No-Fault Case Law
Mega Supply & Billing Inc. v Allstate Ins. Co. (2005 NY Slip Op 52168(U))
December 30, 2005
The relevant facts considered by the court included the plaintiff's motion for summary judgment to recover no-fault benefits from the defendant in the amount of $540.00, which the defendant failed to pay or deny within the required 30-day period. The main issue decided by the court was whether the defendant had a valid basis to toll the 30-day period for payment of benefits. The court also considered the defense of lack of medical necessity and the assertion by the defendant that the accident was staged in order to deny the claim. The holding of the case was that the plaintiff's motion for summary judgment was granted, and the court directed the clerk to enter judgment in favor of the plaintiff in the sum of $540.00, statutory interest, and attorney's fees.
St. Vincent’s Hosp. & Med. Ctr. v County Wide Ins. Co. (2005 NY Slip Op 10114)
December 27, 2005
The court considered an action to recover no-fault medical payments under an insurance contract. The main issue was whether the plaintiffs were entitled to summary judgment on their first and second causes of action, and whether the defendant's cross motion for summary judgment dismissing those actions should be granted. The holding was that the Supreme Court correctly granted the defendant insurer's cross motion for summary judgment dismissing the first cause of action, but erred in granting summary judgment dismissing the second cause of action. The second cause of action was reinstated, as numerous questions of fact existed as to how the claim was processed and whether it should be paid by a workers' compensation carrier. Neither party demonstrated its prima facie entitlement to judgment as a matter of law, and the remaining contentions were deemed without merit.
Lamed Med. P.C. v Travelers Ins. Co. (2005 NY Slip Op 52142(U))
December 22, 2005
The court case involved Lamed Medical P.C., a medical services provider, seeking to vacate a master arbitration award after the lower arbitrator denied its claim, and the master arbitrator subsequently denied the request for review on the basis that the appeal was untimely. The main issue decided was whether the request for review was timely made, and if not, whether the Master Arbitrator had the authority to deny the request for review. The court held that the petitioner failed to demonstrate a ground to vacate the Master Arbitrator's decision and that the determination that petitioner failed to timely appeal the lower arbitration award was not arbitrary or a violation of petitioner's due process rights. The court dismissed the petition to vacate the Master Arbitrator's award, stating that the petition would be denied even if it had complied with statutory requirements.
Multiquest, P.L.L.C. v Allstate Ins. Co. (2005 NY Slip Op 52071(U))
December 20, 2005
The court considered a series of 12 actions seeking no fault first class benefits, which involved motions for summary judgment from plaintiff Multiquest, P.L.L.C., and cross-motions. The main issue decided was whether the decision of the New York Court of Appeals in State Farm v. Mallela should be applied to the cases at hand. The holding of the case was that the decision in State Farm v. Mallela should be applied, and that under the facts of the case, Multiquest, P.L.L.C. was entitled to summary judgment on its claim.
Multiquest PLLC v Allstate Ins. Co. (2005 NY Slip Op 52209(U))
December 19, 2005
The court considered whether Multiquest PLLC was entitled to summary judgment in its action against Allstate Insurance Company to recover the cost of health care services, according to the Insurance Law and regulations of the New York State Insurance Department. The main issue at hand was whether the evidence provided by Multiquest was sufficient to warrant summary judgment, and whether Allstate was entitled to summary judgment to deny payment to Multiquest based on allegations of fraudulent billing practices. The court held that Multiquest's motion for summary judgment was denied, and Allstate's motion for summary judgment was granted. The complaint filed by Multiquest was dismissed. Despite Multiquest's failure to establish evidence supporting their claim, the court also noted that recent Court of Appeals decisions involving No-Fault Law have addressed the issue of insurance fraud, which has undermined the goals of the law.
Multiquest, P.L.L.C. v Allstate Ins. Co. (2005 NY Slip Op 52069(U))
December 19, 2005
The court considered the motion for summary judgment from both parties, who were involved in a case concerning the Comprehensive Motor Vehicle Reparations Act for reimbursement of psychological injury treatments following an automobile accident. The critical issue was whether the plaintiff could receive payment for the psychological treatments due to a timely denial from the defendant. The court holding is that the defendant's failure to issue a timely denial of claim rendered the no-fault benefits overdue according to the law. The defendant argued that the plaintiff did not have a psychologist as an "owner" at the time of billing for services, and the corporate structure of the plaintiff was defective. However, the court did not take these arguments into account. Furthermore, the court determined that the regulation does not apply retroactively to bar recovery of the no-fault claim.
JSI Expert Servs. Inc. v Firemans Fund Ins. Co. (2005 NY Slip Op 52058(U))
December 16, 2005
The court considered a case in which JSI Expert Services Inc., sought to recover first party no-fault benefits for medical equipment provided to treat its assignor. The main issue was whether the insurance company had the right to raise a defense at the arbitration hearing that the assignor was working at the time of the accident, despite failing to deny the claim in a timely manner. The court concluded that the defense raised by the insurance company was a denial of coverage defense and was not precluded by the fact that it failed to timely deny the claim. The holding of the court was that the arbitrator's award was rational and not arbitrary or capricious, so the petition was dismissed and the insurance company's motion to dismiss the petition was granted.
Careplus Med. Supply Inc. v State-Wide Ins. Co. (2005 NY Slip Op 25545)
December 15, 2005
The relevant facts of the case were that Careplus Medical Supply was seeking to recover first-party no-fault benefits for medical supplies it provided, while State-Wide Insurance Company had submitted a properly completed denial of claim form covering all the claims involved in the lawsuit. The main issue was whether the denial of claim form submitted by State-Wide Insurance Company established that the claims were sent and received. The court held that the denial of claim form submitted by State-Wide Insurance Company sufficiently established that the plaintiff sent and the defendant received the claims. Therefore, the court unanimously reversed the previous order without costs, granted plaintiff's motion for summary judgment, and remanded the matter to the court below for a calculation of statutory interest and an assessment of attorney's fees.
Air Plus Surgical Supply, Inc. v Progressive Ins. Co. (2005 NY Slip Op 52088(U))
December 12, 2005
The relevant facts the court considered in this case included a dispute over first-party no-fault benefits for medical supplies provided to the plaintiff's assignor. The main issue decided was whether the plaintiff was entitled to summary judgment, as the plaintiff had established its prima facie entitlement to summary judgment by showing that it submitted completed proofs of claims, and that payments of no-fault benefits were overdue. The court held that the plaintiff's motion for summary judgment should be granted in the principal sum of $2,983, and the matter was remanded for a calculation of statutory interest and an assessment of attorney's fees. The court also dismissed the defendant's cross-appeal. The court emphasized that the defendant was required to submit proof in admissible form to rebut the plaintiff's prima facie showing, and since the report was not in admissible form, plaintiff's motion should have been granted.
Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co. (2005 NYSlipOp 09484)
December 12, 2005
The case involved a dispute over an action to recover no-fault medical payments under insurance contracts. The plaintiffs appealed the lower court’s denial of their summary judgment motion, while the defendant cross-appealed from portions of the order denying their cross motion for summary judgment dismissing the complaint. The court held that the defendant was not obligated to pay or deny the claim until receiving verification of all relevant information requested. The defendant was found to be entitled to summary judgment dismissing both the first and second causes of action, as the plaintiffs failed to respond to the defendant’s request for verification. The defendant’s cross motion was granted, along with an award of costs, and the plaintiff’s complaint was dismissed. The denial of the defendant’s summary judgment motion was reversed, and the plaintiff’s second cause of action was dismissed as well, given the lack of a timely response to the defendant’s request for verification.