No-Fault Case Law

VIT Acupuncture, P.C. v State Farm Auto. Ins. Co. (2010 NY Slip Op 51560(U))

The relevant facts the court considered in this case were that the defendant insurance provider moved to dismiss all causes of action in the complaint based on the plaintiff's alleged failure to attend two requested Examinations Under Oath (EUOs). The main issues addressed were the sufficiency of the defendant's evidence to support the motion to dismiss, and whether the plaintiff's complaint stated a cause of action. The court held that the defendant's affidavits were not documentary evidence as required under CPLR 3211(a)(1), and that the plaintiff's complaint did state a cause of action. The court also rejected the defendant's argument that the action should be dismissed as premature due to the plaintiff's alleged failure to comply with verification requests, as the defendant had already issued a denial for the claim, inviting the plaintiff's subsequent proceedings to challenge the denial. Therefore, the defendant's motion to dismiss was denied, and the plaintiff was given 30 days to serve and file an answer.
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Urban Radiology, P.C. v GEICO Ins. Co. (2010 NY Slip Op 51554(U))

The court considered a motion to consolidate a provider's claim against an insurance company with forty-five other pending cases, the amendment of the insurance company's answer to include a fraudulent incorporation defense, additional discovery, and a stay pending resolution of the fraudulent incorporation issue in all the cases. The main issue decided was whether the cases should be consolidated and a stay granted, and if the insurance company should be allowed to amend its answers and have additional discovery. The court held that the cases should not be consolidated, as they did not arise from a common set of facts or accident, and consolidation would be unwieldy and prejudicial to the plaintiff. The court also denied a stay, as the insurance company did not have a good faith basis to allege fraudulent incorporation and the request for a stay was based on speculation rather than specific proof. The court denied the request for leave to amend and for additional discovery without prejudice to renew upon a proper showing in each case.
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Quality Psychological Servs., P.C. v GEICO Ins. Co. (2010 NY Slip Op 51423(U))

The court considered the defendant's application to amend its answers to interpose counterclaims for fraud and unjust enrichment in an action to recover assigned first party no-fault benefits. The defendant sought to strike the notices of trial, compel discovery, including a deposition, and to consolidate 19 captioned actions. The main issue decided was whether the defendant's counterclaims for fraud and unjust enrichment were palpably insufficient and patently devoid of merit because the claims were not denied on the grounds of fraudulent billing. The court held that the counterclaims were palpably insufficient and patently devoid of merit, and denied the defendant's application to amend the answers. Therefore, the remaining parts of the order to show cause to strike the notices of trial, compel discovery, including a deposition, and to consolidate all 19 captioned actions were also denied as moot.
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Hillcrest Radiology Assoc. v State Farm Mut. Auto. Ins. Co. (2010 NY Slip Op 51467(U))

The main issue of this case was whether a medical provider was entitled to recover assigned first-party no-fault benefits. The relevant facts considered by the court included a motion made by the defendant for summary judgment dismissing the complaint on the grounds that the services billed were not medically necessary, as well as contradictory reports submitted by the defendant as part of their motion. The decision of the court was to affirm the order without costs, as the defendant had failed to establish its prima facie entitlement to summary judgment as a matter of law due to contradictory evidence submitted as part of their motion. One judge concurred in part and dissented in part, agreeing with the majority's decision but stating that a specific MRI study was not subject to summary judgment due to conflicting evidence, while granting summary judgment for other MRIs that were found to be medically unnecessary.
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Points of Health Acupuncture, P.C. v Lancer Ins. Co. (2010 NY Slip Op 51455(U))

The main issue in this case was whether the insurance company was liable to pay first-party no-fault benefits to the plaintiff, a healthcare provider, after the plaintiff failed to appear for two scheduled examinations under oath (EUOs). The defendant argued that the plaintiff's claims should be denied due to their failure to attend the EUOs, and moved for summary judgment. The Civil Court denied the defendant's motion and granted the plaintiff's cross motion for summary judgment, finding that the defendant failed to prove the timely mailing of the denial of claim forms and the EUO scheduling letters. The Appellate Term, however, reversed this decision, ruling that the defendant had indeed established the timely mailing of the EUO scheduling letters, and that the appearance of the plaintiff at an EUO is a condition precedent to the insurer's liability on the policy. Therefore, the court held that the defendant's motion for summary judgment dismissing the complaint should have been granted, and the plaintiff's cross motion for summary judgment should have been denied.
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Mega Supply & Billing, Inc. v Larendon Natl. Ins. Co. (2010 NY Slip Op 51452(U))

The main issue in this case was whether the defendant had established a lack of medical necessity for the supplies provided to the plaintiff, who was seeking to recover assigned first-party no-fault benefits. The court considered the timely denial of the claim by the defendant on the grounds of lack of medical necessity, as well as an affirmed peer review report. The court held that the defendant had established its prima facie entitlement to summary judgment by providing evidence of the timely denial and the peer review report. In opposition to the motion, the plaintiff failed to submit an affirmation from a doctor rebutting the conclusions in the peer review report, and also failed to demonstrate a need for additional documents. Ultimately, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.
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Stephen Fealy, M.D., P.C. v State Farm Mut. Auto Ins. Co. (2010 NY Slip Op 51442(U))

The case involves a dispute over first-party no-fault benefits in the amount of $25,000, with an insurance company seeking summary judgment to dismiss the complaint on the grounds that the injuries of the plaintiff's assignor were preexisting and unrelated to the subject accident. The plaintiff, an orthopedic surgeon, performed medical procedures on the assignor and submitted a claim for reimbursement, which was denied based on an independent peer review indicating that the injuries were unrelated to the accident. The defendant submitted medical evidence to support their motion for summary judgment, but the court found that the plaintiff's opposition, including an affidavit from the surgeon who performed the procedure, raised a genuine issue of fact that needed to be resolved at trial. Therefore, the court affirmed the order denying the defendant's motion for summary judgment.
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Kew Gardens Med & Rehab, P.C. v Travelers Ins. Co. (2010 NY Slip Op 51356(U))

The main issue decided in this case was whether the plaintiff's motion to vacate a prior order which had granted on default the defendant's motion to dismiss the complaint for failure to prosecute should be denied. The court considered the fact that the plaintiff had commenced the action in July 2002 to recover assigned first-party no-fault benefits, and issue was joined in September 2002. However, there was no further activity in relation to the litigation until March 2007, when the defendant served a 90-day demand pursuant to CPLR 3216 (b) and the plaintiff did not respond. The court held that the order denying the plaintiff's motion to vacate the order dismissing the complaint should be affirmed, as there was no proof that a notice of change of attorney form was executed in 2003 and filed with the Civil Court at any time prior to the defendant's service of the 90-day demand in March 2007. Therefore, proper service of the demand and of the subsequent motion to dismiss on the plaintiff's former counsel was upheld.
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AVA Acupuncture, P.C. v AutoOne Ins. Co. (2010 NY Slip Op 51350(U))

The court considered the plaintiff's motion for summary judgment and the defendant's cross motion to compel the plaintiff to provide discovery and produce its owner for an examination before trial. The main issues decided were whether the plaintiff was obligated to produce certain information in response to the defendant's supplemental demand for discovery and inspection and whether the plaintiff's motion for summary judgment was premature pending the completion of discovery. The holding of the court was that the defendant's cross motion to compel the plaintiff to respond to outstanding discovery demands was granted to the extent of compelling the plaintiff to provide the information sought in certain items of the defendant's supplemental demand for discovery and inspection within 60 days. Additionally, the court found that the plaintiff's motion for summary judgment was premature pending the completion of discovery.
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John Giugliano, DC, P.C. v Merchants Mut. Ins. Co. (2010 NY Slip Op 20308)

The court found in favor of the plaintiff, Giugliano, DC, P.C. in this matter wherein plaintiff was seeking to recover first party no-fault benefits from defendant, Merchants Mutual Ins. Co. Plaintiff submitted bills for medical procedures pursuant to the New York Workers' Compensation Medical Fee Schedule, however, defendant disputed the billing practices used by the plaintiff. The main issue decided by the court was whether the plaintiff was entitled to recover for the claims submitted based on the fee schedule. The court found that plaintiff proved its prima facie case and the procedures were properly billed pursuant to the fee schedule, which is why it granted judgment in favor of the plaintiff in the amount of $2,980.58 plus costs, disbursements, statutory interest, and statutory attorney's fees.
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