Friday, May 29, 2009


Cornell Med., P.C. v Mercury Cas. Co.
2009 NY Slip Op 29228 (App. Term 2d Dept. 2009)

This case is extremely complicated. There are two points of law that came from this case. The first point of law that came from this case, and it is significant, is that a prima facie demonstration of failure to bill in accordance with the fee schedule raises an inference that a plaintiff attorney is not entitled to an attorney fee. The plaintiff attorney must then prove the two exceptions that are set forth in 65-4.6(i). Secondly, a counterclaim for monies paid in excess of the fee schedule is untenable.

Acupuncture may be paid at the chiropractor rates as a matter of law

AVA Acupuncture, P.C. v GEICO Gen. Ins. Co.
2009 NY Slip Op 51017(U)

It is amazing that Plaintiffs are still fighting what the proper reimbursement is for acupuncture services that are paid at the chiropractor rate. Some Plaintiffs are still arguing that the "geographic reasonable value" is the proper basis for no-fault compensation. Others are arguing that the defendant's claims representative needs to affirmatively state that the insurance carrier's standard practice is to pay claims at the chiropractor rate.

This case holds that reimbursement at the chiropractor rate is proper as a matter of law. Period. No strings, no streamers and no conditional statements to the contrary. From a point of practice, this case only discusses reimbursement under CPT Code 97780. Thus, a case coded with CPT Code 97780 and paid at the physician rate ($42.84) or at the chiropractor rate ($29.30), should allow the insurance carrier to prevail on motion or at trial.

Once the Appellate Term breaks down the proper amount of compensation for CPT Codes 97810, 97811, 97813 and 97814, then the paradigm will be completed.

Stricken v. dismissed

V.S. Med. Servs., P.C. v Travelers Ins. Co.
2009 NY Slip Op 29226 (App. Term 2d Dept. 2009)

I am not sure why this case did not receive a (u) or Misc.3d(A) citation, but I take it the Appellate Term is trying to remind people what the difference is between an action that is sticken from the calendar verses an action that is dismissed due to a party's non-appearance. If a non-superior court case is stricken, you have one year to restore it. Restoration needs to be made by motion (or so-ordered stipulation) and a reasonable excuse needs to be set forth as to why the matter was stricken. Compare, CPLR 3404 (Superior court actions can be revived as a matter of right within one year from the Note of Issue being stricken). After one year, you need to satisfy the four factors that defendant and the Civil Court argued needed to be satisfied. Contrariwise, if a case is dismissed, then the traditional 5015 factors need to be proved in order to revive the case.

Strategically, a no-fault plaintiff many times would prefer to have a case dismissed for non-appearance provided the six year SOL has not expired, than have it marked off the calendar. A dismissed case can be refiled, as long as it is without prejudice which is usually the case in the Civil Courts. A case marked off the calendar is not dismissed. And, in the Second Department, it probably can never be dismissed since 3404 does not apply.

A plain disaster

A.M. Med. Servs., P.C. v GEICO Ins. Co.
2009 NY Slip Op 51029(U)(App. Term 2d Dept. 2009)

Simply put, you have to read this case. It looks to be a real disaster. Three points of law seem to come from this case.

First, if you have an order that conditionally dismisses or precludes a party should an EBT not be performed on or before a certain date, the party wishing to give effect to that order needs to follow the Appellate Term's Fogel decision. Yes Fogel.

The Appellate Term has previously applied Fogel, in a 5102(d) action, when it denied an EBT dismissal motion on the basis that the Defendant failed to offer evidence from someone with personal knowledge that EBT was attempted to be scheduled and did not occur. It is the same principle here or even in EUO cases. You need to obtain an affidavit from someone with personal knowledge that the EUO did not occur. This could be from a calendar clerk or attorney, provided the right foundation is laid in the affidavit or affirmation. That was probably missing in this case.

Second, late papers will be accepted provided there is no prejudice. The effect of this is self explanatory.

Third, Golia's dissent is priceless and explains why we now have a different crop of attorneys (on both sides) fighting the appellate wars. I will leave it at that.

Six year SOL

Spring World Acupuncture, P.C. v NYC Tr. Auth.
2009 NY Slip Op 29229 (App. Term 2d Dept. 2009)

Finally, someone convinced the Appellate Term that no-fault actions created by statute have a six year SOL. The lead case on this one, Elrac v. Suero, clearly held that a first-party action, created by statute but contractual in nature from the eyes of the injured person should trigger the 6 year SOL that pertains to contractual actions.

Whether or not one agrees with Suero, it is binding precedent. But until the Appellate Division or the Court of Appeals says otherwise, this is the law.

What seemed bizarre in the three years since Suero was that the Appellate Term, in actions against MVAIC, routinely held that the SOL was three years, based upon the portion of the CPLR which states that actions pursuant to a statute have a 3-year SOL. Yet, if a self-insured entity that is forced to provide first-party benefits by statute is bound by the contractual 6-year SOL, why should MVAIC be any different?

Good job to the Plaintiff's attorneys on this one.

Thursday, May 28, 2009

In the Rehab of Interboro

Matter of Interboro Mut. Indem. Ins. Co.
2009 NY Slip Op 29225 (Sup. Ct. Nasaau Co. 2009)

This case, despite how simple it appears, involved an extremely complicated analysis of Article 73 of the Insurance Law, Article 74 of the Insurance Law (Companies involved in rehabilitation/liquidation), Article 51 of the Insurance Law (No-fault), CPLR Section 2221 (leave to renew), and why established precedent from the 1930s should guide this matter, as opposed to the plethora of modern no-fault law cases.

The case may be best summarized as follows. A company exiting rehabilitation is in a completely different position than a company that never entered rehabilitation. Similar to an entity that succeeds in fulfilling its obligations under a Chapter 11 or Chapter 13 bankruptcy plan, an entity that successfully exits rehabilitation will play by a different set of rules. That is really what this case is about, and within the confines of commercial practice, this makes sense.

Tuesday, May 26, 2009


While there is a drought in the well of new no-fault cases, here is a case that garnered my attention.

Liberty Mut. Ins. Co. v Perez
2009 NY Slip Op 50993(U) (App. Term 1st Dept. 2009).

The facts are simple. Defendant, who admitted dozing off while driving a vehicle, hit a legally parked vehicle, insured by Liberty, on a street. The Liberty vehicle was totalled. Plaintiff Subrogee insurance carrier (Liberty) paid out $19,000 in property damage benefits to its insured and sued Defendant, presumably under theories of equitable and contractual subrogation.

Procedurally, Plaintiff subrogee moved for summary judgment on both liability and damages. Defendant did not put up a fight as to liability but opined that Plaintiff did not demonstrate its damages as a matter of law. Civil Court granted Plaintiff summary judgment as to liability and damages. Defendant appealed. The Appellate Term modified, and remanded to Civil Court for an assessment of damages.

Plaintiff in its motion apparently did not "conclusively establish the market value of the vehicle prior to the accident." Furthermore, the court held that on remand, "defendant will have the opportunity to present evidence challenging plaintiff's decision to declare the vehicle a total loss."

So, I take it that Plaintiff would have met its burden had it: (a) presented an affidavit that in accordance with the insurance regulations, the vehicle was a total loss because the cost of repairing it would be in excess of the percentage of loss that is required before a vehicle may be deemed a total loss; and (b) offered competent evidence as to the market value of the vehicle prior to the loss.

In all honestly, this is not a difficult burden at all, when you think about it. It probably requires a form affidavit with certain variables that could be adjusted on a case by case basis. What is interesting is that I was always of the belief that "damages" in property damage matters always required an inquest (on default) or a hearing on damages (when the defendant answered the complaint). I guess according to the Appellate Term, damages can even be adjudged as a matter of law on motion papers.

There is a no-fault relationship here, actually. But, it has nothing to do with the usual "medical provider v. carrier" fight that we deal with on a daily basis. Rather, in a rear-end or uncontested liability case, it would appear that within the confines of an APIP subrogation case or Basic PIP subrogation case (in the limited circumstances this type of action is allowed), an insurance carrier's proof of receipt of the bills and the amount it paid out to its Subrogor or the Subrogor's assignee, would conclusively establish an insurance carrier's damages.

Thus, while general practitioners have always grumbled about how no-fault decisions procedurally impact them, we in the world of no-fault, again, can say that a non no-fault case has now impacted some segment of the no-fault bar. No, not the one you drink at.

Friday, May 15, 2009

A court system not so uniform

There was an interesting decision that came out from The Long Beach City Court. Judge Smolkin, one of the two City Court Judges out here, wrote a very good opinion as to transferring cases from one lower court to another. I will not attempt to elucidate on the relevancy of this topic. In my mind, it is self evident.

The lesson to be learned from this case, in a nut shell, is that if you wish to consolidate or remove a case from one "court system" to another "court system", you will need to commence a Supreme Court of County Court action. As to the mechanics of executing this procedure as well as its practicability and viability, I will leave these topics for another day.

People v. Rome, 2009 NY Slip Op 29200 (City Ct. Long Beach 2009)

Lastly, this is a criminal case so various references are made to the CPL and the Penal Law. But, from a pragmatic standpoint, this case describes how vexatious a journey it is to change the venue of where civil cases are lodged.

Tuesday, May 12, 2009

Forget the insurance carriers. How about the banks?

There has been a dearth of no-fault news out in the most recent decision website. This is not to say that more earth shattering or technical challenges to either virgin or somewhat settled points of law are not on the horizon. I have first-hand knowledge in telling you that some interesting decisions will be coming down the pike in the next few months. I just hope they go my way.

With that introduction, there was a case that came from the District Court Nassau County that caught my attention. It makes me think that whatever prejudices or problems any of us might have had with insurance carriers at one point, there is much worse out there

Meet Judith Lawrence.

And lastly, next time you bash an insurance company, remember that trillions of dollars went to support, in part, institutions like the Petitioner below.

Deutsche Bank Natl. Trust Co. v Oliver
2009 NY Slip Op 29197 (Dis. Ct. Nassau Co. 2009)

In an era when tent cities and new Hoovervilles are rising from the ashes of a foreclosure crisis all across America (NY Times, 3/26/09, p.1), the petitioner, Deutsche Bank National Trust Co., asserts a direct legal challenge to the Court's equitable authority to consider a request for "more time" by a family facing a post-foreclosure eviction. For the reasons stated hereinafter, the Court rejects the challenge, and reiterates that the Court retains the power and equitable discretion to consider claims of genuine hardship in the face of an imminent eviction."


"Respondent, Judith Lawrence, made a timely application to this Court for "more time" by filing her request for an Order to Show Cause on March 10, 2009. Her affidavit, on a form provided by the Court, appears to ask for nothing more than "more time." Although the Court form includes broad, boilerplate language, respecting general requests for relief from a default, it also includes language through which the applicant may seek "such other and further relief as may be just and proper" as well as language providing that, "pending the determination of this motion that the . . .warrant of eviction be stayed."

"Judith Lawrence's moving affidavit presents an extremely compelling equitable case for "more time." In simple, indeed moving terms, she states: "I need more time as my mom lives with me - she is 92 years. I am getting her in a nursing home and SS documents are delayed as she has dementia. I just need more time. Thank you."

"According to petitioner, the “sole equitable relief” permitted on application of a holdover occupant after a judgment of possession “is the statutory authority to grant a stay of issuance or execution of a warrant of eviction for a period not greater than six months from the date of entry of judgment,” further conditioned upon payment “for the occupation of the premises for the period of the stay and such deposit shall also include all rent unpaid by the occupant prior to the period of the stay” (citing RPAPL §753). *3 Based on the provisions cited, petitioner contends that “the relief in the Order was beyond the jurisdiction of this Court to grant except upon condition of payment of $10,000.00 [for five months' use and occupancy] to the Owner or into the Court."

The Court must reject the petitioner's contentions. CPLR 2201 broadly empowers the Court to grant a stay of proceedings “in a proper case, upon such terms as may be just.” The propriety of granting a stay in any given case is limited only by “the Court's own sense of discretion, prudence and justice”


Considering Ms. Lawrence's decades-long occupancy of the subject premises (dating back to 1990), the circumstances under which the premises were lost and then sold to petitioner for $500.00, respondent's need to care for her 92 year old mother, her *4 mother's dementia, the practical difficulties she has encountered arranging for nursing home care for her mother, and her apparently good-faith, honest request for “more time”, the Court believes it can properly afford respondent a reasonable amount of additional time to locate suitable accommodations for herself and her mother without violating petitioner's rights or the Court's oath of office"

Thursday, May 7, 2009

The first of hopefully many

Bongiorno v State Farm Ins. Co.
2009 NY Slip Op 50860(U)(App. Term 2d Dept. 2009)

This case is not remarkable in any way, except according to my calculations, it is the first time a judge in Civil Richmond was overturned on a denied lack of medical necessity summary judgment motion. Actually, I think it is the first time I have seen an appeal from Civil Richmond in a no-fault case in awhile.

Defense attorneys in some courts are told that medical necessity summary judgment motions are not welcome and will be summarily denied.

My hope is that some of the holdout judges in the Second Department, who refuse to grant summary judgment to a carrier's lack of medical necessity motion-when same is not rebutted with any affirmative medical proof- will now follow suit.

Time will tell, as will more appeals should the rule of law not be followed.

Note - this reference does not apply to the First Department - as of now

Friday, May 1, 2009

A minus v. Mercury

I can't comment much on this matter, but if you read the record on appeal in this matter and the record on appeal in the matter of CPT v. NYCM, then you will see that the Appellate Term, First Department, is having trouble figuring out how to resolve an issue that the Appellate Term, Second Department resolved 2 years ago in A Khodadadi Radiology, P.C. v NY Cent. Mut. Fire Ins. Co., 16 Misc 3d 131(A)(App. Term 2d Dept. 2007).

Lastly, this case only gives a Plaintiff more of a reason to file his or her cases in the Bronx.