No-Fault Case Law
Jamhil Med., P.C. v One Beacon Ins. Co. (2017 NY Slip Op 51308(U))
September 29, 2017
The case involved a dispute between Jamhil Medical, P.C. and One Beacon Ins. Co. regarding an order to compel Jamhil Medical to respond to discovery demands including an examination before trial. The Civil Court initially granted One Beacon's motion to dismiss or compel disclosure, but denied the request to compel Jamhil Medical to appear for an examination before trial. One Beacon then sought reargument and the Civil Court vacated its previous decision, directing Jamhil Medical to resubmit responses to the discovery demands within 45 days and to appear for an examination before trial. On appeal, Jamhil Medical argued about the notice to produce, which was not addressed in the order, but did not make specific arguments regarding the examination before trial or the interrogatories. The Appellate Term affirmed the order, with the costs of $25.
NYS Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51263(U))
September 22, 2017
The court considered the fact that NYS Acupuncture, P.C. was seeking to recover first-party no-fault benefits from New York Central Mutual Fire Insurance Company, but the defendant had denied the claims on the ground that the plaintiff's assignor had failed to appear for scheduled independent medical examinations. The main issue was whether the defendant was entitled to summary judgment dismissing the complaint based on the assignor's failure to appear for the examinations. The court held that the defendant was entitled to summary judgment because they had established that the letters scheduling the examinations had been timely mailed, the assignor had failed to appear for the examinations, and the claims had been timely denied on that ground. As the plaintiff failed to raise a triable issue of fact in opposition to the defendant's motion, the court granted summary judgment in favor of the defendant.
Greenway Med. Supply Corp. v Hartford Ins. Co. (2017 NY Slip Op 51262(U))
September 22, 2017
The court considered the fact that in an action by a provider to recover assigned first-party no-fault benefits, the defendant had moved for summary judgment dismissing the complaint based upon the assignor's failure to appear for independent medical examinations. The main issue decided was whether the defendant's motion for summary judgment should be granted. The holding of the case was that the proof submitted by the defendant in support of its motion was sufficient to establish that the defendant had timely denied the claims at issue. As the plaintiff did not challenge the finding that the defendant was otherwise entitled to judgment, the defendant's motion for summary judgment dismissing the complaint was granted.
Medex Health Supply, Inc. v Travelers Ins. Co. (2017 NY Slip Op 51261(U))
September 22, 2017
The court considered an appeal from an order of the Civil Court of the City of New York in which the defendant's motion for summary judgment dismissing the complaint was granted. The main issue in the case was whether the action to recover assigned first-party no-fault benefits was premature due to the plaintiff's failure to provide requested verification. The court held that while the defendant had demonstrated prima facie evidence that it had properly mailed the initial and follow-up verification requests and had not received the requested verification, the affidavit submitted by the plaintiff in opposition to the motion was sufficient to give rise to a presumption that the requested verification had been mailed to and received by the defendant. As a result, the court found that there was a triable issue of fact as to whether the action was premature and reversed the order, denying the defendant's motion for summary judgment dismissing the complaint.
Laga v American Commerce Ins. Co. (2017 NY Slip Op 51254(U))
September 22, 2017
The main issue in this case was whether the provider had failed to appear for scheduled examinations under oath (EUOs) and if this constituted a valid reason to deny the claims for assigned first-party no-fault benefits. The court considered the affirmation submitted by the defendant and found it was sufficient to establish the plaintiff's failure to appear for the EUOs. As a result, the court denied the branches of the plaintiff's motion seeking summary judgment on the second through fourth causes of action and granted the branches of the defendant's cross motion seeking summary judgment dismissing those causes of action. The holding of the case was that the order, insofar as appealed from, was affirmed, with costs.
Atlantic Chiropractic, P.C. v Geico Ins. Co. (2017 NY Slip Op 51253(U))
September 22, 2017
The Court considered the appeal from an order of the Civil Court of the City of New York, Kings County, granting summary judgment to the plaintiff, Atlantic Chiropractic, P.C., in their action to recover assigned first-party no-fault benefits from Geico Ins. Co. The main issues decided were whether defendant Geico had timely denied the claims at issue and whether there was medical necessity for the services provided. The court held that the proof submitted by Geico in opposition to the plaintiff's motion was sufficient to raise triable issues of fact regarding the timely denial of the claims and the medical necessity of the services, and therefore reversed the judgment, vacated the order, and denied the plaintiff's motion for summary judgment.
Charles Deng Acupuncture, P.C. v 21st Century Ins. Co. (2017 NY Slip Op 51252(U))
September 22, 2017
The relevant facts of this case revolve around a claim made by Charles Deng Acupuncture, P.C., as an assignee of Ambroisse Cassandra, against 21st Century Insurance Company. Charles Deng Acupuncture sought to recover first-party no-fault benefits and was appealing the denial of their motion for summary judgment by the Civil Court of the City of New York. The main issues decided were whether the claims at issue had been timely denied, the validity of the fee reductions by the insurance company, and the failure to object to the discovery demands within the prescribed time. The holding of the case was that the appellate term affirmed the decision of the Civil Court, ruling that the plaintiff had not established their prima facie entitlement to summary judgment, and had not objected to the discovery demands within the prescribed time, and thus were obligated to produce the information sought by the defendant.
TAM Med. Supply Corp. v Travelers Ins. Co. (2017 NY Slip Op 51251(U))
September 22, 2017
The relevant facts considered by the court in this case were that a medical supply company was seeking to recover no-fault benefits from an insurance company, and the insurance company had requested verification of the claim. The main issue decided by the court was whether the insurance company's motion for summary judgment dismissing the complaint should be granted on the grounds that the action was premature due to the provider's failure to provide the requested verification. The holding of the court was that there was a triable issue of fact as to whether the action was premature, as the provider's affidavit was sufficient to give rise to a presumption that the requested verification had been mailed to and received by the insurance company. Therefore, the court reversed the order and denied the insurance company's motion for summary judgment dismissing the complaint.
Laga v American Commerce Ins. Co. (2017 NY Slip Op 51250(U))
September 22, 2017
The court considered the denial of summary judgment by the Civil Court as well as the granting of defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was whether the plaintiff was entitled to summary judgment in an action to recover assigned first-party no-fault benefits, and whether the denial of the claim was timely. The court held that the defendant failed to establish that it had timely denied the claim underlying the sixth cause of action, so the branch of defendant's cross motion seeking summary judgment dismissing that cause of action should have been denied. The order was affirmed as to the remaining causes of action, and it was modified to provide that the branch of defendant's cross motion seeking summary judgment dismissing the sixth cause of action is denied.
AL Acupuncture, P.C. v Geico Ins. Co. (2017 NY Slip Op 51249(U))
September 22, 2017
The main issue in this case was whether plaintiff was entitled to recover first-party no-fault benefits for services rendered from July 8, 2008 to September 5, 2008, and from September 8, 2008 to September 25, 2008. The court held that defendant had timely denied the claims for services rendered from July 8, 2008 to September 5, 2008 and had fully paid plaintiff for the services at issue in those claims. As a result, the court granted defendant's cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon these claims. However, the court found that the defendant was not entitled to summary judgment on the claim for services rendered from September 8, 2008 to September 25, 2008 due to issues with the IME scheduling letters, and so the branch of plaintiff's motion seeking summary judgment on this claim was denied.