No-Fault Case Law
Lamed Med. P.C. v Travelers Ins. Co. (2005 NY Slip Op 52142(U))
December 22, 2005
The court case involved Lamed Medical P.C., a medical services provider, seeking to vacate a master arbitration award after the lower arbitrator denied its claim, and the master arbitrator subsequently denied the request for review on the basis that the appeal was untimely. The main issue decided was whether the request for review was timely made, and if not, whether the Master Arbitrator had the authority to deny the request for review. The court held that the petitioner failed to demonstrate a ground to vacate the Master Arbitrator's decision and that the determination that petitioner failed to timely appeal the lower arbitration award was not arbitrary or a violation of petitioner's due process rights. The court dismissed the petition to vacate the Master Arbitrator's award, stating that the petition would be denied even if it had complied with statutory requirements.
Multiquest, P.L.L.C. v Allstate Ins. Co. (2005 NY Slip Op 52071(U))
December 20, 2005
The court considered a series of 12 actions seeking no fault first class benefits, which involved motions for summary judgment from plaintiff Multiquest, P.L.L.C., and cross-motions. The main issue decided was whether the decision of the New York Court of Appeals in State Farm v. Mallela should be applied to the cases at hand. The holding of the case was that the decision in State Farm v. Mallela should be applied, and that under the facts of the case, Multiquest, P.L.L.C. was entitled to summary judgment on its claim.
Multiquest PLLC v Allstate Ins. Co. (2005 NY Slip Op 52209(U))
December 19, 2005
The court considered whether Multiquest PLLC was entitled to summary judgment in its action against Allstate Insurance Company to recover the cost of health care services, according to the Insurance Law and regulations of the New York State Insurance Department. The main issue at hand was whether the evidence provided by Multiquest was sufficient to warrant summary judgment, and whether Allstate was entitled to summary judgment to deny payment to Multiquest based on allegations of fraudulent billing practices. The court held that Multiquest's motion for summary judgment was denied, and Allstate's motion for summary judgment was granted. The complaint filed by Multiquest was dismissed. Despite Multiquest's failure to establish evidence supporting their claim, the court also noted that recent Court of Appeals decisions involving No-Fault Law have addressed the issue of insurance fraud, which has undermined the goals of the law.
Multiquest, P.L.L.C. v Allstate Ins. Co. (2005 NY Slip Op 52069(U))
December 19, 2005
The court considered the motion for summary judgment from both parties, who were involved in a case concerning the Comprehensive Motor Vehicle Reparations Act for reimbursement of psychological injury treatments following an automobile accident. The critical issue was whether the plaintiff could receive payment for the psychological treatments due to a timely denial from the defendant. The court holding is that the defendant's failure to issue a timely denial of claim rendered the no-fault benefits overdue according to the law. The defendant argued that the plaintiff did not have a psychologist as an "owner" at the time of billing for services, and the corporate structure of the plaintiff was defective. However, the court did not take these arguments into account. Furthermore, the court determined that the regulation does not apply retroactively to bar recovery of the no-fault claim.
JSI Expert Servs. Inc. v Firemans Fund Ins. Co. (2005 NY Slip Op 52058(U))
December 16, 2005
The court considered a case in which JSI Expert Services Inc., sought to recover first party no-fault benefits for medical equipment provided to treat its assignor. The main issue was whether the insurance company had the right to raise a defense at the arbitration hearing that the assignor was working at the time of the accident, despite failing to deny the claim in a timely manner. The court concluded that the defense raised by the insurance company was a denial of coverage defense and was not precluded by the fact that it failed to timely deny the claim. The holding of the court was that the arbitrator's award was rational and not arbitrary or capricious, so the petition was dismissed and the insurance company's motion to dismiss the petition was granted.
Careplus Med. Supply Inc. v State-Wide Ins. Co. (2005 NY Slip Op 25545)
December 15, 2005
The relevant facts of the case were that Careplus Medical Supply was seeking to recover first-party no-fault benefits for medical supplies it provided, while State-Wide Insurance Company had submitted a properly completed denial of claim form covering all the claims involved in the lawsuit. The main issue was whether the denial of claim form submitted by State-Wide Insurance Company established that the claims were sent and received. The court held that the denial of claim form submitted by State-Wide Insurance Company sufficiently established that the plaintiff sent and the defendant received the claims. Therefore, the court unanimously reversed the previous order without costs, granted plaintiff's motion for summary judgment, and remanded the matter to the court below for a calculation of statutory interest and an assessment of attorney's fees.
Air Plus Surgical Supply, Inc. v Progressive Ins. Co. (2005 NY Slip Op 52088(U))
December 12, 2005
The relevant facts the court considered in this case included a dispute over first-party no-fault benefits for medical supplies provided to the plaintiff's assignor. The main issue decided was whether the plaintiff was entitled to summary judgment, as the plaintiff had established its prima facie entitlement to summary judgment by showing that it submitted completed proofs of claims, and that payments of no-fault benefits were overdue. The court held that the plaintiff's motion for summary judgment should be granted in the principal sum of $2,983, and the matter was remanded for a calculation of statutory interest and an assessment of attorney's fees. The court also dismissed the defendant's cross-appeal. The court emphasized that the defendant was required to submit proof in admissible form to rebut the plaintiff's prima facie showing, and since the report was not in admissible form, plaintiff's motion should have been granted.
Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co. (2005 NYSlipOp 09484)
December 12, 2005
The case involved a dispute over an action to recover no-fault medical payments under insurance contracts. The plaintiffs appealed the lower court’s denial of their summary judgment motion, while the defendant cross-appealed from portions of the order denying their cross motion for summary judgment dismissing the complaint. The court held that the defendant was not obligated to pay or deny the claim until receiving verification of all relevant information requested. The defendant was found to be entitled to summary judgment dismissing both the first and second causes of action, as the plaintiffs failed to respond to the defendant’s request for verification. The defendant’s cross motion was granted, along with an award of costs, and the plaintiff’s complaint was dismissed. The denial of the defendant’s summary judgment motion was reversed, and the plaintiff’s second cause of action was dismissed as well, given the lack of a timely response to the defendant’s request for verification.
563 Grand Med., P.C. v New York State Ins. Dept. (2005 NY Slip Op 09274)
December 5, 2005
The court considered a case in which the plaintiffs appealed an order that granted the defendants' motion to dismiss their complaint, which declared that a specific regulation violated procedural due process and was unconstitutional. The plaintiffs argued that the regulation allowed for an arbitrator to raise any issues relevant to making an award without giving them a meaningful opportunity to respond, and that it was unconstitutional as applied to them. The court held that the regulation did not violate procedural due process and that there is a strong government interest in according the arbitrator discretion in order to promptly resolve claims. The court also ruled that while the challenge regulation comported with procedural due process, the Supreme Court should have made a declaration as to the constitutionality of the regulation. Therefore, the matter was remitted to the Supreme Court, Kings County, for entry of a judgment declaring that the regulation does not violate procedural due process.
Multiquest, PLLC v Allstate Ins. Co. (2005 NY Slip Op 25512)
December 1, 2005
The pertinent facts in the present case involve a plaintiff seeking to recover overdue no-fault payments for services provided to an assignor. The defendant filed for summary judgment to dismiss the action, claiming the plaintiff was fraudulently organized and therefore not entitled to recover on the no-fault benefits claim. The main issue decided by the court was whether the fraudulently licensed corporation was entitled to reimbursement under New York Insurance Law for medical services provided by licensed medical practitioners, and if 11 NYCRR 65-3.16 (a) (12) applies to unpaid claims that accrued prior to April 4, 2002. The court denied the defendant's motion for summary judgment, stating that the regulation is not retroactively applicable to any claim for treatment provided prior to April 4, 2002, and the other defenses raised by the defendant's motion papers were unavailable, as the defendant failed to show that these defenses were properly preserved in a timely denial of the claim. Moreover, the defendant's motion papers lacked a complete copy of the pleadings, as required by CPLR 3212 (b).