No-Fault Case Law
Boai Zhong Yi Acupuncture Servs., P.C. v Allstate Ins. Co. (2007 NY Slip Op 51601(U))
August 16, 2007
The court considered the evidence presented by the plaintiff in support of their motion for summary judgment, which included an affirmation from plaintiff's counsel, an affidavit by a corporate officer of the plaintiff, and various documents. The main issue decided in the case was whether the affidavit executed by the plaintiff's corporate officer was legally sufficient to establish the officer's personal knowledge of the plaintiff's practices and procedures to lay a foundation for the admission of the documents as business records. The court held that the affidavit was insufficient to establish personal knowledge, and therefore, the plaintiff failed to make a prima facie showing of its entitlement to summary judgment. As a result, the court affirmed the order denying plaintiff's motion for summary judgment.
Prestige Med. & Surgical Supply, Inc. v Clarendon Natl. Ins. Co. (2007 NY Slip Op 27344)
August 16, 2007
This case involves a dispute over first-party no-fault benefits. The plaintiff, the medical supplier, moved for summary judgment based on the argument that the defendant insurance company failed to provide claim forms in a timely manner. Defendant's opposing papers did not present proof to establish that the denial of claim forms were timely mailed to plaintiff. The court held that the defendant's failure to establish timely mailing precluded them from raising the defense of lack of medical necessity. Thus, the court reversed the trial court's order and granted plaintiff's summary judgment. It also remanded the matter back to the trial court for a calculation of statutory interest and attorney's fees.
Lexington Acupuncture, P.C. v MVAIC (2007 NY Slip Op 51604(U))
August 16, 2007
The provider sought summary judgment against MVAIC on assigned no-fault claims, supported by an employee's conclusory affidavit stating that the annexed documents were business records. MVAIC argued the affidavit was insufficient and that the provider had not shown timely filing of a notice of claim under Insurance Law section 5208. The Civil Court denied the motion because MVAIC did not receive a notice of claim. The Appellate Term affirmed on the different ground that the affidavit failed to show personal knowledge of the provider's practices and so did not lay a business-records foundation. It reached no other issue.
Bell Air Med. Supply, LLC v MVAIC (2007 NY Slip Op 51607(U))
August 16, 2007
The provider sued MVAIC for no-fault benefits assigned by three persons, and the Civil Court dismissed the complaint. The Appellate Term held that two assignors who neither filed a timely notice of claim nor sought leave to file a late one under Insurance Law section 5208 were not covered persons, so those claims were properly dismissed. As to the third assignor, the record did not show a failure to meet a condition precedent. The record also did not establish when the cause of action accrued, so MVAIC did not prove the statute of limitations as a matter of law. The order was modified to deny dismissal of the third assignor's claim and otherwise affirmed.
Delta Diagnostic Radiology, P.C. v General Assur. Co. (2007 NY Slip Op 51616(U))
August 16, 2007
The provider moved for summary judgment on assigned no-fault claims and the Civil Court denied the motion because the insurer showed an issue of fact. On appeal the insurer argued that the provider's officer's affidavit failed to lay a foundation for the documents as business records. The Appellate Term agreed that the affidavit did not establish the officer's personal knowledge of the provider's practices and procedures. The provider therefore failed to make a prima facie showing, and the order was affirmed on that other ground.
Union Physician Health Care, P.C. v American Mfrs. Mut. Ins. Co. (2007 NY Slip Op 51505(U))
July 24, 2007
The main issue in this case was whether the plaintiff, a healthcare provider seeking to recover first-party no-fault benefits, was entitled to summary judgment. The defendant had timely denied the claims, and the court ruled that the affidavit submitted by the plaintiff's corporate officer did not lay a proper foundation for the documents annexed to the moving papers. As a result, the plaintiff failed to make a prima facie case for entitlement to summary judgment. The court affirmed the lower court's denial of the motion for summary judgment, and the parties' remaining contentions were not addressed. Therefore, the holding of the case was that the plaintiff's motion for summary judgment was properly denied.
St. Vincent’s Hosp. & Med. Ctr. v Allstate Ins. Co. (2007 NY Slip Op 06227)
July 24, 2007
St. Vincent's Hospital & Medical Center sought to recover no-fault medical payments from AllState Insurance Company. AllState appealed an order by the Supreme Court, Nassau County, which denied its motion to vacate a clerk's judgment entered upon its failure to appear or answer, and for leave to serve a late answer. The defendant claimed a reasonable excuse for its delay in appearing, and a potentially meritorious defense, and the Appellate Division concluded that the Supreme Court had improvidently exercised its discretion in denying the motion. The Appellate Division reversed the order, allowing the defendant's motion, vacating the clerk's judgment, and deeming the answer served on the plaintiff. The Supreme Court's decision was reversed and the defendant's motion to vacate the judgment and serve a late answer was granted.
St. Vincent’s Hosp. & Med. Ctr. v Nationwide Mut. Ins. Co. (2007 NY Slip Op 06226)
July 24, 2007
The case involved St. Vincent's Hospital and Medical Center seeking to recover no-fault benefits for medical services provided to an individual that was injured in a car accident. St. Vincent's motioned for summary judgment in order to recover a specific sum from the insurance company, arguing that the company did not provide a timely denial of claim form as required by law. In opposition to St. Vincent's claim, the insurance company submitted evidence of a denial form that had been mailed. St. Vincent's sued for the lack of information included in the denial form. The court found in favor of the insurance company, ruling that they did issue a timely denial of the claim, allowed by law, which led to a triable issue of fact. St. Vincent's argument that the denial was inadequate was not considered by the court because it was raised for the first time in its reply papers.
Mega Supply & Billing, Inc. v Allstate Indemnity Co. (2007 NY Slip Op 51515(U))
July 23, 2007
The provider's motion for summary judgment was supported by an affidavit of an employee stating in conclusory terms that the attached documents were business records. The insurer argued that the affidavit failed to lay a foundation for admitting the claim forms. The Appellate Term agreed, finding nothing showing the employee's personal knowledge of the provider's practices and procedures. The provider therefore failed to make a prima facie showing, and the order granting it summary judgment was reversed and the motion denied.
Omega Diagnostic Imaging, P.C. v State Farm Mut. Ins. Co. (2007 NY Slip Op 51405(U))
July 20, 2007
The main issue in this case was whether a stipulation of settlement in a judicial action, on the advice of counsel, is subject to the same rules as an ordinary contract. In this case, the court found that it was not. The court declared that a stipulation of settlement such as the one at bar is merely a variant of a judgment on consent. The defendant consents to entry of judgment for the full amount of the complaint, subject to a condition subsequent that payment of a reduced sum within a time certain will satisfy the obligation. The holding of the case was that the entry of judgment for the full amount of the complaint did not constitute an unconscionable penalty for a few days' delay, and Plaintiff's remedy was not limited to a few days of statutory interest on the settlement amount. Therefore, the motion was denied and there was no stay in effect against enforcement of the judgment.