the defendant insurer properly mailed notices for an examination under oath to the plaintiff's assignor, but the assignor failed to appear. The main issue was whether the defendant was entitled to summary judgment dismissing the action for first-party no-fault benefits. The court held that the defendant made a prima facie showing of entitlement to summary judgment by establishing that it properly mailed the notices for the examination and that the assignor failed to appear. The court also held that the plaintiff failed to raise a triable issue as to the reasonableness of the requests or the assignor's failure to attend the examination, and that the defendant was not required to demonstrate that the assignor's failure to appear was willful. Therefore, the court reversed the order of the Civil Court and granted the defendant's motion for summary judgment dismissing the complaint.
Park Slope Med. & Surgical Supply, Inc. v Progressive Ins. Co. (2012 NY Slip Op 50349(U))
February 21, 2012
The court considered the judgment of the Civil Court of the City of New York, Queens County, which awarded the plaintiff $3,808.56 after a nonjury trial. The main issue decided by the court was whether defendant's expert medical witness should have been allowed to testify as to the medical necessity of the billed-for services, limited to the basis for the denial as set forth in the original peer review report. The holding of the court was to reverse the judgment and remit the matter to the Civil Court for a new trial on the limited issue of the medical necessity of the billed-for services. The court also discussed the admissibility and scope of expert testimony, as well as the implications of the ruling that set the only trial issue as medical necessity. Ultimately, the court held that the plaintiff had the burden to establish at trial that the billed-for services were medically necessary, as the presumption of medical necessity no longer existed in the case.
Superior Oxygen & Ortho Supplies, Ltd. v Auto One Ins. Co. (2012 NY Slip Op 50348(U))
February 21, 2012
The court considered an appeal regarding a motion for summary judgment for a provider to recover assigned first-party no-fault benefits. Plaintiff had submitted the claim forms to defendant showing proof of loss and the amount of the loss sustained, and proof that defendant failed to pay or deny the claims within 30 days. Issue was whether the defendant raised a triable issue of fact. An insurer may not rely on a letter, even if denominated a verification request, that merely informs a claimant that a decision on the claim is delayed. The holding was that plaintiff's motion for summary judgment was granted, defendant's cross motion for summary judgment was denied and the case was remitted to the Civil Court for the calculation of statutory interest and an assessment of attorney's fees.
New Life Med., P.C. v Geico Ins. Co. (2012 NY Slip Op 50346(U))
February 21, 2012
The relevant facts the court considered were that the plaintiff, New Life Medical, P.C., was seeking to recover assigned first-party no-fault benefits from defendant Geico Ins. Co. Plaintiff moved for summary judgment and defendant cross-moved for summary judgment dismissing the complaint. The Civil Court denied both motions, finding that the sole issue for trial was the medical necessity of the services provided to plaintiff's assignor. On appeal, defendant argued that it was entitled to summary judgment based on lack of medical necessity and submitted peer review reports to support this argument.
The main issue decided by the court was whether the defendant was entitled to summary judgment based on lack of medical necessity for the services provided. The holding of the court was that defendant's cross motion for summary judgment dismissing the complaint was granted. The court found that the plaintiff's healthcare practitioner's affidavit failed to rebut the conclusions set forth in the peer review reports, and as plaintiff did not challenge the finding that defendant was otherwise entitled to judgment, defendant's motion for summary judgment was granted. Therefore, the court reversed the decision of the Civil Court and granted defendant's motion for summary judgment dismissing the complaint.
Quality Psychological Servs., P.C. v Clarendon Ins. Co. (2012 NY Slip Op 50345(U))
February 21, 2012
The court considered whether the defendant's motion for summary judgment to dismiss the complaint on the ground that there was no medical necessity for the services rendered should be granted. The main issue decided was whether there was a triable issue of fact as to the medical necessity of the services at issue. The court held that the affidavit of the plaintiff's psychologist submitted in opposition to the defendant's motion was sufficient to demonstrate the existence of a triable issue of fact as to the medical necessity of the services at issue, and therefore affirmed the order denying the defendant's motion for summary judgment.
Andromeda Med. Care, P.C. v Utica Mut. Ins. Co. (2012 NY Slip Op 50344(U))
February 21, 2012
The main issue in this case was whether the defendant was entitled to summary judgment dismissing the complaint in a no-fault benefits case. The defendant for this case, a provider to recover assigned first-party no-fault benefits, appealed from an order of the Civil Court which denied its motion for summary judgment dismissing the complaint. The appellate court reversed the order and granted the defendant's motion for summary judgment dismissing the complaint. The court held that the defendant, in support of its motion, submitted an affidavit by its biomechanical engineer, which was in admissible form and demonstrated the lack of a causal connection between the accident and the injuries claimed by the plaintiff's assignors. The burden then shifted to the plaintiff to rebut the defendant's showing, but it failed to do so. Therefore, the defendant was entitled to judgment as a matter of law and the motion for summary judgment dismissing the complaint was granted.
Medical Polis, P.C. v Progressive Specialty Ins. Co. (2012 NY Slip Op 50342(U))
February 21, 2012
The relevant facts of the case were that Medical Polis, P.C. sought to recover first-party no-fault benefits from Progressive Specialty Ins. Co. The main issue was whether Progressive's failure to assert a defense pursuant to State Farm Mut. Auto. Ins. Co. v Mallela precluded it from seeking discovery related to that defense. The court decided that based on the record before them, Progressive made sufficient allegations of fraudulent incorporation to warrant disclosure. Therefore, the court affirmed the order granting Progressive's motion to compel disclosure and produce the plaintiff's owner for an examination before trial, and denying the plaintiff's motion for a protective order. Ultimately, the holding of this case was the decision to affirm the order, allowing Progressive to seek discovery related to their defense based on fraudulent incorporation.
Astoria Wellness Med., P.C. v Autoone Ins. Co. (2012 NY Slip Op 50340(U))
February 21, 2012
The case involved a medical provider seeking to recover assigned first-party no-fault benefits from an insurance company. The insurance company sought to amend its answer to assert an additional affirmative defense and also requested that the medical provider disclose various financial and organizational records. The court granted the insurance company leave to amend its answer, but modified the order to deny the request for disclosure of records. The court found that the medical provider was not prejudiced by the delay in the insurance company asserting its affirmative defense, and therefore, the amendment was allowed. The court also determined that the insurance company's initial discovery demands did not request the records it sought, and therefore could not compel the medical provider to provide them within 60 days. It was also stated that there is no requirement for a CPLR 321 change or withdrawal of attorney form to be notarized. The court's decision was to affirm the modified order, granting the amendment of the answer, but denying the request for disclosure of records.
Darlington Med. Diagnostics, P.C. v Praetorian Ins. Co. (2012 NY Slip Op 50226(U))
February 16, 2012
The court considered the defendant insurer's motion for summary judgment dismissing the complaint, which was denied by the Civil Court of the City of New York, Bronx County. The main issue decided was whether the defendant insurer was entitled to judgment as a matter of law, based on the chiropractor's sworn peer review report stating that the diagnostic testing giving rise to the plaintiff's no-fault claim lacked medical necessity. The court held that the defendant insurer made a prima facie showing of entitlement to judgment as a matter of law, and that the plaintiff failed to raise a triable issue of fact in opposition. Therefore, the court reversed the order, granted the defendant insurer's motion, and dismissed the complaint, with costs to the defendant.
Raz Acupuncture, P.C. v Praetorian Ins. Co. (2012 NY Slip Op 50305(U))
February 14, 2012
The court in this case considered an appeal from an order of the Civil Court of the City of New York that denied the defendant's cross motion for summary judgment dismissing the complaint and found that the plaintiff had established its prima facie case. The main issues before the court were whether the plaintiff had indeed established its prima facie case, and whether the defendant had provided enough evidence to support the dismissal of certain claims. The court held that the plaintiff had not established its prima facie entitlement to summary judgment, as the affidavit submitted was insufficient to prove the admissibility of the documents provided. The court also held that the defendant did not provide sufficient evidence to warrant the dismissal of certain claims, but did provide enough evidence to support the dismissal of the plaintiff's claims for certain dates of service. Therefore, the court modified the order to reflect these holdings.