No-Fault Case Law
Rockaway Blvd. Med. P.C. v Progressive Ins. (2004 NY Slip Op 24184)
June 2, 2004
The court considered the claim form submitted by the plaintiff to the defendant, the absence of disclosure of the business relationship between the treating provider and the billing provider, and the significance of the information required by form N-F 3. The main issues decided were whether the claim submitted by the plaintiff was sufficient to establish its right to payment from the defendant, and whether the plaintiff submitted a proper proof of claim. The holding of the case was that the plaintiff did not submit a proper proof of claim, and therefore did not establish a prima facie case of entitlement to payment of no-fault benefits, resulting in the denial of the motion for summary judgment.
Nyack Hosp. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 04304)
June 1, 2004
The court considered an action to recover no-fault benefits, with the defendant appealing from an order that granted the plaintiff's motion for summary judgment and denied the defendant's cross motion for summary judgment. The main issue in the case was whether the plaintiff demonstrated its entitlement to summary judgment by establishing that the defendant did not deny or pay the two claims in question within 30 days, and if the defendant submitted sufficient evidence to raise a triable issue of fact regarding the medical treatment alleged in the first cause of action and whether the underlying contract of insurance alleged in the third cause of action had been cancelled. The holding of the case was that the plaintiff's motion for summary judgment was properly granted because the defendant did not submit sufficient evidence in admissible form to raise a triable issue of fact, and as a result, the defendant's remaining contentions were deemed academic.
Ocean Diagnostic Imaging v Geico Ins. (2004 NY Slip Op 50511(U))
May 28, 2004
The relevant facts considered by the court were that Ocean Diagnostic Imaging, a health service provider, sought assigned first-party no-fault benefits from Geico Insurance. The main issue decided was whether Ocean Diagnostic Imaging was entitled to summary judgment, and the court held that they were. The court found that Ocean Diagnostic Imaging had established a prima facie entitlement to summary judgment by submitting proper proof of the claim and the amount of the loss, and that Geico Insurance had failed to raise any triable issues of fact. The court also found that Geico Insurance did not respond to the claim within the required 30-day period and that their requests for examinations under oath did not toll the 30-day period, therefore Ocean Diagnostic Imaging's motion for summary judgment should have been granted. The matter was remanded for the calculation of statutory interest and an assessment of attorney's fees.
A.B. Med. Servs., Pllc v N. Y. Cent. Mut. Fire Ins. Co. (2004 NY Slip Op 50550(U))
May 26, 2004
The court considered an action to recover first-party no-fault benefits for medical services rendered to an assignor. The plaintiffs moved for summary judgment, and the court granted summary judgment on certain claims. The main issue was whether the defendant had provided proof in admissible form to rebut the plaintiff's prima facie showing of entitlement to summary judgment. The court found that the defendant had failed to provide sufficient proof to raise a triable issue of fact as to the medical necessity of the services rendered, which would warrant denial of the plaintiff's motion for summary judgment. Therefore, the court held that the plaintiff's motion was properly granted and affirmed the judgment in their favor.
A.B. Med. Servs. v N. Y. Cent. Mut. Fire Ins. Co. (2004 NY Slip Op 50507(U))
May 26, 2004
In this case, the plaintiffs sought to recover first-party no-fault benefits for medical services rendered to their assignor, totaling $5,773.94, as well as statutory interest and attorney's fees. The lower court granted summary judgment on claims totaling $2,576.32, while denying summary judgment on the remaining $1,440 claim. The issue before the appellate court was whether the denial of the motion for summary judgment on the $1,440 claim was proper, and if the remaining claims were properly granted summary judgment. The appellate court affirmed the judgment, finding that the plaintiffs had established their entitlement to summary judgment by submitting complete proofs of claims, and that the defendant had failed to provide proof in admissible form to rebut the plaintiff's showing of medical necessity, as required by law. Therefore, the plaintiffs' motion for summary judgment was properly granted, and the judgment was affirmed.
Park Neurological Servs. P.C. v GEICO Ins. (2004 NY Slip Op 24210)
May 26, 2004
The court in this case was considering a claim for first-party no-fault benefits. The plaintiff, a neurological services provider, had submitted the claim to the defendant insurance company, but the claim was denied based on a peer review. The provider then filed a lawsuit seeking to recover the amount of the original claim, as well as statutory interest and attorney's fees. The main issue was whether the defendant's denial was valid, and the court determined that the denial was not sufficiently supported with reasons, and therefore the defendant was precluded from asserting the defense of lack of medical necessity. The holding of the court was to reverse the lower court's order, grant the plaintiff's motion for summary judgment, and remand the case for the calculation of statutory interest and an assessment of attorney's fees.
A.B. Med. Servs. v Am. Tr. Ins. Co. (2004 NY Slip Op 50515(U))
May 25, 2004
The court considered the appeal by the plaintiffs from an order denying their motion for summary judgment in a case involving a claim for first-party no-fault benefits for medical services rendered to their assignor. The main issue was whether the plaintiffs provided the defendant with properly completed claim forms, as required by Insurance Law § 5101 et seq. In support of their motion, the plaintiffs submitted an affidavit from the practice and billing manager of one of the plaintiffs, but the affidavit did not specify for which plaintiff she was the billing manager, making it insufficient to establish that the plaintiffs provided the defendant with properly completed claim forms. As a result, the plaintiffs failed to make a prima facie showing of entitlement to summary judgment, and the order denying their motion was affirmed.
Amaze Med. Supply Inc. v Allstate Ins. Co. (2004 NY Slip Op 50447(U))
May 20, 2004
The court considered the plaintiff's motion for summary judgment in an action to recover first-party no-fault benefits, arguing that the defendant's failure to timely deny its claim entitled the plaintiff to summary judgment. The plaintiff submitted a complete proof of claim to the defendant, which the defendant neither paid nor denied within 30 days, as required by law. The plaintiff provided evidence of mailing the bills to the defendant on September 18, 2001, shifting the burden to the defendant to come forward with a triable issue of fact. The defendant's attorney argued that the denial letter was timely, stating that the defendant received the claim on October 18, 2001, but lacked personal knowledge of the underlying facts. The court held that the lower court should have granted the plaintiff's motion for summary judgment and remanded the matter for the calculation of statutory interest and attorney's fees pursuant to Insurance Law § 5106 (a) and the regulations promulgated thereunder.
Dependable Ambulette, Inc. v Progressive Ins. Co. (2004 NY Slip Op 24160)
May 19, 2004
The court considered the case of Dependable Ambulette, Inc., who had provided ambulette services to Boris Cherkalin and filed a complaint against Progressive Insurance Co. after being denied payment for their services. Progressive Insurance Co. argued that plaintiff lacked jurisdiction to bring the case and that assigned ambulette services were not eligible for reimbursement under the No-Fault Law, Insurance Law § 5102. The main issue in the case was whether assigned ambulette services are eligible for reimbursement under the No-Fault Law. The court found that according to the law, ambulette services do not constitute covered expenses incurred pursuant to the No-Fault Law and are not considered "health services," therefore dismissing the plaintiff's complaint.
A.B. Med. Servs. v Country-Wide Ins. Co. (2004 NY Slip Op 50535(U))
May 14, 2004
The court considered the motion for partial summary judgment in the amount of $11,420.05 filed by plaintiffs in an action to recover first-party no-fault benefits, statutory interest, and attorney's fees for health services provided to their assignor. The main issue was whether the plaintiffs had provided the defendant with properly completed claim forms. The court decided to affirm the order denying the motion for partial summary judgment, stating that the affidavit submitted by plaintiffs' billing manager was insufficient to establish that the defendant had been provided with properly completed claim forms. Therefore, the plaintiffs failed to make a prima facie showing of entitlement to judgment as a matter of law. The decision was made on May 14, 2004.