No-Fault Case Law
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.
Ultimate Health Prods., Inc. v Travelers Ins. Co. (2019 NY Slip Op 51620(U))
October 11, 2019
The case involved Ultimate Health Products, Inc., as the assignee of Zenaida Solero, suing Travelers Insurance Company to recover first-party no-fault benefits. The main issue in the case was whether plaintiff had failed to appear for scheduled examinations under oath (EUOs). At the nonjury trial, the Civil Court dismissed the complaint after finding that the defendant had established that plaintiff had failed to appear for the EUOs. The appellate court reviewed the determination made after the nonjury trial and affirmed the judgment, stating that the trial court's opportunity to observe and evaluate the testimony and demeanor of the witnesses affords it a better perspective from which to assess their credibility.
Therefore, the holding of the case was that the judgment of the Civil Court, which dismissed the complaint on the grounds that the plaintiff had failed to appear for scheduled EUOs, was affirmed by the appellate court.
AOM Med. Supply, Inc. v Hereford Ins. Co. (2019 NY Slip Op 51619(U))
October 11, 2019
The court considered a case where AOM Medical Supply, Inc., as the assignee of Tiana Addison, sought to recover first-party no-fault benefits from Hereford Insurance Co. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint should be granted. The court held that the defendant's motion for summary judgment dismissing the complaint was affirmed, as the plaintiff's assignor had failed to appear for scheduled independent medical examinations. The court's decision was affirmed based on the reasons stated in a similar case, Allay Med. Servs., P.C., as Assignee of Mills, Keith A. v Metropolitan Gen. Ins. Co., which was decided concurrently.
Allay Med. Servs., P.C. v Metropolitan Gen. Ins. Co. (2019 NY Slip Op 51617(U))
October 11, 2019
The court considered the fact that defendant sought summary judgment to dismiss the complaint on the grounds that the plaintiff's assignor had failed to appear for scheduled examinations under oath (EUOs). Defendant established that the letters scheduling the EUOs had been timely mailed, that the plaintiff's assignor had failed to appear on either date, and that the claims had been timely denied on those grounds. The main issue decided was whether defendant's cross motion for summary judgement should be granted. The holding of the case was that the order denying defendant's cross motion for summary judgement was reversed, and defendant's cross motion for summary judgment was granted.