Courtside by Larry Rogak brings to the fore cases and decisions of relevance to doing insurance business. Some of the results are, in a word, “unbelievable”.
Matter of Country-Wide Ins. Co. v TC Acupuncture P.C. Master arbitration awards in NY PIP may be reviewed de novo by a court. In such cases, the claimant’s attorney fees are not based on the limits in Regulation 68, but instead are determined by the court based on a “reasonableness” standard.— LNR Order, Supreme Court, […]
Denial’s Use of Non-Statutory Language Does Not Make it Invalid Insurance Law 5106(c) pemits a de novo review of a No-Fault master arbitrator’s award over $5,000. In this case, Allstate appealed from an arbitration award to a medical provider on both medical necessity and fee schedule issues. Supreme Court ruled in favor of the provider […]
Queens-Roosevelt Med. Rehabilitation, P.C. v Response Ins. Co. In this no-fault lawsuit, the doctor who owned the plaintiff medical facility appeared for two EUOs, but refused to answer questions about other professional corporations he owned. The Appellate Term held that the insurer’s questions were valid, and based on the doctor’s non-cooperation, his lawsuit was dismissed.—LNR […]
Berenblit v Aetna Cas. & Sur. Co. In this no-fault suit, plaintiff obtained a judgment on default in 1998. But it was not until 2017 that plaintiff sent the judgment to the marshal for enforcement. When defendant was served by the marshal, it moved to vacate the judgment. Civil Court did not vacate the judgment […]
Bronx Chiropractic Care, P.C. v State Farm Ins. Appeal from an order of the Civil Court of the City of New York, Kings County (Devin P. Cohen, J.), entered December 16, 2016. The order granted defendant’s motion for summary judgment dismissing the complaint. Affirmed. In this action by a provider to recover assigned first-party no-fault […]
B.Z. Chiropractic, P.C. v Allstate Ins. Co. In this declaratory judgment action arising out of a No-Fault suit, the Court rules that plaintiff’s delay of 14 years in enforcing a judgment it obtained in 2001 does not toll the accumulation of interest at 2% per month, compounded, as per the Insurance Department regulations in effect […]
Dynamic Balance Acupuncture, P.C. v State Farm Ins. In this no-fault suit, State Farm moved for summary judgment on the grounds of the provider’s failure to respond to two EUO requests. Civil Court denied the motion, finding an issue of fact as to the reasonableness of the EUO requests. The Appellate Term reversed, holding that […]
Hinton v Village of Pulaski The Court of Appeals rules here that an exterior public stairway which connects a sidewalk with a municipal parking lot is the equivalent of a sidewalk, and therefore the municipality that owns it must have prior written notice of a defect as a condition precedent to liability for injuries.—LNR The […]
Jamjyan v West Mtn. Ski Club, Inc. Edited by Lawrence N. Rogak In this personal injury suit, plaintiff alleged she was injured while snow tubing. The facility moved for summary judgment under the “assumption of risk” doctrine. The Court held that an issue of fact exists at to whether the facility’s personnel increased the ordinary […]
A & S Med. Supply, Inc. v MVAIC Ins. Co. Claimant was insured by Long Island Insurance Co., which went into liquidation. Claimant’s medical provider sent bills to MVAIC, which denied the claims on the grounds that there was potential coverage through the Liquidation Bureau. The Appellate Term held that the Liquidation Bureau’s records […]
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