No-Fault Case Law
Island Life Chiropractic Pain Care, PLLC v Nationwide Ins. (2020 NY Slip Op 51359(U))
November 13, 2020
The Court considered an appeal from an order of the Civil Court of the City of New York, which granted the defendant's motion for summary judgment dismissing the complaint and denied the plaintiff's cross motion for summary judgment. The main issue decided was whether the defendant's motion for summary judgment should have been denied, and if the plaintiff's arguments against it were properly before the court. The holding was that all of the plaintiff's arguments as to why the defendant's motion for summary judgment should have been denied were not properly before the court, as they were being raised for the first time on appeal, and were therefore declined to be considered. As a result, the Court affirmed the order.
Unitrin Advantage Ins. Co. v Cohen & Kramer M.D., P.C. (2020 NY Slip Op 06474)
November 12, 2020
The main issues decided in this case involved a dispute over whether an insurance company had a duty to pay no-fault benefits to a medical provider. The court found that the insurer's evidence, including affidavits attesting to regular business procedures and practices, provided sufficient proof of proper mailing of notices of scheduled IME exams to the claimant. Although the notices incorrectly added a "1st Floor" designation to the address, there was no dispute that the address was otherwise correct and that the claimant resided at that building. The burden then shifted to the defendant, who failed to offer any evidence in opposition, such as an affidavit from the claimant disavowing receipt of the IME notices, or even describing the building in a way that would support an inference that the inclusion of a floor in the address would result in nonreceipt. Therefore, the court held that the defendant's claims to no-fault benefits for its medical services rendered to the claimant were denied.
LVOV Acupuncture, P.C. v Nationwide Ins. Co. (2020 NY Slip Op 51343(U))
November 6, 2020
The relevant facts considered by the court were that LVOV Acupuncture, P.C. was seeking to recover assigned first-party no-fault benefits from Nationwide Ins. Co. The court granted the defendant's motion for summary judgment, dismissing the complaint on the grounds that the defendant had already fully paid the plaintiff for the services in question. The main issue decided in this case was whether the defendant had fulfilled its obligation to pay the plaintiff for the services at issue. The holding of the court was that the order granting the defendant's motion for summary judgment was affirmed, with $25 costs. This decision was in line with the court's reasoning in a related case, and was made by Justices Aliotta, Elliot, and Siegal.
NL Quality Med., P.C. v GEICO Ins. Co. (2020 NY Slip Op 51340(U))
November 6, 2020
The court considered the case of NL Quality Medical, P.C., who appealed an order of the Civil Court that granted GEICO Ins. Co.'s motion for summary judgment dismissing the complaint and denied the plaintiff's cross motion for summary judgment. The main issue was whether the proof submitted by the defendant was sufficient to give rise to a presumption that certain documents had been timely mailed and to demonstrate that the plaintiff had failed to comply with a condition precedent to coverage. The holding of the case was that the court modified the order by denying the branch of defendant's motion seeking summary judgment dismissing the second cause of action, as they found that an issue of fact exists as to whether the plaintiff is entitled to recover any additional reimbursement with respect to the services. Therefore, the branch of plaintiff's cross motion seeking summary judgment upon the second cause of action was properly denied.
LVOV Acupuncture, P.C. v Nationwide Ins. Co. (2020 NY Slip Op 51339(U))
November 6, 2020
The court considered the motion for summary judgment filed by the defendant, Nationwide Ins. Co., in a case brought by LVOV Acupuncture, P.C., as the assignee of Ozhan Tastaban, to recover first-party no-fault benefits. The main issue decided was whether the defendant had properly used the workers' compensation fee schedule to determine the amount owed to the plaintiff for the services in question. The court held that the defendant had fully paid the plaintiff for the services at issue, and that the affidavit executed by the defendant's certified medical coder established that the defendant had properly used the workers' compensation fee schedule. The court found that the plaintiff failed to rebut the defendant's showing, and affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.
Flushing Traditional Acupuncture, P.C. v GEICO Ins. Co. (2020 NY Slip Op 51338(U))
November 6, 2020
The court considered whether the defendant insurance company had properly used the workers' compensation fee schedule applicable to chiropractors to reimburse the plaintiff, a provider of acupuncture services, for the services rendered. The main issue decided was whether the plaintiff was entitled to recover the unpaid portion of claims for services billed under specific CPT codes. The holding of the case was that the Civil Court denied the branches of the plaintiff's motion seeking summary judgment for the unpaid portion of the claims and granted the branches of the defendant's cross motion seeking summary judgment dismissing those claims. The decision was affirmed by the court.
Flushing Traditional Acupuncture, P.C. v GEICO Ins. Co. (2020 NY Slip Op 51337(U))
November 6, 2020
This case involved an appeal from a decision in a no-fault benefits action by a healthcare provider against an insurance company. The main issue at hand was whether the insurance company properly used the workers' compensation fee schedule applicable to chiropractors to reimburse the healthcare provider for acupuncture services rendered. The court found that the insurance company had provided sufficient evidence to show that it had fully paid the healthcare provider for the services at issue in accordance with the fee schedule for acupuncture services performed by chiropractors. As a result, the court affirmed the lower court's decision to grant the insurance company's motion for summary judgment and dismiss the portion of the healthcare provider's complaint seeking to recover the unpaid portion of the claims for services at issue.
Healing Art Acupuncture, P.C. v GEICO Ins. Co. (2020 NY Slip Op 51336(U))
November 6, 2020
The relevant facts the court considered were that Healing Art Acupuncture, P.C. sought to recover assigned first-party no-fault benefits and defendant, GEICO Ins. Co., argued that it had properly used the workers' compensation fee schedule applicable to chiropractors who render the same services as acupuncturists to reimburse plaintiff for the acupuncture services. The main issue decided was whether the defendant had properly used the fee schedule to reimburse the plaintiff for the acupuncture services. The holding was that the Civil Court denied plaintiff's motion for summary judgment and granted defendant's cross motion for summary judgment dismissing the complaint. The order was affirmed by the Supreme Court, Appellate Term, Second Department.
ABC Physical Therapy, P.C. v GEICO Ins. Co. (2020 NY Slip Op 51335(U))
November 6, 2020
The court considered the facts of an action by a provider to recover assigned first-party no-fault benefits, in which the defendant's motion for summary judgment dismissing the complaint was granted and the plaintiff's cross motion for summary judgment was denied. The main issue decided was whether the branch of defendant's motion seeking summary judgment dismissing the first cause of action should be denied. The holding of the court was that the order was modified by providing that the branch of defendant's motion seeking summary judgment dismissing the first cause of action is denied, and as modified, the order is affirmed, without costs.
Lacina v Hereford Ins. Co. (2020 NY Slip Op 51333(U))
November 6, 2020
The court considered the denial of a provider's motion for summary judgment and the granting of the defendant's cross motion for summary judgment in a case involving the recovery of assigned first-party no-fault benefits. The main issue decided was whether the defendant's affidavit and contemporaneous affidavits were sufficient to establish the proper mailing of denial of claim forms. The court held that the affidavit executed by the defendant's no-fault supervisor and the contemporaneous affidavits executed by the defendant's mailing officer were indeed sufficient to establish the proper mailing of the denial of claim forms. Therefore, the court affirmed the order, with costs.