Lost wages not proven within a reasonable degree of certainty.
Court dismisses no-fault lost wages claim where unemployed plaintiff's projected income from potential job opportunity lacked reasonable degree of certainty.
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July 2017 Articles
19 articles published in July 2017
Discovery granted/ Owner hailed into an EBT
Court rules insurance company entitled to examine healthcare provider's owner under oath in no-fault benefits case, demonstrating broad discovery rights in medical provider litigation.
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Sloppy EUO practice comes back to haunt Allstate
Allstate's procedural errors in EUO scheduling led to an untimely claim denial in this New York no-fault insurance case, highlighting the importance of strict compliance with regulatory deadlines.
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Mutual rescheduling issues
New York court ruling on mutual EUO rescheduling: why agreed postponements don't constitute failure to appear under no-fault insurance law.
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Functional ATIC/ medial necessity and fee schedule defense susbstantiated
New York court decision on medical necessity and fee schedule defenses in no-fault insurance cases, featuring expert affidavit requirements and proper coding analysis.
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Can a mailing to the attorney on the IME n/s defense be dispositive on the proof and fact of the no-show?
Court ruling clarifies that IME scheduling letters sent to attorneys only establish proper notice if there's proof the patient was actually represented by that attorney.
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Back when ATIC had a functional litigation defense strategy
ATIC's functional litigation defense strategy in Compas Med v American Trust Insurance Co case involving fee schedule defenses and CPT code bundling issues.
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Hearsay insufficient to substantiate a fraud defense/Fee Schedule discussion
Court ruling on hearsay evidence in no-fault insurance fraud defenses and fee schedule denial requirements. Analysis of Box #18 denials and coverage disputes.
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Additional Verification non-receipt
Court rules that no-fault insurer's 30-day payment period doesn't start until they actually receive requested verification documents, even if provider claims they were sent.
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EUO is untimely and not a double no-show
New York court rules EUO scheduling was untimely and rescheduling prevents valid no-show claims in no-fault insurance case, establishing key precedent for providers.
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An EUO defense that was precluded
Court rules insurance company's EUO defense was precluded due to untimely scheduling letter sent more than 30 days after receiving claims, highlighting critical timing requirements.
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Where was the partner? Not at the office
Court rules that law firm partner's affirmation lacks personal knowledge to prove EUO no-show, highlighting burden of proof requirements in no-fault insurance cases.
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EUO letter to Assignor did toll time to pay or deny
EUO letter to assignor tolls time to pay or deny no-fault claims. Key requirements: timely EUO scheduling letter plus delay notice to provider.
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The DJ as to the provider that never was
New York appellate court ruling on amendment to pleadings and res judicata defense in no-fault insurance case, analyzing default judgment procedures.
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Procedurally improper
Appeals court rules on judgment offset motion in no-fault insurance case, finding Civil Court's refusal to set off judgments was not improper exercise of discretion.
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The sad man’s DJ
Court dismisses insurance company's fraud-based declaratory judgment action lacking EUO testimony and claims-specific evidence, calling it a "sad man's DJ"
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Trial de-novo win where carrier did not respond to verification objection letter and wins.
Trial de-novo win where no-fault carrier failed to respond to verification objection letter, highlighting communication requirements in NY insurance claims.
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Arrest warrant not issued
Court denies arrest warrant for defendant who failed to comply with post-judgment subpoena in no-fault insurance case, despite contempt finding.
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Very interesting discussion on Perl
Santos v Traylor-Pagan analysis: carpal tunnel causation fails without contemporaneous treatment under Perl standard in NY personal injury threshold cases
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