“Not based on an examination”
Court rules medical affirmation insufficient when not based on patient examination and fails to rebut defendant's examining physician findings.
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November 2018 Articles
24 articles published in November 2018
Different peer doctor’s testimony acceptable
Court ruling clarifies that insurance companies can use different expert witnesses to testify about peer review reports in no-fault cases, expanding defense flexibility.
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Nexus between receipt and mailing
Court ruling clarifies that insurance company's internal mail handling procedures are irrelevant when proving proper mailing of EUO scheduling letters under CPLR 3212(g).
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Preliminary Conference is deemed a stipulation
Court ruling establishes that preliminary conference orders are binding stipulations, requiring fraud or duress to vacate under New York law.
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Gap in treatment analyzed
Court ruling clarifies that gaps in medical treatment only matter for causation issues when defendants fail to establish prima facie lack of causation in serious injury claims.
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Discovery – what is material and necessary
Court ruling on physician-patient privilege waiver in personal injury discovery - what medical records are material and necessary when claiming lost earnings.
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Default vacated
Second Department vacates default judgment in GEICO v Avenue C Med case, granting defendants' motion based on law office failure and miscommunication between counsel.
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Court approves of service in the court room
New York court clarifies that defendants can be served with legal papers even inside courtrooms, rejecting the misconception that courthouse appearances provide immunity from service.
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Another policy exhaustion case went nowhere
Another New York no-fault insurance case demonstrates that insurers must prove policy exhaustion with specific timing evidence to successfully defend coverage claims.
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The By Report paradigm
Analysis of Pavlova v Allstate case on "by report" billing requirements and verification procedures in NY no-fault insurance claims (156 chars)
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Objective reasons not necessary to prove an EUO no-show defense
Recent NY court rulings clarify insurers don't need objective reasons to request EUOs when proving no-show defense, though proper objections can change this dynamic.
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120-day rule rebutted
Court ruling shows affidavit alone can create triable issue on verification receipt despite 120-day rule, prompting questions about documentary evidence standards.
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Prima Facie Staged accident
New York Court of Appeals decision on staged accident claims in no-fault insurance cases, examining prima facie evidence standards and insured incident requirements.
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The existence of a workers compensation award is lack of coverage
Court rules workers compensation award creates coverage defense in no-fault cases, changing how insurers can challenge medical billing claims under NY law.
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Nationwide took an ax to Unitrin
Fourth Department clarifies EUO nonappearance defense as policy exclusion rather than coverage matter in Nationwide v Jamaica Wellness Medical declaratory judgment case.
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Mr. Ortega, why did you lie to us?
Ortega v Healthcare Services Group case analysis - plaintiff's incomplete disclosure of health history leads to jury verdict favoring defendant on causation and damages.
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Stipulation not strictly enforced
Court rules on debt collection case where borrower missed one payment after paying $45,000, examining whether strict enforcement of settlement stipulation was appropriate.
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Another must read in the battle involving “significant limitation” and “permanent consequential”
Tejada v LKQ case analysis: Court finds triable issue for significant limitation but not permanent consequential limitation in lumbar spine injury claim.
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Shoulder surgery with physical therapy – valued at $550,000
Court reduces $1.15M jury award to $550K for shoulder surgery case, highlighting how trial courts evaluate excessive pain and suffering damages in personal injury claims.
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Timely notice
Court ruling reinforces 30-day notice requirement for no-fault claims, with insurance company successfully defending late notice denial under 11 NYCRR 65-1.1.
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A basic EUO no-show
NY appellate court ruling on EUO no-show requirements: insurers must prove two proper demands, two failures to appear, and timely denial for summary judgment.
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The recent examination
New York court case highlights critical requirement for physicians to specify objective testing methods when measuring range of motion in no-fault threshold injury claims.
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Electronic signatutres
New York courts have evolved to accept electronic signatures on physician reports, overturning earlier restrictive precedents in personal injury litigation.
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202.48 – settle an order
Court rules on discretionary application of 60-day settlement order deadline, prioritizing judicial efficiency over strict procedural compliance in liability cases.
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