No-Fault Decisions, September 2018

2 decisions · 2 Appellate Term

Issues this month: Medical necessity 1 Verification requests 1

Decisions

Appellate Term, First Department Sep 26, 2018 2018 NY Slip Op 51358(U) Insurer prevailed

Mingmen Acupuncture Servs., PC v Global Liberty Ins. Co. of N.Y.

The insurer's IME report established that further acupuncture treatment was not medically necessary. The Appellate Term, First Department, reversed the order, insofar as appealed from, granted the insurer's motion for summary judgment, and dismissed the provider's complaint. The insurer timely denied the claims based on a sworn IME report that supplied a factual basis and medical rationale for concluding that the assignor's injuries had resolved. The provider's principal's affidavit raised no triable issue because it was not based on an examination and did not meaningfully rebut the examiner's findings, including normal range-of-motion results. The assignor's subjective pain complaints did not overcome the objective tests detailed in the report.

Appellate Term, First Department Sep 17, 2018 2018 NY Slip Op 51311(U) Insurer prevailed

Village Med. Supply, Inc. v Travelers Prop. Cas. Ins. Co.

The provider's claims were premature because it failed to answer verification requests for a manufacturer's invoice. The record conclusively established that the provider failed to respond to timely requests for verification. Its assertion that the insurer lacked a good reason under 11 NYCRR 65-3.2 (c) to request a manufacturer's invoice documenting the supplies' cost raised no triable issue. The court also relied on 12 NYCRR 442.2 (a). The Appellate Term, First Department, reversed the order denying the insurer's summary judgment motion, granted the motion and dismissed the complaint.

All months

YearJanFebMarAprMayJunJulAugSepOctNovDecTotal
2026 20 29 19 11 15 13 11 6 6 1 131
2025 6 11 13 6 16 6 8 6 5 7 11 19 114
2024 13 7 9 2 3 8 3 3 5 2 3 4 62
2023 2 9 12 5 7 8 6 2 8 5 2 7 73
2022 7 6 7 18 6 54 17 25 20 6 12 38 216
2021 2 16 6 19 28 15 25 6 8 10 8 23 166
2020 13 9 7 6 14 16 9 28 5 18 53 10 188
2019 13 9 57 28 60 14 34 48 4 76 35 59 437
2018 12 22 6 9 39 66 13 3 2 5 99 16 292
2017 16 16 17 30 15 12 40 33 68 28 35 154 464
2016 7 16 59 16 14 66 14 8 69 58 36 18 381
2015 4 14 44 16 44 13 26 30 27 15 54 23 310
2014 8 24 36 25 25 5 15 30 5 9 4 63 249
2013 16 33 24 14 33 15 20 20 5 34 32 24 270
2012 24 21 21 44 29 40 24 70 21 19 14 30 357
2011 22 11 21 23 18 19 25 16 11 51 19 62 298
2010 25 13 34 25 15 18 28 13 3 32 31 29 266
2009 19 18 22 29 22 38 44 5 4 14 11 22 248
2008 10 23 21 26 18 12 40 12 38 24 13 22 259
2007 25 43 57 23 25 18 16 20 23 20 20 16 306
2006 11 26 27 15 30 30 45 13 12 19 23 32 283
2005 10 26 39 31 13 19 22 13 10 19 11 19 232
2004 6 10 19 15 14 19 13 8 18 14 15 29 180
2003 1 4 4 14 23

Headnotes, outcome labels and monthly summaries are our own summaries, not the courts’ words; the decision itself is the authority. Months follow the date a decision was handed down; new decisions are added monthly, so a recent month can still grow.