No-Fault Case Law
Kingsbrook Jewish Med. Ctr. v Allstate Ins. Co. (2009 NY Slip Op 00351)
January 20, 2009
The relevant facts considered by the court were that a patient was injured in an automobile accident and received treatment at White Plains Hospital. The hospital billed the patient's insurance company, Allstate, for $26,979.83. Allstate did not pay the claim or issue a denial within the required 30 days. The main issue decided was whether the diagnosis and procedure codes adopted by the United States Department of Health and Human Services could be judicially noticed by the courts and used to decipher no-fault billing forms. The holding of the case was that the diagnosis and procedure codes key published by the United States Government on its HHS Web site may properly be given judicial notice, and that the codes submitted by Allstate were insufficient to raise a triable issue of fact in admissible evidentiary form sufficient to warrant denial of summary judgment in favor of White Plains Hospital. Therefore, the Supreme Court properly granted White Plains Hospital's motion for summary judgment.
Hereford Ins. Co. v Paitou (2009 NY Slip Op 50060(U))
January 13, 2009
The relevant facts the court considered in this case were that Justice Paitou was struck by a motor vehicle and sustained serious injuries, and Rosillo & Licata, P.C. was retained to represent him in a personal injury claim. Hereford Insurance Company sought to recover a statutory lien of $198,926.00 from the settlement proceeds obtained by Rosillo & Licata in their representation of Paitou. The main issue decided by the court was whether Hereford was entitled to enforce a statutory lien against Rosillo & Licata and Paitou under Worker's Compensation Law section 29. The court held that Hereford could not seek to enforce a lien against Rosillo & Licata based on the settlement of the claim and the payment of their attorney's fees, and therefore granted the motion to dismiss the complaint with prejudice as to both Rosillo & Licata and Justice Paitou.
V.S. Med. Servs., P.C. v Travelers Ins. Co. (2009 NY Slip Op 50048(U))
January 9, 2009
The court considered the case of V.S. Medical Services, P.C. as assignee of Mohamad Nazir against Travelers Insurance Co. The main issue was whether the plaintiff had made a prima facie case to recover assigned first-party no-fault benefits. At trial, the plaintiff offered testimony from a former employee and sought to admit claim forms into evidence, but the defendant objected on the grounds of hearsay and failure to lay a foundation for their admission. The court reserved decision on the admissibility of the documents and on the defendant's motion to dismiss the complaint. After reviewing the submissions, the court dismissed the complaint, finding that the plaintiff had failed to make a prima facie case. The holding of the case was that the plaintiff failed to establish a prima facie case because their witness did not testify as to the generation of the claim forms, rendering them inadmissible as business records. As a result, the judgment was affirmed.
Vista Surgical Supplies, Inc. v State Farm Mut. Ins. Co. (2009 NY Slip Op 50047(U))
January 9, 2009
The main facts of the case are that Vista Surgical Supplies, Inc. was seeking to recover assigned first-party no-fault benefits from State Farm Mutual Insurance Co. After a nonjury trial, the court dismissed the complaint. Plaintiff did not call any witnesses, but instead moved for the admission of its notice to admit and defendant's response to establish its case. However, the court held that the notice to admit was improper because it sought information going to the heart of the matter. The main issue decided was whether plaintiff had made a prima facie showing of its case. The holding of the case was that plaintiff failed to lay a sufficient foundation to establish that the claim form is admissible pursuant to the business records exception to the hearsay rule, and therefore, the court properly held that plaintiff failed to make a prima facie showing. The judgment was affirmed, and the court did not reach any other issues.
Uptodate Med. Serv., P.C. v State Farm Mut. Auto. Ins. Co. (2009 NY Slip Op 50046(U))
January 9, 2009
The main issue in this case was whether the defendant should have been granted leave to amend its answer to assert the affirmative defenses of res judicata and collateral estoppel. The court considered the burden of the party attempting to defeat the application of collateral estoppel to establish the absence of a full and fair opportunity to litigate. The court also examined whether the plaintiff had a full and fair opportunity to litigate the issue determined in the arbitration proceeding. The holding was in favor of the defendant, as the court found that the defendant was entitled to amend its answer to assert the affirmative defenses and that the plaintiff had failed to establish that it did not receive a full and fair opportunity to litigate in the prior arbitration proceeding. As a result, the judgment in favor of the plaintiff was reversed, and the defendant's cross motion for summary judgment was granted.
All Mental Care Medicine, P.C. v State Farm Mut. Ins. Co. (2009 NY Slip Op 50042(U))
January 9, 2009
The relevant facts considered in this case include the plaintiff offering a notice to admit and an affirmation made by the defendant's attorney in order to prove its prima facie case at trial. The court found that the plaintiff failed to produce a witness and therefore failed to make its prima facie case, resulting in the dismissal of the complaint. The main issue decided was whether the plaintiff had successfully proven its case in order to recover assigned first-party no-fault benefits. The holding of the case was that the judgment was affirmed without costs, as the plaintiff failed to make its prima facie case and therefore the complaint was dismissed.
Union Physician Healthcare, P.C. v Utica Mut. Ins. Co. (2009 NY Slip Op 50039(U))
January 9, 2009
The court considered the appeal of a provider seeking to recover assigned first-party no-fault benefits, in which the lower court had granted the provider's motion for summary judgment. The main issue was whether the affidavit submitted by the provider's officer laid a proper foundation for the admission of the documents annexed to the provider's moving papers, and whether the provider had established a prima facie case. The holding of the court was that the affidavit submitted by the provider's officer was insufficient to demonstrate personal knowledge of the provider's practices and procedures, and therefore failed to lay a foundation for the admission of the documents as business records. As a result, the provider failed to make a prima facie showing of entitlement to summary judgment, and the judgment was reversed, the order granting the provider's motion for summary judgment was vacated, and the provider's motion for summary judgment was denied.
Complete Orthopedic Supplies, Inc. v State Farm Mut. Auto. Ins. Co. (2009 NY Slip Op 29014)
January 9, 2009
The case involved Complete Orthopedic Supplies, Inc. as an assignee of Ana Valencia, a medical provider, that was seeking to recover first-party no-fault benefits from State Farm Mutual Automobile Insurance Company. The provider moved for summary judgment, while the insurance company cross-moved for summary judgment, arguing that there was no medical necessity for the supplies provided. The Civil Court granted the provider's motion for summary judgment and denied the insurance company's cross motion. The Appellate Term, Second Department reversed this decision, ultimately holding that the insurance company's denial of claim forms, based on lack of medical necessity, were timely mailed and that there was no medical necessity for the supplies provided by the medical provider. As a result, the insurance company's cross motion for summary judgment dismissing the complaint was granted, and the provider's motion for summary judgment was denied.
Long Is. Multi-Medicine Group, P.c. v Travelers Ins. Co. (2009 NY Slip Op 50030(U))
January 8, 2009
The relevant facts considered by the court were that Long Island Multi-Medicine Group, P.C. sought to recover assigned first-party no-fault benefits, and defendant Travelers Ins. Co. denied a number of the claims on the basis that they were not timely submitted. Plaintiff moved for summary judgment, which was granted, and defendant appealed, arguing that it had not waived its defense of untimeliness. The main issue decided was whether defendant waived its defense of untimeliness, and the court held that defendant had failed to establish that it timely denied the subject claims, and therefore failed to raise a triable issue of fact with respect to the claims at issue. The judgment was affirmed on other grounds.
Matter of Long Is. Ins. Co. (2009 NY Slip Op 50003(U))
January 5, 2009
The court considered the petitioner's request for summary judgment based on newly discovered evidence regarding a hit and run. The petitioner claimed the respondent intentionally failed to disclose that his father, who died in 2001, was the named insured under the insurance policy for which he was making claims. The court also considered the petitioner's motion to vacate the arbitration award on the ground that there was no valid agreement to arbitrate. The main issue decided was whether there was a valid contract between the deceased insured and the insurer, and whether there was a rational basis for the arbitration award. The holding of the court was that there was no valid contract between the respondent and the insurer due to the fact that the respondent's deceased father was the named insured. Therefore, the arbitration award was vacated and summary judgment was granted to the petitioner on the issue of non-coverage.