No-Fault Case Law
A.B. Med. Servs. v Travelers Prop. Cas. Corp. (2004 NY Slip Op 50517(U))
May 25, 2004
Plaintiff providers sued for assigned first-party no-fault benefits and appealed the denial of their summary judgment motion. Their only proof of mailing the claim forms was an affidavit from a person who called herself the practice and billing manager of 'plaintiff' without saying which plaintiff she worked for. The Appellate Term held that this was insufficient to establish that properly completed claim forms were provided to the insurer. The providers therefore did not make a prima facie showing and the denial was affirmed. The court also noted that the insurer was precluded from asserting the examination under oath defense because the applicable regulation had no such requirement.
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.
Matter of Avis Rent-A-Car Sys., Inc. v GE Auto & Home Assur. (2004 NY Slip Op 04013)
May 17, 2004
An accident occurred in a vehicle that a renter had rented from Avis, and the renter had a policy with GE Auto and Home. After paying no-fault benefits to the occupants, Avis submitted contribution claims against GE to compulsory arbitration, which were denied. Avis then petitioned to vacate the awards, and the Supreme Court denied the petition and confirmed the awards. The Appellate Division held that, as between the no-fault insurer of a rental vehicle and the no-fault insurer of a nondriver renter, the rental vehicle's insurer is the primary source of no-fault benefits. The order was affirmed.
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.
A.B. Med. Servs. v Allstate Ins. Co. (2004 NY Slip Op 50373(U))
April 27, 2004
The court considered the fact that plaintiffs were seeking to recover first-party no-fault benefits for chiropractic services they provided to an injured assignor in the sum of $2,603.36. The main issue decided was whether the plaintiffs provided defendant with properly completed claim forms to establish their entitlement to summary judgment. The court held that the affidavit submitted by the plaintiffs' billing manager was insufficient to establish that the claim forms were properly completed, as it did not indicate for which plaintiff she was the billing manager, and thus plaintiffs failed to make out their prima facie entitlement to summary judgment. Therefore, the court affirmed the order denying plaintiffs' motion for summary judgment.
King’S Med. Supply v Progressive Ins. (2004 NY Slip Op 50311(U))
April 14, 2004
The relevant facts considered by the court in this case were that a medical supply house, plaintiff, sought to recover first-party no-fault benefits for medical equipment furnished to its assignor, submitting claims for $795 and $1,220, and subsequently filing a motion for summary judgment. The main issue decided was whether the plaintiff was entitled to summary judgment on its claims, and the holding of the court was that the plaintiff was entitled to partial summary judgment in the sum of $1,925. The court found that the defendant failed to timely pay or deny the $795 claim, and that the request for the assignor to appear for an examination under oath did not toll the 30-day period within which the defendant was required to pay or deny the $1,220 claim. The court also determined that the plaintiff's compensation should be reduced by the amount billed for an unprescribed medical item. As a result, the matter was remanded to the lower court for further proceedings.