No-Fault Case Law
Flatbush Chiropractic, P.C. v GEICO Ins. Co. (2013 NY Slip Op 51104(U))
July 1, 2013
The court considered the relevant facts that the insurance policy in question was issued to a Delaware resident for a car registered in Delaware, and that the accident in question had occurred in Delaware. The main issue decided was whether the Delaware insurance policy had been exhausted and whether it provided sufficient coverage for the medical expenses claimed by the plaintiff. The holding of the case was that the defendant had demonstrated that there was a lack of coverage due to the exhaustion of the limits of the applicable insurance policy, and therefore the order denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment dismissing the complaint was affirmed.
Alev Med. Supply, Inc. v Government Empls. Ins. Co. (2013 NY Slip Op 51096(U))
June 27, 2013
The main issues in this case were the admissibility of a peer review report in a trial on the issue of medical necessity for first-party no-fault benefits, and whether the supplies in question were medically necessary. The court considered whether the peer review report was admissible, and whether defendant's doctor's testimony had demonstrated that the supplies in question were not medically necessary. The holding of the case was that the trial court properly admitted the peer review report into evidence, and that defendant had established the lack of medical necessity at trial through the testimony of its expert witness. Therefore, the judgment dismissing the complaint was affirmed. The appellate court found that the plaintiff's objections to the admissibility of the peer review reports and the underlying medical records lacked merit, and that the remainder of plaintiff's contentions similarly lacked merit.
New York Diagnostic Med. Care, P.C. v GEICO Gen. Ins. Co. (2013 NY Slip Op 51036(U))
June 25, 2013
The relevant facts the court considered were that New York Diagnostic Medical Care, P.C. appealed from an order of the Civil Court denying its motion for summary judgment in an action to recover assigned first-party no-fault benefits. The main issue decided was whether the provider was entitled to recover assigned first-party no-fault benefits from GEICO General Insurance Company. The holding of the court was that the order denying plaintiff's motion for summary judgment was reversed and that the plaintiff's motion for summary judgment was granted. The case was remitted to the Civil Court for a calculation of statutory interest and an assessment of attorney's fees pursuant to Insurance Law § 5106 and the regulations promulgated thereunder.
LOF Med. Supply, Inc. v GEICO Gen. Ins. Co. (2013 NY Slip Op 51035(U))
June 25, 2013
The relevant facts considered included a provider seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the provider was entitled to summary judgment in their favor. The holding of the case was that the order of the Civil Court denying the provider's motion for summary judgment was reversed, and the provider's motion for summary judgment was granted. The case was remitted to the Civil Court for a calculation of statutory interest and an assessment of attorney's fees. This decision was in accordance with Insurance Law § 5106 and the regulations promulgated thereunder.
New Century Med. Diagnostics, P.C. v Utica Mut. Ins. Co. (2013 NY Slip Op 23204)
June 24, 2013
The case involves a dispute between New Century Medical Diagnostics, P.C. and Utica Mutual Insurance Company over no-fault benefits. New Century submitted its claims on time, but Utica denied the claims because New Century did not appear at two scheduled examinations under oath, which is considered a failure to comply with a condition precedent to coverage. New Century argued that the notices for the examinations were defective because they sought the production of a specific individual, but the court held that New Century's failure to appear at the scheduled examinations permitted Utica to deny the claims. The court granted Utica's motion for summary judgment, dismissing the complaint. The decision was based on the fact that while New Century was not required to produce the specific person Utica requested, its failure to produce any person at the scheduled examinations under oath allowed Utica to deny New Century's claims.
Huntington Regional Chiropractic, P.C. v Allstate Ins. Co. (2013 NY Slip Op 23201)
June 18, 2013
Procedural facts: The defendant has moved to strike the notice of trial and certificate of readiness for trial on the grounds that discovery is not complete. The Plaintiff has resisted, arguing that the demands for material and documents are overbroad, unduly burdensome, and irrelevant. Substantive facts: The case involves a dispute between the plaintiff and defendant over whether a medical facility, Huntington Medical Plaza, P.C., owned by Dr. Perez, is subject to a Mallela defense, which relates to fraudulent billing in connection with no-fault claims. Allstate Insurance Company, the defendant, has repeatedly requested copies of relevant documents and material, such as banking resolutions and statements, tax returns, management and office equipment leasing agreements, in connection with the Mallela defense. Legal issues: The main issue is whether Huntington Medical Plaza, P.C. is subject to a Mallela defense and, if so, whether the defendant is entitled to the production and discovery of material and documents related to this defense. Holding: The court granted the defendant's motion to the extent that the plaintiff shall produce the demanded material for an in-camera inspection. All proceedings in this action are stayed pending the production of the documents and inspection by the court.
Right Aid Diagnostic Medicine, P.C. v GEICO Ins. Co. (2013 NY Slip Op 51034(U))
June 17, 2013
The court considered the denial of first-party no-fault benefits, based on a lack of medical necessity, to a provider by an insurance company. The insurance company timely denied the claim and submitted an affirmed peer review report stating the lack of medical necessity for the services at issue. The main issue was whether the insurance company's showing that the services were not medically necessary was rebutted by the provider. The holding was that the insurance company's cross motion for summary judgment dismissing the complaint should have been granted, as the provider did not rebut the showing that the services were not medically necessary. Therefore, the order denying the insurance company's cross motion was reversed and the cross motion was granted.
Right Aid Diagnostic Medicine, P.C. v Travelers Ins. Co. (2013 NY Slip Op 51033(U))
June 17, 2013
The relevant facts considered by the court in this case included an action by a medical provider to recover assigned first-party no-fault benefits from an insurance company. The insurance company had denied the claims based on the failure of the medical provider's assignor to appear for scheduled independent medical examinations (IMEs). The main issue decided by the court was whether the insurance company had established its entitlement to summary judgment as a matter of law. The holding of the court was that the insurance company had indeed established its entitlement to judgment as a matter of law, and as a result, the order granting the medical provider's motion for summary judgment was reversed. The court held that the insurance company's cross motion for summary judgment dismissing the complaint was granted.
Ss Med. Care, P.C. v Hartford Ins. Co. (2013 NY Slip Op 51032(U))
June 17, 2013
The relevant facts in this case were that SS Medical Care, P.C. as the assignee of Beato Boyd was seeking to recover first-party no-fault benefits from Hartford Insurance Company. The main issue decided by the court was whether Hartford Insurance Company had timely and properly denied the plaintiff's claims based on the assignor's failure to appear for scheduled examinations under oath (EUOs). The holding of the court was that defendant had properly demonstrated that it had mailed the EUO scheduling letters and denials, and as the plaintiff raised no other argument with respect to the granting of defendant's cross motion, the order denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment dismissing the complaint was affirmed.
Central Radiology Servs., P.C. v First Am. Ins. (2013 NY Slip Op 51031(U))
June 17, 2013
The court considered an order from the Civil Court granting a default judgment against the defendant in a case where a provider was seeking to recover first-party no-fault benefits. The defendant then sought to vacate the order and dismiss the complaint, alleging that the plaintiff had failed to serve process upon the defendant and had mistakenly served the third-party claims administrator. The main issues decided were whether the defendant submitted to the jurisdiction of the court and whether there was a reasonable excuse for the default and a meritorious defense to the action. The court held that the defendant submitted to the jurisdiction of the court when seeking to vacate the order and permit it to defend the action, and that the defendant failed to demonstrate a meritorious defense, as there was no evidence to support the assertion that the assignor had been acting within the course of her employment when the accident occurred. Therefore, the court affirmed the order.