tag:blogger.com,1999:blog-40392907537243083222023-11-15T08:18:26.656-08:00No Fault Law - a defense attorney's perspectiveA defense attorney's perspective on New York PIP lawNoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.comBlogger78125tag:blogger.com,1999:blog-4039290753724308322.post-75274410491755726882009-09-27T18:44:00.000-07:002009-09-27T18:50:03.405-07:00New location for this BlogI have relocated this blog to the following URL: http://nofault.lisquared.com/<br /><br />Please let me what you think of the new site..NoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.com0tag:blogger.com,1999:blog-4039290753724308322.post-74949176714290956252009-09-17T18:01:00.000-07:002009-09-17T18:57:37.323-07:00A default that is more than meets the eyesThe one thing that we can all say about Second Department practice, whether it be at the Appellate Term or the Appellate Division, is that the decision/orders of these courts never elucidate upon the facts of a given matter. This is not necessarily a bad thing, especially when you are on the losing side of a case. But when a case has lived an interesting life, it would be nice to know what happened.<br /><br />While the Appellate Division’s decision tells a different story, a review of the record of appeal in <em>Mercury <span class="blsp-spelling-error" id="SPELLING_ERROR_0">Cas</span>. Co. v. Surgical Center at <span class="blsp-spelling-error" id="SPELLING_ERROR_1">Milburn</span>, <span class="blsp-spelling-error" id="SPELLING_ERROR_2">LLC</span></em>, 2009 N.Y. Slip Op. 06516 (2d Dept. 2009), shows us that this is not your every day run of the mill “default” case.<br /><br />This case started as a $12,000 no-fault AAA arbitration, where the Defendant sought to recover for surgery services performed on its Assignor. Plaintiff denied the claim on the basis that the surgery was not causally related to the motor vehicle accident. In support of this defense, Plaintiff presented the report of a radiologist who, upon a review of the applicable MRI films, found that the injuries were <span class="blsp-spelling-error" id="SPELLING_ERROR_3">pre</span>-existing, degenerative and not related to the underlying motor vehicle accident.<br /><br />The lower arbitrator, upon a review of the record, did not find the Plaintiff's proof convincing and awarded Defendant the principle sum of $12,000, along with interest, costs and attorney fees. It is not uncommon these days for an insurance carrier to lose in arbitration.<br /><br />Plaintiff, as would be expected, filed a master <span class="blsp-spelling-error" id="SPELLING_ERROR_4">arbitral</span> demand and perfected its master <span class="blsp-spelling-error" id="SPELLING_ERROR_5">arbitral</span> brief. Similarly, Defendant proceeded to perfect his master arbitral brief. Following due deliberation, the master arbitrator upheld the award of the lower arbitrator, finding that the award was not defective as a matter of law. This decision was probably correct.<br /><br />Since the amount in controversy, however, exceeded $5,000, Plaintiff sought a trial <span class="blsp-spelling-error" id="SPELLING_ERROR_6">de</span>-<span class="blsp-spelling-error" id="SPELLING_ERROR_7">novo</span>. In this regard, a summons and complaint, fashioned as an action seeking a declaration that the surgery was not related to the motor vehicle accident, was filed with the Supreme Court and served upon Defendant. The action seeking a declaratory judgment spelled out the procedural history and the nature of the defense to the underlying no-fault claim.<br /><br />Defendant failed to timely answer or move, and Plaintiff moved for leave to enter a default judgment against Defendant. Defendant opposed the motion, but failed to set forth a reasonable excuse or any evidence to support a potentially meritorious defense. All Defendant attached to his answering papers were the proofs he presented at the lower arbitration. In order to raise a potentially meritorious defense, Defendant would have had to obtain a radiology review that contradicted, point by point, Plaintiff’s own film review. As to the proof necessary to defeat a causation defense predicated upon a radiology review, please see my prior posts.<br /><br />The Supreme Court denied Plaintiff's motion. A notice of appeal was promptly filed. At the Appellate Division, Plaintiff moved to stay the Supreme Court case, pending the outcome and determination of the appeal. This motion was granted. The appeal was then perfected. Following due deliberation, the order of the Supreme Court was reversed and Plaintiff’s motion was granted. Consequently, the matter was remitted to the Supreme Court for the purpose of entering a judgment, declaring that the surgery was not causally related to the motor vehicle accident.<br /><br />Here are a few thoughts. First, it would appear that the collateral <span class="blsp-spelling-error" id="SPELLING_ERROR_8">estoppel</span> consequences of this type of a decision are huge, as I have opined in previous posts. The second thing, and one of a practical matter, is that a demand for a trial <span class="blsp-spelling-error" id="SPELLING_ERROR_9">de</span>-<span class="blsp-spelling-error" id="SPELLING_ERROR_10">novo</span>, in this type of proceeding, should be commenced as a declaratory judgment type of action. There are other ways to commence a trial <span class="blsp-spelling-error" id="SPELLING_ERROR_11">de-</span><span class="blsp-spelling-error" id="SPELLING_ERROR_12">novo</span>, but these methods are not as effective or efficient as commencing it through a declaratory judgment action.NoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.com0tag:blogger.com,1999:blog-4039290753724308322.post-62257566288551088612009-08-28T18:27:00.001-07:002009-08-28T18:35:25.632-07:00The failure to serve a demand for master arbitral review in the manner set forth in the regulations will foreclose review of the underlying award<span style="font-style: italic;">Matter of Progressive Northeastern Ins. Co. v Seaport Orthopedic Assn.</span> 2009 NY Slip Op 31915(U)(Sup Ct NY Co. 2009)<br /><br />In this case, a master arbitrator failed to consider the merits of the insurance carrier’s appeal since there was insufficient proof as to whether the demand for master arbitral review was sent via certified mail, return receipt requested, in accordance with 65-4.10. Petitioner commenced an Article 75 proceeding in Supreme Court, New York County, to vacate the award of the master arbitrator.<br /><br />The Supreme Court confirmed the award of the master arbitrator. The Court found the following: <br /><br />“Courts are reluctant to disturb the decisions of arbitrators lest the value of this<br />method of resolving controversies be undermined.” Goldfinger v. Linger, 68 N.Y.2d 225,230 (1986)(citations omitted). The Notice failed to set forth compliance with 11 N.Y.C.R.R. 65-4.10(d)(3) in that it failed to set forth the manner of service. There is no basis to vacate the award under CPLR § 7511. From the face of the Notice, the Master Arbitrator was within his power to hold that service was improper, and refuse to reach the merits of the decision of the lower arbitrator.”<br /><br />The above rationale appears to be based upon the more deferential standard that applies to non-compulsory arbitrations, as opposed to the Article 78 standard that applies to the review of PIP arbitrations. It also appears that the Appellate Division, First Department, in T<span style="font-style: italic;">ravelers Indem. Co. v. Rapid Scan Radiology, P.C.</span>, 61 A.D.3d 466 (1st Dept. 2009), already held that the failure to comply with certain service provisions in 65-4.10, is deemed de minimus, as recognized below:<br /><br />“The master arbitrator did not exceed his authority and his determination was not arbitrary or capricious. As to petitioner's claim that respondent did not comply with the filing requirements of 11 NYCRR 65-4.10 (d) (2) because it failed to state the nature of the claim and grounds for review and failed to include a copy of the lower arbitrator's award, this was not the basis of their challenge before the master arbitrator. Further, no prejudice has been shown since the parties submitted memoranda fully apprising the master arbitrator of the issues at hand and of the lower arbitrator's decision<br /><br />While it is conceded that Rapid Scan served its request by regular mail, not certified mail as required by 11 NYCRR 65- *467 4.10 (d) (3), as the Supreme Court found, petitioner participated in the master arbitrator's review and recognized in its own submission that the defect could be viewed as “de minimus and/or harmless.”<br /><br />Hopefully, Progressive preserved the argument set forth in <span style="font-style: italic;">Rapid Scan</span> and will appeal this decision since it is contrary to established First Department precedent.NoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.com0tag:blogger.com,1999:blog-4039290753724308322.post-85670363518472096452009-08-28T09:50:00.000-07:002009-08-28T17:26:22.924-07:00Robbing someone while they are chaging a tire is considered use and operation in Florida<span style="font-family:georgia;font-size:100%;">In light of the dearth of no-fault cases, I have devoted this week's postings to interesting issues that have arisen in Florida no-fault law. Today's case is from the Florida Supreme Court, and was decided in 1999. It should be noted that the issue of "use and operation" in New York is one that has created numerous conflicts between the Second Department and Third Department.</span><span style="font-size:100%;">
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<br /></span><span style="font-family:georgia;font-size:100%;">But, this case is really interesting in seeing how expansive the phrase "use and operation" of a motor vehicle is in Florida.</span><span style="font-size:100%;">
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<br /><em style="font-family: georgia;">Blish v. Atlanta Causalty Company</em></span><span style="font-family:georgia;font-size:100%;">, 736 So.2d 1151 (Fla. 1999)</span><span style="font-size:100%;">
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<br /></span><span style="font-family:georgia;font-size:100%;">Karl Blish left work on January 6, 1995, drove a coworker home, spent a few minutes at the coworker’s house, and then headed home himself. Blish’s pickup truck had a blowout on U.S. 1 in Brevard County and he pulled over to change the tire. He jacked up the truck and was loosening the lug nuts when he was attacked from behind by several assailants. The men choked and beat him (he testified that he “might have went unconscious”) and stole between eighty and a hundred dollars from his pocket. After the attack, Blish recovered his glasses, did his best to finish changing the tire, and drove home (“I just barely got the tire on and I drove home.“). He did not go to the hospital or call police because he did not think that he had been hurt badly enough (“I was just going to write it off as a loss, I guess.“).</span><span style="font-size:100%;">
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<br /></span><span style="font-family:georgia;font-size:100%;">A week later, he experienced severe abdominal pain, was rushed to the hospital in an ambulance, and was diagnosed as suffering from a ruptured spleen, which doctors removed.</span><span style="font-size:100%;">
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<br /></span><span style="font-family:georgia;font-size:100%;">Under these circumstances, the actual source of the injury-causing blow is not dispositive--whether it came from a negligent driver in a passing vehicle or a violent group of passing thugs is not decisive. </span><span style="font-size:100%;"><strong style="font-family: georgia;">It was the use and maintenance of the truck that left Blish stranded and exposed to random acts of negligence and violence</strong></span><span style="font-family:georgia;font-size:100%;">, and he was in the very act of performing emergency maintenance on the vehicle when he was injured.</span><span style="font-size:100%;">
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<br /></span><span style="font-family:georgia;font-size:100%;">Acts of violence are an ageless and foreseeable hazard associated with the use of a vehicle--for once a person sets out in a vehicle, he or she is vulnerable. The highwaymen and desperados of bygone times preyed on the wayfarer, and these villains are with us still. Each Floridian today, when he or she gets behind the wheel, faces a variety of dangers: a car-jacking at a stoplight, or a strong-arm robbery at a deliberately staged rear-end collision, or a road rage assault in rush hour traffic, or even a random shooting by an anonymous sniper from an overpass.</span><span style="font-size:100%;">
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<br /></span><span style="font-family:georgia;font-size:100%;">The danger is particularly acute when the motorist is stranded as the result of a disabled vehicle. The scenario in the present case is every motorist’s nightmare. Losses resulting from a violent encounter with this ageless road hazard--i.e., the highwayman or opportunistic thug--might reasonably be said to be very much in the contemplation of Florida consumers when they are contracting to purchase auto insurance. The motivation of the assailant--whether it be to “possess or use” the vehicle, or to steal the victim’s wallet or purse, or simply to harm the victim--is a nonissue to the consumer.</span><span style="font-size:100%;">
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<style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;} </style> <![endif]--><span style="font-style: italic;font-family:georgia;font-size:100%;" >Hammond v. GMAC Ins. Group</span><span style="font-size:100%;"><b face="georgia"> </b></span><span style="font-family:georgia;font-size:100%;">56 AD3d 882 (3d Dept. 2008)</span><span style="font-size:100%;"><b face="georgia">;<o:p></o:p></b></span><span style="font-family:georgia;font-size:100%;"> </span><span style="font-size:100%;"><em style="font-family: georgia;">Matter of Manhattan & Bronx Surface Transit Operating Authority</em></span><span style="font-family:georgia;font-size:100%;">, 71 AD2d 1004 (2d Dept. 1979). </span><span style="font-size:100%;"><em style="font-family: georgia;">But see</em></span><span style="font-family:georgia;font-size:100%;">, Mazzarella v. Paolangeli, 63 AD3d (3d Dept. 2009); </span><span style="font-size:100%;"><em style="font-family: georgia;">1420Trentini v. Metropolitan Property and Cas. Ins. Co.</em></span><span style="font-family:georgia;font-size:100%;">, 2 AD3d 957 (3d Dept. 2003).</span>NoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.com0tag:blogger.com,1999:blog-4039290753724308322.post-13039290861227127842009-08-28T09:43:00.000-07:002009-08-28T09:49:51.332-07:00Many thanksI would like to thank Roy Mura at coverage counsel for including this blog in his google search. The irony is that you never really know who is reading your blog until you come across something like that, while reading their blog.<br /><br />As to Dave Gottlieb's beard from nofaultparadise, my vote is for him to keep the shaved head, non-facial hair look. That beard is a public health hazard. Please leave your comments on his blog as to what you think...NoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.com0tag:blogger.com,1999:blog-4039290753724308322.post-30681529360179336702009-08-25T19:34:00.000-07:002009-08-25T19:37:54.330-07:00May a peer report be performed after the 30-day claims determination period?The District Court of Appeal, Third Division answered this question in the affirmative.<br /><br />In the matter of <span style="font-style: italic;">Millennium Diagnostic Imaging Ctr., Inc. v. United Auto Ins. Co.</span>, 975 So. 2d 1149 (Fla. 3d DCA 2009), the Court held the following:<br /><br />The language in section 627.736(4)(b) pertains to PIP benefits that are “due” under the policy. If a medical bill is submitted for treatment that is not reasonable, related, or necessary, there can possibly be no benefits “due” under the policy, and therefore, that claim cannot be deemed “overdue.” Section 627.736(4)(b) provides that the insurer can assert, “at any time, including . . . after the 30-day time period for payment,” that “the claim was unrelated, was not medically necessary, or was unreasonable.”<br /><br />Based on the unambiguous language of section 627.736(4)(b) and applicable case law, we answer the certified question, as phrased by the trial court, in the affirmative, and conclude that the thirty-day time period set forth in section 627.736(4)(b) does not apply to claims for unrelated, unreasonable, or unnecessary treatment. Therefore, an insurer may challenge such treatment at any time, and is permitted to rely on a report, obtained pursuant to section 627.736(7)(a), even if the report is obtained more than thirty days after the claim was submitted. The insurer, however, must keep in mind that if its challenge fails, it will be liable for interest and attorney’s fees.<br /><br />Oh I forgot to add that I was referencing Florida law. <span style="font-style: italic;"> Compare</span>, Br<span style="font-style: italic;">onx Expert Radiology, P.C. v. New York Cent. Mut. Fire Ins. Co.</span> 24 Misc.3d 134(A)(App. Term 1st Dept. 2009); <span style="font-style: italic;">Dilon Medical Supply Corp. v. New York Cent. Mut. Ins. Co.</span>, 18 Misc.3d 128(A)(App. Term 2d Dept. 2007).NoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.com1tag:blogger.com,1999:blog-4039290753724308322.post-37699602187250512402009-08-18T19:41:00.001-07:002009-08-18T19:43:13.538-07:00The timeliness of follow-up additional verification requests will be argued before the Appellate Division, Second Department<meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 12"><meta name="Originator" content="Microsoft Word 12"><link rel="File-List" href="file:///C:%5CUsers%5CJason%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml"><link rel="themeData" href="file:///C:%5CUsers%5CJason%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_themedata.thmx"><link rel="colorSchemeMapping" href="file:///C:%5CUsers%5CJason%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_colorschememapping.xml"><!--[if gte 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mso-style-parent:""; margin-top:0in; margin-right:0in; margin-bottom:10.0pt; margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:Calibri; mso-fareast-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} .MsoChpDefault {mso-style-type:export-only; mso-default-props:yes; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:Calibri; mso-fareast-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} .MsoPapDefault {mso-style-type:export-only; margin-bottom:10.0pt; line-height:115%;} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;} </style> <![endif]--> <p class="MsoNormal">The issue involving whether a premature follow-up additional verification request may be deemed valid is now before the Appellate Division, Second Department.<span style=""> </span>The case of “Infinity Health Products v. Eveready Insurance Company”, is slated for oral arguments on September 11, 2009.</p> <p class="MsoNormal">http://www.courts.state.ny.us/courts/ad2/calendar/09calendars/September/Publication_Calendar_20090911_P1.pdf</p> NoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.com0tag:blogger.com,1999:blog-4039290753724308322.post-64526141670506600872009-08-13T21:04:00.000-07:002009-08-13T21:07:22.408-07:00The best evidence rule under fire<span style="font-weight: bold;">Madison-68 Corp. v Malpass 2009 NY Slip Op 06154 (1st<br />Dept. 2009)</span><br /><br />“Plaintiff's objection, made under the best evidence rule, to the admission of the lease rider was properly overruled because it had offered into evidence a copy of the same document.”<br /><br />First, we saw the end of the New York rule. Now, we have a curtailment of the Best Evidence rule. I am not sure we can cite to Prince Richardson, the Farrell edition, in order to fully understand New York evidence law. Henry David Thoreau said it best: “Any fool can make a rule, and any fool will mind it.”NoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.com2tag:blogger.com,1999:blog-4039290753724308322.post-52689985391067943272009-08-13T21:00:00.000-07:002009-08-13T21:03:55.738-07:002309 - again<span style="font-weight: bold;">Andromeda Med. Care, P.C. v Utica Mut. Ins. Co., 2009 NY Slip Op 51629(U)(App. Term 2d Dept. 2009)</span><br />“The affidavits proffered by defendant in support of its motion for summary judgment were executed out of state. Although the affidavits were accompanied by documents that purported to be certificates of conformity, the certificates did not comply with Real Property Law § 299-a and, thus, the affidavits did not comply with CPLR 2309 (c)”<br /><br />Another case involving CPLR § 2309(c). Read my previous comments on this topic.NoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.com0tag:blogger.com,1999:blog-4039290753724308322.post-36507772443463215742009-08-13T20:56:00.000-07:002009-08-13T21:00:45.002-07:00Personal knowledge as to EUO non-appearences has become a lot less personal<font style="font-weight: bold;">W & Z Acupuncture, P.C. v Amex Assur. Co. 2009 NY Slip Op 51732(U)(App. Term 2d Dept. 2009)</font><br />“In opposition to plaintiff's motion and in support of its cross motion for summary judgment, defendant submitted the affirmation of a partner in the law firm retained by defendant to conduct plaintiff's EUO. Counsel alleged facts sufficient to establish that plaintiff's owner had failed to appear at counsel's law office for duly scheduled EUOs”<br /><br />This case is interesting because a supervisor at a law firm may lay the appropriate foundation to satisfy the Fogel personal knowledge requirement , even though the supervisor had nothing to do with the scheduling and non appearances at the attempted EUOs. Again, a well drafted and copiously detailed affidavit, similar to that of a mailing affidavit, is a prerequisite to utilizing this method to demonstrate the Fogel personal knowledge requirement.NoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.com0tag:blogger.com,1999:blog-4039290753724308322.post-66387799355850344982009-08-12T19:44:00.000-07:002009-08-13T08:25:16.165-07:00Claims office failure is excusable in certain instances<p class="MsoNormal"><b>Urban Radiology, P.C. v American Tr. Ins. Co. 2009 NY Slip Op 51734(U)(App. Term 2d Dept. 2009)</b></p><p class="MsoNormal"><meta content="text/html; charset=utf-8" equiv="Content-Type"><meta content="Word.Document" name="ProgId"><meta content="Microsoft Word 12" name="Generator"><meta content="Microsoft Word 12" name="Originator"><style> <!-- /* Font Definitions */ @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:0; mso-generic-font-family:roman; mso-font-pitch:variable; mso-font-signature:-1610611985 1107304683 0 0 159 0;} @font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4; mso-font-charset:0; mso-generic-font-family:swiss; mso-font-pitch:variable; mso-font-signature:-1610611985 1073750139 0 0 159 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-unhide:no; mso-style-qformat:yes; mso-style-parent:""; margin-top:0in; margin-right:0in; margin-bottom:10.0pt; margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:Calibri; mso-fareast-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} p {mso-style-noshow:yes; mso-style-priority:99; mso-margin-top-alt:auto; margin-right:0in; mso-margin-bottom-alt:auto; margin-left:0in; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman","serif"; mso-fareast-font-family:"Times New Roman";} .MsoChpDefault {mso-style-type:export-only; mso-default-props:yes; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:Calibri; mso-fareast-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} .MsoPapDefault {mso-style-type:export-only; margin-bottom:10.0pt; line-height:115%;} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style>
<br />"In the case at bar, defendant's no-fault supervisor, who was also the claims representative who handled the instant claims, submitted an affidavit in which he stated that defendant had lost the file containing the summons and complaint and had not found out about the default until June 25, 2007. The record also indicates that defendant's attorney initiated the instant motion to vacate the default judgment promptly in July 2007."</p><p class="MsoNormal"><meta content="text/html; charset=utf-8" equiv="Content-Type"><meta content="Word.Document" name="ProgId"><meta content="Microsoft Word 12" name="Generator"><meta content="Microsoft Word 12" name="Originator"><link href="file:///C:%5CUsers%5CJason%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C04%5Cclip_filelist.xml" rel="File-List"><link href="file:///C:%5CUsers%5CJason%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C04%5Cclip_themedata.thmx" rel="themeData"><link href="file:///C:%5CUsers%5CJason%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C04%5Cclip_colorschememapping.xml" rel="colorSchemeMapping"><style> <!-- /* Font Definitions */ @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:0; mso-generic-font-family:roman; mso-font-pitch:variable; mso-font-signature:-1610611985 1107304683 0 0 159 0;} @font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4; mso-font-charset:0; mso-generic-font-family:swiss; mso-font-pitch:variable; mso-font-signature:-1610611985 1073750139 0 0 159 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-unhide:no; mso-style-qformat:yes; mso-style-parent:""; margin-top:0in; margin-right:0in; margin-bottom:10.0pt; margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:Calibri; mso-fareast-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} .MsoChpDefault {mso-style-type:export-only; mso-default-props:yes; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:Calibri; mso-fareast-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} .MsoPapDefault {mso-style-type:export-only; margin-bottom:10.0pt; line-height:115%;} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style></p><p class="MsoNormal">It is nice to see the courts allowing the claims offices some leeway in vacating defaults.<span style="font-size:0;"> </span>The law in the Second Department used to be that claims office failure was always fatal to the vacatur of a default.<span style="font-size:0;"> </span>The law has steadily evolved, and now under appropriate circumstances, claims office failure may form the basis to vacate a default.</p><p class="MsoNormal">What troubled me, however, was that the default was only partially vacated.<span style="font-size:0;"> </span>Thus, if someone brought a multisuit with many assignors, the default would be vacated only as to the causes of action where there was a meritorious defense.<span style="font-size:0;"> </span>This makes sense in the abstract.<span style="font-size:0;"> </span>But since the causes of action would most likely be severable had a timely answer been interposed, a defendant’s default in answering appears to give the plaintiff an inordinate advantage through promoting the joining of unrelated actions, in the first instance.
<br /></p><p></p>NoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.com0tag:blogger.com,1999:blog-4039290753724308322.post-50678629640999981082009-08-12T19:35:00.000-07:002009-08-13T08:29:29.994-07:00Identity fraud in the procument of the insurance policyAlexander Alperovich, M.D., P.C. v Auto One Ins. Co., 2009 NY Slip Op 51721(U)(App. Term 2d Dept. 2009)<br /><br />They say many times that the devil is in the details. In this case, the defense to the payment of no-fault claims was that there was some type of misrepresentation or “fraud” in the procurement of the insurance policy. We learned last week that the Appellate Term, First Department in the misrepresentation context stated that the misrepresentations must be intentional. We also saw that settled Appellate Division case law holds that a material misrepresentation may be unintentional.<br /><br />Except for the Kaplan case that was discussed awhile back, the appellate courts have not discussed the extent of third-party liability in relation to “misrepresentations” or other “fraud” in the procurement of an insurance policy.<br /><br />While Plaintiff prevailed in this case, I would call this a victory for the insurance carriers. The Appellate Term has now framed the issue as to whether “plaintiff's assignor participated in or was aware of such a fraudulent scheme.”<br /><br />The defense is now proved if the carrier can show participation or awareness in the so-called scheme. Prior to this case, the standard for third-party liability appeared to be “intentional” involvement in the scheme or involvement in a “conspiracy” in relation to the scheme.NoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.com0tag:blogger.com,1999:blog-4039290753724308322.post-78515012243198147612009-07-30T20:40:00.001-07:002009-07-30T20:40:46.177-07:00Back to Workers CompensationOne of the most intriguing things about this area of law is that in a matter of 6 months, the same court can make pronouncements that are apparently inconsistent with each other. Some of these inconsistencies are subtle. Some of them are more pronounced.<br />An example of a sublte change is the pronouncement that an uncertified police report may under certain circumstances be considered admissible evidence in accord with CPLR 4518(a). People v. Hunter, 62 A.D.3d 1207 (3d Dept. 2009); Westchester Medical Center v. State Farm Mut. Auto. Ins. Co., 44 A.D.3d 750 (2d Dept. 2007) Compare, CPLR § 4518(c).<br />Another subtle change involves the proof necessary to demonstrate intoxication in a civil case. A proper certified hospital record or police record will now suffice. Six months prior, it did not suffice. Compare, Westchester Medical Center v. Progressive Cas. Ins. Co., 51 A.D.3d 1014 (2d Dept. 2008)(“A blood alcohol test result, as set forth in a certified hospital record, constitutes prima facie evidence of the test result pursuant to CPLR 4518(c) Thus, the blood alcohol test results contained in a certified hospital record from Sound Shore would be sufficient to make a prima facie showing that Forthmuller was intoxicated at the time of the accident”), with Westchester Medical Center v. State Farm Mut. Auto. Ins. Co., 44 A.D.3d 750 (2d Dept. 2007)(“the defendant was unable to establish, prima facie, that Gjelaj was intoxicated at the time of the accident. The result of a blood alcohol test may be admitted on the issue of intoxication in litigation involving an exclusion in a no-fault policy provided that a proper foundation is laid. At bar, the defendant failed to lay a proper foundation for admission of the BAC report by proffering any evidence regarding the care in the collection of Gjelaj's blood sample and its analysis.”)<br />Then there is the question: what is a prima facie case? I will not even go there, but a NYLJ article that will be published next week will gloss on that issue.<br />Now we have the workers compensation defense issue. Specifically, is the workers compensation defense one of standing or is it an exclusion. Notice that I left out the word “coverage”. Coverage, as we learned in Fair Price, is only implicated in rare instances. Workers Compensation issues do not implicate coverage.<br />Last month, the Appellate Division, Second Department, told us that the workers compensation defense is an exclusion that needs to be preserved in a timely denial. The Appellate Term, Second Department, followed suit under principles of stare decisis. I discussed this in prior posts.<br />The case that triggered this post is LMK Psychological Serv., P.C. v American Tr. Ins. Co. 2009 NY Slip Op 06004 (2d Dept. 2009). The pertinent portion of the opinion is as follows:<br />“There has been no determination by the Workers' Compensation Board as to whether the assignors are entitled to Workers' Compensation benefits for their injuries. The Workers' Compensation Board has primary jurisdiction to determine factual issues concerning coverage under the Workers' Compensation Law. Where "a plaintiff fails to litigate that issue before the Board, the court should not express an opinion as to the availability of compensation but remit the matter to the Board'"<br />It is not clear whether the Appellate Division has now decided that the compensation defense is now a standing issue (id), or is precludable as was set forth in Westchester Med. Ctr. v Lincoln Gen. Ins. Co., 60 AD3d 1045 (2d Dept. 2009). Without resort to the record on appeal, it is hard to tell what exactly happened here.NoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.com4tag:blogger.com,1999:blog-4039290753724308322.post-39196120157760497642009-07-23T19:47:00.000-07:002009-08-12T19:56:53.847-07:00Intentional loss - preponderence and not fraud<meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 12"><meta name="Originator" content="Microsoft Word 12"><link rel="File-List" href="file:///C:%5CUsers%5CJason%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml"><link rel="themeData" href="file:///C:%5CUsers%5CJason%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_themedata.thmx"><link rel="colorSchemeMapping" href="file:///C:%5CUsers%5CJason%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_colorschememapping.xml"><!--[if gte mso 9]><xml> <w:worddocument> 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mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;} </style> <![endif]--> <p class="MsoNormal"><b><span style="line-height: 115%;font-family:";font-size:12pt;" >AA Acupuncture Serv., P.C. v Safeco Ins. Co. of Am.,
<br /></span></b></p><p class="MsoNormal"><b><span style="line-height: 115%;font-family:";font-size:12pt;" >2009 NY Slip Op 29311 (App. Term 1<sup>st</sup> Dept. 2009)</span></b><span style="line-height: 115%;font-family:";font-size:12pt;" ><o:p></o:p></span></p> <p class="MsoNormal"><span style="line-height: 115%;font-family:";font-size:12pt;" >This was a really interesting decision.<span style=""> </span>It is so rare that the Appellate Term, First Department writes a lengthy decision about any topic, let alone one involving a no-fault case.<span style=""> </span>The law announced in this case represents established law.<span style=""> </span>An insurance carrier may disclaim all no-fault benefits or other first-party benefits as to a party who makes material misrepresentations in the procurement of an insurance policy. <o:p></o:p></span></p> <p class="MsoNormal"><span style="line-height: 115%;font-family:";font-size:12pt;" >There was an interesting line in there, which I am not sure represents settled law:<o:p></o:p></span></p> <p class="MsoNormal"><span style="line-height: 115%;font-family:";font-size:12pt;" >This evidence was <span style="color:red;">[*2]</span>sufficient to establish prima facie that the insured <b style="">intentionally</b> misrepresented her address in order to obtain insurance at reduced premiums, and that the misrepresentation was material, since defendant would not have issued the policy under the same terms had it known that the insured resided in Brooklyn<o:p></o:p></span></p> <p class="MsoNormal"><span style="line-height: 115%;font-family:";font-size:12pt;" >Yet, the Appellate Division last year stated the following in <span class="groupheading5"><u><span style="line-height: 115%;font-family:";color:black;" >Precision Auto Accessories, Inc. v. Utica First Ins. Co.</span></u></span><u></u></span><b><span style="color:black;">, </span></b><span class="informationalsmall3"><span style="line-height: 115%;font-family:";color:black;" >52 AD3d 1198</span> (4th Dept. 2008):</span><o:p></o:p></p> <p class="MsoNormal"><span style="line-height: 115%;font-family:";font-size:12pt;color:black;" >Defendant's president further stated in his affidavit that, “if [defendant] had been aware of plaintiff's true </span><a name="sp_7049_1201"></a><a name="SDU_1201"></a><span class="starpage1"><span style="line-height: 115%;font-family:";font-size:12pt;" ><span title="StarPage" name="StarPage">*1201</span></span></span><span style="line-height: 115%;font-family:";font-size:12pt;color:black;" > <a name="citeas((Cite_as:_52_A.D.3d_1198,_*1201,_"></a>loss history ... [defendant] would not have issued a policy of insurance to plaintiff.” Contrary to plaintiff's contention, defendant is correct that it need not establish that the misrepresentations were willful in order to rescind the contract. Insurance Law § 3105(b) does not specify that a misrepresentation must be willful, and “[w]hether or not plaintiff intended to provide inaccurate statements or misrepresentations at the time [it] filled out the application is irrelevant”</span><span style="line-height: 115%;font-family:";font-size:12pt;" ><o:p></o:p></span></p> <p class="MsoNormal"><span style="line-height: 115%;font-family:";font-size:12pt;" >Besides the above, Justice McKeon’s concurring opinion was interesting.<span style=""> </span>He made an interesting observation, one I always joke about.<span style=""> </span>Specifically, have you ever wondered whether the registrants of out of state vehicles, registered in non no-fault states, really reside in those states?<span style=""> </span><o:p></o:p></span></p> NoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.com0tag:blogger.com,1999:blog-4039290753724308322.post-55721612293624502852009-07-16T09:33:00.001-07:002009-07-16T09:33:49.148-07:00The standard to rebut a peer review was raised a few notchesPan Chiropractic, P.C. v Mercury Ins. Co.<br />2009 NY Slip Op 51495(U)(App. Term 2d Dept. 2009)<br /><br />Sensing the belief that no-fault actions were starting to follow the trend in Ins Law 5102(d) actions (the no-fault threshold statute), the Defendant appealed the order finding that Plaintiff’s affidavit of merit was sufficient to raise a triable issue of fact, in opposition to Defendant’s summary judgment motion.<br /><br />Factually, this case involved $660 worth of diagnostic testing. Defendant’s peer review set forth numerous reasons and cited to various authorities for the proposition that the diagnostic testing was either never necessary or not necessary in relation to the patient’s presented symptomology.<br /><br />Plaintiff relied on the reports annexed to Defendant’s papers and concluded that the services were indeed medically necessary. There was no meaningful disagreement with Defendant’s doctor’s medical rationale for finding that the services lacked medical necessity.<br /><br />The Court in applying the meaningful disagreement standard found in 5102(d) causation cases rightly found that Plaintiff failed to rebut the inference that the services lacked medical necessity.<br /><br />I would opine that a provider, in successfully opposing this type of motion, is going to have to send these cases to their own peer doctor to perform a utilization review in their own right in order to raise a triable issue of fact in opposition to a defendant’s motion for summary judgment. This should be interesting.NoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.com0tag:blogger.com,1999:blog-4039290753724308322.post-14348717323216429422009-07-16T09:20:00.000-07:002009-07-16T09:22:53.397-07:00Standing. All rise.Davydov v Progressive Ins. Co.<br />2009 NY Slip Op 29299 (App. Term 2d Dept. 2009)<br /><br />The concept of standing has numerous meanings. In Civil Procedure, it refers to the existence of a case or controversy, which is a precondition to allowing a Court to hear a case. In Criminal Procedure, it addresses the ability to contest a Fourth Amendment search and seizure violation. As a matter of common law and statutory law, it involves the ability of a party to prosecute an action, even though there is a case or controversy. I would be remiss if I did not include the statement that in English parlance, standing means to be on one’s feet in an upright, vertical position. If you were playing Password and someone said, in that funny opposite like voice “sitting”, the answer would be “standing”.<br /><br />In regards to the common law notion of standing, there appears to have developed two different types of standing issues. The first is a statute or a regulation vesting or stripping a party of so-called standing. For instance, 65-3.16, the regulation that Malella is predicated upon, states that improperly formed corporations, and most likely their assignors in a direct first-party suit, do not have standing to prosecute overdue no-fault healthcare-expense bills. This “standing” rule also involves corporations prosecuting actions on behalf of independent contractors; and I would argue that 65-3.19 strips a health care provider’s ability to prosecute bills where a worker’s compensation carrier is deemed “primary”. <em>But see</em>, <em>Westchester Med. Ctr. v Lincoln Gen. Ins. Co.</em>, 60 AD3d 1045 (2d Dept. 2009).<br /><br />As to an example of a statute that vests standing, where it would not otherwise exist, one should look to GBL 349. Prior to the amendments promulgated years ago, the attorney General was the only official who could prosecute a GBL 349 (consumer fraud) claim.<br /><br />The second notion of standing represents so-called technical standing. The Courts have over the last decade deemed technical standing issues, mainly as to valid assignments, to fall within this category. As to technical standing issues, the deficiencies in the assignment forms in the no-fault scenario are deemed waived if not properly addressed during the claim stage, and in non no-fault actions, the defect is waived if not properly pleaded in an answer or a pre-answer motion. <em>See</em>, e.g., <em>Wells Fargo ]Bank Minn., N.A. v Mastropaolo</em>, 42 AD3d 239, 241-243 (2d Dept. 2008)<br /><br />Judge Golia’s dissent is only too logical. On a blank slate, it is correct. The type of technical defect in this matter, i.e., an assignment that assigns a claim to another entity should be a bar to a prima facie case in any type of action. This is a true standing issue, although deemed technical in nature. This statement would not hold true for issues such as missing signatures and other hyper-technical issues, where the intent to assign a claim to the proper entity may be inferred from the document. The issue of true standing should never be waivable since it addresses the fundamental right to access the courts. But the Appellate Courts have seemed to reject untimely challenges to technical defects, involving the nature of true standing.<br /><br />I lastly wonder why Davydov, M.D., was not impleaded in a third-party contribution action in this case. This would most likely address the issue of proper standing and would protect the carrier from a subsequent action that Davidof M.D., could possibly bring against the carrier.NoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.com2tag:blogger.com,1999:blog-4039290753724308322.post-51008215915649713312009-07-08T21:40:00.000-07:002009-07-08T21:44:01.406-07:00Collateral Estoppel may not apply in no-fault arbitrations – so says the Fourth Department> <![endif]--> <p class="MsoNormal">In a very interesting case, the Appellate Division, Fourth Department held that principles of collateral estoppel do not apply in arbitration.<span style=""> </span></p> <p class="MsoNormal"><span style="">Matter of Falzone v New York Cent. Mut. Fire Ins. Co. </span>2009 NY Slip Op 05423 (4th Dept. 2009)<br /></p><p class="MsoNormal"></p><p class="MsoNormal"><span style=""><o:p></o:p>In this case, a Claimant initially arbitrated a no-fault claim between himself and his insurance carrier.<span style=""> </span>The issue that was arbitrated involved whether Claimant’s injuries were causally related to the motor vehicle accident.<span style=""> </span>A no-fault arbitrator found the injuries to be causally related to the motor vehicle accident and awarded benefits.<o:p></o:p></span></p> <p class="MsoNormal"><span style="">The Claimant after obtaining an award for no fault benefits then sought to obtain SUM benefits arising from the same loss.<span style=""> </span>Accordingly, Claimant commenced a second arbitration between himself and the same carrier upon which he was awarded no-fault benefits.<span style=""> </span>The insurance carrier’s defense to payment in this SUM arbitration, similar to that in the no-fault arbitration, was that there was a lack of a causal nexus between the motor vehicle accident and the alleged injuries. <span style=""> </span><o:p></o:p></span></p> <p class="MsoNormal"><span style="">Since the parties and issues to be resolved in this SUM matter were the same as that in the no-fault matter, <span style=""> </span>i.e., whether the injuries were causally related to the motor vehicle accident, you would think that principles of collateral estoppel would come into play and bind the SUM arbitrator to the same decision as that of the no-fault arbitrator.<span style=""> </span>As we saw in a previous post involving the matter of Lobel v. Allstate, a no-fault arbitrator’s decision on causation will collaterally estopp a party from re-litigating a previously arbitrated issue in Court.<span style=""> </span>Yet, the SUM arbitrator, aware that the prior arbitrator found a causal nexus existed between the motor vehicle accident and the injuries, nonetheless ruled that there was no causal connection between the injuries and the motor vehicle accident.<o:p></o:p></span></p> <p class="MsoNormal"><span style="">An Article 75 challenge was lodged in the Supreme Court.<span style=""> </span>The Supreme Court granted the petition, reversed the SUM arbitrator’s decision and <span style=""> </span>properly found that the results of the no-fault arbitration collaterally estopped the parties from contesting the causal relationship between the motor vehicle accident and the injuries at the SUM arbitration.<span style=""> </span>Thus, the SUM arbitratror, as a matter of law, had to find that there was a causal relationship between the motor vehicle accident and the loss.<span style=""> </span>The carrier appealed and the Fourth Department surprisingly reversed the order and judgment of the Supreme Court as set forth herein:<o:p></o:p></span></p> <p class="MsoNormal"><b>“</b>We agree with respondent that Supreme Court erred in granting claimant's motion. The fact that a prior arbitration award is inconsistent with a subsequent award is not an enumerated ground in either subdivision (b) or (c) of CPLR 7511 for vacating or modifying the subsequent award (<i>see Matter of City School Dist. of City of Tonawanda v Tonawanda Educ. Assn.</i>, 63 NY2d 846, 848). As the court properly recognized, "[i]t was within the [SUM] arbitrator's authority to determine the preclusive effect of the prior arbitration on the instant arbitration" (<i>Matter of Progressive N. Ins. Co. v Sentry Ins. A Mut. Co.</i>, 51 AD3d 800, 801). The court erred in noting, however, that it was unable to determine whether the SUM arbitrator even considered claimant's contention with respect to collateral estoppel. Arbitrators are not required to provide reasons for their decisions (<i>see Matter of Solow Bldg. Co. v Morgan Guar. Trust Co. of N.Y.</i>, 6 AD3d 356, 356-357, <i>lv denied</i> 3 NY3d 605, <i>cert denied</i> 543 US 1148; <i>Matter of Guetta [Raxon Fabrics Corp.]</i>, 123 AD2d 40, 41), and thus the SUM arbitrator was not required to state that he had considered that contention. “<b><o:p></o:p></b></p> <p class="MsoNormal"><span style="">Two points need to be considered.<span style=""> </span>First, the Fourth Department cites a 2007 Second Department case entitled<b> <span style=""> </span></b></span><i>Matter of Progressive N. Ins. Co. v Sentry Ins. A Mut. Co.</i> for its rule of law.<span style=""> </span>Yet, the Progressive case actually held that collateral estoppel should be given effect to prior arbitration awards involving the same parties and the same issue.<span style=""> </span>Second,<b> </b><span style="">there was a two Justice dissent, which as a matter of right brings this case to the Court of Appeals.<span style=""> </span><b><o:p></o:p></b></span></p> <p class="MsoNormal"><span style="">For the sake of commonsense, this case should be reversed.<span style=""> </span>Otherwise, there will be too many instances where inconsistent decisions will arise in post-ime cases, other policy violation cases and coverage cases, among others.<span style=""> </span>It would be a fair assessment to say that no-fault and other first-party practitioners will not benefit from the uncertainty and some could say absurdity that this case could rein upon the arbitral process.<o:p></o:p></span></p>NoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.com0tag:blogger.com,1999:blog-4039290753724308322.post-27797468808768901982009-07-07T17:08:00.000-07:002009-07-07T17:27:23.828-07:00What do CPLR § 2309 and CPLR § 2106 have in common?The answer, unfortunately, is that too many practitioners fail to understand how to utilize and work with these statutes. It seems that in the field of no-fault and commercial debt collection, attorneys are forever mangling the application of these statutes.<br /><br /><em>Crossbridge Diagnostic Radiology v Encompass Ins.</em>, 2009 NY Slip Op 51415(U)(App. Term 2d Dept. 2009)<br /><br />The above case, which was decided this week, demonstrates the special hazards that CPLR § 2309 presents. In fact, this case appears to be especially problematic for the insurance carrier since monies in excess of the no-fault policy limits are now due and owing because of an attorney’s misunderstanding of this statute. We learn this fact through Justice Golia’s thoughtful dissent.<br /><br />The following quote from the Appellate Term says it all:<br /><br />“However, the affidavit proffered by defendant, in which defendant's claims representative asserted that the available coverage had been exhausted, was not in admissible form. Defendant's affidavit was not in conformity with CPLR 2309 (c), which fact was duly objected to by plaintiff in the Civil Court”<br /><br />Just remember that if you are executing an affirmation, executing an out of state affidavit or are in receipt of papers containing these documents, you should really be familiar with the procedural nuances of 2106 and 2309(c). The failure to appreciate the nuances of these statutes may lead to a deleterious and unfortunate result.NoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.com0tag:blogger.com,1999:blog-4039290753724308322.post-13620394952385463742009-06-30T18:02:00.000-07:002009-07-07T10:04:09.659-07:00May an insurance carrier's expert offer an opinion beyond the confines of his peer or IME report?In affirming the denial of plaintiff's summary judgment motion, the Appellate Term, First Department in <em>Krishna v Liberty <span class="blsp-spelling-error" id="SPELLING_ERROR_0">Mut</span>. Ins. Co. </em>2009 NY Slip Op 51312(U)(App. Term 1st Dept. 2009) reiterated its position (<em>Response Medical Equipment v. General <span class="blsp-spelling-error" id="SPELLING_ERROR_1">Assur</span>. Co.</em>13 Misc.3d 129[A][App. Term 1st Dept. 2006]; <em><span class="blsp-spelling-error" id="SPELLING_ERROR_2">Mollins</span> v. Allstate Ins. Co.</em>20 Misc.3d 141[A][App. Term 1st Dept. 2008]) that an insurance carrier's expert may comment on medical evidence not contained in a peer report or <span class="blsp-spelling-error" id="SPELLING_ERROR_3">IME</span> report in support of its lack of medical necessity defense.<br /><br />The pertinent portion of the <em>Krishna</em> opinion states the following: "The initial peer review report relied upon by defendant, <strong>as amplified upon defendant's receipt of additional <span class="blsp-spelling-corrected" id="SPELLING_ERROR_4">documentation</span> from plaintiff regarding his claim</strong>, set forth sufficient facts to raise a <span class="blsp-spelling-error" id="SPELLING_ERROR_5">triable</span> issue as to the medical necessity of the health services and diagnostic tests performed by plaintiff. "NoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.com0tag:blogger.com,1999:blog-4039290753724308322.post-77645182644659768732009-06-30T17:54:00.000-07:002009-07-07T09:56:32.033-07:00Priority of payment disputes must be adjudicated through Ins. Law 5105 intercompany arbitrationThe law is simple: Disputes involving whether an insurance carrier in a no-fault coverage dispute is primary, secondary, or tertiary must be resolved through intercompany arbitration. This fact pattern was presented four years ago in SZ Medical, P.C. v. Lancer Ins. Co.7 Misc.3d 86 (App. Term 2d Dept. 2005) and was again presented in M.N. Dental Diagnostics, P.C. v Government Employees Ins. Co. 2009 NY Slip Op 29266(App. Term 1st Dept. 2009).NoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.com0tag:blogger.com,1999:blog-4039290753724308322.post-27131195449731883912009-06-30T07:02:00.001-07:002009-07-07T10:40:07.882-07:00Workers Compensation defenseI would be remiss if I did not thank Dave <span class="blsp-spelling-error" id="SPELLING_ERROR_0"><span class="blsp-spelling-error" id="SPELLING_ERROR_0"><span class="blsp-spelling-error" id="SPELLING_ERROR_0">Barshay</span></span></span> for the citation to this blog in his article. I also must thank David <span class="blsp-spelling-error" id="SPELLING_ERROR_1"><span class="blsp-spelling-error" id="SPELLING_ERROR_1"><span class="blsp-spelling-error" id="SPELLING_ERROR_1">Gottlieb</span></span></span> for posting Mr. <span class="blsp-spelling-error" id="SPELLING_ERROR_2"><span class="blsp-spelling-error" id="SPELLING_ERROR_2"><span class="blsp-spelling-error" id="SPELLING_ERROR_2">Barshay's</span></span></span> citation to this article on his blog. While I am not sure it is really critical that you read this blog, despite what Mr. <span class="blsp-spelling-error" id="SPELLING_ERROR_3"><span class="blsp-spelling-error" id="SPELLING_ERROR_3"><span class="blsp-spelling-error" id="SPELLING_ERROR_3">Gottlieb</span></span></span> says to the contrary, I thank him for the compliment nonetheless. Now that the peremptory "thank yous" are out of the way, now onto the cases.<br /><br /><br />A.B. Med. <span class="blsp-spelling-error" id="SPELLING_ERROR_4"><span class="blsp-spelling-error" id="SPELLING_ERROR_4"><span class="blsp-spelling-error" id="SPELLING_ERROR_4">Servs</span></span></span>., <span class="blsp-spelling-error" id="SPELLING_ERROR_5"><span class="blsp-spelling-error" id="SPELLING_ERROR_5"><span class="blsp-spelling-error" id="SPELLING_ERROR_5">PLLC</span></span></span> v American Tr. Ins. Co., 2009 NY Slip Op 29271 (App. Term 2d Dept. 2009)<br /><br />A.B. Med. <span class="blsp-spelling-error" id="SPELLING_ERROR_6"><span class="blsp-spelling-error" id="SPELLING_ERROR_6"><span class="blsp-spelling-error" id="SPELLING_ERROR_6">Servs</span></span></span>., <span class="blsp-spelling-error" id="SPELLING_ERROR_7"><span class="blsp-spelling-error" id="SPELLING_ERROR_7"><span class="blsp-spelling-error" id="SPELLING_ERROR_7">PLLC</span></span></span> v American Tr. Ins. Co., 2009 NY Slip Op 51262(U)(App. Term 2d Dept. 2009)<br /><br />A.B. Med. <span class="blsp-spelling-error" id="SPELLING_ERROR_8"><span class="blsp-spelling-error" id="SPELLING_ERROR_8"><span class="blsp-spelling-error" id="SPELLING_ERROR_8">Servs</span></span></span>., <span class="blsp-spelling-error" id="SPELLING_ERROR_9"><span class="blsp-spelling-error" id="SPELLING_ERROR_9"><span class="blsp-spelling-error" id="SPELLING_ERROR_9">PLLC</span></span></span> v American Tr. Ins. Co., 2009 NY Slip Op 51263(U)(App. Term 2d Dept. 2009)<br /><br /><span class="blsp-spelling-error" id="SPELLING_ERROR_10"><span class="blsp-spelling-error" id="SPELLING_ERROR_10"><span class="blsp-spelling-error" id="SPELLING_ERROR_10">Inwood</span></span></span> Hill Med., P.C. v <span class="blsp-spelling-error" id="SPELLING_ERROR_11"><span class="blsp-spelling-error" id="SPELLING_ERROR_11"><span class="blsp-spelling-error" id="SPELLING_ERROR_11">Metropolitan</span></span></span> Prop. & <span class="blsp-spelling-error" id="SPELLING_ERROR_12"><span class="blsp-spelling-error" id="SPELLING_ERROR_12"><span class="blsp-spelling-error" id="SPELLING_ERROR_12">Cas</span></span></span>. Ins. Co. 2009 NY Slip Op 51264(U)(App. Term 2d Dept. 2009)<br /><br />The day after the no-fault wrap up, the Appellate Term, Second Department issued a slue of opinions regarding the Workers <span class="blsp-spelling-error" id="SPELLING_ERROR_13"><span class="blsp-spelling-error" id="SPELLING_ERROR_13"><span class="blsp-spelling-error" id="SPELLING_ERROR_13">Compensation</span></span></span> defense, which was consistent with what Mr. <span class="blsp-spelling-error" id="SPELLING_ERROR_14"><span class="blsp-spelling-error" id="SPELLING_ERROR_14"><span class="blsp-spelling-error" id="SPELLING_ERROR_14">Barshay's</span></span></span> article stated. Again, I discussed this issue on a previous blog post.<br /><br />However, when the issue is phrased in light of the "exceptional" <span class="blsp-spelling-error" id="SPELLING_ERROR_15"><span class="blsp-spelling-error" id="SPELLING_ERROR_15"><span class="blsp-spelling-corrected" id="SPELLING_ERROR_15">circumstance</span></span></span> of non-coverage, as recently opined upon by the Court of Appeals in <em>Fair Price</em>, the Workers <span class="blsp-spelling-error" id="SPELLING_ERROR_16"><span class="blsp-spelling-error" id="SPELLING_ERROR_16"><span class="blsp-spelling-error" id="SPELLING_ERROR_16">Compensation</span></span></span> defense is <span class="blsp-spelling-error" id="SPELLING_ERROR_17"><span class="blsp-spelling-error" id="SPELLING_ERROR_17">waivbale</span></span>.<br /><br />However, when this issue is evaluated through the prism of "standing", the Appellate Division's conclusion may not be correct. As the law stands right now, a service rendered by an independent contractor or an improperly formed medical corporation is not subject to the "preclusion" sanction, through the failure to timely or properly d<span class="blsp-spelling-corrected" id="SPELLING_ERROR_18"><span class="blsp-spelling-error" id="SPELLING_ERROR_18">eny</span></span> a claim. This is because an independent contractor and an improperly formed corporation lacks standing to prosecute a no-fault claim. It thus follows that based upon 65-3.19, the Workers <span class="blsp-spelling-error" id="SPELLING_ERROR_18"><span class="blsp-spelling-error" id="SPELLING_ERROR_19"><span class="blsp-spelling-error" id="SPELLING_ERROR_19">Compensation</span></span></span> defense, in relation to a claim for medical benefits, should not be subject to the 30-day pay or deny rule. This follows from the s<span class="blsp-spelling-corrected" id="SPELLING_ERROR_20">imple</span> conclusion that an injured person and his or her <span class="blsp-spelling-error" id="SPELLING_ERROR_21"><span class="blsp-spelling-error" id="SPELLING_ERROR_20">assignee</span></span> lack standing to prosecute such a first-party no-fault claim for medical benefits.<br /><br />The above standing <span class="blsp-spelling-corrected" id="SPELLING_ERROR_22">analysis</span> in no way applies to wage benefits, since the regulations explicitly state that no-fault wage coverage is secondary to Workers C<span class="blsp-spelling-error" id="SPELLING_ERROR_23"><span class="blsp-spelling-error" id="SPELLING_ERROR_21">ompensation</span></span> wage coverage.NoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.com0tag:blogger.com,1999:blog-4039290753724308322.post-40480870448333295172009-06-18T16:23:00.000-07:002009-07-07T10:41:26.239-07:00Conclusory affidavits will not defeat an insurance carrier's summary judgment motion<strong>Bronze Acupuncture, P.C. v Mercury Ins. Co.</strong><br />2009 NY Slip Op 51219(U)(App. Term 2d Dept. 2009)<br /><br />This case hints at what a medical provider must proffer in its answering papers to stave off an insurance carrier's summary judgment motion, based upon the lack of medical necessity of a rendered service.<br /><br />In this case, a <span class="blsp-spelling-error" id="SPELLING_ERROR_0">conclusory</span> or boilerplate affidavit attesting to a service's lack of medical necessity is insufficient to raise an issue of fact.<br /><br />Here is the holding:<br /><br />"The papers submitted by defendant in support of its motion, including the affirmed <span class="blsp-spelling-error" id="SPELLING_ERROR_1">IME</span> [*2]report and an affidavit executed by the <span class="blsp-spelling-corrected" id="SPELLING_ERROR_2">acupuncturist</span> who performed the <span class="blsp-spelling-error" id="SPELLING_ERROR_3">IME</span>, established, <span class="blsp-spelling-error" id="SPELLING_ERROR_4">prima</span> <span class="blsp-spelling-error" id="SPELLING_ERROR_5">facie</span>, a lack of medical necessity for the services at issue. <strong>The opposing affidavit submitted by plaintiff's treating <span class="blsp-spelling-corrected" id="SPELLING_ERROR_6">acupuncturist</span> merely stated that she disagreed with the results of the <span class="blsp-spelling-error" id="SPELLING_ERROR_7">IME</span> report without setting forth any facts to support her conclusion</strong>. <span class="blsp-spelling-corrected" id="SPELLING_ERROR_8">Consequently</span>, the opposition papers failed to raise a <span class="blsp-spelling-error" id="SPELLING_ERROR_9">triable</span> issue of fact as to medical necessity."<br /><br />This should be compared to the operative language in<strong>Park Slope Medical and <span class="blsp-spelling-corrected" id="SPELLING_ERROR_10">Surgical Supply</span> Inc. v. New York Central <span class="blsp-spelling-error" id="SPELLING_ERROR_11">Mut</span>. Fire</strong> Ins. 22 Misc.3d 141(A)(App. Term 2d Dept. 2009) , where the court held the following: "[p]<span class="blsp-spelling-error" id="SPELLING_ERROR_12">laintiff</span> submitted an affidavit from Dr. Shapiro in which he stated that he <strong>disagreed with the peer review report and affidavit furnished by defendant because he concluded that the supplies provided were medically necessary</strong>. Since the affidavit of Dr. Shapiro <span class="blsp-spelling-corrected" id="SPELLING_ERROR_13">demonstrated</span> the existence of an issue of fact as to medical necessity."<br /><br />The next question will be what facts are sufficient to support the conclusion that a service is medically necessary. I <span class="blsp-spelling-corrected" id="SPELLING_ERROR_14">guarantee</span> it is not going to be the <span class="blsp-spelling-corrected" id="SPELLING_ERROR_15">regurgitation</span> of the documents a peer review doctor examined. I also <span class="blsp-spelling-corrected" id="SPELLING_ERROR_16">guarantee</span> it is not going to be the boilerplate one size fits all affidavit we saw in Park Slope, which we can probably now say is bad law.<br /><br />I know there will be many more of these types of appeals, and this issue will be answered at some time in the future.NoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.com0tag:blogger.com,1999:blog-4039290753724308322.post-17047672314635582512009-06-18T16:10:00.000-07:002009-07-07T09:39:46.602-07:00Nunc pro tunc under the former serve and file regime<strong>J.R. <span class="blsp-spelling-error" id="SPELLING_ERROR_0"><span class="blsp-spelling-error" id="SPELLING_ERROR_0">Dugo</span></span>, D.C., P.C. v New York Cent. <span class="blsp-spelling-error" id="SPELLING_ERROR_1"><span class="blsp-spelling-error" id="SPELLING_ERROR_1">Mut</span></span>. Ins. Co.,</strong><br />2009 NY Slip Op 29261 (App. Term 2d Dept. 2009)<br /><br />I suspect that if this case was decided in 2005, it might have been more <span class="blsp-spelling-corrected" id="SPELLING_ERROR_2">relevant to the practice of law</span>. As it is, it explains one of the reasons why the serve and file system was abolished in the lower court system. I would only say that the Civil Court, City Court and District Court clerks routinely allowed Plaintiffs to purchase index numbers well after the 14 or 21 day period after service was complete.<br /><br />The practice of law under the now-abolished serve and file system was nightmarish from the aspect that the defendant who wanted to move on a case within 60-days of <span class="blsp-spelling-error" id="SPELLING_ERROR_3"><span class="blsp-spelling-error" id="SPELLING_ERROR_2">joinder</span></span> of issue had to either: (1) purchase an index number; or (2) wait until Plaintiff served Defendant with the index number. This gave the Plaintiff the clear advantage, since the Defendant was many times at the mercy of the Plaintfif to inform the said Defendant of the index number.<br /><br />It also was a rare event when <span class="blsp-spelling-error" id="SPELLING_ERROR_3">nunc</span> pro <span class="blsp-spelling-error" id="SPELLING_ERROR_4"><span class="blsp-spelling-error" id="SPELLING_ERROR_4">tunc</span></span> relief would not be afforded to the Plaintiff. In any event, this case explains why the public policy of the state is advanced through the lower courts, save the justice courts, following the Superior Courts' method of commencing a case.NoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.com0tag:blogger.com,1999:blog-4039290753724308322.post-78515837124710798082009-06-13T18:55:00.000-07:002009-07-07T10:47:52.493-07:00An angry Appellate Division strikes a complaint based upon discovery violations<b><span class="blsp-spelling-error" id="SPELLING_ERROR_0"><span class="blsp-spelling-error" id="SPELLING_ERROR_0"><span class="blsp-spelling-error" id="SPELLING_ERROR_0"><span class="blsp-spelling-error" id="SPELLING_ERROR_0">Northfield</span></span></span></span> Ins. Co. v Model Towing & Recovery<br /></b>2009 NY Slip Op 04878 (2d Dept 2009).<br /><br />While this case represents nothing unique, the path the Appellate Division took was. The facts, as relayed to the reader, are that the following discovery orders were in place and in some way were violated:<br /><br />1. Preliminary conference (7/28/05)- discovery was ordered to be completed prior to the Compliance Conference (12/19/06) .<br /><br />2. Compliance conference (12/19/06) - discovery was ordered to be completed by 2/14/07.<br /><br />3. There were v<span class="blsp-spelling-error" id="SPELLING_ERROR_1"><span class="blsp-spelling-error" id="SPELLING_ERROR_1"><span class="blsp-spelling-error" id="SPELLING_ERROR_1">arious</span></span></span> status conferences in between the dates of 2/14/07 and 12/12/07.<br /><br />4. At the 12/12/07 status conference, discovery was ordered to be completed on or before 1/16/08.<br /><br />5. Discovery was not completed on 1/16/08 .<br /><br />6. A motion was interposed based upon the failure to comply with the 1/16/08 order. The Court in this order set forth a discovery schedule, and stated that it was to be obeyed under penalty of a 3126 remedy, upon a subsequent motion. In English, it looked as if the violation of this order would result in a conditional order of preclusion or a conditional order of dismissal.<br /><br />Excluding status conferences and the P.C. order, there were 2 orders. Moreover, only one resulting order was the result of a motion made on notice.<br /><br />The Defendant appealed the 1/16/08 order on the basis that the Court should have stricken the complaint. What happened next is something that is very rarely seen in downstate New York practice: The Appellate Division reversed the order of Supreme Court and struck the complaint.<br /><br />Now for those of us who have practiced in Supreme Kings (my favorite example) as defendants and have had the opportunity to make discovery based motions in <span class="blsp-spelling-error" id="SPELLING_ERROR_1"><span class="blsp-spelling-error" id="SPELLING_ERROR_2"><span class="blsp-spelling-error" id="SPELLING_ERROR_2"><span class="blsp-spelling-error" id="SPELLING_ERROR_2">CCP</span></span></span></span>, you will observe that it is almost impossible to obtain an order containing conditional preclusion or dismissal language, let alone an order that will <span class="blsp-spelling-corrected" id="SPELLING_ERROR_2"><span class="blsp-spelling-error" id="SPELLING_ERROR_3"><span class="blsp-spelling-error" id="SPELLING_ERROR_3"><span class="blsp-spelling-error" id="SPELLING_ERROR_3">unconditionally</span></span></span></span> strike the complaint. Almost 10 discovery orders can be violated and a conditional order of dismissal, conditional order of preclusion or an absolute order of preclusion or dismissal will never occur. That is life, and we accept it because when these orders get appealed, the Appellate Division will usually not find an abuse of discretion and affirm the order of the Supreme Court, with the Defendant paying one bill of costs and <span class="blsp-spelling-corrected" id="SPELLING_ERROR_3"><span class="blsp-spelling-corrected" id="SPELLING_ERROR_4"><span class="blsp-spelling-corrected" id="SPELLING_ERROR_4"><span class="blsp-spelling-error" id="SPELLING_ERROR_4">disbursements</span></span></span></span> to the <span class="blsp-spelling-corrected" id="SPELLING_ERROR_4"><span class="blsp-spelling-corrected" id="SPELLING_ERROR_5"><span class="blsp-spelling-corrected" id="SPELLING_ERROR_5"><span class="blsp-spelling-error" id="SPELLING_ERROR_5">recalcitrant</span></span></span></span> Plaintiff.<br /><br />Here, there were 3 disobeyed orders (including the P.C. order) and some status conferences that appeared to be disregarded. The Appellate Division, on appeal, reversed Supreme Court and struck the complaint. Since the SOL probably expired, the dismissal order was with prejudice. My question is as follows: are we going to see this type of <span class="blsp-spelling-corrected" id="SPELLING_ERROR_6">vigilance</span> in other cases, or is this case just an <span class="blsp-spelling-corrected" id="SPELLING_ERROR_6">anomaly</span>?NoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.com0tag:blogger.com,1999:blog-4039290753724308322.post-85545334723444528742009-06-11T08:58:00.000-07:002009-07-07T09:28:34.862-07:00A no fault claim representative's affidavit may cure inaccuracies in the NF-10 formWe kind of saw it in a previous post involving a Mercury case where a claim <span class="blsp-spelling-error" id="SPELLING_ERROR_0">representative's</span> sworn affidavit could explain <span class="blsp-spelling-error" id="SPELLING_ERROR_1">typographical</span> errors in a resulting NF-10. Some wondered why the Appellate Term never expounded on this point. Now, they have.<br /><br /><b><b>Bath Med. Supply, Inc. v Country Wide Ins. Co.<br /></b></b><b>2009 NY Slip Op 51145(U)(App. Term 2 Dept. 2009)<br /><br />The highlights are as follows:<br /></b><br />"Plaintiff contends that defendant's opposing papers did not establish that the claim <span class="blsp-spelling-corrected" id="SPELLING_ERROR_2">determination</span> period was tolled because, while the affidavit of defendant's no-fault litigation supervisor sets forth the dates on which the <span class="blsp-spelling-corrected" id="SPELLING_ERROR_3">verification</span> requests were mailed, the denial of claim forms set forth incorrect dates as to when final <span class="blsp-spelling-corrected" id="SPELLING_ERROR_4">verification</span> was requested. However, the <span class="blsp-spelling-error" id="SPELLING_ERROR_5">unsworn</span> denial of claim forms do not purport to state the dates on which defendant first requested <span class="blsp-spelling-corrected" id="SPELLING_ERROR_6">verification</span>, whereas, in the sworn affidavit, defendant's no-fault litigation supervisor states the dates on which <span class="blsp-spelling-error" id="SPELLING_ERROR_7">verification</span> was first requested, the dates on which the <span class="blsp-spelling-error" id="SPELLING_ERROR_8">verification</span> was received and the dates on which the denial of claim forms were mailed. <span style="FONT-WEIGHT: bold">To the extent the <span class="blsp-spelling-error" id="SPELLING_ERROR_9">unsworn</span> denial of claim forms suggest that defendant may have sent a further request for <span class="blsp-spelling-error" id="SPELLING_ERROR_10">verification</span> after receiving the <span class="blsp-spelling-error" id="SPELLING_ERROR_11">verification</span> it initially sought, they do not contradict the sworn statement by defendant's no-fault litigation supervisor or otherwise nullify defendant's position that the claim <span class="blsp-spelling-error" id="SPELLING_ERROR_12">determination</span> period was tolled."</span><br /><br />My observation is that the days of challenging denials for <span class="blsp-spelling-error" id="SPELLING_ERROR_13">typographical</span> errors have ended. We saw this starting with AB v. Liberty and extending through Al <span class="blsp-spelling-error" id="SPELLING_ERROR_16">Correa</span> v. State Farm, as well as other cases decided subsequent to Al Correa.<br /><br />I suppose the best questions to ask are as follows. First, how much of an NF-10 needs to be filled out in order to preserve the defense(s) on it? Second, how many mistakes are allowed to be present on the NF-10, so as to preserve the defenses on the denial? We shall await the answer to these questions.NoFaultDefenderhttp://www.blogger.com/profile/13933423891308559023noreply@blogger.com0