Arizona and ATIC
New York appellate decision highlights critical issues with notice delivery in insurance cancellations and problematic attorney conduct during depositions in ATIC case.
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December 2017 Articles
31 articles published in December 2017
Arbitration is waivable
New York arbitration law allows waiver of arbitration clauses when fee sharing and venue provisions prevent statutory wage claims from being pursued.
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Alleviation is going to the Appellate Division – what happens next is for you to decide.
Allstate's motion for leave to appeal Alleviation Medical Services case granted by Appellate Division. Analysis of potential outcomes and regulatory implications.
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Giant Oops from the Appellate Term
Appellate Term grants clarification motion on 9% interest rate in no-fault case despite CPLR 5004 allowing different rates when other statutes apply.
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Was the Plaintiff the owner? Court says triable issue of fact.
Fourth Department ruling establishes triable issue of fact regarding vehicle ownership despite conflicting documentation and testimony in no-fault insurance case.
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Was the femur broken in the accident?
Court highlights credibility issues when plaintiff claims femur fracture but walks unassisted post-accident, creating factual disputes in no-fault threshold cases.
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The cited to report raised an issue of fact
New York court finds defendant's expert report created fact issues by relying on plaintiff's medical records showing accident-related injuries and limited range of motion.
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Out of scope peer: it is okay
Queens Village Medical case examines when physical medicine experts can testify about orthopedic peer reviews in NY no-fault insurance disputes and expert witness competency rules.
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Fee schedule defense not substantiated
NY court rules insurance company failed to substantiate fee schedule defense by not proving correct conversion factor was used in calculating reimbursement rates.
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Partial response to verification insufficient
New York no-fault case shows partial response to verification requests is insufficient - providers must fully comply or risk premature dismissal of benefits claims.
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Non responded to verification fatal to plaintiff’s case
Court rules that partial responses to verification requests render no-fault insurance claims premature, emphasizing the critical importance of complete compliance with verification requirements.
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CPT Code 97039 again
Court ruling on CPT Code 97039 billing disputes in NY no-fault insurance cases, covering "By Report" documentation requirements and insurer denial defenses.
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IME no show disclaimer substantiated
Court ruling on IME no-show disclaimer timing - denial valid after verification received despite prior grounds for disclaimer existing under NY no-fault law.
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Fee schedule defense: Court separates 97811, 97813, 97814 from remainder of case
Court ruling allows insurance company to use workers' compensation fee schedule defense for acupuncture services, separating specific CPT codes from the broader case.
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Charley Deng called the wrong number
Court dismisses no-fault case where provider called wrong investigator and phone number for EUO rescheduling, highlighting importance of following exact instructions.
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The peer review and its entry into evidence?
New York court ruling on peer review reports in no-fault insurance medical necessity cases. Analysis of evidentiary standards and expert testimony requirements.
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Timeliness of the EUO relative to the billings (again)
Recent New York appellate cases reinforce that insurance companies must schedule EUOs within 30 days of receiving no-fault claims to preserve their right to examination.
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Proof of no-show?
Analysis of St. Locher Med. v IDS case on proving EUO no-shows and potential legal strategies for challenging insurance carrier documentation in New York no-fault claims.
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EBT granted
Appellate court reverses denial of EBT motion against radiology provider, emphasizing insurers' right to examine medical professionals in necessity disputes.
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Lynn Carter
MCMC's use of fake employee "Lynn Carter" for IME scheduling raises questions about no-show personal knowledge requirements in NY no-fault insurance cases.
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Fee schedule defense failed
Court ruling in Laga v GEICO shows insurers must provide precise proof when applying Ground Rule 11 reductions to no-fault medical bills under New York's fee schedule.
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45-day rule appeal was meritless
Court rejects healthcare provider's appeal of 45-day rule denial, finding their own papers proved claims were submitted late under 11 NYCRR 65-2.4(c).
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Allstate’s inability to prove the timely mailing of claims documents
Seven court cases show Allstate's repeated failure to prove timely mailing of claims documents, highlighting a critical issue in no-fault insurance litigation.
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Bad faith and GBL 349 has really arrived
Court ruling establishes bad faith and GBL 349 claims against insurers who pressure IME doctors to deny no-fault benefits, allowing consequential damages.
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Lost wage case reinstated
Court of Appeals reverses Appellate Division ruling on lost wage claims, finding triable issues of fact exist where lower court deemed claims speculative.
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Attorneys fees on a DJ
Analysis of attorney fee recovery in New York declaratory judgment actions, examining when medical providers and insureds can recover legal costs in no-fault insurance disputes.
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TRUMP!
Court dismisses defamation case against Trump, ruling statements were too vague and subjective to be legally actionable under New York law.
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Oh somebody had a bad day.
Court case highlights attorney malpractice risks in SUM claims when settling without insurer consent, emphasizing professional duty requirements.
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Dismissed due to discovery violation
NY court dismisses no-fault insurance case due to plaintiff's willful discovery violations after repeated court orders and warnings of dismissal.
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Limitations on medical record discovery
Court limits medical record discovery in slip and fall case to injuries actually claimed, rejecting 20+ years of disability records for unrelated conditions.
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Judicial notice of Supreme Court order in the reply brief
Court allows judicial notice of Supreme Court order in reply brief, finding res judicata bars no-fault provider's claims based on prior declaratory judgment action.
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