No Fault, No Fix, No Fuss: Why everyone loves No Fault just the way it is

What can one say about a field of law where judges write things like this in their decisions:

“No-fault litigation [is] a Frankenstein monster that has assumed a life force of its own, becoming so unmanageable and uncontrollable that it acts out in ways never envisioned by its creator.” [1] “The disturbing reality [is] that first-party no-fault benefits litigation has become the antithesis of what was supposed to be an expeditious and simplified process for the payment of medical costs for injuries sustained in motor vehicle accidents. Too often, lawsuits with a value akin to a small claims action become bogged down by an insistence by one party or another that mailing of routine forms be established with scientific precision, asking judges, already burdened to the breaking point with the veritable legion of no-fault cases overflowing from our court dockets… to require multiple witnesses to be summoned to the courthouse, merely to establish a presumption of mailing, even in the absence of an express denial of receipt of the disputed correspondence. Unfortunately, this class of cases has spawned a body of “gotcha” jurisprudence, marked by a near manic preoccupation with form over substance.”[2] “The experience in the trial courts attempting to reconcile the rules of evidence and civil practice with regulations promulgated which are more suited to arbitration should now be a sufficient signal to the Legislature that some action on its part is required. This is particularly true given the avalanche of no-fault litigation threatening to crush the court system…” [3]

 A Frankenstein monster? An avalanche threatening to crush the court system? A manic preoccupation with form over substance? These are not comments exchanged over lunch. These are judges writing in published decisions. Does it sound like an emergency? It is. Is anything being done about it? No. Why? If you ask me, it’s because nobody really wants it to change.

Since graduating from Brooklyn Law School in 1981, I have spent most of my career on the defense side of the insurance and liability area of the practice of law, including two years working in the claims departments of insurance companies. To say that I “wrote the book” on New York PIP is no mere metaphor: there is only one published treatise on the subject, and I am the author.[4] During the twenty-five-plus years of my legal career, during which I have defended over 17,000 PIP suits and arbitrations, no-fault[5] has undergone a startling transformation. From the time of the enactment of the no-fault law (it took effect in 1974), the processing and payment of no-fault bills was more or less a ministerial task: consisting mostly of processing emergency room bills, a few hospital bills, and some bills for follow-up visits to the doctor’s office, the job of the no-fault examiner was basically to log in medical bills and pay them.

Because of the no-fault “serious injury” threshold, the 1980s saw an upswing of personal injury plaintiffs who believed (usually after consultation with their attorneys) that going to a chiropractor or physical therapist for 90 days would automatically carry them over the no-fault threshold like a old-fashioned bride. For quite a while, documentation of medical treatment for more than 90 days was accepted by the courts as “meeting the threshold.”

The courts began a slow process of heightening their scrutiny of these medical records to see if, notwithstanding the continued treatment, the claimants were actually suffering from substantial disability for over 90 days — but the medical bills themselves were still not showing up on the insurance company radar as an incoming squadron of bombers.

Starting around 1994, without warning, a veritable tsunami of no-fault claims began to hit the beaches of the insurance world. An entirely new phenomenon arose due to a confluence of forces: large numbers of people – often immigrants — were being recruited to pile into automobiles, crash into other automobiles or stationary objects, and then hook up with compliant medical clinics who stood ready, willing and able to provide these patients with all the chiropractic, acupuncture, massage, xrays, MRIs, psychological testing and therapy, thermography, fluoroscopy, ultrasound, nerve conduction testing, and every other form of medical and quasi-medical testing and treatment that they could get away with – regardless of whether the patient needed them or not.

In addition, even persons involved in genuine but minor accidents began to be approached on a regular basis by “runners” who would recommend them to various clinics for free, unlimited treatment.

Having not seen this tsunami coming, insurance companies were unprepared, and some were washed away, while others found themselves awash in red ink. The no-fault tsunami did not come about by accident. It took the cooperation – explicit or tacit – of numerous medical professionals willing to rent out their licenses to clinic owners; a small army of licensed providers of various disciplines willing to provide excessive and unnecessary testing and treatment; and attorneys willing to play their role in exploiting the no-fault regulations which were designed for insurance companies to pay medical bills quickly, without looking at them too closely – or giving them adequate time or tools to do so.

And so for about 17 years now, insurance companies and self-insured corporations have had to formulate defenses – and re-formulate them constantly, because the plaintiffs’ no-fault bar seems to constantly think up new strategies, for which the insurers must think up new tactics for defense, which are then countered by yet newer strategies – much like in a protracted war, and almost as expensive. Because no-fault is a creature of statute, and has no parallel in common law, there is no substitute for knowing the statutes and regulations. Moreover, the learning process never ends, because new case law, with new interpretations of the many regulations, comes out on a daily basis. One cannot rely on last year’s knowledge and expect to have any effectiveness in either prosecuting or defending no fault litigation and arbitration. PIP has several distinct features which are the cause of most of its problems. Those features are as follows:

The system is easy to exploit

The PIP regulations were obviously drafted with a presumption that people do not go for more medical treatment than is absolutely necessary. This presumption was reasonable back in 1977. However, because the law created a “threshold” which claimants had to meet before they were eligible to sue a tortfeasor for personal injuries, auto accident victims were often, shall we say, encouraged to continue treatment with a chiropractor and/or other medical provider for 90 days—whether it was actually necessary or not—in order to meet the law’s requirement that the claimant be substantially restricted from their usual daily activities for 90 out of the 180 days following an accident. This particular aspect of exploiting PIP has not only been eclipsed by the current form of exploitation, but has also been rendered more or less obsolete by court decisions which have required much more than mere treatment.[6]

The exploitation that exists today is of a different kind, one that was never anticipated by the Legislature—or anyone else for that matter. Today’s PIP exploitation consists of excessive treatment primarily for the benefit of the medical providers. Today’s PIP exploitation is characterized by persons involved in auto accidents who are referred to multidisciplinary medical clinics, where they are treated to—or subjected to, depending on one’s viewpoint—a cornucopia of treatment from a pastiche of practice areas that usually include chiropractic, acupuncture, massage therapy, and even psychological treatment, as well as a deluge of expensive diagnostic tests such as MRIs, EMGs, and SSEPs, which are often ordered on the initial visit, before the patient gets a chance to respond to any of the treatment modalities, and “DME”—durable medical equipment, more commonly known as medical supplies.

Even more curious is the fact that these patients often receive these treatments several times a week; far more than one would usually expect for people who have jobs and lives to which to attend. Among the “red flags” of excessive treatment is a frequency and duration of in-office visits for people whose basic diagnosis is sprains and strains. The general consensus of the many medical doctors with whom I consult in the course of defending PIP suits (their opinion being much more valuable than my own) is that the variety, frequency and duration of treatment and testing given to PIP claimants far exceeds that given to patients who are being treated for similar injuries in a non-PIP environment. In a word, they are being overtreated. Where is the line between treatment and overtreatment? That’s one of the prodigious challenges for insurers, which is my next point.

2. Every presumption in PIP runs in favor of the claimant

The Courts have repeated the mantra in innumerable decisions: “No-fault reform was enacted to provide prompt uncontested, first-party insurance benefits. That is part of the price paid to eliminate common- law contested lawsuits.”[7] Using this benchmark, New York PIP is the only field of law in which the burden of proof is on the defendant to disprove the plaintiff ’s claims. In most PIP lawsuits and arbitrations, the burden on the insurer is to prove, by a preponderance of the evidence, that the treatment or testing was not medically necessary. In order to do this, the insurer must base its denial on the opinion of an expert (whether a medical doctor, chiropractor, licensed acupuncturist, etc) who is qualified to give an opinion on the specific type of treatment or testing involved. This is done by either (or both) of two methods: a independent medical exam (IME) or a peer review.

When these suits go to trial, the insurer’s expert must persuade the judge that the testing or treatment was, more likely than not, medically unnecessary. From a practical standpoint, that is a considerable burden. For one thing, a mere difference of opinion is not enough; i.e., the fact that the expert doctor disagrees with the treating doctor.[8]

The expert doctor must back up his opinion with a medical rationale that overcomes the presumption that the testing or treatment was medically necessary. Among other things, this burden is compounded by the fact that doctors generally do not speak “legalese,” and fail to appreciate that in a court of law, semantics is often more important than substance. The turn of a phrase often makes the difference between winning and losing at trial. Here is a common example: in most peer review reports, the doctor writes, “The medical necessity of [the testing or treatment in question] has not been established.” To a doctor, that makes perfect sense. In PIP litigation, that’s not the standard.

The medical provider is under no obligation to establish the necessity of the treatment. The “correct” phraseology – the “magic words,” if you will – would be, “My review of the records leads me to conclude that [the testing or treatment] was not medically necessary.” To a lay person, the two phrases mean the same thing. In a courtroom, they are as different as night and day. In PIP, form often triumphs over substance. And that’s not just my opinion; as quoted earlier in this article, the Appellate Term judges said so themselves. Judges say it all the time at trial: “I am reluctant to second-guess decisions made by a treating doctor.” And as a general proposition, that’s a good rule of thumb. But in PIP litigation, it requires a suspension of disbelief, because the exploitation of PIP benefits is not just the grumblings of “greedy” insurance companies; it’s a documented fact recognized by the Court of Appeals.[9]

3. Almost any error by the insurer in the course of a claim is fatal to the defense

PIP insurers are bound by several very strict rules. A medical bill must be denied by a properly-completed form (the “NF- 10” form) within 30 days of receipt of the bill, unless delayed by a timely and proper written request for further verification. The NF-10 form has thirty-three boxes on it which require various pieces of data; almost any error, typographical or otherwise, forfeits the insurer’s right to defend the claim, regardless of the merits. And although court decisions have held that errors on an NF-10 may be excused if they are neither “basic” nor “numerous.”[10] But which errors are “basic” and how many is “numerous” are questions which must be litigated on a case by case basis.

The failure of a no-fault insurer to issue a timely and proper denial of a bill requires that the bill be paid – even if the evidence should show that the bill was for services that were not actually provided. The Court of Appeals has held that not only is “overbilling” a defense that is waived by an untimely denial, but completely fraudulent billing must be paid as well. The Court specifically rejected the contention that there is “no coverage” for medical bills for services that were not really rendered.[11]

On the other hand, while there are time frames in the law for claimants as well, for the most part a failure to comply with those time frames can be excused not only by the insurer’s failure to issue a timely and proper denial, but by a reasonable excuse provided by the claimant. No timing error by a claimant during the claims process is automatically fatal.

4. No-Fault fraud: The Defense That Dare Not Speak Its Name

There is an expression in French, “le non dit,” which roughly means “that which everyone knows but does not speak of.” In PIP litigation, fraud is pretty much le non dit: judges simply don’t want to hear it, except perhaps in a case where the defense can show strongly documented proof that the accident was “staged” or perhaps did not occur at all. But in a defense based on medical necessity, as much as insurers and their attorneys might wish to say, “Come on, Judge, everybody knows that these medical mills treat all patients as much as they can regardless of whether they are injured or not,” – you can’t say it. It’s le non dit. And even if you did say it, it wouldn’t do any good. Even in cases where the medical provider has been criminally prosecuted for fraud and convicted, the Courts routinely hold that unless the conviction was directly related to the treatment involved in this case, it is irrelevant. The insurer still has the same burden of proof. And yet the Court of Appeals has stated: Between 1992 and 2001, reports of suspected automobile insurance fraud increased by 275%, the bulk of the increase occurring in no-fault insurance fraud. Reports of no-fault fraud rose from 489 cases in 1992 to 9,191 in 2000, a rise of more than 1700%. No-fault fraud accounted for three-quarters of the 16,902 reports of automobile-related fraud received by the Insurance Department’s Frauds Bureau in 2000, and more than 55% of the 22,247 reports involving all types of insurance fraud. In 1999, the Superintendent established a No- Fault Unit within the Frauds Bureau to focus specifically on no-fault fraud and abuse. By one estimate, the combined effect of no-fault insurance fraud has been an increase of over $100 per year in annual insurance premium costs for the average New York motorist.

The Insurance Information Institute [I I I] issued a statement in January 2011 which contained the following findings: Medical payments under New York’s no-fault’s PIP, or personal injury protection, the coverage part that pays for medical care and other benefits if the policyholder has an auto accident, are rising dramatically, in part due to fraud and abuse. PIP average claims costs in the third quarter of 2009 stood at $8,690, the third highest in the country, the first being Michigan and the second being New Jersey. Since the end of 2004, claims costs have risen an astounding 55 percent and fraud investigations have more than doubled. In 2008 the number of arrests for no-fault fraud was 52 percent higher than in 2007. Based on the amount fraud costs add to each claim, no-fault fraud and abuse cost consumers and insurers about $229 million in 2009, according to the Insurance Information Institute. The additional costs, when averaged out over all claims filed in 2009, comes to $1,561, or 22 percent of each claim. When claim costs rise due to fraud, policyholders are forced to pay for it in the form of higher premiums. This so-called fraud tax will rise to an estimated $1,644 per claim if no reforms are enacted.

In the City of New York, states the I I I, about one in every five claims settled appears to have some element of fraud and as many as one in three appears to be inflated, according to the IRC [Insurance Research Council]. Over the period 2007 to 2010, the percentage of no-fault claims that were fraudulent or were inflated (built-up) by excessive billing by unscrupulous medical care providers or by unnecessary medical services rose from 29 percent to 35 percent. In the fall of 2010 alone, fraud was found in 22 percent of all New York City metropolitan area no-fault auto insurance claims and build-up in another 14 percent. By comparison, outside the City, fraud was found in only 4 percent of nofault claims settled and build-up in other four percent. [D]uring the first six months of 2010 questionable liability claims involving excessive medical treatment surged 42 percent, from 304 during the same period in 2009 to 431. Many involved no-fault auto insurance claims submitted by medical mills. The most common were those in which the healthcare provider purposely miscoded diagnoses to extract more money from the insurer.

An analysis of PIP claims from insurers representing 50.1 percent of the state’s auto insurance market, found that between 2007 and 2009 more than four in 10 no-fault claims resulted in lawsuits and almost all of the plaintiffs in lawsuits relating to PIP were healthcare providers. Only 0.4 percent of injured claimants filed lawsuits over that period. These statements of fact might be dismissed by medical providers and their attorneys as “insurance industry propaganda,” and in fact, that is a widespread attitude among those on the plaintiff side of the bar. The plaintiff ’s bar often proclaims that insurance carriers are making record profits, and moreover that they make a habit of knee-jerk denials of claims without regard to merit. They also take the positions that IMEs “invite fraud” by the insurance carriers because the IME doctors are not truly “independent;” that EUOs are “contrived” in the hope that the witness will not appear (thus forming the basis for a denial of claim); and that putting every patient through every kind of diagnostic test is just good medical practice.[12] Nevertheless, “on the ground,” where I do my job strategizing, defending, and taking these suits to trial, the naked truth is this: in court, judges do not take the reality of PIP fraud into consideration in individual cases. It is le non dit. Judges only want to know about “thiscase,” not the general problems pervasive in the field of no-fault claims. Unless, of course, if the insurer can show by a preponderance of the evidence that the collision was intentional, it need not go further and prove that the intentional collision was part of an insurance fraud scheme. No Fault does not cover deliberate collisions, period – if the insurer can prove the collision was deliberate.[13]

This is why I counsel insurers that, for the most part, the fraud defense is not going to win cases for them. My theory is that if an accident did not really happen, or if a patient has received excessive treatment, then the most practical strategy is to prove that the treatment was not medically necessary. That is the defense to which judges will at least listen. One type of fraud, however, has of late been resulting in significant rulings in favor of insurers. “Rate evasion”, also known as rate-jumping, is when a policyholder uses a false home address on his insurance application in order to get a lower rate than he would get for his true home address. Recent decisions have held that this constitutes a material misrepresentation which voids all first-party benefits, even to “innocent” claimants who were not party to the fraud (liability coverage, however, cannot be rescinded).[14]

5. It costs money to defend PIP suits

Probably the most frustrating reality to PIP claims examiners is that they cannot wave a wand and make PIP lawsuits go away. Especially when the amount of the suit is less than the cost of defending it – which is a large percentage of the time. The economics of PIP are decidedly against the insurers. They are always searching for a way to defend PIP claims that costs less than simply paying them; the ugly truth is, most of the time there is no way to do that. The reason is simple: every PIP claim that is denied by the insurer will go into suit or arbitration, and the cost of hiring counsel and a doctor usually exceeds the amount in controversy. Each insurer has its own legal fee scale for attorneys, ranging from fairly generous to what I might diplomatically call “frugal.” But even at minimum compensation levels, a great many PIP lawsuits seek less than $1,000.00, raising the ubiquitous question, “Is this suit worth defending?”

When faced with a PIP suit in the amount of, say, $879.73 (the fee schedule amount for a single MRI), an insurer must take into consideration that it must pay its attorney a minimum of $500.00 to defend the suit (under the most “frugal” of fee schedules), and a doctor a minimum of $1,500.00 to testify at trial. It immediately becomes apparent that the insurer cannot possibly come out ahead; it is a Hobson’s choice. In the course of a typical business day I usually speak to at least one adjuster who finds this reality hard to accept, thinking that somehow, some way, there must be a magic bullet. There isn’t. The answer is, by necessity, a philosophical one. Having decided that a particular PIP claim has no merit, are you going to just pay it when it goes into suit?

Or defend it?

The way I look at it, if a claims adjuster is going to pay claims that have no merit, then it is a waste of time and money to send the bill to a doctor for a peer review, or to send the claimant to a doctor for an IME. And yet every day of the week I see cases where the insurer has done exactly that. It’s like a poker game where you keep calling another player’s raise, putting up more and more money, and then folding. Not only that, but the attorneys for the medical providers pay close attention to the behavior of insurance carriers – again, just like an experienced poker player sizes up opponents. If they know you will fold, they will keep raising until you do. For insurers, my viewpoint is that they must understand that denying PIP claims will lead to lawsuits, and that if they are going to issue a denial, the only sensible policy is to follow through by defending the suit when it comes in – and that applies whether the suit is for $33.71 or $50,000.00. Since the cost of defending most PIP suits is roughly the same, regardless of the amount in controversy, the micro-economics of any individual suit have to be ignored. On the micro level, it rarely “pays” to defend any PIP suit. But if that’s going to be a company’s philosophy, then it doesn’t need claims examiners; all it needs is a clerk to cut a check for every PIP bill. I have had clients who went by that philosophy; they were liquidated by the Insurance Department.

That being said, it is also a mistake to have a blanket philosophy to apply to all PIP suits. It is just as bad to adopt the attitude of “defend all suits” as it is to say “settle all suits.” There are factors which must be considered on each individual claim, such as: how well the doctor testifies; how good the plaintiff ’s attorney tends to be at trial; whether the denial is perfect or whether it has flaws that may be excusable; and even the venue of the suit (because the rules of evidence are currently different in the First Department than in the Second Department). And, of course, the amount of money involved in the suit. These decisions should be made on a case-by-case basis, with defense counsel’s input, if necessary.

It is, in my opinion, a mistake for insurers to pick a number and to decide that all suits for less than that number will be settled. Plaintiff attorneys constantly “test” insurers to determine what that number is (much the way computer hackers keep trying different passwords until they discover the right one), and once it is discovered, that insurer will be targeted with suits below the magic number. Regarding suits for small amounts, I often put this analogy to insurers: suppose your home was burglarized every day while you were away at work, but each time, the burglar only took the change that you left on your night table? How many times will you allow yourself to be robbed of small amounts before you invest in an alarm system and better locks?

6. Defense counsel has to know the medicine

My observation over the past 29 years of practice is that most of the attorneys in the field know very little about medicine, and that of those who do, almost all of them are on the plaintiff side. Judges, after all, are not doctors, and it is the judge who is making the decision about medical necessity. They hear doctors testify all day long, but doctors do not necessarily make good witnesses. There is a world of difference between being an expert, and getting your message across to people who are not experts. The job of a good trial lawyer is to bring out the message that his witnesses have to offer, in a way that persuades the trier of fact – a jury, when there is one, or the judge, as in almost all PIP trials.

And when the medical provider takes the stand, or produces its own expert in rebuttal, that is a golden opportunity for defense counsel to conduct a cross-examination that will highlight the medical provider’s lack of justification for the testing or treatment – an opportunity that, from what I have seen, is rarely used to maximum advantage because it takes a working knowledge of medicine to conduct an effective cross-examination.

But it is important for claims examiners to understand the difference between effective defense attorneys, and those who are, let us say, not very effective. A few years ago I met with a claims manager of a self-insured entity about the possibility of my representing his company in PIP suits. He said to me, “There’s no difference between one No-Fault lawyer and another. You all do the same thing. So I just go with the cheapest.” His company is now out of business.

7. The landscape keeps changing – insurers must change with them

There is no other field of law where some court decision comes out every few weeks that redefines or changes one of the rules. Whether it involves the number of days in which to mail a second verification request, or whether medical records reviewed by a peer doctor are admissible at trial, the rules keep changing from week to week and are often different depending on what county the suit is being heard in. That is why I publish a blog that reviews the latest court decisions every day.[15] Good defense counsel keeps the claims examiner current on important new developments. And astute claims examiners pay attention to those developments and fine tune their procedures to stay in compliance with the law. Unfortunately, I frequently encounter resistance on the part of insurers to change their procedures when new court decisions dictate. The lament, “This is the way we’ve always done it” are lapidary words that may as well be inscribed on a tombstone for all the good they will do an insurer that is out of compliance. And speaking of being “out of compliance,” the New York State Insurance Department reviews complaints from members of the public – and, often, from medical providers who complain when their PIP claims are denied – and where insurers are found to be out of compliance with Regulation 68 (the PIP regs), fines can be assessed.

Conclusion

Most PIP suits are, in effect, smallclaims cases. The vast majority of them involve under $5,000.00. And yet because of the huge volume of claims, the complexity of the regulations, and the precision with which insurers must comply with those regulations, every single claim must be treated as important. When I first got into this business, a wise old claims examiner told me something I have never forgotten: that regardless of whether the amount at issue is $1 or $1 million, “a claim is a claim,” and should be handled according to good claims practices. Given all I have written here about New York PIP practice, the inevitable question is: why doesn’t somebody do something to fix it? The answer is a matter of opinion; here is mine: Nobody is going to “fix it” because everybody is making money from it. The plaintiff ’s attorneys are making money; the medical providers are making money; the defense attorneys are making money; the insurance companies are making money. So who’s complaining? The Legislature doesn’t bestir itself unless some powerful interest prods them.

The only party ultimately paying the price for all that goes on in New York PIP is “John Q. Public,” the average policyholder. And not only does nobody represent “John’s” interests, but even he doesn’t care. My own informal, unscientific polling of ordinary people about PIP is that their main concern is that when it’s their turn to make a claim, they want those benefits to be available. And if insurance companies are getting ripped off, John Q. has little sympathy. [IA] Lawrence N. Rogak is the managing partner at Lawrence N. Rogak LLC, 3355 Lawson Boulevard, Oceanside, New York 11572. Mr. Rogak is the author of Rogak’s New York No-Fault Law & Practice and writes a daily blog, The Rogak Report. His Web site can be found at www.NoFaultAnswers.com.

 

 

FOOTNOTES:

[1] Judge 1 Charles J. Markey, Metropolitan Radiological Imaging P.C. a/a/o William Taylor v. State Farm Mutual Automobile Insurance Company, 2005 NY Slip Op 25063.
[2] Lenox Hill Radiology, PC a/a/o Edward Bredy v Tri-State Consumer Ins. Co., 2010 NY Slip Op 20530, Appellate Term, First Department
[3] Judge Bernice D. Siegal, CPT Medical Service, P.C. a/a/o Albert Mullakandov et al. v. Utica Mutual Ins. Co., 2006 NY Slip Op 26098
[4] Rogak’s New York No-Fault Law & Practice
[5] The terms “No Fault” and PIP are synonymous; PIP stands for “Personal Injury Protection.”
[6] Most significantly, the Court of Appeals’ decision in Pommels v. Perez, 4 NY3d 566 put an end to “meeting the threshold by the mere demonstration of a disc herniation on an MRI; the Court held that the claimant must demonstrate an actual disability resulting from the herniation.
[7] Originally stated by the Court of Appeals in Presbyterian 6 Hosp. in City of N.Y. v Maryland Cas. Co. (90 NY2d 274 [1997]), quoted in many subsequent decisions.
[8] I am using the term “doctor” here as shorthand for any kind of medical provider or expert.
[9 ]Medical Society of the 8 State of New York v. Serio, 100 NY2d 854 (2003)
[10] Nyack Hospital v. State Farm Mutual Ins. Co., 16 AD2d 564 ( 2d Dept. 2005). [11] Fair Price Medical Supply v. Travelers Indemnity Co., 10 NY3d 556.
[12] Unfortunately, there are examples to be found of bad claims practices by insurers, giving the plaintiffs’ bar ammunition for such contentions.
[13] V.S. Medical Services PC v. Allstate Ins. Co., 2009 NYSlipOp 29310 (App. Term, 2d Dept 2009)
[14] AA Acupuncture v. Safeco Ins. Co., 2009 NYSlip Op 29311 [1st Dept 2009]; AB Medical v. Commercial Mutual Ins. Co., 12 Misc.3d 8, 820 NYS2d 378 [2d Dept 2006].
[15] www.NewYorkNoFaultAdvisor.com