Fee Schedule/not precluded
Analysis of Oleg's Acupuncture v Hereford Insurance case examining fee schedule defenses, untimely denials, and certified medical coder affidavits in NY no-fault claims.
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January 2018 Articles
16 articles published in January 2018
Policy voided
New York court upholds insurance company's retroactive policy rescission under Florida law, demonstrating how choice of law principles apply in multi-state insurance disputes.
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EUO no-show: Declaratory Judgment substantiated
New York court upholds insurer's declaratory judgment after claimant's EUO no-show, confirming proper notice requirements and compliance with scheduling regulations.
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Coverage – use or operation
New York court clarifies that auto insurance coverage extends beyond vehicle operation to include related activities like luggage handling at bus stops.
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Priority of payment, again
Court remands case for hearing on whether policy limits were exhausted before provider claims arose, highlighting critical priority of payment issues in no-fault insurance disputes.
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Out of scope – need foundation
New York medical malpractice case highlights the critical requirement for expert witnesses to establish proper foundation when testifying outside their area of specialization.
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There is no safety valve for a late follow-up
Court ruling establishes that late follow-up EUO scheduling letters void claim denials, creating split with other decisions on no-fault insurance timing requirements.
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No need to send letter to attorney
Court clarifies delay letter requirements under 11 NYCRR 65-3.6(b), ruling insurers only must notify attorneys when seeking verification from third parties, not plaintiffs.
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Verification issues
Analysis of Atlantic Radiology v Travelers case addressing verification request failures and timing issues in NY no-fault insurance claims litigation.
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Certified medical coder sufficient
Court ruling establishes that a certified medical coder's affidavit provides sufficient evidence to support workers' compensation fee schedule defenses in summary judgment motions.
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Punitive damages in medical malpractice case
New York court allows punitive damages in medical malpractice cases when doctors alter or destroy records to evade liability, serving deterrence and public policy.
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Causation – interesting observations
Court rules on causation in personal injury case where plaintiff had prior accident but fully recovered before sustaining new cervical spine injuries.
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CPM from the Civil Court
Civil Court ruling supports CPM reimbursement claims by medical providers, creating significant implications for no-fault insurance reimbursement rates and regulatory oversight.
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Prima facie case for trial purposes
Analysis of two NY appellate cases establishing prima facie requirements for no-fault insurance trials, including burden of proof for claim submission and payment denial.
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The loss was not intentional
Court rules on uninsured motorist coverage dispute, finding no intentional acts exclusion applies and injuries resulted from accident despite criminal intent.
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By report? Again?
Analysis of BR code requirements in New York no-fault insurance fee schedule disputes, examining provider prima facie cases and affirmative defenses.
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