No Fault Defender – A Defense Attorney's Perspective on New York No-Fault Law

Excel Imaging, P.C. v All Car Rent A Car, Inc., 2012 NY Slip Op 50104(U)(App. Term 1st Dept. 2012)

“The record raises triable issues as to whether the notices for examinations under oath were properly mailed by defendant and received by plaintiff (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720, 721 [2006]; cf. Eagle Surgical Supply, Inc. v Progressive Cas. Ins. Co., 21 Misc 3d 49, 51 [2008]).”

I think I know why there was a CF there.  Mr. Zuppa, the c.f. guru, can perhaps share his thoughts.

Diagnostic Medicine, P.C. v Clarendon Natl. Ins. Co., 2012 NY Slip Op 50102(U)(App. Term 1st Dept. 2012)

What happened to Pomona v. Geico?  Why did A-minus go sour?

“[Defendant] submitt[ed] competent medical evidence, including a sworn peer review report, that the diagnostic testing giving rise to plaintiff’s claims lacked medical necessity (see CPT Med. Servs., P.C. v NY Cent. Mut. Fire Ins. Co., 18 Misc 3d 87, 88 [2007]). Plaintiff’s opposition consisting of an attorney’s affirmation — unaccompanied by any medical evidence or other competent proof — was insufficient to raise a triable issue.”

Total Equip., LLC v Praetorian Ins. Co., 2012 NY Slip Op 50078(U)(App. Term 2d Dept. 2012 [9th and 10th Jud. Dis])

The 9th and 10th again tell Nassau District Court that they are not exempt from the rule that an unopposed lack of medical necessity motion spells doom.

Elmont Open MRI & Diagnostic Radiology, P.C. v Tri State Consumer Ins. Co., 2012 NY Slip Op 50079(U)(App. Term 2d Dept. 2012 [9th and 10th Jud. Dis])

I like this line:

“Since plaintiff, in opposition to defendant’s motion, failed to submit any medical evidence sufficient to raise a triable issue of fact as to medical necessity, defendant was entitled to summary judgment”

A.B. Med. Servs., PLLC v American Tr. Ins. Co., 2012 NY Slip Op 50076(U)(App. Term 2d Dept. 2012)

This case in many ways represents the shuffelling of too many papers.  There is an interesting take from this case:

“The District Court granted leave to renew based on plaintiffs’ purported “new facts.” However, the “new facts” offered in support of renewal were in the form of a letter from plaintiffs’ counsel to the Board, requesting that the Board schedule a hearing pursuant to the District Court’s July 21, 2008 order, and a letter from the Board’s General Counsel to plaintiffs’ counsel which was not responsive to plaintiffs’ counsel’s letter, did not refer to the instant case, and, in fact, referred to a different letter from plaintiffs’ counsel. There was nothing in plaintiffs’ submissions to indicate any personal knowledge that a proper application for workers’ compensation benefits had been made by plaintiffs’ assignor, or that the Board had actually rejected such application. Accordingly, leave to renew should have been denied, and the District Court improvidently exercised its discretion in granting plaintiffs’ motion.”

Perhaps this is nothing earth shattering.  But, what I find interesting is that the Court has now laid out a road map of what is necessary to comply with the “prompt application” requirement that the Appellate Term has laid out.

Ortho Prods. & Equip., Inc. As Assignee of Daniel Robinson, Nicholas Manickchand & Bradley Forbes v Interboro Ins. Co., 2012 NY Slip Op 61416(U)

Appellate Term of the Supreme Court

of the State of New York for the 2nd, 11th & 13th judicial Districts

MICHELLE WESTON, J.P.

MICHAEL L. PESCE

JAIME A. RIOS, JJ.

DECISION & ORDER ON MOTION

2011-551 K C

Motion by appellant on an appeal from an order of the Civil Court of the City of New York, Kings County, entered December 16, 2010, to strike paragraphs 8, 9, 12, 13, 14 and 15 from the respondent’s brief.

Upon the papers filed in support of the motion and no papers having been filed in opposition thereto, it is

ORDERED that the motion is denied.

It is noted that this court will not consider any matter that is dehors the record (see Chimarios v Duhl, 152 AD2d 508 [1989]).

I do not know why this Court could not do what the Appellate Division does and refer this motion to the panel of judges hearing the appeal.  Orders like this embolden  sloppy Civil Court work with the incentive that on appeal the court will allow the Appellant or Respondent to raise unpreserved legal argument in and get away with it.

Unreal.

Grant v United Pavers Co., Inc., 2012 NY Slip Op 00239 (1st Dept. 2012)

“Although plaintiff’s physicians did not expressly address defendants’ expert’s conclusion that the injuries were degenerative in origin, by relying on the same MRI report as defendants’ expert, and attributing plaintiff’s injuries to a different, yet equally plausible cause, plaintiffs raised a triable issue of fact (see Lee Yuen v Arka Memory Cab Corp., 80 AD3d 481, 482 [2011]; Linton v Nawaz, 62 AD3d 434, 440 [2009], affd 14 NY3d 821 [2010]). Although “[a] factfinder could of course reject this opinion” (Perl v Meher, __ NY3d __, 2011 NY Slip Op 08452 [2011]), we cannot say on this record, as a matter of law, that plaintiff’s injuries had no causal connection to the accident.”

Arzu v NYC Tr. Auth., 2012 NY Slip Op 22008 (Civ. Ct. Kings Co. 2012)

The last thorny issue in PIP practice that has not gotten much attention: 65-3.9(d).  This is the toll of interest that applies when a plaintiff lets a case sit in limbo ad finitium.

As we all know, interest accrues at 2% per month.  For those who have been lucky to find old reg bills that were prosecuted within the 6-year SOL, that 2% is compounded.  Yet, what happens when a Plaintiff purchases an index number and bottles a case up for 10 years?

Well, one particular plaintiff attorney, in my estimation “mastered” this trick.  You cannot blame him and have to respect him.  If you are able to sit on receivables without a client demanding immediate recompense, then why would you not attempt to obtain at least 24% on your receivables, when the amount you can obtain from the bank on this money is 1.05%?

Here, we have an endorsed complaint for $25,000 and a plaintiff who happily waited for Defendant to draw first blood.  Defendant woefully failed to comprehend who he was dealing with and ended up in a situation where the within case was not even trial ready, and 10-years of interest accrued.

Defendant, however, appears to have outfoxed the Plaintiff by arguing that 3.9(d) applies and interest must toll.  Yet, Plaintiff still did not make out badly.  Here are some snippets of this case that should arouse some thought.

Rule of Law

(1) Significantly, claimants or applicants are also required to act promptly or face the tolling of insurance. Pursuant to 11 NYCRR §65-3.9(c), where the applicant does not commence litigation within 30 days of the denial of the claim or payment of benefits, the interest shall be tolled until such action is taken. Pursuant to 11 NYCRR §65-3.9(d), interest shall accrue once the applicant has submitted a dispute to arbitration of the courts “unless the applicant unreasonably delays the …court proceeding.” Thus, “[f]ailure to act promptly after a denial of claim results in a toll of the statutory interest provisions, for to do otherwise would reward a recalcitrant plaintiff with a windfall of punitive interest payments and would contravene the legislative goal of promptly resolving no fault claims.” Devonshire Surgical Facility et al v. American Transit Ins. Co., 2011 NY Slip Op 50793(U), 31 Misc 3d 1221(A) (Civil Ct., NY Co., 2011). See East Acupuncture. P.C., supra, 61 AD3d at 210.

(2) Per the clear language of the regulation, the interest which accrues on overdue no fault penalties acts as an incentive for both insurers and claimants to act promptly. The insurer must first promptly adjust the claims or face payment of interest to an applicant who prevails in litigation. However, once a denial or payment of benefits has been made by the insurer, the incentive to act promptly switches to the applicant who first initiate the lawsuit within 30 days of the denial and must then not unreasonably delay the prosecution of the case in order to avoid the tolling of interest. See, Devonshire Surgical, supra at 4; See also, LMK Psychological Services, Inc., 12 NY3d 217, 223-24 (2009) (the Superintendent of Insurance has interpreted the tolling of interest provision contained in subdivision (c) to apply, regardless of whether the particular denial at issue was untimely so as to encourage applicants to swiftly seek to resolve any dispute). Canarsie Med. Health, P.C. v. National Grange Mut. Ins. Co., 21 Misc 3d 791, 797 (Sup. Ct., NY Co. 2008)(The regulation contains a “built-in protection against potential delay by providing that where an applicant chooses not to timely press forward to seek redress for a denial, there will be no interest penalty assessed against the insurer until such time as the applicant chooses a remedy. This is in keeping with the intent of the No-Fault Law as a whole because it seeks to encourage the parties moving forward toward a quick resolution, while not economically favoring one side or the other.”).

Court’s Observation

(1) Here, plaintiff’s delay in prosecuting the case is especially egregious. Plaintiff first waited nearly four years to respond to discovery demands resulting in defendant filing a motion to preclude plaintiff from offering evidence. Only upon receipt of this motion did plaintiff enter into a So-Ordered stipulation whereby plaintiff was to provide copies of the allegedly unpaid [*4]bills within 45 days or be precluded from offering such evidence at trial. Defendant disputes that it ever received the sought disclosure as a rationalization as to why it did not serve plaintiff with a notice to resume prosecution and file a note of issue for approximately five years. Yet, ironically, plaintiff claims that it actually mailed the sought after discovery in 2005. Hence, by its own admission, plaintiff concedes that it waited five years to resume prosecution of the case, and that it was spurred to action by being served by defendant with a notice to resume prosecution and file a note of issue.

Remedy

To make both the insurer and applicant equally responsible for moving the case forward would contravene both the explicit language of the regulations and the intent of the legislation by creating an incentive for the applicant to do nothing and hence receive a windfall in punitive interest payments as the case languished in perpetuity. As such, this Court holds that inaction on the part of the applicant for five years after it received discovery from the defendant constitutes an unreasonable delay and directs that the interest be tolled from one year after plaintiff complied with the discovery request.

An Aside

I probably would have made a pre-answer motion to dismiss under Lopes v Liberty Mut. Ins. Co., 24 Misc.3d 127(A)(App. Term 2d Dept. 2009).   I think there would be a decent chance of success and you would limit the interest exposure.  Be careful for Domotor issues; still, make Plaintiff properly plead out his case.

Woodward Med. Rehabilitation, P.C. v State Farm Fire & Cas. Co., 2011 NY Slip Op 52442(U)(App. Term 2d Dept. 2011)

In this case, which seems to be one of first impression, the Court held that a motion cannot be withdrawn or amended without leave of court.  Does this mean that a letter carbon copied to the other side requesting that a motion be withdrawn is now invalid?

“Nowhere in the papers in support of defendant’s amended motion did defendant set forth why it concluded that the amended motion was necessary, nor did defendant seek to withdraw the original motion. On the return date, the Civil Court denied both the original motion as defective and the amended motion as having been made “more than one year after the original motion without leave of court.” Defendant’s sole argument on appeal is [*2]that the Civil Court improperly refused to consider its amended motion.”

“A party who concludes that a motion is defective or insufficient should apply for and obtain leave to withdraw or amend it” (60 CJS, Motions and Orders § 41; see generally Hoover v Rochester Print. Co., 2 App Div 11 [1896]). As the record in this case does not indicate that defendant either sought leave to withdraw the original motion or to amend it, and as defendant did not set forth any reason why an amended motion was necessary, the Civil Court did not improvidently exercise its discretion in refusing to entertain the amended motion.”

Radiology Today, P.C. v New York Cent. Mut. Fire Ins. Co., 2011 NY Slip Op 52452(U)(App. Term 2d Dept. 2011)

The carrier is delaying for an MRI film from an MRI facility.  What is the basis?  Lack of causal relationship?  Seeking to obtain the film at the workers compensation rate of $5.00 per sheet, as opposed to having to pay market rate during discovery in the personal injury matter?

Here are the facts and the holding.

“Contrary to plaintiff’s contention, the affidavit of defendant’s litigation examiner, submitted in support of defendant’s motion, established that defendant had timely mailed its requests and follow-up requests for verification (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb [*2]Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]), and that plaintiff had failed to provide the MRI films which, among other things, defendant’s requests for verification had sought.”

Jamaica Med. Supply, Inc. v Kemper Cas. Ins. Co., 2011 NY Slip Op 52441(U)(App. Term 2d Dept. 2011)

Why is a prima facie case different in a DME case?  All this discrimination against DME suppliers…

“The billing records submitted by plaintiff in support of its motion for summary judgment do not assert that the supplies at issue had been delivered to plaintiff’s assignor. Nor did plaintiff’s affiant state that he had delivered the supplies to plaintiff’s assignor. Indeed, he stated that it is his general practice to either (1) deliver his supplies directly to the eligible injured person or to (2) deliver them to the prescribing healthcare providers for subsequent delivery to the eligible injured person. He did not specify in his affidavit which method of delivery was used in this case. Accordingly, plaintiff’s moving papers failed to demonstrate its prima facie entitlement to summary judgment.”