No-Fault Case Law
A.B. Med. Servs., Pllc v N. Y. Cent. Mut. Fire Ins. Co. (2004 NY Slip Op 50550(U))
May 26, 2004
The court considered an action to recover first-party no-fault benefits for medical services rendered to an assignor. The plaintiffs moved for summary judgment, and the court granted summary judgment on certain claims. The main issue was whether the defendant had provided proof in admissible form to rebut the plaintiff's prima facie showing of entitlement to summary judgment. The court found that the defendant had failed to provide sufficient proof to raise a triable issue of fact as to the medical necessity of the services rendered, which would warrant denial of the plaintiff's motion for summary judgment. Therefore, the court held that the plaintiff's motion was properly granted and affirmed the judgment in their favor.
A.B. Med. Servs. v N. Y. Cent. Mut. Fire Ins. Co. (2004 NY Slip Op 50507(U))
May 26, 2004
In this case, the plaintiffs sought to recover first-party no-fault benefits for medical services rendered to their assignor, totaling $5,773.94, as well as statutory interest and attorney's fees. The lower court granted summary judgment on claims totaling $2,576.32, while denying summary judgment on the remaining $1,440 claim. The issue before the appellate court was whether the denial of the motion for summary judgment on the $1,440 claim was proper, and if the remaining claims were properly granted summary judgment. The appellate court affirmed the judgment, finding that the plaintiffs had established their entitlement to summary judgment by submitting complete proofs of claims, and that the defendant had failed to provide proof in admissible form to rebut the plaintiff's showing of medical necessity, as required by law. Therefore, the plaintiffs' motion for summary judgment was properly granted, and the judgment was affirmed.
Park Neurological Servs. P.C. v GEICO Ins. (2004 NY Slip Op 24210)
May 26, 2004
The court in this case was considering a claim for first-party no-fault benefits. The plaintiff, a neurological services provider, had submitted the claim to the defendant insurance company, but the claim was denied based on a peer review. The provider then filed a lawsuit seeking to recover the amount of the original claim, as well as statutory interest and attorney's fees. The main issue was whether the defendant's denial was valid, and the court determined that the denial was not sufficiently supported with reasons, and therefore the defendant was precluded from asserting the defense of lack of medical necessity. The holding of the court was to reverse the lower court's order, grant the plaintiff's motion for summary judgment, and remand the case for the calculation of statutory interest and an assessment of attorney's fees.
A.B. Med. Servs. v Am. Tr. Ins. Co. (2004 NY Slip Op 50515(U))
May 25, 2004
The court considered the appeal by the plaintiffs from an order denying their motion for summary judgment in a case involving a claim for first-party no-fault benefits for medical services rendered to their assignor. The main issue was whether the plaintiffs provided the defendant with properly completed claim forms, as required by Insurance Law § 5101 et seq. In support of their motion, the plaintiffs submitted an affidavit from the practice and billing manager of one of the plaintiffs, but the affidavit did not specify for which plaintiff she was the billing manager, making it insufficient to establish that the plaintiffs provided the defendant with properly completed claim forms. As a result, the plaintiffs failed to make a prima facie showing of entitlement to summary judgment, and the order denying their motion was affirmed.
Amaze Med. Supply Inc. v Allstate Ins. Co. (2004 NY Slip Op 50447(U))
May 20, 2004
The court considered the plaintiff's motion for summary judgment in an action to recover first-party no-fault benefits, arguing that the defendant's failure to timely deny its claim entitled the plaintiff to summary judgment. The plaintiff submitted a complete proof of claim to the defendant, which the defendant neither paid nor denied within 30 days, as required by law. The plaintiff provided evidence of mailing the bills to the defendant on September 18, 2001, shifting the burden to the defendant to come forward with a triable issue of fact. The defendant's attorney argued that the denial letter was timely, stating that the defendant received the claim on October 18, 2001, but lacked personal knowledge of the underlying facts. The court held that the lower court should have granted the plaintiff's motion for summary judgment and remanded the matter for the calculation of statutory interest and attorney's fees pursuant to Insurance Law § 5106 (a) and the regulations promulgated thereunder.
Dependable Ambulette, Inc. v Progressive Ins. Co. (2004 NY Slip Op 24160)
May 19, 2004
The court considered the case of Dependable Ambulette, Inc., who had provided ambulette services to Boris Cherkalin and filed a complaint against Progressive Insurance Co. after being denied payment for their services. Progressive Insurance Co. argued that plaintiff lacked jurisdiction to bring the case and that assigned ambulette services were not eligible for reimbursement under the No-Fault Law, Insurance Law § 5102. The main issue in the case was whether assigned ambulette services are eligible for reimbursement under the No-Fault Law. The court found that according to the law, ambulette services do not constitute covered expenses incurred pursuant to the No-Fault Law and are not considered "health services," therefore dismissing the plaintiff's complaint.
A.B. Med. Servs. v Country-Wide Ins. Co. (2004 NY Slip Op 50535(U))
May 14, 2004
The court considered the motion for partial summary judgment in the amount of $11,420.05 filed by plaintiffs in an action to recover first-party no-fault benefits, statutory interest, and attorney's fees for health services provided to their assignor. The main issue was whether the plaintiffs had provided the defendant with properly completed claim forms. The court decided to affirm the order denying the motion for partial summary judgment, stating that the affidavit submitted by plaintiffs' billing manager was insufficient to establish that the defendant had been provided with properly completed claim forms. Therefore, the plaintiffs failed to make a prima facie showing of entitlement to judgment as a matter of law. The decision was made on May 14, 2004.
Matter of Empire Ins. Co. v Eagle Ins. Co. (2004 NY Slip Op 24146)
May 4, 2004
The case involved a dispute over the statute of limitations related to the reimbursement of no-fault insurance payments made by a petitioner. The petitioner filed a demand for arbitration in 1998, which was denied over statute of limitations grounds. The matter was remanded twice for new hearings, but arbitration forums continued to deny the claim based on the expiration of the statute of limitations. The Court ruled that the arbitrator's award dismissing the claim as barred by the statute of limitations was arbitrary and capricious, and remanded the matter to be heard by a different arbitrator. The Court also expressed strong disapproval of the respondent and their lawyer's persistent refusal to abide by their prior rulings on the matter and recommended the imposition of sanctions.
MOPS Med. Supply v GEICO Ins. Co. (2004 NY Slip Op 24140)
May 3, 2004
The relevant facts the court considered were that the plaintiff, MOPS Medical Supply, was seeking payment of first-party no-fault benefits for medical equipment provided to Leonie Joiles. Defendant GEICO Insurance Company denied payment based on medical necessity after an independent medical peer review. The main issue decided was whether the defendant's motion to dismiss the plaintiff's complaint for failing to appear at an examination before trial (EBT) should be granted. The court held that the defendant's motion was granted unless the plaintiff appeared for an EBT under the terms set forth in the decision. The court also found that the defendant's noticing of the deposition at the same time as sending the demand for interrogatories, without taking action to enforce the request for a deposition until after receiving the interrogatories, bordered on abuse of the judicial system. The court stated that one form of discovery should generally be completed before invoking another.
Matter of New York Cent. Mut. Fire Ins. Co. (Valois) (2004 NY Slip Op 03399)
April 30, 2004
In this case, the respondent sustained injuries in a single-car accident and registered a blood alcohol content of .10% when tested at the hospital. She later pleaded guilty to driving while ability impaired. When she filed for no-fault benefits, her claim was denied by the petitioner due to the policy's intoxication exclusion. As a result, the respondent filed for arbitration while the petitioner sought a stay. The relevant facts in the case included whether the respondent was actually intoxicated at the time of the accident. The court decided that the parties had agreed to arbitrate the dispute and that it was for the arbitrator to address the merits of the dispute. The holding of the case was that the matter would proceed to arbitration, and the court denied the petitioner's motion for a permanent stay and the respondent's cross-motion for summary judgment without costs.