Malella and priority of coverage discovery disallowed
Court rejects insurer's discovery attempts to find primary coverage and investigate fraudulent incorporation in NY no-fault case, ruling demands improper.
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June 2012 Articles
30 articles published in June 2012
Assignor did not show up to his IME and EUO – double whammy
Court confirms insurer's summary judgment when assignor failed to appear at both IME and EUO after proper notice, citing Unitrin precedent for no-fault claims.
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Electronic signatures unconditionally accepted
New York First Department rules electronic signatures have same validity as handwritten signatures under State Technology Law § 304(2) for legal affidavits and court documents.
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A judge in Supreme Nassau on a standard no-fault matter applies Unitrin
Nassau Supreme Court applies Unitrin precedent in no-fault case, clarifying burden of proof standards for IME no-show defenses in provider litigation.
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Reverse Pan Chiropractic
Ocean Diagnostic v. Allstate case analysis showing how medical necessity burden shifted when plaintiff provided stronger evidence than insurer's peer review report.
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The substitute peer doctor
Nassau District Court ruling in Bajaj v GEICO clarifies when substitute peer doctors can testify in no-fault medical necessity cases, overturning restrictive precedent.
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CAN-O
New York court rejects hospital's jurisdictional challenge in no-fault insurance declaratory judgment action, establishing important precedent for provider liability cases.
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I wonder which plaintiff no-fault firm wrote this and had this State Senator introduce it…
Analysis of proposed New York no-fault insurance law changes affecting examination under oath procedures and claimant rights in 2012.
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An interesting decision on a well known performer of enhanced MUA
Court decision on CPT codes 99455 and 99456 billing abuse in New York no-fault insurance MUA claims, featuring Flatbush Chiropractic v MetLife arbitration award.
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An interesting observation from a District Court decision
District Court decision explores EUO document request scope and consequences of non-attendance in New York no-fault insurance cases.
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IME no-show substantiated
Court reverses order in IME no-show case, establishing key precedent for no-fault insurance claims when proper notice procedures are followed and examinations missed.
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Peer review
Court ruling emphasizes that peer review reports must provide clear medical rationale and factual basis to successfully challenge medical necessity claims in no-fault cases.
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Jumped the gun on preclusion
Appellate Term reverses premature discovery preclusion order, ruling employee with knowledge can verify interrogatories and sanctions require willful misconduct.
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Surprised?
New York appellate court reverses lower court decision in Oriental World Acupuncture v GEICO, highlighting the importance of strategic appellate arguments in no-fault cases.
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Conclusory affidavit?
Court ruled healthcare provider's affidavit was insufficient to rebut insurance company's peer review reports denying medical necessity claims.
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Form and procedure – not part of a prima facie case in a cancellation case
New York appellate court clarifies burden of proof in no-fault insurance cancellation disputes, shifting responsibility to claimants to prove procedural defects.
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Follow up verification issued >25 days too late is a loser
Court rules that follow-up EUO verification requests sent more than 25 days late violate Triangle "R" rule, making insurance denials untimely under no-fault regulations.
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Mr. Five Boro finally squeaks one out
Five Boro Psychological Services defeats GEICO on procedural grounds when peer review reports lacked proper CPLR 2106 affidavit requirements in NY no-fault case.
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The United States Postal Service at the Appellate Term (again?)
Appellate Term case Vista Surgical v Clarendon shows prima facie mailing case failed when certified mail receipt lacked proper documentation and witness testimony.
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There is something in that Rochester water.
Fourth Department ruling in Monette v Trummer clarifies that liability includes serious injury determination under Insurance Law 5102(d) for personal injury cases.
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Lawyer who tried to do his job but failed? Fine: $10,000
Court sanctions $10,000 fine against law firm for frivolous conduct in personal injury case, but appellate court reverses finding attorney's defense had merit
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Certificate of acknowledgment can possibly(?) be cured nunc-pro-tunc
NY appellate court rules certificate of acknowledgment defects in prenuptial agreements may be cured nunc pro tunc with proper evidence of contemporaneous execution.
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Oral application granted (untimely papers accepted) and the deeming acceptable of an affirmation of a physician in a different specialty
Court grants oral application accepting untimely expert papers and physician affirmation from different specialty in Buffalo General Hospital case.
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49.5 hours of interrogation – Fourth Department deems this acceptable
Fourth Department upholds confession after 49-hour interrogation with minimal sleep, raising serious questions about police procedure limits and constitutional protections.
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Proof of exacerbation insufficient in 5102(d) case to defeat summary judgment motion
Court rules insufficient proof of exacerbation cannot defeat summary judgment in NY serious injury threshold case. Fourth Department analysis of pre-existing conditions.
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Mr. Five Boro – the distant cousin of Mr. All Boro – has reappeared
Court ruling in Five Boro Psychological v GEICO clarifies that insurers don't need to provide medical records when defending medical necessity denials in no-fault cases.
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Staged accident and non-payments of premiums
Insurance fraud case reveals challenges with internet policy binding and payment requirements, highlighting need for stronger due diligence in no-fault claims.
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Another liability appeal…
Personal injury attorney Jason Tenenbaum examines recent liability appeals and challenges the legal maxim about summary judgment being rarely granted in negligence cases.
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Judge Levine gets stringsighted by the Second Department
Second Department cites Civil Court decisions by Judge Levine on 30-day notice requirements in no-fault insurance, highlighting interesting case law hierarchy.
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The failure to serve a notice of entry allows a 7 year old case to be adjudicated on appeal
Court rules that failure to serve notice of entry means the 30-day appeal deadline never starts, allowing a 7-year-old case to proceed on appeal.
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