No-Fault Case Law
Friendly Physician, P.C. v GEICO Ins. Co. (2010 NY Slip Op 51772(U))
October 5, 2010
The court considered the circumstances under which a motion for summary judgment was granted on default and the subsequent motion to vacate that order. The main issue was whether the defendant had a reasonable excuse for the default and a meritorious defense to the action. The holding of the case was that the defendant had sufficiently demonstrated a reasonable excuse for the default and a meritorious defense, based on the details provided in their attorney's affirmations and the employee's affidavit. Therefore, the court reversed the previous order, granting the defendant's motion to vacate the prior order and denying the plaintiff's motion for summary judgment.
Park Slope Med. & Surgical Supply, Inc. v GEICO Ins. Co. (2010 NY Slip Op 51771(U))
October 5, 2010
The main issue in this case was whether the medical equipment provided to plaintiff's assignor was medically necessary, and if the denial of the claim by the defendant was justified. The court considered the evidence provided by both the plaintiff and the defendant, including an affirmed peer review report setting forth the rationale for the doctor's conclusion that the supplies were not medically necessary. The court held that the defendant had proffered sufficient evidence to demonstrate the existence of a triable issue of fact as to medical necessity and that the plaintiff's motion for summary judgment should have been denied. Consequently, the judgment was reversed, the order granting plaintiff's motion for summary judgment was vacated, and plaintiff's motion for summary judgment was denied.
Friendly Physician, P.C. v GEICO Ins. Co. (2010 NY Slip Op 51770(U))
October 5, 2010
The relevant facts the court considered in this case were that Friendly Physician, P.C. was seeking to recover first-party no-fault benefits, and the defendant, GEICO Ins. Co., had denied the claim. The main issues decided were whether the documents submitted by the plaintiff were admissible and whether the defendant had established that denial of claim forms were timely mailed. The holding of the case was that the affidavit submitted by the plaintiff's billing administrator was sufficient to establish the admissibility of the documents, and the defendant had failed to establish that the denial of claim forms were timely mailed. As a result, the defendant failed to establish its entitlement to summary judgment or the existence of a triable issue, so the judgment in favor of the plaintiff was affirmed.
A.M. Med. Servs., P.C. v Liberty Mut. Ins. Co. (2010 NY Slip Op 20416)
October 5, 2010
The court considered the fact that a default judgment had been vacated by the Civil Court, and the defendant had alleged that the default judgment was obtained through the plaintiff's fraud, misrepresentation, or misconduct. The main issue was whether the defendant's default was excusable as the result of law office failure, and if there was a meritorious defense of intrinsic fraud committed by the plaintiff. The holding of the case was that the Civil Court had improvidently exercised its discretion in granting the defendant's motion to vacate the default judgment, and as a result, the defendant's motion to vacate the default judgment was denied, and the judgment was reinstated. The dissenting opinion of Judge Golia argued that the defendant's default was excusable as the result of law office failure, and that there was a meritorious defense of intrinsic fraud committed by the plaintiff, and therefore, they would affirm the Civil Court's order.
D.A.V. Chiropractic, P.C. v American Tr. Ins. Co. (2010 NY Slip Op 51738(U))
October 1, 2010
The relevant facts considered by the court in the case of D.A.V. Chiropractic, P.C. v American Tr. Ins. Co. were that the providers were seeking assigned first-party no-fault benefits. The main issue was whether the assignor of the benefits was eligible for workers' compensation benefits, and the court needed to determine the availability of compensation through the Workers' Compensation Board. The holding of the case was that because the Workers' Compensation Board has primary jurisdiction to determine factual issues concerning coverage under the Workers' Compensation Law, the matter needed to be remitted to the Board to be held in abeyance pending a prompt application to determine the parties' rights. The decision was ultimately made to reverse the judgment, vacate the order granting the providers' motion for summary judgment, and remit the matter to the Civil Court to be held in abeyance pending a prompt application to resolve the issues through the Workers' Compensation Board.
Manhattan Med. Imaging, P.C. v GEICO Ins. Co. (2010 NY Slip Op 51737(U))
October 1, 2010
The pertinent facts of the case were that Manhattan Medical Imaging, P.C. moved for summary judgement to recover assigned first-party no-fault benefits. GEICO Ins. Co. opposed the motion on the grounds that the services rendered were not medically necessary. The Civil Court granted plaintiff's motion for summary judgment, and this appeal followed. However, the Appellate Term found that the defendant had provided enough evidence to demonstrate the existence of a triable issue of fact as to medical necessity. Consequently, the judgment was reversed, and plaintiff's motion for summary judgment was denied. Therefore, the main issue decided was whether the services rendered were medically necessary, and the holding of the case was that the defendant had provided sufficient evidence to demonstrate a triable issue of fact as to medical necessity, leading to the reversal of the judgment and denial of plaintiff's motion for summary judgment.
I.V. Med. Supply, Inc. v Mercury Ins. Group (2010 NY Slip Op 51736(U))
October 1, 2010
The court considered the motion by the defendant for summary judgment dismissing the complaint, arguing lack of medical necessity for first-party no-fault benefits. Plaintiff submitted only an affirmation from its counsel in opposition to the motion. The court denied the defendant's motion, finding that the only issue for trial was the medical necessity of the supplies at issue. On appeal, the court reversed the order and granted the defendant's motion for summary judgment dismissing the complaint. This decision was based on the sufficiency of the affidavit submitted by the defendant, as well as the lack of a meaningful rebuttal to the conclusions set forth in the peer review report by the plaintiff, leading the court to find in favor of the defendant.
Irina Kazanskaya, Ac v GEICO Ins. Co. (2010 NY Slip Op 51735(U))
October 1, 2010
The relevant facts considered by the court in this case were that an acupuncturist was seeking to recover assigned first-party no-fault benefits from an insurance company. The main issue decided by the court was whether the insurance company had timely and properly reimbursed the acupuncturist. The holding of the case was that the court reversed the judgment, vacated the order granting the acupuncturist's motion for summary judgment, and granted summary judgment to the insurance company dismissing the complaint. This decision was based on the finding that the insurance company had timely mailed its claim denial and had properly reimbursed the acupuncturist using the workers' compensation fee schedule applicable to chiropractors.
Alfa Med. Supplies v Progressive Northeastern Ins. Co. (2010 NY Slip Op 51733(U))
October 1, 2010
The court considered the denial of a claim for first-party no-fault benefits by Progressive Northeastern Insurance Co. to Alfa Medical Supplies. The denial was based on lack of medical necessity for supplies totaling $1480. The main issue decided was whether the denial of the claim form was timely and whether there was a lack of medical necessity for the supplies. The holding was that the denial of the $455 claim was paid in full and therefore should have been granted as to that claim. Additionally, the court found that the denial of the $1480 claim for lack of medical necessity was timely and supported by an affirmed peer review report, and the plaintiff failed to rebut the conclusions set forth in the report, so the motion for summary judgment dismissing the complaint was granted for this claim as well.
MIA Acupuncture, P.C. v GEICO Ins. Co. (2010 NY Slip Op 51731(U))
October 1, 2010
The relevant facts considered by the court were that MIA Acupuncture, P.C. brought an action against GEICO Ins. Co. to recover first-party no-fault benefits. MIA Acupuncture, P.C. moved for summary judgment, with defendant GEICO Ins. Co. opposing the motion based on timely denial of claim forms and reduced payment due to the workers' compensation fee schedule. The main issues decided by the court were whether MIA Acupuncture, P.C. was entitled to summary judgment, if there were triable issues of fact with respect to defendant's defense of lack of medical necessity, and whether defendant's use of the workers' compensation fee schedule was appropriate. The holding of the case was that MIA Acupuncture, P.C. was not entitled to summary judgment and that partial summary judgment was granted to defendant, dismissing certain claims and remitting the matter to the Civil Court for further proceedings.