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On the motorcycle and hit again – Is there coverage? May 27, 2015

Boyson v. Kwasowsky, 2015 N.Y. Slip Op. 03964 (4th Dept. 2015)
Facts: Woman (a passenger) is dropped from motorcycle.  Vehicle that motorcycle avoided from hitting collided with the motorcycle, and the motorcycle went into the woman.  Woman sought no-fault benefits from vehicle that collided into

A distinction between Alrof-Safeco and reality May 27, 2015

Harmonic Physical Therapy v Encompass Home & Auto Ins. Co., 2015 NY Slip Op 50733(U)(App. Term 1st Dept. 2015)
“Contrary to the motion court’s conclusion, defendant submitted competent evidence of the assignor’s nonappearance in the form of an affirmation of the scheduled exam

The prima facie case in the First Department and sinking of a disclosure based defense May 27, 2015

Tutto Anesthesia v American Country Ins. Co., 2015 NY Slip Op 50738(U)(App. Term 1st Dept. 2015)
What is there to discover?  Did I just say that?  In light of Ralph Medical, discovery is so limited on the carrier end, outside of good-faith based Mallela allegations.
(1) Plaintiffs-providers esta

IME letters do not need to be sent to provider May 27, 2015

Pugsley Chiropractic PLLC v MVAIC, 2015 NY Slip Op 50718(U)(App. Term 1st Dept. 2015)
(1) Defendant MVAIC made a prima facie showing of entitlement to judgment as a matter of law by demonstrating that it timely denied plaintiff’s first-party no-fault claims based on a sworn independent medic

45-day rule in action (or inaction) May 27, 2015

SMB Med. P.C. v Chubb Indem. Ins. Co., 2015 NY Slip Op 50719(U)(App. Term 1st Dept. 2015)
“Defendant failed to establish its entitlement to summary judgment dismissing the complaint based upon plaintiff’s alleged untimely submission of the claims beyond the applicable 45-day time limit

Taking a stab at our respected jurist from Staten Island May 27, 2015

Richard A. Hellander, M.D., P.C. v Metlife Auto & Home Ins. Co., 2015 NY Slip Op 25164 (App. Term 2d Dept. 2015)
“In view of some of the remarks contained in the amended order, we take this opportunity to remind the judge that, as one commentator has noted:
“Judges may face a dilemm

Another old fee schedule 20553 reduction case May 27, 2015

Alleviation Med. Servs., P.C. v State Farm Mut. Auto. Ins. Co., 2015 NY Slip Op 50778(U)(App. Term 2d Dept. 2015)
“Plaintiff’s main argument on appeal with respect to defendant’s cross motion is that defendant failed to demonstrate that it had properly reduced the sum billed for C

Affidavits of no show are insufficient May 27, 2015

T & J Chiropractic, P.C. v Geico Ins. Co., 2015 NY Slip Op 50772(U)(App. Term 2d Dept. 2015)
“While defendant submitted properly sworn statements by the chiropractor and doctor who were scheduled to perform the IMEs, neither health care professional demonstrated personal knowledge of the

Boilerplate affidavit mandates triable issue of fact on verification issue May 27, 2015

Longevity Med. Supply, Inc. v Allstate Ins. Co., 2015 NY Slip Op 50757(U)(App. Term 2d Dept. 2015)
“[a]n affidavit from plaintiff which asserts that material responsive to the verification requests had been sent to defendant.”
New Way Med. Supply Corp. v National Liab. & Fire Ins. C

What was the other basis for finding the EUO no shows are invalid? May 27, 2015

(1) “Here, defendant alleges that plaintiff’s assignor was scheduled to appear for an EUO on four different dates, that he did not appear at all, and that his conduct constituted a failure to comply with a condition precedent to coverage. However, defendant concedes on appeal that the se