Another look at MUA
New York court ruling on MUA expert testimony qualifications in no-fault insurance cases, examining when medical experts can testify outside specialty areas.
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December 2013 Articles
24 articles published in December 2013
Medical necessity disputes in major medical disputes may be raised at any time
New York courts require competent expert medical proof to challenge medical necessity in no-fault insurance disputes, with fair and reasonable charges being key factors.
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First Application of Etienne
Westchester Med. Ctr. v Allstate case analysis: prima facie requirements under Etienne standard vs. Mary Immaculate precedent in NY no-fault claims.
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How come there have been no new master arbitration decisions posted on AAA’s website since October 15, 2013?
Attorney questions why AAA stopped posting master arbitration decisions after October 2013, highlighting the importance of these decisions for no-fault insurance practitioners.
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What is a prima facie case? I still am unsure
Learn what constitutes a prima facie case in New York no-fault insurance litigation. Analysis of Viviane Etienne case and burden of proof requirements for summary judgment.
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There was no long arm jurisdiction
New York court case where out-of-state insurance company successfully challenged personal jurisdiction under Civil Court Act 404 long-arm statute requirements.
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Failure to enter default within one year allows vacatur of default under a Woodson theory
NY court vacates default judgment using inherent discretionary power when plaintiff failed to move for default within one year, demonstrating Woodson theory application.
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The faiure to issue a denial in duplicate is no necessarily fatal to preserving a defense
Court ruling clarifies that failure to serve no-fault denial in duplicate copies alone is not fatal to preserving defenses, following post-Rusk case developments.
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Personal knowledge is well not too personal
Court ruling clarifies personal knowledge requirements for proving EUO no-shows in no-fault insurance cases, emphasizing detailed business practice affidavits.
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A choice of law analysis – PA law controls
New York court applies Pennsylvania law to auto insurance dispute, finding PA's protection for innocent third parties prevents policy rescission against assignor.
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EUO no-show mailing and personal knowledge substantiated
Court ruling confirms that proper mailing procedures and attorney's personal knowledge can establish EUO no-shows, setting important precedent for no-fault insurance disputes.
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An intentional default excused based upon court’s inherent power to vacate defaults
Court's inherent power to vacate default judgments in NY personal injury cases - Gurin v Pogge demonstrates when intentional defaults may be excused for substantial justice.
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An arbitrator’s order is not binding where the provider was not named in the underlying arbitration
Court rules arbitrator's decision non-binding when medical provider wasn't named in proceeding, highlighting importance of proper party inclusion in no-fault arbitrations.
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Civil Court properly granted motion to stay when DJ action is pending
Civil Court properly grants stay motion when declaratory judgment action pending - avoiding inconsistent adjudications in no-fault insurance cases.
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EUO tolling and reasonableness issues
Eagle Surgical Supply v Allstate case analysis on EUO scheduling timeliness, tolling effects, and reasonableness standards in New York no-fault insurance law.
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The denial need not be authenticated as a busines record
New York court clarifies that insurance claim denials don't require business record authentication under CPLR 4518, as they're not submitted as recorded transactions.
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Mutual rescheduling prior to the first no-show
Court ruling clarifies that mutual EUO rescheduling before the original date doesn't constitute a no-show, but insurers must still provide three examination opportunities.
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Proof of the no-show
Court ruling establishes that investigator affidavits and on-record statements provide sufficient proof of no-show at scheduled EUOs in no-fault insurance cases.
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IME no show reversal based upon the new 800 pound guerilla: proof of the no show
Long Island court ruling on IME no-show reversals and proof requirements in New York no-fault insurance cases, featuring Jacoby Chiropractic decision.
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The policy of insurance does not need to be included in the motion papers
Court rules insurance companies don't need to produce policy documents to establish EUO provisions when accident occurred after 2002 mandatory endorsement.
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A prima facie case involving durable medical equipment
Court ruling demonstrates how incomplete delivery documentation can derail a durable medical equipment provider's prima facie case for no-fault insurance benefits.
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EUO preclusion and EBT’s based upon preserved box #18 defense
New York court ruling on EUO preclusion and EBT rights based on preserved box 18 defense in no-fault insurance cases - key timing requirements explained.
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Appellate Term declines to follow First Department 3-year self insured statute of limitations precedent
Appellate Term follows Second Department precedent over First Department ruling in no-fault insurance statute of limitations dispute involving self-insured entities.
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Medical provider needs to prove that Assignor was represented by counsel and that counsel failed to receive notification of IME
NY court rules medical providers must prove assignor had counsel and counsel wasn't notified of IME scheduling to challenge no-fault insurance denials.
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