No-Fault Case Law
Uptodate Med. Serv., P.C. v State Farm Mut. Auto. Ins. Co. (2009 NY Slip Op 50046(U))
January 9, 2009
The main issue in this case was whether the defendant should have been granted leave to amend its answer to assert the affirmative defenses of res judicata and collateral estoppel. The court considered the burden of the party attempting to defeat the application of collateral estoppel to establish the absence of a full and fair opportunity to litigate. The court also examined whether the plaintiff had a full and fair opportunity to litigate the issue determined in the arbitration proceeding. The holding was in favor of the defendant, as the court found that the defendant was entitled to amend its answer to assert the affirmative defenses and that the plaintiff had failed to establish that it did not receive a full and fair opportunity to litigate in the prior arbitration proceeding. As a result, the judgment in favor of the plaintiff was reversed, and the defendant's cross motion for summary judgment was granted.
All Mental Care Medicine, P.C. v State Farm Mut. Ins. Co. (2009 NY Slip Op 50042(U))
January 9, 2009
The relevant facts considered in this case include the plaintiff offering a notice to admit and an affirmation made by the defendant's attorney in order to prove its prima facie case at trial. The court found that the plaintiff failed to produce a witness and therefore failed to make its prima facie case, resulting in the dismissal of the complaint. The main issue decided was whether the plaintiff had successfully proven its case in order to recover assigned first-party no-fault benefits. The holding of the case was that the judgment was affirmed without costs, as the plaintiff failed to make its prima facie case and therefore the complaint was dismissed.
Union Physician Healthcare, P.C. v Utica Mut. Ins. Co. (2009 NY Slip Op 50039(U))
January 9, 2009
The court considered the appeal of a provider seeking to recover assigned first-party no-fault benefits, in which the lower court had granted the provider's motion for summary judgment. The main issue was whether the affidavit submitted by the provider's officer laid a proper foundation for the admission of the documents annexed to the provider's moving papers, and whether the provider had established a prima facie case. The holding of the court was that the affidavit submitted by the provider's officer was insufficient to demonstrate personal knowledge of the provider's practices and procedures, and therefore failed to lay a foundation for the admission of the documents as business records. As a result, the provider failed to make a prima facie showing of entitlement to summary judgment, and the judgment was reversed, the order granting the provider's motion for summary judgment was vacated, and the provider's motion for summary judgment was denied.
Complete Orthopedic Supplies, Inc. v State Farm Mut. Auto. Ins. Co. (2009 NY Slip Op 29014)
January 9, 2009
The case involved Complete Orthopedic Supplies, Inc. as an assignee of Ana Valencia, a medical provider, that was seeking to recover first-party no-fault benefits from State Farm Mutual Automobile Insurance Company. The provider moved for summary judgment, while the insurance company cross-moved for summary judgment, arguing that there was no medical necessity for the supplies provided. The Civil Court granted the provider's motion for summary judgment and denied the insurance company's cross motion. The Appellate Term, Second Department reversed this decision, ultimately holding that the insurance company's denial of claim forms, based on lack of medical necessity, were timely mailed and that there was no medical necessity for the supplies provided by the medical provider. As a result, the insurance company's cross motion for summary judgment dismissing the complaint was granted, and the provider's motion for summary judgment was denied.
Long Is. Multi-Medicine Group, P.c. v Travelers Ins. Co. (2009 NY Slip Op 50030(U))
January 8, 2009
The relevant facts considered by the court were that Long Island Multi-Medicine Group, P.C. sought to recover assigned first-party no-fault benefits, and defendant Travelers Ins. Co. denied a number of the claims on the basis that they were not timely submitted. Plaintiff moved for summary judgment, which was granted, and defendant appealed, arguing that it had not waived its defense of untimeliness. The main issue decided was whether defendant waived its defense of untimeliness, and the court held that defendant had failed to establish that it timely denied the subject claims, and therefore failed to raise a triable issue of fact with respect to the claims at issue. The judgment was affirmed on other grounds.
Matter of Long Is. Ins. Co. (2009 NY Slip Op 50003(U))
January 5, 2009
The court considered the petitioner's request for summary judgment based on newly discovered evidence regarding a hit and run. The petitioner claimed the respondent intentionally failed to disclose that his father, who died in 2001, was the named insured under the insurance policy for which he was making claims. The court also considered the petitioner's motion to vacate the arbitration award on the ground that there was no valid agreement to arbitrate. The main issue decided was whether there was a valid contract between the deceased insured and the insurer, and whether there was a rational basis for the arbitration award. The holding of the court was that there was no valid contract between the respondent and the insurer due to the fact that the respondent's deceased father was the named insured. Therefore, the arbitration award was vacated and summary judgment was granted to the petitioner on the issue of non-coverage.
All Mental Care Medicine, P.C. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 52588(U))
December 31, 2008
The court considered the motion for summary judgment filed by All Mental Care Medicine, P.C. to recover assigned first-party no-fault benefits. Defendant asserted that it timely denied the claims because the assignor failed to appear for two independent medical examinations (IMEs). However, defendant failed to establish by proof in admissible form that the IME requests were timely mailed to the assignor and that the assignor failed to appear for the IMEs. As a result, the court granted partial summary judgment to the plaintiff, awarding it the sums of $240.20 and $1,201. The matter was remanded to the court below for the calculation of statutory interest and attorney's fees thereon. The court ultimately reversed the order denying plaintiff's motion for summary judgment and granted partial summary judgment on the claims for $240.20 and $1,201.
Acupuncture Healthcare Plaza, P.C. v Zurich Ins. Co. (2008 NY Slip Op 52585(U))
December 31, 2008
The court considered a case in which a provider was seeking to recover assigned first-party no-fault benefits, but the defendant had been granted summary judgment on default. The main issue decided was whether the plaintiff's motion to vacate the default judgment and deny the defendant's motion for summary judgment should be granted. The court held that the plaintiff's claim of law office failure did not amount to a reasonable excuse for the default, as it was conclusory, undetailed, and uncorroborated. Therefore, the court reversed the order granting the plaintiff's motion to vacate the default judgment and denied the defendant's motion for summary judgment. The court did not consider any other issues in the case.
New Century Osteopathic v State Farm Fire & Cas. Ins. Co. (2008 NY Slip Op 52584(U))
December 31, 2008
The court considered the fact that New Century Osteopathic and George Laikeas, M.D. d/b/a Medical Plaza had filed a complaint to recover assigned first-party no-fault benefits, but the court denied their motion at trial and dismissed the complaint because the plaintiffs presented no evidence. The main issue decided was whether a prior order which stated that the plaintiffs' motion for summary judgment made a prima facie showing dispensed with the need for the plaintiffs to establish a prima facie case at trial. The holding of the case was that the appeal by the plaintiffs was dismissed, as the court denied their oral motion and no appeal lies from an order which does not decide a motion made on notice. Additionally, no appeal lies from a decision to dismiss the complaint. Therefore, the court's decision to deny the motion and dismiss the complaint was upheld.
Yklik Med. Supply, Inc. v Allstate Ins. Co. (2008 NY Slip Op 28532)
December 31, 2008
The relevant facts considered by the court were that the plaintiff, a medical supply provider, submitted unpaid bills for medical equipment it provided to the defendant's assignor and moved for summary judgment because the defendant failed to pay or deny the claim within the required 30 days. The defendant opposed the motion by arguing that the plaintiff failed to establish a prima facie case and by asserting that its partial payment to the plaintiff raised an issue of fact about whether the plaintiff was paid the appropriate amount for medical services. The main issue decided was whether the defendant was barred from raising the defense of fee schedule noncompliance and partial payment according to the fee schedule because of its failure to submit a timely denial.
The holding of the case was that the defense of fee schedule noncompliance and partial payment made in accordance with the fee schedule was precluded because the defendant failed to disclaim coverage in a timely manner. As a result, summary judgment was granted to the plaintiff.