No-Fault Case Law
American Tr. Ins. Co. v Excell Clinical Lab (2024 NY Slip Op 50820(U))
June 28, 2024
The court considered the petitioner's unopposed petition to vacate an arbitration award related to a no-fault benefits claim. The petitioner argued that the respondents failed to establish the medical necessity of the disputed services provided, shifting the burden onto the respondents. However, the court disagreed, stating that the evidentiary standards for no-fault arbitrations differ from those in trials or motions for summary judgment. The court emphasized the limited judicial review of arbitration awards and found that the arbitrators' decisions were not irrational and did not violate any strong public policy. As a result, the court denied the petition to vacate the arbitration award in its entirety.
UGP Acupuncture, P.C. v Progressive N. Ins. Co. (2024 NY Slip Op 50814(U))
June 26, 2024
The court considered the procedural and factual history of the case, including the initial filing of a No-Fault action by UGP Acupuncture, P.C. against Progressive Northern Insurance Company for payment reimbursement for medical services. The court also noted the execution of a Stipulation of Settlement and Discontinuance preserving the index number for Plaintiff to reserve the correct insurance carrier. The main issue decided was whether the court should amend the summons and complaint to remove Progressive as the outgoing defendant and add Country Wide Insurance Company as the incoming defendant. The court ultimately held that the Stipulation of Settlement and Discontinuance rendered the index number disposed, vacated the Interim Order, and deemed the motion to amend moot.
Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. (2024 NY Slip Op 50803(U))
June 14, 2024
The court considered an action by a provider seeking to recover assigned first-party no-fault benefits from the defendant insurance company. The defendant had filed a motion for summary judgment dismissing the complaint, arguing that the plaintiff failed to respond to timely requests for additional verification. The plaintiff argued that the denial of the defendant's motion for summary judgment in a previous declaratory judgment action in another court should not have a preclusive effect on this case. The court held that the denial of the defendant's motion for summary judgment in the previous action did not have a preclusive effect on the current case. Therefore, the court modified the order to deny the defendant's motion for summary judgment dismissing the complaint.
Pak Hong Sik, MD, Med. Care, P.C. v Mid-Century Ins. Co. (2024 NY Slip Op 50804(U))
June 14, 2024
The main issue in this case was whether the provider could recover assigned first-party no-fault benefits from the insurance company. The court considered the defendant's argument that the policy limits had been exhausted and that, according to the fee schedule, the provider could not recover the bills in question. The court found that the defendant failed to provide sufficient evidence to prove that payments listed in the payment log had been made. The court also noted that the argument regarding the fee schedule was raised for the first time on appeal, and therefore not considered. The court ultimately affirmed the order granting the defendant's motion for summary judgment, dismissing the complaint.
Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. (2024 NY Slip Op 50803(U))
June 14, 2024
In this case, the court considered the validity of the plaintiff's claims for no-fault benefits assigned by a patient after the defendant, an insurance company, sought summary judgment to dismiss the complaint. The main issues included whether the plaintiff provided sufficient verification of the claims and the procedural implications of an unrelated declaratory judgment action involving the same parties. The court determined that the affidavit from the plaintiff sufficiently demonstrated that verification had been mailed and received by the defendant, thus providing a presumption in favor of the plaintiff. Ultimately, the holding modified the previous order by denying the defendant's motion for summary judgment and affirming the case without costs, allowing the plaintiff's claims to proceed.
Pak Hong Sik, MD, Med. Care, P.C. v Mid-Century Ins. Co. (2024 NY Slip Op 50804(U))
June 14, 2024
The court considered a case where a medical provider, as the assignee of a patient, sought to recover no-fault insurance benefits from Mid-Century Insurance Company. The main issues involved whether the insurance company had appropriately demonstrated that the policy limits were exhausted and if the provider was barred from recovering based on the fee schedule. The court found that the defendant's payment log did not meet the necessary evidentiary standards to prove that payments had been made to the provider for the claims in question. However, the court noted that the plaintiff's argument regarding the fee schedule was not preserved for appeal since it was raised for the first time on appeal. Ultimately, the order granting summary judgment in favor of the defendant was affirmed.
American Tr. Ins. Co. v Jong Won Yom (2024 NY Slip Op 50723(U))
June 12, 2024
The court considered multiple instances where Respondents' attorneys pursued aggressive litigation tactics, including failure to issue satisfactions of judgment despite partial payments by Petitioner. It assessed the reasonableness of Petitioner's attorney fees at $210 per hour, totaling $1,470 for each proceeding, based on the complexity and time spent on each case. The main issue was whether Respondents' conduct warranted sanctions and attorney fees under CPLR 130-1.1, which the court granted, imposing $735 in fees against each attorney and daily sanctions of $10 for delays in issuing satisfactions of judgment, totaling $2,570 to $3,010 per case. The holding affirmed the awards of attorney fees and sanctions, emphasizing the excessive litigation tactics of Respondents' counsel.
Akai Acupuncture, P.C. v Foremost Prop. & Cas. Ins. Co. (2024 NY Slip Op 50630(U))
May 17, 2024
The court considered a case where a provider was seeking first-party no-fault benefits for services rendered after a motor vehicle accident, with the vehicle insured under a Florida automobile insurance policy. The insurer had claimed the policy was cancelled before the accident due to nonpayment of the premium, but the provider disputed this based on Florida law requirements for notice of cancellation. The issue was whether the insurer had provided sufficient proof of mailing the cancellation notice to the insured, as required by Florida law. The court held that the insurer's submitted Certificate of Bulk Mailing did not meet the requirements for proof of mailing under the statute, and therefore, the branch of the insurer's motion seeking to dismiss the complaint was denied.
Community Med. Imaging P.C. v American Tr. Ins. Co. (2024 NY Slip Op 50301(U))
March 21, 2024
The main issue in this case was whether a No-Fault insurance arbitration determination should be vacated where the hearing arbitrator found that the respective bill was mailed past the 45-day deadline for submitting proof of claim due to a lack of an affidavit describing mailing procedures or confirming the actual mailing of the bill. Petitioner's sole evidence on the issue was a USPS certificate of mailing found to contain an illegible postmark. The court considered the arbitration award, the submissions from both parties, and relevant case law in making its decision. The court held that the No-Fault insurance arbitration determination should be vacated based on the lack of sufficient evidence supporting the mailing of the bill. This was made in consideration of the specific procedures and deadlines outlined in the relevant state law and regulations.
Hereford Ins. Co. v Physio Care Physical Therapy, PC (2024 NY Slip Op 24083)
March 18, 2024
The court considered the fact that the plaintiff had already filed a summons and complaint and an amended summons and amended complaint, and that the defendant failed to answer, appear, or otherwise respond to the amended complaint. The court also considered the unsworn statement submitted by the plaintiff, which was found to satisfy the requirements of CPLR 2106 as amended. The main issue decided was whether the plaintiff was entitled to a default judgment. The court held that the plaintiff was entitled to a default judgment, as the plaintiff had shown prima facie good service of process, the defendant had failed to respond, and the unsworn statement submitted by the plaintiff constituted adequate proof of the facts constituting the claims. Therefore, the court granted the motion for an order directing the entry of a default judgment in favor of the plaintiff and against defendant Shekima Roberts.