More acupuncture from the First Department
First Department ruling on acupuncture fee schedule disputes in no-fault cases, highlighting importance of proper billing rates and timely denial procedures.
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November 2013 Articles
14 articles published in November 2013
Proof of objective standards are waived if EUO demand is not responded to
Court ruling establishes that healthcare providers waive their right to challenge EUO objective standards if they fail to respond to examination demands.
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HIPPA does not apply to no-fault: New trial ordered.
Appellate court rules HIPAA doesn't prevent insurers from using medical records in no-fault cases, orders new trial after improper exclusion of evidence.
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Acupuncture fee schedule from the First Department
First Department ruling on acupuncture fee schedules in no-fault insurance cases, analyzing chiropractor rate limitations and prima facie defense requirements.
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Claims documents considered as business records and unsuccessful mailing challenge
Court ruling on business records admissibility under CPLR 4518 and successful mailing challenges in insurance cases, lowering the burden of proof for standard office procedures.
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Maybe we have come along way and maybe we have not?
Legal analysis of People v Williams case examining how medical advances in HIV treatment affected criminal charges, reflecting broader changes in legal standards over time.
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Evidentiary issues in what appeared to be a personal grudge match at the 4th Department
4th Department rules on evidentiary issues including unsworn chiropractic reports, expert disclosure limitations, and serious injury standards in personal injury case.
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DJ denial reversed: A misspelling can be excused, and notice to the attorney is enough
DJ denial reversed: Court excuses IME notice misspelling, rules proper service to attorney sufficient for no-fault insurance claim coverage denial.
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Failure to attend IMEs voids coverage – with citation to Court of Appeals precedent
Court of Appeals precedent confirms failure to attend IMEs voids no-fault insurance coverage. American Transit v. Lucas case analysis and implications.
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Bad faith claim not adequately pleaded
New York court dismisses bad faith claim against Allstate, ruling plaintiff failed to allege tort independent of contractual obligations in no-fault insurance dispute.
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The peer review was insufficient
Court ruled peer review report lacked factual basis for denying medical supplies, showing First Department's higher scrutiny standards for peer reviews in no-fault cases.
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Some substance to an IME cut off defense
Court ruling establishes that IME reports must provide factual basis and medical rationale when claiming injuries are resolved in no-fault insurance cases.
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Evidence insufficient to prove that provider complied with verification request
Court rules that generic affidavit from third-party biller insufficient to prove mailing compliance in no-fault verification dispute case.
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Another IME no show from the App. Term First Dept
Appeals court confirms insurance companies can retroactively deny all no-fault claims when patients fail to appear for required IMEs, regardless of timing.
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