No-Fault Case Law
Gz Med. & Diagnostic, P.C. v Mercury Ins. Co. (2010 NY Slip Op 50491(U))
March 19, 2010
In this case, the plaintiff, GZ Medical and Diagnostic, P.C., was seeking to recover first-party no-fault benefits from defendant Mercury Ins. Co. The defendant moved for partial summary judgment to dismiss plaintiff's second and third causes of action on the grounds that the medical services provided were not medically necessary. Defendant submitted evidence to support their position, including a peer review report from their doctor. The plaintiff opposed the motion, arguing that there was a question of fact as to medical necessity and that they did not have access to all the necessary information and documents to effectively rebut the defendant's position. However, the court found that the plaintiff failed to raise a triable issue of fact and that defendant's motion for partial summary judgment should be granted. Therefore, the court reversed the original decision and granted defendant's motion for partial summary judgment dismissing plaintiff's second and third causes of action.
Ambrister v Integon Natl. Ins. Co. (2010 NY Slip Op 50489(U))
March 19, 2010
The Court considered the denial of the plaintiff's motion for summary judgment and the granting of the defendant's cross motion for summary judgment, based on the failure of the plaintiff to provide requested verification in an action to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant had properly requested verification pursuant to Insurance Department Regulations, as the plaintiff argued that the defendant failed to prove it had properly requested verification. The Court held that the action was premature due to the plaintiff's failure to provide requested verification, and rejected the plaintiff's argument that the defendant failed to submit a copy of its initial verification request. Therefore, the judgment was affirmed without costs.
St. Vincent Med. Care, P.C. v Country Wide Ins. Co. (2010 NY Slip Op 50488(U))
March 19, 2010
The main issue in the case was whether St. Vincent Medical Care, P.C. had properly established a prima facie case in its action to recover assigned first-party no-fault benefits, and whether the defendant, Country Wide Insurance Company, had standing to bring the action due to a defective assignment of benefits form. The court held that the documents annexed to St. Vincent's motion for summary judgment were admissible as business records and established the mailing of the bills. Additionally, the court held that the defendant waived any defenses based on the assignment of benefits form, as it did not timely object to the form or seek verification of the assignment. The court also found that the defendant tolled the 30-day statutory time period within which it had to pay or deny plaintiff's claims, rendering the action premature. The judgment was reversed, and the matter was remitted to the Civil Court for entry of an appropriate judgment upon plaintiff's seventh cause of action.
Crossbay Acupuncture, P.C. v Hartford Cas. Ins. Co. (2010 NY Slip Op 50487(U))
March 19, 2010
The relevant facts of the case involved a provider seeking first-party no-fault benefits for injuries sustained by a pedestrian who was allegedly hit by the insured's car. The provider sued the insurance company after the company sought to establish an affirmative defense that the injuries did not arise from an insured incident. The main issue decided was whether the insurance company had sufficient evidence to establish its defense. The holding of the court was that the insurance company had sustained its burden of proof, and the provider failed to raise a triable issue of fact, so the court properly granted the insurance company's motion for summary judgment dismissing the complaint.
IAV Med. Supply, Inc. v Progressive Ins. Co. (2010 NY Slip Op 50433(U))
March 15, 2010
The relevant facts considered by the court in this case include the medical services provided to Orlando Lainez-Rodriguez after an automobile accident on June 16, 2008. The main issue decided by the court was the medical necessity of the services provided to the assignor. The court examined the admissibility of expert testimony from Dr. Lown and the peer review reports from Dr. Schechter, as well as the sufficiency of the disclosure notice provided by the defendant. The holding of the court was that the peer review reports were not admissible as business records, but Dr. Lown's testimony and opinion based on the peer review reports were admissible and accepted by the court. The court ultimately found in favor of the defendant, dismissing the case and ruling that the services provided were not medically necessary.
Advanced Med., P.C. v GEICO Ins. Co. (2010 NY Slip Op 50454(U))
March 10, 2010
The relevant facts in this case included a provider seeking to recover assigned first-party no-fault benefits. The defendant argued that there was a lack of medical necessity for the services at issue. The main issue decided in the case was whether the defendant was entitled to summary judgment dismissing the plaintiff's third and fifth causes of action. The court held that the defendant's submission of denial of claim forms and an affirmation by the doctor who performed the independent medical examination established that there was no medical necessity for the services at issue in plaintiff's third and fifth causes of action, and therefore the defendant's cross motion seeking summary judgment dismissing said causes of action should have been granted.
Favorite Health Prods., Inc. v Geico Ins. Co. (2010 NY Slip Op 50453(U))
March 10, 2010
The court considered a case where a provider was seeking to recover first-party no-fault benefits, and defendant insurance company denying the claims on grounds of lack of medical necessity. The main issue was whether there was a lack of medical necessity for the medical supplies at issue, and whether the defendant was entitled to summary judgment dismissing the complaint. The court held that the defendant had established timely mailing of the denial of claim forms, and had submitted peer review reports showing lack of medical necessity, which was unrebutted by the plaintiff. Therefore, the defendant's cross motion for summary judgment dismissing the complaint was granted.
Co-Op City Chiropractic, P.C. v Mercury Ins. Group (2010 NY Slip Op 50452(U))
March 10, 2010
The court considered the motion for summary judgment filed by the defendant, who sought to dismiss the complaint on the ground of lack of medical necessity. The defendant's chiropractor provided an affidavit and peer review report that concluded there was a lack of medical necessity for the services rendered, in line with previous cases. However, the plaintiff's treating chiropractor submitted an affidavit in opposition to the motion that demonstrated the existence of a triable issue of fact as to the medical necessity of the services rendered. The main issue decided was whether there was sufficient evidence to demonstrate the medical necessity of the services rendered, and the court held that the plaintiff's affidavit created a triable issue of fact, leading to the affirmation of the order denying the defendant's motion for summary judgment.
Nursing Personnel Homecare v New York Cent. Mut. Fire Ins. Co. (2010 NY Slip Op 50450(U))
March 10, 2010
The relevant facts considered by the court were that the plaintiff was seeking to recover first-party no-fault benefits and the defendant had failed to appear in court, resulting in a default judgment. The main issue decided was whether the defendant had a reasonable excuse for the default and a meritorious defense in order to vacate the default judgment. The court held that the defendant had established that it did not receive actual notice of the summons in time to defend the action, and had also shown the existence of a meritorious defense to the action, as the assignor had cancelled her insurance policy with the defendant prior to the date of the accident. The court therefore reversed the decision of the Civil Court of New York and granted the defendant's motion to vacate the default judgment.
Prestige Med. & Surgical Supply, Inc. v Chubb Indem. Ins. Co. (2010 NY Slip Op 50449(U))
March 10, 2010
The relevant facts considered in the case included a provider's attempt to recover assigned first-party no-fault benefits from an insurance company. The main issue decided was whether the insurance company had waived its reliance on the 45-day rule for submitting the claim, and if the provider had provided a reasonable justification for their failure to submit the claim within the required timeframe. The holding of the case was that the insurance company had not waived its reliance on the 45-day rule, and the provider had failed to provide a reasonable justification for the delay in submitting the claim. Therefore, the insurance company's motion for summary judgment dismissing the complaint was affirmed by the court.