Failure to answer questions voids coverage
Court rules failure to answer EUO questions voids no-fault coverage when doctor refuses to respond to relevant insurance company inquiries during examination.
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November 2015 Articles
27 articles published in November 2015
Delay letters v. verification requests
New York court clarifies that generic delay letters don't toll statutory payment deadlines—only specific verification requests can extend an insurer's time to pay or deny claims.
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Why was misrepresentation material?
Insurance companies must prove misrepresentations were material to deny coverage. Court found insufficient evidence that false vehicle use claims would have increased premiums.
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EBT upheld
Court upholds EBT examination order in no-fault case where medical necessity disputed, rejecting provider's resistance to deposition despite summary judgment denial.
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Another less than valid verification compliance affidavit suffices
New York court accepts inadequate verification compliance affidavit despite lack of specific details about mailing dates and contents in no-fault insurance case.
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Need to wait for the non-EUO based verification before disclaiming
New York no-fault insurers must wait for verification responses before disclaiming claims based on EUO failures, as established in Alleviation Med. Services v Citiwide Auto Leasing.
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Maya failed to prove mailing of the IME scheduling letters
New York court rules Maya Assurance failed to prove proper mailing of IME scheduling letters, highlighting the strict procedural requirements insurance companies must meet.
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Clennon applied
Palafox PT v State Farm case analysis on EUO justification requirements under Clennon precedent, showing insurers need only prove dual demands and failures to appear.
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Failed to avail itself of the opportunity afforded to it on the NF-10
NY court ruling emphasizes that healthcare providers must actively use regulatory safety valves when facing late notice denials in no-fault insurance claims.
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Lost to Dr. Bhatt
Appellate Term affirms Civil Court ruling against medical provider in no-fault case where defendant failed to prove services weren't medically necessary.
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Prima facie case in MVAIC matter
Court ruling clarifies MVAIC prima facie case requirements, emphasizing medical providers must prove NY residency and notice of intention filing beyond basic claim submission.
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65-3.5(b) discussed in the EUO context
New York's no-fault insurance regulations require insurers to request EUOs within 15 days of receiving a claim. Courts strictly enforce this timing requirement.
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Lincoln General citing
Court ruling shows insurance companies lose IME defense rights when they fail to deny claims within mandatory 30-day period under NY no-fault regulations.
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Medical necessity finding not sufficient upon search of record
Court improperly searched record to grant defendant summary judgment on medical necessity when plaintiff never moved on that issue, violating procedural fairness.
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NF-2 is sufficient to remit case to the Workers Compensation Board
Court rules that NF-2 form admission of employment status creates sufficient factual question to remit no-fault case to Workers Compensation Board for determination.
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EUO no show defense substantiated
Court ruling confirms insurers don't need objective reasons for EUO demands when proving prima facie case for no-show defense in New York no-fault claims.
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Do you really believe that the verification was mailed? I don’t
Court ruling shows how medical providers can counter insurance company claims of non-receipt through proper affidavit evidence in no-fault verification disputes.
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Non-Receipt substantiated
Court ruling in Compas Med. v Praetorian establishes that detailed mail receipt procedures can rebut presumption of claim receipt in no-fault insurance disputes.
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Severance appropriate
Court rules on severance motion in no-fault insurance case involving multiple assignors from separate motor vehicle accidents under CPLR 603.
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Etienne applied differently in First Department
Second Department Appellate Term applies Viviane Etienne precedent differently than First Department, showing varying interpretations of prima facie standards in no-fault cases.
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A verification non receipt decision that does not make sense.
Court decision analysis reveals flawed verification non-receipt ruling where affidavit failed to specify mailed items or dates, creating questionable precedent.
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EUOs must be scheduled within 30-days of receipt of the bill (again)
Court reaffirms that insurance companies must schedule EUOs within 30 days of receiving no-fault claims, or lose their right to deny payment under New York law.
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Make a promise in your papers and fail to keep it? Summary judgment lost
Court case shows how matching the wrong documents to an affidavit can destroy an insurance company's summary judgment motion in no-fault litigation.
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No-show troubles
NY courts rule on IME no-show cases requiring personal knowledge proof. Three 2015 decisions show insufficient conclusory affidavits fail summary judgment standards.
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Put on a case at your own risk after the Plaintiff rests
Criminal defendants face significant risks when presenting evidence after the prosecution rests, as they may inadvertently cure deficiencies in the state's case.
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Familiar theme on experts and 2106
Expert witness qualifications and CPLR 2106 objection requirements in NY medical malpractice cases - Lopez v Gramuglia analysis of cross-specialty testimony standards.
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Judge Judy’s son threw a tantroom
Long Island attorney Jason Tenenbaum criticizes Judge Judy's son, Putnam County DA Adam Levy, for handling a legal dispute unprofessionally in Levy v Smith case.
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