First Department on Unitrin again
First Department rules on IME no-show requirements in Priority Med v NY Central Mut, requiring competent evidence beyond standard practices for no-fault claims.
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April 2015 Articles
25 articles published in April 2015
Another Mailing
Court rejects mailing affidavit from employee who started after the denial was sent, highlighting importance of personal knowledge in proving proper mailing procedures.
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Exhaustion of benefits – strict priority of payment regimen is somewhat abrogaded
NY court ruling on no-fault insurance policy exhaustion defense when claims are properly denied but coverage limits reached through arbitration awards to other providers.
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Failure to provide proof of Medicare status kills post-verdict interest
Court vacates post-verdict interest when plaintiff fails to provide Medicare status affidavit required under CPLR 5003-a for defendant's federal reporting compliance.
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Alrof again…
Court denies both summary judgment motions in no-fault case, highlighting importance of proper EUO scheduling and appearance requirements under Alrof precedent.
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EUO time-frame according to the Appellate Term Second Department
New York appellate court clarifies strict 15-day deadline for no-fault insurers to request EUOs, ruling that late scheduling letters are nullities under regulations.
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Objective basis need not be proven
NY court rules insurers don't need objective basis to request EUOs under No-Fault Regulation 68, making EUO requests easier to justify as reasonable.
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Defaults – the right to notice
Analysis of Paulus v Christopher Vacirca ruling on CPLR 3215(g)(1) notice requirements for default judgments when defendants have appeared in NY actions.
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Cost of doctor for aborted trial not reimbursable
New York court rules that trial costs and expert witness cancellation fees are not reimbursable when defense attorney becomes ill, reversing $6,900 award.
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Parties cannot stipulate away issues of pure coverage
NY Court rules parties cannot stipulate away pure coverage issues in no-fault insurance disputes. Key precedent for coverage defense strategies.
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Non-disruptive representative allowed at IME
Court rules that having a non-disruptive representative present during an IME doesn't prevent defendants from conducting meaningful medical examinations under CPLR 3121.
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First application of 11 NYCRR 65-3.8(g)(1)(ii)
Landmark case establishing first application of 11 NYCRR 65-3.8(g)(1)(ii) regarding prevailing fees and timeliness requirements in New York no-fault insurance claims.
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An interesting case in the realm of misrepresentations
Court finds insurer can deny coverage despite keeping premiums when policyholder misrepresented property status on application, highlighting material misrepresentation defense complexities.
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Suspended physician
Court rules that a physician's medical affirmation remains admissible even after license revocation, as long as the affirmation was executed while licensed.
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Defective cancellation abrogated upon proof that another carrier picked up risk
NY Court ruling on auto insurance cancellation: when another carrier picks up coverage, prior policy automatically terminates under VTL §313(1)(a).
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Appellate Term (again) reverses course on Unitrin
Appellate Term reverses course on Unitrin case law regarding IME no-show denials and retroactive claim denial rights in New York no-fault insurance disputes.
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Non receipt and verification
Court ruling on non-receipt denials and verification requirements in NY no-fault insurance claims, including burden of proof standards for medical providers.
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Does not need to be mailed in duplicate (again)
Court clarifies that failure to mail no-fault denial forms in duplicate is not automatically fatal to insurance company's defense, reinforcing procedural flexibility.
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A taste of Unitrin in the Second Department
Second Department case analyzing IME failure as coverage defense in New York no-fault insurance law, examining conditions precedent to insurer liability.
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Third-party vendor troubles
New York no-fault insurance carriers risk costly legal defeats when third-party mailing vendors fail to prove proper delivery procedures for claim denials.
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The application of the 10-day follow up period to send EUO requests
Court ruling clarifies timing requirements for EUO follow-up requests in no-fault cases, emphasizing proper application of verification timeframes under NY insurance regulations.
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CPT Code 20553 reduced from $4,000 to less than $1,000
NY court reduces CPT Code 20553 billing from $4,000 to under $1,000 using workers' compensation fee schedule Ground Rules 3 and 5 in no-fault insurance case.
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EUO denial not vague or conclusory for not stating dates
Court rules EUO denial valid despite not specifying examination dates, rejecting plaintiff's argument that omission made denial vague or conclusory under New York no-fault law.
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Failure to object (again) spells end to fishing expedition on “reasonableness”
Court reaffirms that healthcare providers who fail to object to EUO requests cannot later challenge their reasonableness in discovery disputes.
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Welcome to my new site
Long Island attorney Jason Tenenbaum launches his new website in 2015, transitioning from his popular no-fault insurance law blog to provide enhanced legal content.
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