Putting the wrong floor is not fatal
Court rules that incorrect floor designation in IME notice mailing address is not fatal when building address is otherwise correct and proper mailing procedures followed.
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March 2021 Articles
28 articles published in March 2021
NF-3 is the operative document
Court ruling confirms NF-3 forms trigger 15-day IME request deadline, and patient no-shows at two scheduled exams justify insurance coverage disclaimer.
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Independent contractor defense proven
Court ruling demonstrates successful independent contractor defense in no-fault insurance case, analyzing control factors and employment relationship criteria.
Read More →![$5000 (Ins Law 5106[c]) cannot be manipulated](https://cdn.jtnylaw.com/blog/5000-ins-law-5106c-cannot-be-manipulated.avif)
$5000 (Ins Law 5106[c]) cannot be manipulated
New York court clarifies that the $5,000 threshold for no-fault arbitration appeals cannot be artificially inflated by combining separate medical bills or services.
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Perlbinder
Landmark bad faith insurance case Perlbinder v Vigilant allows punitive damages for breach of implied covenant, potentially reshaping NY insurance law.
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Standing (favorite statutes)
New York's RPAPL 1302-a prevents homeowners from waiving standing defenses in foreclosure cases, even if not raised initially—a game-changing protection for defendants.
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Alleviation – not much alleviated
Appellate Division affirms Civil Court in Alleviation Medical v Allstate, clarifying insurer obligations for exhausted policy limits and verified claims under NY no-fault law.
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Expert opinion
Court reminds attorneys that expert opinions must address specific assertions with cited evidence, not just conclusory statements, in personal injury litigation.
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It did not have to be mailed to the attorney
Pavlova v Nationwide case establishes insurers can mail EUO notices directly to assignors, bypassing attorneys - concerning precedent for NY no-fault claims.
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Reasonableness of healthcare bill
NY court case on healthcare provider's right to recover reasonable value for medical services when insurance claims are improperly processed or denied.
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Prescribed forms are not part of the no show
Court clarifies that insurers don't need to prove they mailed prescribed forms when seeking summary judgment for provider EUO no-shows in New York no-fault cases.
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It is the bill, not the NF-2
New York court clarifies that IME scheduling requirements are triggered by receiving bills, not NF-2 forms, in no-fault insurance cases.
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Choice of law?
Court applies New York no-fault law over New Jersey law based on most significant relationship test, despite accident occurring in New Jersey.
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MUA is dangerous
Court finds MUA treatment too aggressive without proper foundation. Expert testimony on medical necessity prevails in no-fault insurance dispute.
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An Mvaic Notice of Claim
Learn about MVAIC notice of claim requirements in NY. Court rules NF-2 application and police report don't constitute proper notice under Insurance Law § 5208.
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Wind it up
Professional corporation can continue operating and seek no-fault benefits despite revoked license, according to NY Appellate Term ruling on Business Corporation Law requirements.
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PT Fee schedule denial not substantiated
New York court ruling highlights insurance carriers must properly authenticate documents when denying physical therapy claims under fee schedule limits.
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The power of the certified medical coder
Court ruling demonstrates how certified medical coders can establish proper fee schedule application in New York no-fault insurance disputes through expert affidavits.
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Policy Exhaust?
New York court rejects insurance company's policy exhaustion defense, ruling that paying other claims after denying specific ones doesn't warrant dismissal.
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Objective standards
New York court ruling clarifies that insurance companies don't need objective reasons to request examinations under oath in no-fault cases, creating legal precedent.
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Post claim IME
Court rules that insurance company cannot use IME no-show defense when initial IME wasn't scheduled within required 30-day timeframe under New York regulations.
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CPT Code 97813 and 97814
New York court ruling clarifies CPT codes 97813 and 97814 acupuncture billing rates under workers' compensation fee schedule for no-fault insurance claims.
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There was no policy
Court confirms workers' compensation policies don't cover no-fault benefits. Healthcare providers must verify correct insurance type before filing claims.
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Verification, EUO and IME
Court clarifies insurer's right to request verification and IMEs before claim payment deadlines begin running in New York no-fault insurance cases.
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Policy exhaustion and the business records
Insurance companies must properly authenticate payment records with foundation evidence. A missing affidavit undermines policy exhaustion defense in no-fault cases.
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Pre and post claim EUO
Understanding when insurance companies can schedule examinations under oath in no-fault cases, whether before or after claim submission, based on recent court decisions.
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The second EUO no-show is operative
Court clarifies that insurers can deny claims after second EUO no-show, with implications for providers who miss multiple examination appointments in complex cases.
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Interest of justice vacatur
New York court grants vacatur of default judgment in no-fault insurance case where claim was barred by res judicata, demonstrating interests of justice standard.
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