A sighting of “interboard” in action
Court ruling shows "interboard" IME cutoff requirements in action - acupuncture provider loses no-fault case for lack of medical evidence opposing summary judgment motion.
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June 2016 Articles
28 articles published in June 2016
Reversal of Supreme Court’s vacatur on a First Department 75
First Department reverses Supreme Court's vacatur of arbitration award involving Mallela defense burden of proof in no-fault insurance reimbursement case.
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Default – First Department reverses vacatur of the judgment
First Department reverses vacatur of default judgment due to insurer's inadequate excuse for two-year delay and lack of personal knowledge of office procedures.
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The Civil Kings briefing schedule
Court case analyzing default judgment after late opposition papers, examining Civil Kings briefing schedule adherence and prejudice standards in NY courts.
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Expansion of Mallela
Second Department expands Mallela doctrine in Liberty Mutual v Raia Medical, addressing physician billing rights when practice owner lacks specific certification skills
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5102(d) baseline under an aggravation and exacervbation
How defendants can defeat 5102(d) serious injury threshold claims under aggravation and exacerbation theories - Boroszko v Zylinski case analysis
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Equitable subrogation takes the backseat to the wording of the regualtion
New York no-fault insurance regulation limits benefit payments to applicants or healthcare providers only, blocking health insurers from claiming subrogation rights.
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Late notice defense sustained
Court sustains late notice defense when medical provider failed to submit no-fault claims within required timeframe and couldn't prove valid excuse for delay.
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IME/EUO no-show substantiated (First Department).
New York appellate court decisions clarify evidence requirements for proving IME and EUO no-shows in no-fault insurance disputes through sworn affidavits.
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EUO sustained – failure to challenge EUO requests is fatal to provider’s position
Court upholds no-fault insurer's EUO denial after provider failed to challenge examination requests. Key ruling on EUO justification requirements in NY.
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The verification affidavits again
Court ruling shows how healthcare providers can overcome insurance company claims of non-receipt of verification documents through proper affidavits and evidence.
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EBT’s of medical necessity cases.
Court decisions on EBT examinations in New York no-fault medical necessity cases, including timing of summary judgment motions and compelling plaintiff depositions.
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Prestigious EUO firm seems to have partners who lack personal knowledge
NY appeals court rejects EUO firm's affirmations lacking personal knowledge in three no-fault insurance cases, highlighting procedural deficiencies in summary judgment motions.
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EUO no-show from the First Department – lucky win by Mapfre?
First Department ruling on EUO no-shows in Mapfre v Manoo case - examining scheduling requirements and follow-up provisions under NY no-fault insurance regulations.
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EUO no show – what’s the reason?
Learn why EUO no-shows occur when insurers fail to provide required justification. Court rules insurers must give specific objective reasons for EUO requests.
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Medical necessity
A key New York no-fault case showing how IME reports can establish lack of medical necessity even when acknowledging ongoing disabilities and need for some treatment.
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Allstate EUO no-show cases
Court rejects Allstate's EUO no-show defense due to insufficient proof of nonappearance, highlighting the importance of proper documentation in no-fault insurance disputes.
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Renewal granted
Court grants renewal motion to correct typographical error in affidavit, demonstrating judicial discretion when parties show reasonable justification for mistakes.
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The denial just has to set forth a fee schedule defense
Court ruling clarifies that insurance companies can raise fee schedule defenses without specific details in denial forms, contrary to recent AAA arbitration trends.
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The IME doctor is in numerous places
Court finds serious concerns when IME doctors claim to be in multiple locations simultaneously, potentially establishing grounds for bad faith insurance claims.
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Enough with the Rybak verification affidavit
Long Island no-fault attorney criticizes Appellate Term's handling of Rybak verification affidavit cases, calling for proper proof standards in summary judgment motions.
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SUM game changer
NY Court ruling on SUM insurance offsets changes game for motor vehicle accident claims involving non-motor vehicle tortfeasors like municipalities.
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Uncertified police report valid to the extent there is an admission
Court rules that uncertified police reports containing defendant admissions are admissible evidence, even when defendant later contradicts those statements in affidavit.
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Interesting new regulation fee schedule discussion and an example of sloppiness?
Analysis of Tyorkin v Garrison case discussing New York no-fault insurance regulation fee schedule defenses and NF-10 denial form requirements in 2016 court decision.
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Defaults – required military affidavit (Maybe OCA can do something?)
Analysis of military affidavit requirements for default judgments in NY courts, discussing jurisdictional defects and OCA reform proposals for streamlined procedures.
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Use and occupation
Important Nakhla case clarifies "use and operation" coverage when person exits vehicle and is struck - affects first-party benefits and SUM coverage priority rules.
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The permissive use statute trumps the rental agreement
New York Appellate Term rules permissive use statute prevents rental companies from seeking indemnification from renters for accidents by unauthorized drivers.
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Policy exhaustion and the Harmonic Physical Therapy exception
NY court ruling on no-fault policy exhaustion disputes and Harmonic Physical Therapy exception for priority of payment under arbitration awards in 2016 case.
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