No-Fault Case Law

The court considered the fact that Quality Rehab and P.T., P.C. was seeking to recover first-party no-fault benefits from Tri State Consumers Ins. Co. as the assignee of Amnun Aminov. Tri State Consumers Ins. Co. had moved for summary judgment to dismiss the complaint on the grounds that verification of the claims remained outstanding and that the services at issue lacked medical necessity and the amounts sought exceeded the amounts permitted by the workers' compensation fee schedule. The court decided that defendant had not received all of the requested verification for the claims, making the causes of action premature, and plaintiff failed to raise a triable issue of fact. Additionally, the court found that the services at issue lacked medical necessity and the amounts sought exceeded the amounts permitted by the workers' compensation fee schedule. As a result, the court affirmed the judgment in favor of Tri State Consumers Ins. Co.

The relevant facts the court considered in this case were that the defendant, Tri State Consumers Ins. Co., had moved for summary judgment to dismiss a complaint by a provider to recover assigned first-party no-fault benefits, on the grounds that the services lacked medical necessity and exceeded the amount permitted by the workers' compensation fee schedule. The plaintiff, Jules Francois Parisien, M.D., as Assignee, had cross-moved for summary judgment. Defendant submitted an affirmed report from a doctor who had performed an independent medical examination (IME) of the plaintiff's assignor before the services at issue had been rendered, concluding a lack of medical necessity for further treatment. The Civil Court denied defendant's motion but held that defendant had timely denied plaintiff's claims. The main issue decided in this case was whether the services at issue lacked medical necessity and whether the amount sought exceeded the amount permitted by the workers' compensation fee schedule. The holding of the case was that the defendant's motion for summary judgment dismissing the complaint was ultimately granted, as defendant had established a lack of medical necessity for further treatment through the IME report, which was not rebutted by plaintiff. As a result, the defendant's motion for summary judgment dismissing the complaint was granted, and the order was reversed.

The relevant facts considered by the court included a provider seeking to recover assigned first-party no-fault benefits from an insurance company, and the application of the workers' compensation fee schedule. The main issue decided by the court was whether the provider was entitled to recover the principal sum of $1,498.09. The holding of the court was that the judgment awarding the principal sum to the provider was affirmed, with the insurance company being ordered to pay $25 in costs. The court also referenced a previous case involving the same provider and insurer, in which the judgment was affirmed for similar reasons.

The main issue in this case was the application of the workers' compensation fee schedule in a lawsuit by a provider to recover assigned first-party no-fault benefits. The court consolidated this action for trial with two other actions involving the same provider and insurer. After a nonjury trial, the Civil Court found in favor of the plaintiff and awarded them the principal sum of $2,807.40. The Appellate Term, Second Department affirmed the judgment, stating that for the reasons stated in another related case, the judgment in this case is affirmed. The court also deemed the notice of appeal from a previous decision as a premature notice of appeal from the final judgment.

The relevant facts considered by the court include the issue of whether the plaintiff, as the assignee of David Wright, was entitled to recover first-party no-fault benefits from the defendant insurer. The main issue decided was the application of the workers' compensation fee schedule, as the trial focused on this specific issue. The holding of the court was that the judgment awarding the plaintiff the principal sum of $2,111.94 was affirmed. The court stated that the defendant failed to demonstrate that the amount plaintiff sought to recover exceeded the amount permitted by the workers' compensation fee schedule, and therefore, there was no basis to disturb the Civil Court's determination.

The court considered the plaintiff's argument that they were entitled to a default judgment in the amount of $1,221.96, as well as interest on the original sum sought, costs, and disbursements. The main issue decided was whether the plaintiff was entitled to vacate the administrative dismissal of the action and, upon such vacatur, the entry of a default judgment. The court, in an order dated June 13, 2019, denied the plaintiff's motion to vacate the administrative dismissal of the action and for the entry of a default judgment. The court directed the defendant to pay the $50.00 difference between the payment made and the stipulation within 30 days, but affirmed that the order, insofar as appealed from, without costs.

The main issue in this case was whether the failure of the Civil Court to decide on the branch of the defendant's motion seeking to toll the accrual of no-fault statutory interest was appealable. The Court considered the fact that the Civil Court denied the branch of the defendant's motion seeking to dismiss the complaint, granted the branches seeking to strike the notice of trial and compel discovery, and did not decide the branch seeking to toll the accrual of no-fault statutory interest. The Appellate Term, Second Department ultimately held that no appeal lies from an order or portion thereof which fails to determine a motion or branch thereof, and as such, dismissed the appeal. Therefore, the higher court did not make a decision on the issue of tolling the accrual of no-fault statutory interest.

The court considered a case in which Englinton Medical, P.C., as assignee of Kavita Sewdat, sought to recover first-party no-fault benefits from Ameriprise Insurance Company in the amount of $7,570.30 for unspecified claims. Ameriprise moved for summary judgment to dismiss the complaint, arguing they had denied bills due to plaintiff's failure to appear for examinations under oath (EUOs) and lack of medical necessity. They also pointed out that they had already paid $3,253.92 for services rendered on September 1, 2016. Plaintiff cross-moved for summary judgment, but did not provide any bills or dispute the $3,253.92 claim that had been paid in a separate arbitration. The court ultimately reversed the order, granting summary judgment to Ameriprise and denying it to Englinton Medical, P.C. It held that Ameriprise was entitled to dismissal of the complaint in its entirety, finding that plaintiff had failed to appear for the EUOs, which was a condition precedent to the insurer's liability on the policy. The court also dismissed the $3,253.92 claim, as it had already been paid in a separate arbitration.

The Appellate Division, Second Department considered a case involving a dispute over the proper rate of interest to accrue on a judgment entered in favor of B.Z. Chiropractic, P.C. against Allstate Insurance Company. The case involved several procedural and substantive history, including an appeal from the Civil Court to the Appellate Term, as well as a subsequent Supreme Court action seeking declaratory judgment on the correct interest rate. Allstate sought to preclude the Supreme Court from considering the interest issue claiming that it had been resolved by the Appellate Term. The court held that an advisory opinion or dicta in an order by a court does not qualify under res judicata, collateral estoppel, or the law of the case doctrines to preclude a court in a later proceeding from considering the same issue. Therefore, the Supreme Court properly determined the rate of interest as 2% per month compounded, which applied in this case based on New York Insurance Law. The court held that there was no reason or opportunity for BZ to earlier litigate the rate of interest to which it was entitled as to trigger res judicata or collateral estoppel. Arguments as to the operation of CPLR 5019 (a) and whether the declaratory judgment represented an improper collateral attack upon the 2001 judgment itself were not raised by any party on appeal and were therefore not properly before the court.

Defendant moved for summary judgment to dismiss the complaint due to plaintiff's failure to appear at Examinations Under Oath (EUOs) on four separate occasions. However, the plaintiff argued that the defendant refused plaintiff's requests to reschedule the EUOs for lengthy adjournments of two to three months and did not present any evidence that the defendant had otherwise sent any requests for additional verification on the relevant 30-day periods for some of those bills. The Court considered the dates plaintiff failed to appear at EUOs, in this action seeking to recover assigned first-party no-fault benefits. The main issue was whether the plaintiff raised triable issues of fact as to whether plaintiff had failed to appear at the EUOs. Another issue was whether the EUOs scheduled before the defendant received the billed amounts at issue tolled the 30-day period for defendant to pay or deny the bills received. The prior decision and order decided both the motion and cross-motion, but it was recalled and vacated. The Court found in favor of the plaintiff and granted the motion to compel defendant to provide discovery.