WeSuThem

  Compas Med., P.C. v Praetorian Ins. Co. , 2016 NY Slip Op 51000(U)(App. Term 2d Dept. 2016) “Moreover, defendant failed to establish as a matter of law that the misrepresentation by plaintiff’s assignor as to his place of residence was material ( see Interboro Ins. Co. v Fatmir , 89 AD3d 993  [2011]). For the foregoing reasons, the branches of defendant’s cross motion seeking summary judgment dismissing the first through third causes of action should have been denied.” The citing of Fatmir now opens up a new door regarding the evidence necessary to substantiate “material misrepresentations” in establishing a fraudulent procurement defense. “A misrepresentation is material if the insurer would not have issued the policy had it known the facts misrepresented ( see  Insurance Law § 3105 [b];  Novick v Middlesex Mut. Assur. Co. , 84 AD3d at 1330;  Varshavskaya v Metropolitan Life Ins. Co. , 68 AD3d at 856). “To establish materiality as a matter of law, the in...

  JCC Med., P.C. v Infinity Group , 2016 NY Slip Op 26439 (App. Term 2d Dept. 2016) (1) It is uncontroverted that defendant had issued a Georgia automobile  insurance policy to the brother of plaintiff’s assignor, “effective from August 28, 2010 through August 28, 2011,” who had made various representations to defendant in his insurance application, including that he resided in Georgia, that the insured vehicle was garaged in Georgia, and that the assignor was an adult who resided in his Georgia household and also drove the insured vehicle. (2) “ Upon a review of the record, we find that defendant failed to show that there is a conflict between the laws of Georgia and New York with respect to the retroactive rescission of an automobile insurance policy which has been issued to a natural person for a private passenger vehicle, as both states prohibit the retroactive rescission of such a policy  ( see  Vehicle and Traffic Law § 313;  Matter of Government Empl...

  “A motion for leave to renew “shall be based upon new facts not offered on the prior motion that would change the prior determination” (CPLR 2221 [e] [2]) and must “contain reasonable justification for the failure to present such facts on the prior motion” (CPLR 2221 [e] [3]).   We note that a claim for workers’ compensation benefits must be filed by the injured worker on a particular Board form within two years after the date of the accident (Workers’ Compensation Law § 28) and may not be assigned (Workers’ Compensation Law § 33).   Plaintiff did not demonstrate that its assignor had made a proper application for workers’ compensation benefits ( see A. B. Med. Servs., PLLC v American Tr. Ins. Co. , 34 Misc 3d 141 [A], 2012 NY Slip Op 50076[U] [App Term, 2d Dept, 9th & 10th Jud Dists 2012]).” Assume a decision comes out from the court stating that the EIP must make a prompt application to the board, the EIP does this and has the claim is denied due to failing to com...

  “On consideration of the above authority, we now hold that where, as here, a plaintiff recovers compensatory damages for a medical professional’s malpractice, a plaintiff may also recover punitive damages for that medical professional’s act of altering or destroying medical records in an effort to evade potential medical malpractice liability. Allowing an award of punitive damages for a medical professional’s act of altering or destroying medical records in an effort to evade potential medical malpractice liability will serve to deter medical professionals from engaging in such wrongful conduct, punish medical professionals who engage in such conduct, and express public condemnation of such conduct. Thus, the Supreme Court did not err in submitting the issue of punitive damages to the jury.” Good public policy.

  Something very interesting happened last week in the Sunshine State. A comprehensive bill i) Mandating BI coverage for the first time in state history; ii) Legislatively approving Florida’s crazy bad-faith case law; and iii) Eliminating PIP passed both houses. Where do I stand? I do both Plaintiff and Defense PIP in FLA, so I am saddened that my $3000 attorney fee and cost settlements may end. I also think the new bad faith statute will trip up insurance carriers more than the Harvey v. Geico standard. Also, eliminating threshold will lead to larger verdicts and more reversals where the jury find for Plaintiff on LOP medical bills but denies compensation for pain and suffering. The PIP system is quite broken here, only beat out by the roofing cases and the out of control litigation on those matters. Yet, the way people drive in Florida, PIP is a very helpful coverage. There was a compromise bill that I thought would pass – it would replace PIP with $5,000 in mandatory Medpay cov...

  Florida’s version of American Transit Ins. Co., United Auto Ins. Co, disclaimed benefits on the basis of a purported material misrepresentation that was made on the insurance application. United later realized there was no material misrepresentation and they were mistaken. Medical provider sends bills United Auto Ins. Co well after the 35-day period under FSA 627.736(5)(c) to submit the bills. United Auto denies on this ground. Provider brings a lawsuit stating that the insurance carrier is “equittably esopped” from disclaiming coverage based upon the prior disclaimer. Presuit demand was made; the carrier did not pay. A lawsuit was commenced in Miami-Dade County Court. The parties agreed that necessity, relatedness and reasonableness were not issues. The parties made dueling summary judgment motions. The County Court sustained the defense of equittable estoppel United appealed and the 3d DCA affirned in a written opinion. “Through no fault of his own, Akins was advised by United ...

  In a case with major implications, the Appellate Term for the 9th and 10th Judicial Districts reached a key compromise behind the dicta found at the Appellate Term’s holding in Fair Price v. Travelers (a precluded defense based upon fraud and unjust enrichment may be recouped in a civil action) and one of the many holdings in Cornell Medical v. Mercury (counterclaims or civil actions for paid-out monies are not permitted when the defense to the paid-out monies has been precluded). Namely, a counterclaim or civil action is permitted where the payments to the alleged fraudulent claims are made within 30-days of receipt of the bills.  To quote the court: If an insurer is precluded from asserting a defense due to its failure to pay or deny a claim within the 30-day claim determination period, it may not later seek to recover amounts it paid on the claim based on a theory of unjust enrichment ( see e.g. Cornell Med., P.C. v Mercury Cas. Co. , 24 Misc 3d 58  [App Term, 2d, 11...

  I was asked again about the defamation that appears sporadically against me on the internet. I took down my last post because I thought by both OREN ZIV and his attorney being sued for defaming me, it would stop. Well, I was being rational and that was a mistake. I would note that I rid my condominium complex in New York of some bad actors and now I have the joy of having to eliminate the internet of defamation – mostly written in broken English – on a weekly basis. Whatever is written about me is untrue. Sadly, the internet gives anyone the ability to attack who they want anonymously. My next focus in life will be to deal with the protections 230 gives to website operators; I will put that on my 2022 bucket list. What you will note is that if you type my name on yahoo or google, you will see blog posts explaining what I have done and why I am being harassed. Those are written by people who have access to all the facts and are true. Some of them are written by me, but most are no...

  Lumbermens Mut. Cas. Co. v A B Med. Servs., PLLC , 2020 NY Slip Op 07280 (1st Dept. 2020) “As an initial issue, 11 NYCRR 65-3.11 (a) limits no-fault medical billing to employees of the provider that submits claims for no-fault benefits. It is submitted that Supreme Court properly granted judgment in favor of plaintiffs, because the treating providers were independent contractors, as opposed to employees. The record supports a finding that the “degree of control exercised by the purported employer” ( Bynog v Cipriani Group , 1 NY3d 193 , 198 [2003]), “not only over the results produced but also over the means used to produce the results” ( Matter of O’Brien v Spitzer , 7 NY3d 239 , 242 [2006]), was insufficient to give rise to an employer-employee relationship. “Factors relevant to assessing control include whether the worker (1) worked at his [or her] convenience, (2) was free to engage in other employment, (3) received fringe benefits, (4) was on the employer’s payroll and (5) w...

CEDA HEALTH OF HIALEAH, LLC, etc., vs STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY   , 3D21-11 Similar to the 2012 NY regulatory changes, the Florida law prohibits billings for services not rendered.  See  FSA 627.736(5)(b)1.c.. The statute, when triggered, applies to all billings. The NY regulation only seems to apply to services that were billed but not provided. Here are the facts: ” Dr. Canizares testified that he did not have personal knowledge of the treatments, but that based on his review of the records, it appeared that two units of Current Procedural Terminology (“CPT”) code 97110 were mistakenly billed at $90.00 each instead of one unit of CPT code 97110 at $90.00 and one unit of CPT code 97112 at $95.00. Dr. Canizares attested that two units of code 97110 were billed, although only one unit was performed on the date of treatment, and that there was no entry for code 97112 although one unit was performed on that date” The question is whether the provider’s us...

Pavlova v Nationwide Ins. , 2021 NY Slip Op 50213(U)(App. Term 2d Dept. 2021) “To establish its prima facie entitlement to summary judgment dismissing a complaint on the ground that a plaintiff’s assignor failed to appear for an EUO, an insurer must demonstrate, as a matter of law, that it twice duly demanded an EUO from the assignor, that the assignor twice failed to appear, and that the insurer issued a timely denial of the claims ( see Interboro Ins. Co. v Clennon , 113 AD3d 596, 597 [2014]). Contrary to the determination of the Civil Court, the affirmations of defendant’s counsel, as well as the transcripts of the EUOs, were sufficient to establish that plaintiff’s assignor had failed to appear for the EUOs. It is irrelevant whether plaintiff’s assignor was represented by counsel, as defendant was only required to mail the EUO scheduling letters to plaintiff’s assignor ( see  11 NYCRR 65-3.5 [e]; 3.6 [b]). Consequently, as plaintiff failed to raise a triable issue of fact in op...

Might it be said that you are searching for a  Personal Injury Law Firm ? If you're in a mishap, there are notable things to be aware of. You might be qualified for remuneration if another person was careless and caused your wounds. You want the right lawyer close by who will battle for what is fair and just. Yet, how would you track down that individual? What would it be a good idea for you to pay special attention to while picking a personal injury lawyer? Picking the perfect personal injury lawyer for your case is one of the main choices you will make. The most effective way to find a decent lawyer that meets your requirements and spending plan is by asking companions, relatives, or collaborators who they would suggest. You ought to talk with nearby lawyers to pose inquiries about the amount it will cost and what they anticipate charging. As a last resort, take a stab at looking on the web for audits from others who have utilized the administrations of these lawyers previously s...

Business and Commercial Law Firm Florida   are two areas of legitimate practice that have so many covering issues that most lawyers who practice one will have the capacity in the other. Commercial law depends on the course of action and dissipating of things. They support express exchanges. Business law depends on different businesses counting illustrating affiliation and associations. Acquisitions financial sponsor respect, and property issues. For example - renting office or stockroom space. Business selling things will require a lawyer with experience in these fields. Commercial law is obliged by the Uniform Commercial Code (UCC), which is a model arrangement of laws concerning the courses of action of things, leases of items, questionable instruments, and got exchanges. All states have embraced the UCC or some likeness thereof. Notwithstanding, each state is permitted to make changes to the laws as it sees fit. Have A Glance at Services Provided by Our Law Firm? Our  Fort ...

Personal injury law (generally called "wrongdoing" law) allows a hurt person to report a typical lawsuit in court and get an authentic fix ("hurts") for all disasters beginning from a setback or other event.  Personal Injury Law Firm in NY city helps with promising it. The personal injury structure allows the hurt person to be reimbursed fiscally or "made whole" after the individual has persevered through harm as a result of someone else's imprudent or deliberate lead. In this article, we'll: cover the basics of personal injury law debate where personal injury law arrives from, and figure out how an all-around ordinary personal injury case works. The Basics Knowledge Anbout Personal Injury There is a wide scope of conditions where personal injury rules apply: Setbacks.  Personal injury rules apply in conditions, where someone misbehaves, and that rudeness harms another person. Models consolidate car crashes, slip and fall episodes, and clinical ro...

This is not too off topic. The Court of Appeals is run by the prior DA of Westchester. Nassau County DA Singas has now been elevated to the Court of Appeals. Finally, Judge Garcis was a former prosecutor. Judge Cannataro was just elevated to the Court of Appeals but he reminded me of Judge Jeremy Weinstein – a professional administration judge, Not a bad thing mind you. So how does a bench with a dearth of Civil non-criminal experience handle insurance disputes and personal injury disputes? I really do now know. I have read on the criminal law blogs that the defense bar is crying, and I can understand their concern. But it seems that much of the decisions seem to be not necessarily on the pro-consumer side.  Simmons v Trans Express Inc. , 2021 NY Slip Op 03484 (2021)(in effect killing a wage and hour case through limited the bar on collateral estoppel found in the uniform small claims acts);  Himmelstein, McConnell, Gribben, Donoghue & Joseph, LLP v Matthew Bender & Co...

A.C. Med., P.C. v New York Cent. Mut. Fire Ins. Co. , 2021 NY Slip Op 50841(U)(App. Term 2d Dept. 2021) ” Plaintiff claimed, in the papers submitted in support of its amended cross motion, that, in March]2017, it had submitted two bills dated March 29, 2017 to defendant, for services rendered to Mr. Bailey on November 18, 2016, in the total amount of $2,785.16. The sole explanation for the submission of what plaintiff characterized as “amended bills” was a sworn statement by plaintiff’s medical billing supervisor that she “was made aware that the defendant was addressing bills with the incorrect amount and requesting verification for services that were mistakenly added to the bill.” “Plaintiff has not raised an issue of fact precluding summary judgment dismissing the complaint on the ground that the action is premature. Whereas this action was commenced to recover the principal sum of $3,268.16 (the amount sought in the November bills),  plaintiff has now elected not to pursue...

One of the interesting aspects or evolution of New Jersey PIP law is that is has devolved from a comprehensive all encompassing benefit to one that is either limited or non-existent. The historians will remember that until the 1990 Fair Automobile Insurance Reform Act, there was not coverage limit. That changed to $250,000 in 1990 along with the ability to have major medical be deemed primary.. In 1998, AICRA brought the common $15,000 PIP policies and mandated arbitration.   The question that lurked is what happened when major medical said go to PIP, PIP as secondary pays and then seeks to subrogate against the major medical carrier. The Appellate Division said you’re out of luck. (1) “When a PIP-as-secondary insurer receives a claim eligible for primary coverage, it must deny coverage and send the insured a notice advising them to submit the claim to their health insurer” (2) ” Health insurers are also required to make prompt payment of claims, but are governed by N.J.A.C. 11:22-...

Personal injury law (otherwise called "misdeed" law) permits a harmed individual to document a common lawsuit in court and get a legitimate cure ("harms") for all misfortunes originating from a mishap or other occurrence.  Personal Injury Law Firm in NY  city assists with guaranteeing it. The personal injury framework permits the harmed individual to be repaid monetarily or "made entirety" after the person has endured hurt because of another person's careless or purposeful lead. In this article, we'll: cover the essentials of personal injury law talk about where personal injury law comes from, and make sense of how a run-of-the-mill personal injury case works. The Basics of Personal Injury There is a wide range of circumstances where personal injury rules apply: Mishaps.  Personal injury rules apply in circumstances, where somebody acts carelessly and that inconsiderateness hurts someone else. Models incorporate auto collisions, slip and fall episo...