Dilemma and dogma
Court ruling on EUO timing requirements in NY no-fault cases - insurer failed to prove compliance with 15-day deadline for examination under oath notices.
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June 2018 Articles
21 articles published in June 2018
Lack of personal jurisdiction for an out of state insurance carrier
Out-of-state insurance carriers can challenge personal jurisdiction in NY courts for no-fault claims. Key case analysis and jurisdictional requirements explained.
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+15 minute decision begs a better question
Court ruling on acupuncture needle reinsertion claims raises questions about partial false billing defenses in NY no-fault insurance cases.
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Significant limitaiton prong of Ins Law 5102(d)
Analysis of significant limitation prong under Insurance Law 5102(d) in Schaubroeck v Moriarty, examining causation requirements and threshold standards.
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EUO no-show case/objective reasons not necessary/ what’s next?
NY court rules insurers don't need objective reasons for EUO requests when providers fail to appear, but questions remain about remedies after valid excuses.
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New trial ordered due to physician unavailability
New trial ordered when treating physician expert arrived without required original medical file and was unavailable for rescheduled testimony dates.
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120-day rule crumbles
Court case analysis showing how the 120-day rule for no-fault insurance verification demands has been weakened, allowing claims to proceed despite procedural issues.
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Why “contemporaneous” medical inquiry should not be the loadstar of medical necessity determinations
Court ruling demonstrates that medical conditions can evolve over time, challenging the emphasis on immediate post-accident medical examinations in necessity determinations.
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Use and Operation again and again
NY court finds excavator on public highway meets "use and operation" standard for no-fault coverage, even when temporarily parked and unattended during construction work.
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+Bonus attorneys fees
Court clarifies attorney fee awards in no-fault arbitration appeals, establishing precedent for reasonable fee determination in master arbitration proceedings.
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Proof of causation
New York personal injury case law on proving causation in accident claims. Analysis of Hernandez v Marcano regarding medical evidence requirements and causal connection standards.
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Infants compromise order not needed to proceed in arbitration in assignee case
New York court rules that infant compromise orders aren't needed in no-fault arbitration when healthcare provider acts as assignee, not the infant patient as party.
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Triable issue of fact: 45-day rule
NY appellate court rules that insurance company's late receipt of claim forms creates triable issue of fact regarding timely mailing under 45-day rule.
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Non contact case on motion
Court ruling demonstrates how defendant's affidavits from driver and passenger can establish prima facie case that no contact occurred in no-fault insurance claim.
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What happened to those EUO letters? What happened to the IME letters? Where are those denials?
NY appellate court cases showing inadequate office practice affidavits fail to prove proper mailing of EUO letters, IME notices, and claim denials.
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Where was the partner?
Court rules insurance company failed to prove assignor's EUO non-appearance with personal knowledge testimony, highlighting burden of proof requirements in no-fault cases.
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IME no-show unsuccessful
Court rules IME scheduling letters sent to wrong address failed to establish proper notice, highlighting importance of accurate mailing addresses in no-fault cases.
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Neptune EUO scheduling rule on display again
NY appellate court reaffirms EUO scheduling deadlines in no-fault insurance cases, highlighting consequences when insurers fail to meet statutory timing requirements.
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State Farm and Georgia – passes Appellate Term scrutiny
State Farm's Georgia mail processing system passes Appellate Term scrutiny despite mailing challenges in no-fault insurance case Maiga v State Farm.
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The Unitrin/ Westchester split
New York appellate court clarifies insurance companies must preserve IME no-show defenses for each claim separately, even when denying multiple claims from same provider.
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Material Misrepresentations – Must follow the Ins Law 3105 rule
New York court rules insurers must prove material misrepresentation with underwriting documentation. Ameriprise failed to establish it wouldn't have issued policy.
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