No-Fault Case Law
Executive MRI Imaging, P.C. v State Farm Ins. Co. (2008 NY Slip Op 50902(U))
April 21, 2008
The court considered the affidavit submitted by plaintiff's corporate officer in support of their motion for summary judgment, which failed to lay a proper foundation for the admission of the documents annexed to the moving papers. The main issue decided was whether the affidavit was sufficient to establish personal knowledge of the plaintiff's practices and procedures to lay a foundation for the admission of the documents as business records. The holding was that the affidavit submitted was insufficient, and as a result, the plaintiff failed to make a prima facie showing of their entitlement to summary judgment. Therefore, the court reversed the order granting plaintiff's motion for summary judgment and denied the motion.
Orthotic Surgical & Med. Supply, Inc. v GEICO Ins. Co. (2008 NY Slip Op 50869(U))
April 14, 2008
The court considered the case of Orthotic Surgical & Medical Supply, Inc. v GEICO Ins. Co. where the plaintiff was seeking to recover first-party no-fault benefits. The main issue decided was whether the affidavit submitted by an employee of plaintiff's former attorney laid a proper foundation for the documents annexed to plaintiff's moving papers, and whether the plaintiff failed to establish a prima facie case. The holding of the court was that the affidavit submitted was insufficient to establish that the employee possessed personal knowledge of the plaintiff's practices and procedures, and therefore failed to lay a foundation for the admission of the documents as business records. As a result, the plaintiff failed to make a prima facie showing of its entitlement to summary judgment. The judgment was reversed, the order granting the plaintiff's motion for summary judgment was vacated, and the plaintiff's motion for summary judgment was denied.
Health & Endurance Med., P.C. v Liberty Mut. Ins. Co. (2008 NY Slip Op 50864(U))
April 14, 2008
The main issue in this case was whether a billing provider could recover no-fault benefits for services performed by an independent contractor. The court considered the fact that the plaintiff was seeking to recover for services performed by an independent contractor and that the claim forms submitted by the plaintiff stated that the treating professional was an independent contractor. The court held that where a billing provider seeks to recover no-fault benefits for services not rendered by it or its employees, but by an independent contractor, it is not considered a "provider" of the medical services within the meaning of Insurance Department Regulations and is not entitled to recover "direct payment" of assigned no-fault benefits from the defendant insurer. Therefore, the court affirmed the order denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint.
All-Boro Med. Supplies, Inc. v Progressive Northeastern Ins. Co. (2008 NY Slip Op 50766(U))
April 11, 2008
The court considered the fact that the plaintiff sought to recover first-party no-fault benefits for medical supplies provided to Ramel King, who was injured in an automobile accident. The main issue decided was whether the defendant's request for additional verification of the claim tolled the 30-day period in which the defendant had to pay or deny the claim. The court held that the defendant's request for a prescribed NF-3 form constituted additional verification of the claim, which tolled the 30-day period, and therefore, the plaintiff had not established that payment of no-fault benefits was overdue. The court ultimately entered judgment in favor of the defendant, dismissing the plaintiff's claim as premature.
First Aid Occupational Therapy, PLLC v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 50863(U))
April 8, 2008
The court considered the appeal from an order of the Civil Court of the City of New York, Queens County, which granted the plaintiff's motion for summary judgment in a case involving a provider seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the affirmation submitted by the plaintiff's billing manager was sufficient to establish that the documents annexed to the plaintiff's moving papers were admissible as business records. The court held that the affirmation executed by the billing manager was insufficient to establish personal knowledge of the plaintiff's office practices and procedures, and therefore failed to make a prima facie showing of entitlement to summary judgment. As a result, the judgment was reversed, the order granting plaintiff's motion for summary judgment was vacated, and plaintiff's motion for summary judgment was denied.
Vista Surgical Supplies, Inc. v Travelers Ins. Co. (2008 NY Slip Op 03199)
April 8, 2008
The case involved an action to recover first-party no-fault benefits under an insurance contract. The plaintiff, Vista Surgical Supplies, Inc., sought summary judgment on the complaint, which the defendant, Travelers Insurance Company, opposed with peer review reports. The court held that the peer review reports were inadmissible because they contained computerized, affixed, or stamped facsimiles of the physician's signature, which failed to comply with CPLR 2106. As a result, the reports did not constitute competent evidence sufficient to defeat the plaintiff's motion for summary judgment. Therefore, the Appellate Term affirmed the plaintiff's motion for summary judgment on the complaint, as the defendant failed to raise a triable issue of fact in opposition to the plaintiff's showing.
First Help Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2008 NY Slip Op 51266(U))
April 3, 2008
The court considered that the provider had previously commenced an identical action, which was dismissed for failure to comply with a so-ordered discovery stipulation. Defendant argued that this dismissal should be with prejudice, and the court sided with the defendant, agreeing that the dismissal was with prejudice and that the plaintiff was therefore barred from commencing a second action. The main issue decided was whether the dismissal of the prior action was with prejudice, and the holding of the court was that it was, and therefore the defendant's motion for summary judgment dismissing the complaint based on the doctrine of res judicata was affirmed.
Fortune Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 28218)
April 3, 2008
The Court heard a case involving a medical provider seeking to recover first-party no-fault benefits totaling $5,855.82 from an insurance company. The provider was initially awarded the full amount but the insurance company sought to amend the judgment to limit the attorney's fees awarded. The insurance company claimed that attorney's fees could only amount to 20% of the total first-party benefits, with a statutory maximum of $850 for the entire action. The Court ultimately ruled in favor of the medical provider, stating that attorney's fees were to be calculated on a "per claim" basis, with each claim eligible for the full statutory maximum of $850 in attorney's fees. The ruling was based on Insurance Law § 5106 (a) and LMK Psychological Servs., P.C. v State Farm Mut. Auto. Ins. Co. (46 AD3d 1290 [2007]), and effectively overturned the previous decision of the court below to revise the amount of attorney's fees on the judgment.
Countrywide Ins. Co. v 563 Grand Med., P.C. (2008 NY Slip Op 03059)
April 3, 2008
The relevant facts the court considered included a judgment entered in New York County awarding the defendant medical provider the sum of $12,638.96. This brought up for review an order granting the defendant's motion for summary judgment on its claim for first-party no-fault insurance benefits. The main issue decided was whether the defendant was entitled to judgment as a matter of law, as they established that necessary billing documents were mailed to and received by the plaintiff insurer and that payment of the no-fault benefits was overdue. The court held that the defendant did establish prima facie its entitlement to judgment, but the plaintiff raised a triable issue of fact whether the claimed benefits were properly denied for lack of medical justification. The decision was reversed on the law, with defendant's motion for summary judgment denied and the judgment vacated.
A & A Dental, P.C. v State Farm Ins. Co. (2008 NY Slip Op 50709(U))
March 27, 2008
The main issues for consideration in this case were whether the injuries sustained by the plaintiff's assignor were causally related to a motor vehicle accident, and whether the defendant had met their burden of proving that the injuries were not causally related to the accident. The court considered the testimony of the assignor and the defendant's expert, as well as conflicting inferences drawn from the evidence. The court found that the defendant failed to meet their burden of proving that the injuries were not causally related to the accident, and therefore affirmed the judgment in favor of the plaintiff, awarding them the principal sum of $5,250.45. The court's holding was that the defendant's contentions were either unpreserved for appellate review or without merit, and therefore the judgment in favor of the plaintiff was affirmed.