No-Fault Case Law
Daily Med. Equip. Distrib. Ctr., Inc. v GEICO Gen. Ins. Co. (2018 NY Slip Op 51691(U))
November 23, 2018
The court considered the case of Daily Medical Equipment Distribution Center, Inc., as the assignee of Kristina Barbee, seeking to recover first-party no-fault benefits from GEICO General Insurance Company. The main issue of the case was the medical necessity of the supplies in question, as the trial focused on the testimony of defendant's expert witness and whether the supplies were deemed necessary. The Civil Court precluded the testimony of the expert witness and granted the plaintiff's motion for a directed verdict, resulting in a judgment in favor of the plaintiff for $1,556.96. The Appellate Term, Second Department reversed the judgment and remitted the matter to the Civil Court for a new trial, citing a similar case as precedent. The holding of the case was that the judgment in favor of the plaintiff was reversed, and a new trial was ordered.
Nova Chiropractic Servs., P.C. v GEICO Gen. Ins. Co. (2018 NY Slip Op 51690(U))
November 23, 2018
The court considered the issue of the medical necessity of the services in question during a nonjury trial in which a provider was seeking to recover assigned first-party no-fault benefits. The Civil Court precluded the testimony of the defendant's expert witness and granted the plaintiff's motion for a directed verdict, resulting in a judgment in favor of the plaintiff for $2,184.90. The main issue in the case was the admissibility of the defendant's expert witness testimony and the propriety of granting a directed verdict. The holding of the court was that the judgment was reversed, costs were awarded to the defendant, and the matter was remitted to the Civil Court for a new trial.
Note: This summary is based on the information provided and does not include specific details from the case such as names of individuals or specific medical services.
Nova Chiropractic Servs., P.C. v GEICO Gen. Ins. Co. (2018 NY Slip Op 51689(U))
November 23, 2018
The court considered the issue of the medical necessity of the services in question in a nonjury trial of an action by a provider to recover assigned first-party no-fault benefits. The Civil Court precluded the testimony of defendant's expert witness and granted plaintiff's motion for a directed verdict, ultimately awarding the plaintiff the principal sum of $1,310.94. The main issue was whether the services in question were medically necessary, and the court held that the judgment is reversed, with $30 costs, and the matter is remitted to the Civil Court for a new trial. The decision was made based on the reasons stated in a previous case, Nova Chiropractic Servs., P.C., as Assignee of Miguel A. Vizcaino v GEICO Gen. Ins. Co., and was decided on November 23, 2018.
Nova Chiropractic Servs., P.C. v GEICO Gen. Ins. Co. (2018 NY Slip Op 51688(U))
November 23, 2018
The main issue in this case was the medical necessity of the services in question in a provider's action to recover assigned first-party no-fault benefits. The court considered the preclusion of the testimony of defendant's expert witness and the granting of plaintiff's motion for a directed verdict. The court found that defendant's expert medical witness should have been permitted to testify as to their opinion regarding the lack of medical necessity of the services at issue. However, the expert witness's testimony should be limited to the basis for the denial as set forth in the peer review report. The judgment was reversed, and the matter was remitted to the Civil Court for a new trial.
Nova Chiropractic Servs., P.C. v GEICO Gen. Ins. Co. (2018 NY Slip Op 51687(U))
November 23, 2018
The court considered a nonjury trial in an action by a provider to recover assigned first-party no-fault benefits. The main issue was the medical necessity of the services in question. The Civil Court precluded the testimony of defendant's expert witness and granted plaintiff's motion for a directed verdict, resulting in a judgment in favor of the plaintiff in the principal sum of $2,184.90. The Appellate Term reversed the judgment and remitted the matter to the Civil Court for a new trial. The holding of the case was that the judgment in favor of the plaintiff was reversed and remitted for a new trial.
Nova Chiropractic Servs., P.C. v GEICO Gen. Ins. Co. (2018 NY Slip Op 51685(U))
November 23, 2018
The court considered a nonjury trial of a provider's action to recover assigned first-party no-fault benefits, with the sole issue being the medical necessity of the services in question. The Civil Court precluded the testimony of the defendant's expert witness and granted the plaintiff's motion for a directed verdict, resulting in a judgment in favor of the plaintiff in the principal sum of $2,184.90. The main issue decided was the admissibility of the defendant's expert witness testimony, and whether the directed verdict was appropriate. The holding of the case was that the judgment was reversed and the matter was remitted to the Civil Court for a new trial, based on reasons stated in a related case.
Active Care Med. Supply Corp. v American Tr. Ins. Co. (2018 NY Slip Op 51683(U))
November 23, 2018
The court considered the fact that the defendant had established that the examination under oath (EUO) scheduling letters had been timely mailed and that the plaintiff had failed to appear for the duly scheduled EUOs. The main issue decided was whether the defendant had met the requirements for scheduling the EUOs and whether the plaintiff's failure to appear justified the dismissal of the complaint. The holding of the court was that the defendant had indeed met the requirements for scheduling the EUOs and that the plaintiff's failure to appear justified the dismissal of the complaint. Therefore, the court affirmed the order of the Civil Court, granting the defendant's motion for summary judgment dismissing the complaint.
Maiga Prods. Corp. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51682(U))
November 23, 2018
The main issue in this case was whether the defendant, State Farm Mutual Automobile Insurance Co., was entitled to summary judgment dismissing the complaint brought by Maiga Products Corp. as Assignee of Dorsinvil, Mireille, to recover assigned first-party no-fault benefits. State Farm argued that Maiga had failed to appear for duly scheduled examinations under oath (EUOs). The court found that State Farm had established the timely and proper mailing of the EUO scheduling letters and the denial of claim forms, as well as Maiga's failure to appear for the EUOs. The court also found that the only remaining issue for trial was "the nexus between where the bill is received and where the verification and denial is processed and mailed from Ballston Spa, when the bill was received in Atlanta, Georgia. The holding of the court was that State Farm was entitled to summary judgment dismissing the complaint, reversing the order of the Civil Court and granting State Farm's motion.
Maiga Prods. Corp. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51681(U))
November 23, 2018
The main issue in this case was whether an insurer was entitled to summary judgment dismissing a complaint on the basis that a provider failed to appear for examinations under oath (EUOs). The insurer argued that it had twice demanded an EUO from the provider, and that the provider had twice failed to appear, thus justifying their timely denial of the claims. The Civil Court found that the insurer had established the timely and proper mailing of the EUO scheduling letters and the denial of claim forms, as well as the provider's failure to appear for the EUOs. However, the provider challenged this finding and argued that the insurer's practices and procedures regarding the receipt of its mail were irrelevant. The Appellate Term ultimately reversed the order, granting the insurer's motion for summary judgment dismissing the complaint.
Big Apple Med. Supply, Inc. v Nationwide Affinity Ins. Co. of Am. (2018 NY Slip Op 51659(U))
November 21, 2018
The court considered a motion by the defendant to grant summary judgment and dismiss the complaint based on the plaintiff's failure to respond within 120 days to the initial request for verification. The main issue was whether the defendant could prove by admissible evidence that it did not receive the requested verification within the allotted 120-day period. The court held that defendant's conclusory denial of receipt was insufficient to make a prima facie showing of entitlement to summary judgment. Additionally, the court found that the defendant failed to produce an original "certificate of conformity" for two affidavits, rendering the affidavits inadmissible as a matter of law. As a result, the defendant failed to establish their entitlement to summary judgment by admissible evidence, and the motion for summary judgment was denied.