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Category: Coverage

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Procedural Issues (203)

Medical Necessity (184)

Additional Verification (95)

IME issues (161)

MVAIC loses again

March 25, 2011 1 Comment

Omega Diagnostic Imaging, P.C. v MVAIC, 2011 NY Slip Op 50432(U)(App. Term 1st Dept. 2011) “In this action by plaintiff-provider to recover assigned first-party no-fault benefits,

MVAIC gets hit again at the Appellate Term, First Department

March 3, 2011 6 Comments

Omega Med. Diagnostic v MVAIC, 2011 NY Slip Op 50275(U)(App. Term 1st Dept. 2011) They just really do not like MVAIC at 60 Centre Street. Hard

Proof insufficient to prove the accident was intentional

February 21, 2011 No Comments

Infinity Health Prods., Ltd. v American Tr. Ins. Co., 2011 NY Slip Op 50195(U)(App. Term 2d Dept. 2011) “Defendant’s proof consisted of the affidavit of its

Bad papers = Bad result

January 20, 2011 No Comments

Pomona Med. Diagnostic v MVAIC, 2011 NY Slip Op 50042(U)(App. Term 1st Dept. 2011) This was just a stupid case to appeal. If an adversary can

Material misrepresentation in the procurment of the insurance policy is now held to be a precludable defense

January 17, 2011 6 Comments

Westchester Med. Ctr. v GMAC Ins. Co. Online, Inc., 2011 NY Slip Op 00217 (2d Dept. 2011) “Moreover, although the defendants contend that they submitted evidence

Coverage on a MVAIC claim – very interesting decision

January 17, 2011 3 Comments

Englington Med., P.C. v Motor Veh. Acc. Indem. Corp.,2011 NY Slip Op 00176 (App. Term 2d Dept. 2011) “On its motion for summary judgment, MVAIC had

Guidance on how to defeat a lack of causation motion regarding injury to a knee

December 22, 2010 14 Comments

With the uptick in surgeries that are taking place in no-fault practice, the question that every claims representative or defense attorney evaluating these types of cases

The MVAIC blood letting continues

November 8, 2010 10 Comments

Some have said no-pain, no gain. But, how much pain does one have to endure before it becomes apparent that “something is rotten in the State

Lack of causal relationship motion denied based upon evidence that the injured person was "asymptomatic" prior to the motor vehicle accident

October 12, 2010 1 Comment

Interesting discussion on what is probably the only way to beat a threshold motion when representing a member of the “accident of the month” club. The

MVAIC continues to dig its grave at the Appellate Division

October 8, 2010 3 Comments

Motor Veh. Acc. Indem. Corp. v NYC East-West Acupuncture, P.C., 2010 NY Slip Op 07111 (1st Dept. 2010) Sometimes, you win the battle but lose the

She really was not an EIP

September 23, 2010 4 Comments

Lenox Hill Radiology v Government Empls. Ins. Co., 2010 NY Slip Op 51638(U)(App. Term 1st Dept. 2010) “Plaintiff’s listing of Higginbotham as the insured party on

The spreadsheet was not in admissible form?

August 19, 2010 No Comments

Total Family Chiropractic v Mercury Cas. Co., 2010 NY Slip Op 51470(U)(App. Term 2d Dept. 2010) This was another one that did not necessarily go my

Triable issue of fact found as to the issue of whether an injury was causally related to a motor vehicle accident

August 19, 2010 6 Comments

Stephen Fealy, M.D., P.C. v State Farm Mut. Auto Ins. Co., 2010 NY Slip Op 51442(U)(App. Term 2d Dept. 2010) I was involved in this case.

Use and Operation – Should the SUM endorsement be read differently than the no-fault endorsement?

July 26, 2010 No Comments

Use and Operation. This is one area of law that is all over the place. Practitioners that are called upon to give opinions on whether coverage

The Appellate Division grants an Article 75 petition and remands the matter back to AAA arbitration

May 31, 2010 No Comments

Matter of Mvaic v Interboro Med. Care & Diagnostic PC, 2010 NY Slip Op 04522 (1st Dept. 2010) “MVAIC defended the arbitration on the ground that

Broke the chain of causation

May 1, 2010 No Comments

Wilkins v Khoury, 2010 NY Slip Op 03435 (2d Dept. 2010) “While the plaintiff, in opposition, raised a triable issue of fact as to whether the

Causation defense rebuffed – notice the subtleties of this case

April 28, 2010 No Comments

McDuffie v Rodriguez, 2010 NY Slip Op 03366 (1st Dept. 2010) “Defendants met their prima facie burden of establishing that plaintiff did not sustain a serious

The Civil Court – in case you did not know – has limited declaratory judgment powers

April 21, 2010 No Comments

Five Boro Psychological Servs., P.C. v AutoOne Ins. Co., 2010 NY Slip Op 20131 (App. Term 2d Dept. 2010) “In any event, the Civil Court would

Collateral estoppel in the declaratory judgment action does not necessarily apply to the underlying no-fault action

April 21, 2010 No Comments

Magic Recovery Med. & Surgical Supply Inc. v State Farm Mut. Auto. Ins. Co., 2010 NY Slip Op 20130 (App. Term 2d Dept. 2010) “Plaintiff herein

Default Judgment seeking a declaration of non-coverage is denied based upon the failure to adduce any non-hearsay evidence

March 7, 2010 No Comments

This is a most interesting case. I will discuss my thoughts in some detail because this case seems to possibly support the inference that a default

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