No-Fault Case Law
Compas Med., P.C. v Allstate Ins. Co. (2017 NY Slip Op 51842(U))
December 19, 2017
The relevant facts considered in this case were that Compas Medical, P.C. filed a lawsuit to recover first-party no-fault benefits and the defendant, Allstate Insurance Company, moved for summary judgment to dismiss the complaint based on the plaintiff's assignor's failure to attend scheduled examinations under oath. The main issue decided was whether the defendant's affidavit sufficiently demonstrated that their denial of claim forms had been timely mailed. The holding of the case was that the order granting the defendant's motion for summary judgment was reversed, and the defendant's motion for summary judgment was denied, as the defendant did not demonstrate its entitlement to summary judgment.
City Care Acupuncture, P.C. v Allstate Prop. & Cas. Ins. Co. (2017 NY Slip Op 51839(U))
December 19, 2017
The court considered the issue of whether an action by providers to recover assigned first-party no-fault benefits was premature because the plaintiffs had failed to provide requested verification. The main issue was whether the plaintiffs had provided all of the requested verification, as required by law. The court held that the action was indeed premature, as the record demonstrated that the defendant had not received all of the requested verification. Therefore, the court affirmed the order of the Civil Court, which had granted the defendant's cross motion for summary judgment dismissing the complaint.
Jamaica Med. Plaza, P.C. v GEICO Gen. Ins. Co. (2017 NY Slip Op 51837(U))
December 19, 2017
The relevant facts considered by the court were that Jamaica Medical Plaza was seeking to recover first-party no-fault benefits and the issue in question was the medical necessity of the services provided. The court found that the testimony of the defendant's expert witness, who was not the expert who prepared the peer review report, should have been permitted to testify about the lack of medical necessity of the services. The court reversed the judgment and remitted the case to the Civil Court for a new trial, stating that the expert witness's testimony should be limited to the basis for the denial as set forth in the original peer review report. The holding of the case was that the judgment was reversed and a new trial was ordered.
Easy Care Acupuncture, P.C. v 21 Century Advantage Ins. Co. (2017 NY Slip Op 51836(U))
December 19, 2017
The relevant facts considered by the court were that Easy Care Acupuncture, P.C. was seeking to recover assigned first-party no-fault benefits from 21 Century Advantage Ins. Co. The main issue decided was whether plaintiff's opposition to defendant's motion for summary judgment raised a triable issue of fact. The holding of the court was that the papers submitted by the plaintiff did not raise a triable issue of fact, and therefore the order granting defendant's motion for summary judgment dismissing the complaint was affirmed.
Charles Deng Acupuncture, P.C. v Unitrin Auto & Home Ins. Co. (2017 NY Slip Op 51834(U))
December 19, 2017
The court considered the dispute between Charles Deng Acupuncture, P.C. and Unitrin Auto and Home Insurance Company over first-party no-fault benefits. Charles Deng Acupuncture, P.C. moved for summary judgment, while Unitrin Auto and Home Insurance Company cross-moved for summary judgment dismissing the complaint. The main issue decided was whether the affidavit submitted by Unitrin Auto and Home Insurance Company was sufficient to demonstrate that the independent medical examination scheduling letters had been timely mailed. The court held that the affidavit submitted by Unitrin Auto and Home Insurance Company was indeed sufficient, and therefore affirmed the order, denying the branch of plaintiff's motion seeking summary judgment upon the second cause of action and granting the branch of defendant's cross motion seeking summary judgment dismissing that cause of action.
GBI Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51832(U))
December 19, 2017
The court considered the untimeliness of the denial of claim forms with respect to the first four causes of action, as well as the propriety of the fee reductions in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors. The main issues decided were the timeliness of the denial of claim forms and whether the fee reductions were proper. The holding of the case was that the branches of the defendant's motion seeking summary judgment dismissing the first four causes of action were denied, as the denial of claim forms were untimely on their face and the fee reductions were found to be proper in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors.
Healthy Way Acupuncture, P.C. v NY Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51828(U))
December 19, 2017
The main issue in this case was whether the plaintiff, Healthy Way Acupuncture, P.C., had failed to provide requested verification for a claim to recover assigned first-party no-fault benefits, which led to the dismissal of the complaint as premature. The court considered the follow-up verification requests issued by the defendant and determined that they were proper under the law. The court also acknowledged that any confusion on the part of the plaintiff as to what was being sought should have been addressed by further communication, not inaction. Ultimately, the court affirmed the order of the Civil Court, granting defendant's motion for summary judgment and dismissing the complaint, while also denying plaintiff's cross motion for summary judgment.
Tyorkin v Country Wide Ins. Co. (2017 NY Slip Op 51827(U))
December 19, 2017
The relevant facts considered by the court were that the plaintiff, a provider seeking to recover assigned first-party no-fault benefits, had filed a motion for summary judgment, which was granted by the Civil Court. The defendant, an insurance company, had filed a cross motion for summary judgment to dismiss the complaint, which was denied. The main issue decided was whether the defendant's evidence was sufficient to establish that the plaintiff's assignor's alleged injuries did not arise from an insured incident so as to warrant the dismissal of the complaint. The holding of the court was that the defendant's evidence was insufficient to establish this as a matter of law and that there was a triable issue of fact, so the plaintiff was not entitled to summary judgment. The court modified the order to provide that the plaintiff's motion for summary judgment was denied, with the appellate judges concurring.
Alas Lifespan Wellness, PT, P.C. v Global Liberty Ins. Co. of NY (2017 NY Slip Op 51825(U))
December 19, 2017
The court considered the motion for summary judgment by the defendant to dismiss the complaint on the grounds that the plaintiff's assignor failed to appear for independent medical examinations (IMEs). The plaintiff had also cross-moved for summary judgment. The main issues decided were whether the defendant's IME scheduling letters were properly mailed and whether the plaintiff's assignor had failed to appear for the IMEs. The holding of the court was that the only issues for trial were the mailings of the IME scheduling letters and the failure of the plaintiff's assignor to appear for the IMEs. The court affirmed the order with the costs of $25.
Island Life Chiropractic, P.C. v 21st Century Ins. Co. (2017 NY Slip Op 51824(U))
December 19, 2017
The court considered the fact that Island Life Chiropractic, P.C. was appealing the denial of its motion for summary judgment to recover assigned first-party no-fault benefits from 21st Century Insurance Company. The main issue decided was whether Island Life Chiropractic had established its prima facie entitlement to summary judgment, and if the claims at issue had been timely denied. The court held that Island Life Chiropractic failed to establish its entitlement to summary judgment, as the proof it submitted did not establish that the claims had not been timely denied or that 21st Century Insurance Company had issued timely denial of claim forms that were conclusory, vague, or without merit as a matter of law. Therefore, the court affirmed the decision denying Island Life Chiropractic's motion for summary judgment.