Great Wall is binding precedent on American Arbitration Association
Court rules American Arbitration Association arbitrator failed to follow binding Great Wall precedent on acupuncture fee schedules in no-fault insurance dispute.
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April 2013 Articles
22 articles published in April 2013
Rules on Trial De-Novo
Rules governing trial de novo in New York no-fault arbitration cases, including timing requirements and jury trial demands under CPLR §3405.
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Court has discretion to overlook absence of pleadings
New York courts have discretion to overlook missing pleadings in summary judgment motions when the record is sufficiently complete, per Washington Realty case.
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IME issues
Court ruling clarifies IME procedures: no videotaping allowed and plaintiff's attorneys cannot be excluded without special circumstances in New York.
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Late papers in accordance with CPLR 2214 are okay
Courts have discretion to accept late papers under CPLR 2214 when plaintiffs show valid excuse and minimal delay without prejudice to defendants.
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Additional Verification non-receipt and lack of medical necessity.
Court ruling on no-fault insurance claim denial for acupuncture services due to insufficient response to verification requests and lack of medical necessity evidence.
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Summary judgment granted on Mallela case
Court grants summary judgment in Mallela case, ruling healthcare providers must meet licensing requirements for no-fault insurance reimbursement under NY Insurance Law.
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Chubb defense substantiated and unrebutted on this record
Court dismisses no-fault claim when medical provider's bare-bones affidavit fails to rebut insurer's causation defense with factual basis or address contrary expert findings.
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A preclusion order renders the defense deficient as a matter of law – prima facie burden established
Court awards summary judgment to no-fault provider when preclusion order renders insurance company's defense legally insufficient, establishing prima facie case.
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Defendant failed to meet its prima facie burden on a medical necessity motion
Court ruling shows how insufficient peer review reports fail to establish prima facie burden in medical necessity motions under New York no-fault law.
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UB-04 + nothing else does not equal Prima Facie
Court rules UB-04 forms alone don't establish prima facie no-fault claims - NF-5 forms required to trigger 30-day payment period under New York insurance law.
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Police accident report sufficient to trigger Workers Comp inquiry
New York court rules police accident report alone can trigger Workers' Compensation inquiry, potentially barring no-fault insurance benefits in workplace injury cases.
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The doctor himself could not get his bills into evidence
Court rejects doctor's testimony on billing records foundation in NY no-fault case, finding gaps in witness knowledge of separate billing company procedures.
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Personal knowledge became more personal
Court rules attorney affidavit lacking personal knowledge insufficient for EUO no-show summary judgment in New York no-fault case
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MSJ + EBT = disaster for plaintiff
Court case analysis showing how failed summary judgment motion led to mandatory EBT order for medical provider in no-fault insurance dispute.
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Additional Verification
New York court ruling clarifies that insurance delay letters must request specific verification to toll statutory payment deadlines, raising questions about required detail levels.
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Shell game
Court case analysis where defendant's motion to renew and reargue was denied after defaulting on no-fault insurance summary judgment opposition papers.
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Conclusory denial of receipt of IME letter is insufficient to stave off summary judgment
Court rules that simply denying receipt of an IME notice letter isn't enough to defeat summary judgment in no-fault insurance cases without additional evidence.
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Late written notice not excused
Court denied excuse for late written notice when attorney failed to explain why claim was initially submitted to wrong carrier, establishing prima facie case for summary judgment.
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Another less than noteworthy prima facie decision
Analysis of New York Diagnostic Med. Care v GEICO decision on prima facie requirements in no-fault insurance claims and medical necessity standards.
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It looks like someone did not include the fee schedule as an exhibit in their acupuncture motion
Insurance companies must properly submit fee schedules as evidence when denying acupuncture claims, or risk having their payment denials overturned by courts.
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A copy of a peer report is all that is needed
New York court clarifies that peer review reports need only be copies when requested by providers, and cannot be used as evidence to prove lack of medical necessity at trial.
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