From the Department of Financial Services today
New York Department of Financial Services announces criminal charges against 18 healthcare providers for no-fault insurance fraud, highlighting ongoing enforcement efforts.
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October 2013 Articles
22 articles published in October 2013
2309(c) defect waived (again)
Court rules that missing authentication certificates for out-of-state notarized affidavits under CPLR 2309(c) is not a fatal defect when waived by opposing party.
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8 units applies to billing medical providers only?
Suffolk County District Court rules on 8-unit billing limit for medical providers under NY no-fault insurance fee schedule, allowing reimbursement despite multiple claims.
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EBT order as an alternative to a denied medical necessity motion
When medical necessity motions are denied, providers can use EBT orders to compel chiropractor depositions in no-fault cases under CPLR 3101(a) discovery rules.
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EUO letter did not toll time to pay or deny
Court rules EUO scheduling letter must identify specific person being requested for examination or lose toll benefit under NY Insurance Regulation 65-3.6(b).
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Mallela based disclosure granted
Court grants discovery motion to determine if medical provider meets licensing requirements under Mallela defense, vacating premature trial notice.
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Tax records denied in Mallela based disclosure matter
Court denies insurance company's request for tax records in no-fault case, reinforcing that tax returns require special circumstances to be discoverable in litigation.
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Conditional discovery order vacated upon showing of law office failure
New York courts may vacate discovery sanctions when defendants show reasonable law office failure excuse and meritorious defenses, as demonstrated in Elite Medical case.
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Initial visit compensable
Court ruling highlights insurance companies must address initial evaluation codes separately from routine treatment codes in no-fault insurance disputes.
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IME no show defense sustained
NY appellate court upholds IME no-show defense when scheduling letters were properly addressed to insured's last known address and attorney received copies.
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And why do you think the signature was stamped?
Court rejects challenge to peer review report based solely on claim of stamped signature, emphasizing need for expert proof in no-fault insurance disputes.
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Chiropractor fee schedule applies to all billed for codes
New York court rules that chiropractor fee schedules apply to acupuncture services regardless of provider type, impacting no-fault insurance reimbursement rates.
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Partial Summary Judgment granted on appeal
NY Appellate Term allows appeals of partial summary judgment orders on prima facie case and timely denials in no-fault insurance litigation.
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Proof that the injury was pre-existing was not refuted
Get expert legal analysis on Proof that the injury was pre-existing was not refuted from Law Office of Jason Tenenbaum | Personal Injury Lawyers
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That the testing was necessary to rule out herniations is sufficient to warrant a trial on medical necessity
New York court rules that detailed medical affidavit explaining need for MRI to rule out disc herniations creates triable issue of medical necessity in no-fault case.
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MVAIC again fails in its quest to prove the mailing of IME letters
MVAIC fails again to prove proper mailing of IME letters due to deficient affidavits lacking personal knowledge and specific procedural details.
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Triable issue of fact – medical necessity
Hunt City Chiropractic case shows conflicting medical expert opinions can create triable issues of fact on medical necessity in no-fault insurance disputes.
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Cessation of treatment and its interplay with no-fault fraud?
Court ruling on cessation of no-fault treatment - when plaintiffs must prove benefit termination and reasonable explanation for stopping therapy in 5102(d) cases.
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Without the data, the affidavit was conclusory
Court rules expert affidavit was conclusory when transportation engineer failed to provide underlying data supporting accident reconstruction opinions.
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Summary judgment granted as to negligence yet “sole proximate cause” and comparative negligence left as open questions
Court grants summary judgment on negligence but leaves causation questions open, demonstrating how complex liability cases can be divided into discrete legal issues.
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It is MVAIC again
Court decisions highlight differing approaches to MVAIC claims when vehicle owners are known versus unknown, affecting no-fault benefit recovery strategies.
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This one managed to get published
New York court case American Transit v. Megan Ash addresses Independent Medical Examination procedures in no-fault insurance claims and provider obligations.
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