No-Fault Case Law
Vista Surgical Supplies, Inc. v Liberty Mut. Ins. Co. (2006 NY Slip Op 26276)
June 30, 2006
The relevant facts considered in this case were that Vista Surgical Supplies, Inc. was seeking to recover no-fault benefits from Liberty Mutual Insurance Co. after having its motion for summary judgment denied. The main issue decided was whether Vista Surgical Supplies, Inc. had submitted the claims for no-fault benefits and established that payment was overdue in order to be entitled to summary judgment. The court determined that in order to establish a prima facie entitlement to summary judgment, Vista Surgical Supplies, Inc. had to prove that it submitted the claims and that payment was overdue. The holding of the case was that Vista Surgical Supplies, Inc. failed to provide competent proof that the claim forms were mailed to Liberty Mutual Insurance Co., and therefore their motion for summary judgment was properly denied.
Contemporary Acupuncture P.C. v Travelers Ins. Co. (2006 NY Slip Op 51278(U))
June 29, 2006
The court considered an appeal from an order denying plaintiff's motion for summary judgment and granting defendant's cross motion to compel discovery in a case to recover assigned first-party no-fault benefits. The main issue was whether the plaintiff health care provider had established a prima facie entitlement to summary judgment by proving submission of claim forms to the defendant. The court held that the plaintiff failed to adequately establish proof of proper mailing and submission of claim forms, as required by law. The court also dismissed the appeal from the portion of the order granting defendant's cross motion to compel discovery, as the plaintiff failed to submit written opposition to the cross motion, resulting in a default. Therefore, the court affirmed the order to deny plaintiff's motion for summary judgment and dismissed the appeal from the portion of the order granting defendant's cross motion to compel discovery.
Bronx Expert Radiology, P.C. v Travelers Ins. Co. (2006 NY Slip Op 51227(U))
June 29, 2006
The relevant facts of the case were that Bronx Expert Radiology, P.C. had filed a motion for summary judgment, as it believed that it had responded to Travelers Insurance Co.'s verification request. However, the affidavit of plaintiff's representative did not create a presumption of mailing, as it did not state that the verifications were actually mailed to the defendant, nor did it describe the plaintiff's mailing office practice and procedures. The main issue was whether the insurer was obligated to pay or deny a claim before receiving verification of all relevant information requested. The holding of the case was that the motion for summary judgment should have been denied, as the plaintiff's submission was insufficient to raise a presumption of receipt, and the matter was remanded to Civil Court for further proceedings.
Ocean Diagnostic Imaging P.C. v State Farm Mut. Auto. Ins. Co. (2006 NY Slip Op 51275(U))
June 28, 2006
The relevant facts the court considered in this case were that the plaintiff was seeking first-party no-fault benefits for medical services rendered to its assignors, and the defendant, an insurance company, had moved for summary judgment dismissing the complaint based on allegations of fraud related to the accident. The main issue decided was whether the plaintiff had standing to bring the action and whether the defendant's untimely denial of the claims was justified. The holding of the court was that defendant's motion for summary judgment was denied, plaintiff's cross motion for summary judgment was granted, and the matter was remanded for the calculation of statutory interest and an assessment of attorney's fees pursuant to Insurance Law. The court found that the defendant had waived any defenses based on the assignment of benefits forms and failed to demonstrate the existence of a triable issue of fact related to the lack of coverage.
Amol, Inc. v Travelers Ins. Co. (2006 NY Slip Op 51271(U))
June 28, 2006
The court considered the facts surrounding a dispute between Amol, Inc. and Travelers Ins. Co. regarding the denial of plaintiff's claim for first-party no-fault benefits. The main issue decided was whether defendant's denial of plaintiff's claim was untimely, and if defendant was precluded from raising its defense of lack of medical necessity. The court held that the denial of plaintiff's claim was not untimely, as the affidavit of plaintiff's owner failed to establish the date the claim was mailed to defendant. It was also established that defendant denied plaintiff's claim on the ground of lack of medical necessity, and since plaintiff failed to establish that the denial of claim form was untimely, defendant was not precluded from raising its defense. Therefore, the lower court's denial of plaintiff's cross motion for summary judgment was affirmed.
Mary Immaculate Hosp. v Countrywide Ins. Co. (2006 NY Slip Op 51222(U))
June 28, 2006
The relevant facts considered by the court in this case involved a dispute between Mary Immaculate Hospital and Countrywide Insurance Company over $55,105.27 in medical services provided to Thomas Matamoros. The main issue decided by the court was whether the insurance company was required to pay for the medical services or whether they could deny the claim based on an alleged exclusion in the insurance policy. The holding of the case was that the hospital was awarded summary judgment against the insurance company for the amount of $55,105.27, along with statutory interest, attorney's fees, costs, and disbursements, as the court found that the insurance company failed to provide evidence to establish entitlement to apply the alleged exclusion from coverage.
Proscan Radiology of Buffalo v Progressive Cas. Ins. Co. (2006 NY Slip Op 51242(U))
June 27, 2006
The case involved a commercial claim brought by Proscan Radiology of Buffalo, Proscan Imaging, Buffalo, & Dr. Gurmeet Dhillon against Progressive Casualty Insurance Company. It began in the small claims part of the City Court of Buffalo and was adjourned at the consent of both parties. The main issue decided was the amount of payment owed by Progressive Casualty Insurance Company to the claimants. The court considered the evidence presented by both parties and ultimately held that Progressive Casualty Insurance Company was required to make a payment of $2,297.74 to the claimants.
Boai Zhong Yi Acupuncture Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 51202(U))
June 23, 2006
The court considered the fact that the plaintiff filed a motion for summary judgment to recover first-party no-fault benefits for health care services rendered to its assignor. The defendant had timely sent requests for verification, which it argued tolled the 30-day period within which it was obligated to pay or deny the claims. The main issue decided was whether the defendant had established the timely mailing of its verification requests. The holding of the court was that the defendant's opposition papers established the timely mailing of the verification requests, therefore tolling the 30-day period. As a result, the denials of claims were not untimely, and the plaintiff's motion for summary judgment was denied.
A.B. Med. Servs. PLLC v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 51347(U))
June 22, 2006
The relevant facts the court considered were whether the medical service providers were entitled to receive first-party no-fault benefits for the health care services rendered. The main issue decided was whether the providers had established a prima facie entitlement to summary judgment, shifting the burden to the insurance company to raise a triable issue of fact. The holding of the case was that the judgment was reversed, the order granting summary judgment was vacated, and the matter was remanded for further proceedings. The court held that a low impact study submitted by the insurance company constituted a proper basis for denial of the claims, and that the insurance company had demonstrated the existence of a triable issue of fact as to whether there was a lack of coverage, therefore the motion for summary judgment should not have been granted.
Ocean Diagnostic Imaging P.C. v State Farm Mut. Auto. Ins. Co. (2006 NY Slip Op 51195(U))
June 22, 2006
The court considered that Ocean Diagnostic Imaging P.C. was seeking to recover assigned first-party no-fault benefits and that a default judgment was entered in their favor. State Farm Mutual Automobile Insurance Company then moved to vacate the default judgment, which was granted by the Civil Court of the City of New York, Kings County. The main issue decided was whether defendant State Farm Mutual Automobile Insurance Company had a reasonable excuse for its default and a meritorious defense to the action. The court held that upon review of the record, there was no basis to disturb the lower court's finding that the defendant had established both a reasonable excuse for its default and a meritorious defense to the action, and therefore affirmed the lower court's order granting defendant's motion to vacate the default judgment.