No-Fault Case Law
Universal Acupuncture Pain Servs. P.C. v MVAIC (2006 NY Slip Op 52343(U))
December 5, 2006
The main issue before the court was whether the plaintiff's assignor, Jonathan Laul, qualified for MVAIC no-fault benefits. The defendant argued that there was no coverage with MVAIC due to Laul's failure to qualify for these benefits and because the statute of limitations had expired. The plaintiff claimed that it had rendered services to Laul and submitted bills and claims to the defendant in accordance with no-fault regulations. The court considered the evidence submitted by both parties and ultimately held that the defendant failed to meet its burden of proof for summary judgment. Therefore, the motion for summary judgment by the defendant was denied.
Akita Med. Acupuncture P.C. v MVAIC (2006 NY Slip Op 52340(U))
December 5, 2006
The court considered the facts of a motor vehicle accident on January 27, 2003, and subsequent acupuncture treatments received by the injured party, along with the requirement to provide timely notice of claim to the defendant, Motor Vehicle Accident Indemnification Corporation (MVAIC). The main issue decided was whether the plaintiff fulfilled the reporting requirements of Insurance Law Article 52, specifically the requirement to provide a police report and notarized household affidavit to MVAIC to qualify for benefits. The holding of the court was that the plaintiff failed to establish that the claimant was a "covered person" entitled to MVAIC benefits by not timely filing a proper notice of claim, and therefore, the defendant's motion for summary judgment was granted, resulting in the dismissal of the plaintiff's cause of action for unpaid medical bills in the amount of $1,080.00.
PDG Psychological P.C. v Eveready Ins. Co. (2006 NY Slip Op 52305(U))
December 1, 2006
The court considered the appeal of an order from the Civil Court of the City of New York, Queens County, which denied the plaintiff's motion for summary judgment in a case involving the recovery of assigned first-party no-fault benefits. The main issue decided was whether the plaintiff had established a prima facie entitlement to judgment as a matter of law, and the court held that the plaintiff failed to do so due to deficiencies in the affidavit of the plaintiff's "corporate officer" and a lack of sufficient personal knowledge concerning the plaintiff's office practices with regard to the subject claims. Therefore, the court affirmed the judgment without costs, concluding that the denial of the plaintiff's motion for summary judgment was proper. No other issues were considered in light of this determination.
Mega Supply & Billing Inc. v Auto One Ins. Co. (2006 NY Slip Op 52304(U))
December 1, 2006
The relevant fact considered was that plaintiff's motion to recover assigned first-party no-fault benefits was supported by an affirmation from plaintiff's counsel, an affidavit by a corporate officer of plaintiff, and various documents annexed thereto. The main issue decided was whether the affidavit by plaintiff's corporate officer was sufficient to establish that said officer possessed personal knowledge of plaintiff's practices and procedures so as to lay a foundation for the admission of the documents annexed to plaintiff's moving papers as business records. The court held that the affidavit submitted by plaintiff's corporate officer was insufficient to establish that said officer possessed personal knowledge of plaintiff's practices and procedures, and as a result, plaintiff failed to make a prima facie showing of its entitlement to summary judgment. Therefore, the order was affirmed without costs.
Delta Diagnostic Radiology, P.C. v Liberty Mut. Ins. Co. (2006 NY Slip Op 52303(U))
December 1, 2006
The main issue in this case was whether the plaintiff, Delta Diagnostic Radiology, P.C., had demonstrated its prima facie entitlement to judgment as a matter of law in its action to recover assigned first-party no-fault benefits. The court considered the evidence presented by the plaintiff in support of its motion for summary judgment, which included an affirmation from counsel, an affidavit from a corporate officer, and various documents. The defendant argued that the plaintiff had failed to show that the documents constituted business records and lacked a statement from someone with personal knowledge regarding the documents annexed to the motion papers. The court ultimately held that the plaintiff had failed to demonstrate its prima facie entitlement to judgment as a matter of law, and affirmed the denial of the motion for summary judgment. The decision was based on the failure of the plaintiff's corporate officer to lay a foundation for the admission of the documents as business records.
Dan Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 26483)
December 1, 2006
The Supreme Court, Appellate Term, Second Department heard the case of Dan Medical, P.C., as Assignee of Renee Dyette v New York Central Mutual Fire Insurance Co. The dispute was over a claim for first-party no-fault benefits, with the health care provider plaintiff, Dan Medical, P.C., seeking to recover assigned benefits. Dan Medical filed a motion for summary judgment, and New York Central Mutual Fire opposed the motion and cross-moved for the depositions of various parties. The plaintiff's motion was granted, and the defendant's cross motion was implicitly denied. The court held that the plaintiff did not demonstrate a prima facie case for summary judgment because it failed to lay a proper foundation for its documents due to a lack of personal knowledge of the corporate officer's understanding of office practices. Therefore, the court reversed the order, denied plaintiff's motion for summary judgment, and sent the matter back to the lower court for de novo determination.
Boai Zhong Yi Acupuncture Servs. P.C. v Progressive Cas. Ins. Co. (2006 NY Slip Op 26485)
November 28, 2006
The relevant facts considered by the court included a case to recover first-party no-fault benefits for health care services provided. Plaintiff submitted claims and proof that the payment of benefits was overdue. Defendant submitted timely claim denials citing a lack of medical necessity, based on peer review and independent medical examination reports. The main issue was whether the denial forms provided were factually insufficient, conclusory, or vague, rendering the defense of no merit as a matter of law. The court decided that while the defendant was not required to attach the peer review and IME reports to the denial forms, the lack of medical necessity defense should have been interposed clearly and explicitly. The holding of the case was that the lower court's decision was reversed, and plaintiff's motion for summary judgment was granted, while the defendant's cross motion was denied, and the case was remanded for the calculation of statutory interest and an assessment of attorney's fees.
Montefiore Med. Ctr. v Government Empls. Ins. Co. (2006 NY Slip Op 08953)
November 28, 2006
The relevant facts the court considered were that Montefiore Medical Center, as the assignee of Juan Garcia, was seeking to recover no-fault medical payments under an insurance contract from Government Employees Insurance Company. The main issue decided was whether the defendant's request for additional verification needed to be set forth in a prescribed form, and whether the defendant's response to the claim was untimely. The holding of the court was that the additional verification request tolled the defendant's time within which to pay or deny the claim until the defendant received all of the relevant information requested. The court also held that a triable issue of fact exists as to whether the no-fault benefits under the subject policy were exhausted, and that the determination of this issue must await further proceedings.
Bajaj v Progressive Ins. Co. (2006 NY Slip Op 52387(U))
November 20, 2006
The court considered the fact that the plaintiff was seeking recovery of first-party no-fault benefits for medical services provided to an assignor, and the insurer had timely denied the bills in question on the basis of lack of medical necessity. The main issue decided was that the insurer was not authorized to take the deposition of its expert after the notice of trial was filed, and the deposition testimony was inadmissible due to being based on documents not in evidence. The holding of the case was that the court rendered judgment in favor of the plaintiff, ordering the insurer to pay the full amount prayed for by the plaintiff, along with statutory interest, costs, and attorneys' fees.
Forrest Chen Acupuncture Servs., P.C. v Nationwide Mut. Ins. Co. (2006 NY Slip Op 52270(U))
November 17, 2006
The court considered the fact that the plaintiff failed to prove the mailing of its claims, which is an essential element of its prima facie case to recover first-party no-fault benefits. The main issue decided in the case was whether the plaintiff had submitted a claim, setting forth the fact and amount of the loss sustained, which is required to recover benefits. The holding of the case was that the plaintiff's motion for summary judgment was denied due to its failure to prove mailing of its claims, and the defendant's cross motion for summary judgment was also denied because it failed to establish that it never received the plaintiff's claim or that the claim was submitted beyond the statutory deadline. Therefore, the order was modified by denying the defendant's cross motion for summary judgment and affirmed without costs.