No-Fault Case Law
Alfa Med. Supplies v GEICO Gen. Ins. Co. (2012 NY Slip Op 51765(U))
September 5, 2012
The court considered an appeal from an order denying a provider's motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was whether the denial of claim forms were timely mailed and whether the peer review reports were admissible. The court held that the denial of claim forms were timely mailed and that the peer review reports were admissible, as they contained the electronic stamped facsimiles of the peer reviewers' signatures. As a result, plaintiff's motion for summary judgment was properly denied and defendant's cross motion for summary judgment dismissing the complaint was properly granted, and the judgment was affirmed.
Royal Med. Supply, Inc. v Progressive Northeastern Ins. Co. (2012 NY Slip Op 51727(U))
August 31, 2012
The court considered the facts of the case, where Royal Medical Supply, Inc. was seeking to recover assigned first-party no-fault benefits. The main issue was whether the defendant had demonstrated that Royal Medical Supply's assignor had failed to appear for two duly scheduled examinations under oath (EUOs). The court found that the defendant had submitted sufficient proof that the assignor had failed to appear for the EUOs, which had been timely scheduled after the defendant's receipt of the plaintiff's claim forms. As a result, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.
Atlantic Radiology Imaging, P.C. v NY Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51725(U))
August 31, 2012
The main issue in this case was whether the insurer was liable to pay the first-party no-fault benefits to the provider, Atlantic Radiology Imaging, P.C., as assignee of Emanuel Malayev. The court considered the evidence submitted by the defendant, including an affidavit from an employee of the company responsible for scheduling independent medical examinations (IMEs), affirmations from licensed healthcare professionals who were to perform the IMEs, and an affidavit demonstrating the timely mailing of denial of claim forms. The court held that the appearance of an assignor at a duly scheduled IME is a condition precedent to the insurer's liability on the policy, and since Malayev failed to appear for the IMEs, the insurer was not liable to pay the benefits. Therefore, the court reversed the lower court's order and granted the defendant's motion for summary judgment dismissing the complaint.
Five S & A Rehab Pt, P.C. v Praetorian Ins. Co. (2012 NY Slip Op 51724(U))
August 31, 2012
The relevant facts considered by the court were that the defendant had timely mailed denial of claim forms based on lack of medical necessity, along with an annexed affirmed independent medical examination report. The main issue decided was whether the plaintiff had rebutted the defendant's prima facie showing of lack of medical necessity, which would entitle the defendant to summary judgment dismissing the complaint. The holding of the court was that the defendant's motion for summary judgment dismissing the complaint was granted, as the plaintiff had failed to rebut the defendant's prima facie showing, and the denial of claim forms were based on a factual basis and medical rationale. The order of the Civil Court was reversed, and the defendant's motion was granted.
East Gun Hill Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51723(U))
August 31, 2012
The court considered the appeal of an order from the Civil Court of the City of New York, Queens County, which denied the defendant's motion for summary judgment. The main issues decided were whether the defendant had established, as a matter of law, its proffered grounds for entitlement to summary judgment, specifically whether written notice setting forth the details of the accident had been submitted to defendant within 30 days of the accident, and whether the plaintiff had failed to submit written proof of claim to defendant within 45 days of the services rendered. The holding of the case was that the Civil Court properly denied the defendant's motion for summary judgment dismissing the complaint, as the defendant failed to establish, as a matter of law, its entitlement to summary judgment based on the specific grounds it had proffered. Therefore, the order of the Civil Court was affirmed.
Kamara Supplies, Inc. v Clarendon Ins. Co. (2012 NY Slip Op 51718(U))
August 31, 2012
The relevant facts the court considered in this case were that Kamara Supplies, Inc. was seeking to recover assigned first-party no-fault benefits, and the defendant, Clarendon Insurance Company, submitted an affirmed peer review report in support of its cross motion for summary judgment dismissing the complaint on the ground of lack of medical necessity. The main issue decided by the court was whether the defendant's peer review report clearly established a sufficient medical rationale and factual basis to demonstrate a lack of medical necessity for the supplies at issue. The court held that the defendant's cross motion for summary judgment was properly denied because the affirmed peer review report failed to establish a lack of medical necessity for the supplies at issue. Therefore, the court affirmed the order, without costs.
Right Aid Med. Supply Corp. v Geico Ins. Co. (2012 NY Slip Op 51717(U))
August 31, 2012
In this case, the plaintiff, Right Aid Medical Supply Corp., was seeking to recover first-party no-fault benefits from the defendant, Geico Ins. Co., as the assignee of Andre Kyles. The plaintiff had filed a motion for summary judgment, which was granted by the Civil Court, resulting in a judgment awarding the plaintiff $1,768.76. The defendant appealed this decision. The main issue was whether the denial of claim form provided by the defendant was sufficient to establish a prima facie entitlement to judgment as a matter of law. The Appellate Term, Second Department, reversed the judgment, vacated the order granting the plaintiff's motion for summary judgment, and denied the plaintiff's motion, on the grounds that the denial of claim form provided by the defendant was timely and not conclusory, vague, or without merit as a matter of law. Therefore, the plaintiff did not establish its prima facie entitlement to judgment as a matter of law.
Raz Acupuncture, P.C. v Geico Gen. Ins. Co. (2012 NY Slip Op 51716(U))
August 31, 2012
The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, where the order granted the branches of defendant's motion seeking summary judgment dismissing the complaint insofar as it sought to recover for services rendered from February 23, 2005 to May 4, 2005. The main issue decided was whether the defendant had timely denied those claims based upon the workers' compensation fee schedule. The court found that the defendant had indeed timely denied those claims based on the fee schedule. The holding of the case was that the court affirmed the order, insofar as appealed from, without costs.
Compas Med., P.C. v Delos Ins. Co. (2012 NY Slip Op 51715(U))
August 31, 2012
The court considered whether there was a triable issue of fact as to whether verification was outstanding in the case of Compas Medical, P.C. as Assignee of TRINA GREEN v. Delos Insurance Company. The main issue decided was whether the Civil Court properly denied the defendant's cross motion for summary judgment dismissing the complaint. The court held that there was a triable issue of fact as to whether verification is outstanding, and therefore affirmed the order without costs. The decision was made by Pesce, P.J., Rios and Aliotta, JJ. on August 31, 2012.
Dr. Todd Goldman, D.C., P.C. v Kemper Cas. Ins. Co. (2012 NY Slip Op 51713(U))
August 31, 2012
The court considered the affidavit and independent medical examination report submitted by the defendant in support of its motion for summary judgment. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint on the ground of lack of medical necessity for the services at issue. The holding of the case was that since the defendant's prima facie showing of lack of medical necessity was not rebutted by the plaintiff, the defendant was entitled to summary judgment dismissing the complaint. As a result, the order of the Civil Court denying defendant's motion for summary judgment was reversed, and the defendant's motion for summary judgment dismissing the complaint was granted.