No-Fault Case Law
New Horizon Surgical Ctr., LLC v Travelers Ins. Co. (2019 NY Slip Op 51690(U))
October 18, 2019
In New Horizon Surgical Center, LLC v Travelers Insurance Company, on October 18, 2019, the Second Department of the Appellate Term considered a denial of defendant's (Travelers Insurance Company) motion for summary judgment. They denied the motion for summary judgment, asserting that the provider (New Horizon Surgical Center, LLC) had failed to provide the requested verification for assigned first-party no-fault benefits. The proof defendant submitted was sufficient to demonstrate that defendant had not received the requested verification. The Court found that the defendant was not required to pay or deny plaintiff's claims upon receipt of a partial response to defendant's verification requests. The court reversed the order, concluding that defendant's motion for summary judgment dismissing the complaint should be granted.
Tyorkin v Global Liberty Ins. (2019 NY Slip Op 51689(U))
October 18, 2019
The court considered the fact that the defendant had submitted an affidavit by a supervisor employed by Omnimed Evaluation Services, which had been retained by defendant to schedule independent medical examinations (IMEs) and that the assignor had failed to appear for the duly scheduled IMEs. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint on the ground that the plaintiff's assignor had failed to appear for duly scheduled IMEs. The holding of the case was that the defendant was entitled to summary judgment dismissing the complaint because they had timely denied the claims and the plaintiff had failed to raise a triable issue of fact in opposition to the defendant's cross motion. The court reversed the order denying the defendant's cross motion for summary judgment and granted the defendant's cross motion for summary judgment dismissing the complaint.
Lidas Med. Supply, Inc. v Global Liberty Ins. (2019 NY Slip Op 51688(U))
October 18, 2019
The court considered the fact that the defendant had timely and properly denied the claims at issue based upon the plaintiff's assignor's failure to appear for independent medical examinations (IMEs). The main issue decided was whether the address to which the IME scheduling letters had been mailed was proper. The holding of the case was that the address to which the IME scheduling letters were mailed was proper, as it matched the one provided by the plaintiff's assignor on the assignor's sworn application for no-fault benefits (NF-2) and on the assignor's sworn notice of intention to make claim form which was submitted to the defendant. As a result, the defendant's cross motion for summary judgment dismissing the complaint was granted.
Gentlecare Ambulatory Anesthesia Servs. v GEICO Ins. Co. (2019 NY Slip Op 51684(U))
October 18, 2019
The case involved a dispute between a medical provider and an insurance company over first-party no-fault benefits. The insurance company had denied the provider's claim on the basis that the provider had failed to appear for scheduled examinations under oath (EUOs). The Civil Court granted the insurance company's motion for summary judgment, and the provider appealed. The Appellate Term affirmed the order, holding that the proof submitted by the insurance company was sufficient to demonstrate that the denial of claim form had been timely mailed and that the provider had failed to appear for the EUOs. The court also stated that the insurance company was not required to set forth objective reasons for requesting the EUOs in order to establish its entitlement to summary judgment. Therefore, the Civil Court's order was affirmed.
SMQ Med., P.C. v National Liab. & Fire Ins. (2019 NY Slip Op 51681(U))
October 18, 2019
The court considered that in a no-fault benefits action, the defendant's answer was accompanied by a demand for written interrogatories, and the plaintiff's notice of trial and certificate of readiness in September 2015 stated that discovery was waived. The main issue decided was whether the court properly granted the defendant's motion to vacate the notice of trial based on the erroneous statement that discovery was waived. The holding of the case was that the court did not improvidently exercise its discretion when it denied the plaintiff's cross motion seeking a protective order, and the order to vacate the notice of trial was affirmed. The court also found that the defendant's timely motion to vacate the notice of trial was based upon a certificate of readiness which contained the erroneous statement that discovery was waived.
Spine Care of NJ, P.C. v Global Liberty Ins. Co. of N.Y. (2019 NY Slip Op 51632(U))
October 11, 2019
The court considered an appeal from an order of the Civil Court of the City of New York, Kings County granting the branches of plaintiff's cross motion seeking summary judgment on bills for services rendered on specific dates. The main issue decided was whether the plaintiff was entitled to summary judgment on the bills for services rendered on December 21, 2016 and December 29, 2016. The court held that the branches of plaintiff's cross motion seeking summary judgment on these bills should have been denied, as the evidence submitted failed to establish that the claims had not been timely denied or that the defendant had issued timely denial of claim forms that were conclusory, vague, or without merit as a matter of law. Therefore, the court reversed the order and denied the branches of plaintiff's cross motion seeking summary judgment on the bills for services rendered on those dates.
Acupuncture Approach, P.C. v Global Liberty Ins. Co. of NY (2019 NY Slip Op 51631(U))
October 11, 2019
The main issue in this case was whether the letters scheduling the plaintiff's assignor's examinations under oath (EUOs) were timely and properly mailed. The only witness at trial was an employee of the defendant who testified as to the defendant's policies and procedures regarding mailing EUO scheduling letters. The defendant established that the initial and follow-up letters scheduling an EUO had been timely and properly mailed. As a result, the judgment of the Civil Court awarding the plaintiff the principal sum of $1,342.08 was reversed, and the matter was remitted to the Civil Court for the entry of a judgment in favor of the defendant dismissing the complaint. The court held in favor of the defendant, concluding that the letters scheduling the EUOs had been timely and properly mailed, and the plaintiff's claim for first-party no-fault benefits was dismissed.
Urban Well Acupuncture, P.C. v Metropolitan Prop. & Cas. Ins. Co. (2019 NY Slip Op 51630(U))
October 11, 2019
The court considered the fact that the plaintiff failed to appear for scheduled examinations under oath (EUOs) and did not provide written opposition to the defendant's motion for summary judgment. The main issue decided was whether the plaintiff was entitled to relief from the order granting the defendant's motion for summary judgment, which was denied by the Civil Court. The holding of the case was that the order denying the plaintiff's motion to vacate the prior order of summary judgment was affirmed, as the plaintiff did not establish that they were entitled to relief. The court found that whether the summary judgment was granted on default or not, the plaintiff failed to demonstrate that they had a meritorious opposition to the defendant's motion.
21st Century Pharm., Inc. v Ameriprise Ins. Co. (2019 NY Slip Op 51629(U))
October 11, 2019
The main issue in this case was whether the insurance company was required to provide objective reasons for requesting examinations under oath (EUOs) in order to establish its prima facie entitlement to summary judgment. The Court held that the insurance company was not required to provide objective reasons for requesting EUOs, as they only need to demonstrate, as a matter of law, that they twice duly demanded an EUO from the provider, the provider twice failed to appear, and the insurer issued a timely denial of the claim. Therefore, the Court affirmed the order granting the insurance company's motion for summary judgment dismissing the complaint, which had been denied in a previous order.
Yumi Acupuncture, P.C. v Integon Natl. Ins. Co. (2019 NY Slip Op 51628(U))
October 11, 2019
The relevant facts considered by the court were that the defendant, Integon National Ins. Co., sought summary judgement dismissing the complaint brought by Yumi Acupuncture, P.C. The issue decided was whether the plaintiff's assignor had failed to appear for duly scheduled independent medical examinations (IMEs). The court held that the defendant's motion for summary judgement dismissing the complaint should be granted. The decision was based on the fact that the plaintiff's assignor had failed to appear for the IMEs, and the court's reasoning was consistent with a similar case, Allay Med. Servs., P.C. v Metropolitan Gen. Ins. Co., in which the same decision was reached.