Aetna Health Plans v. Hanover Insurance Company, 2016 NY SLIP OP 04658 https://www.nycourts.gov/ctapps/Decisions/2016/Jun16/97opn16-Decision.pdf The issue presented in this appeal is whether a health insurer who pays for medical treatment that should have been covered by the insured’s no-fau
Avalon Radiology, PC. v Ameriprise Ins. Co., 2016 NY Slip Op 26182 http://www.nycourts.gov/reporter/3dseries/2016/2016_26182.htm Defendant issued denial based upon the failure of plaintiff’s assignor, Avalon Radiology P.C., to appear for two Examinations Under Oath (EUOs). Defendant’
MB Advanced Equip., Inc. v New York Cent. Mut. Fire Ins. Co., 2016 NY Slip Op 50863(U) http://www.nycourts.gov/reporter/3dseries/2016/2016_50863.htm The IME doctors swore they were in a different location, other than the location of the alleged no show. The Court said: In support of its motion,
Great Health Care Chiropractic, P.C. v Hereford Ins. Co., 2016 NY Slip Op 50858(U) http://www.nycourts.gov/reporter/3dseries/2016/2016_50858.htm After Defendant established established that it had timely mailed its verification request and follow-up verification request (see St. Vincent’s Ho
AAA 991410007677 I have not posted any AAA arbitration decisions yet but decided to post this decision since lately it has become somewhat of a trend for the losing party to file an appeal to a Master Arbitrator solely on the basis of the lower arbitrator failing to decide or mention an issue in his
Maxim Tyorkin, M.D. v. Garrison Property & Casualty Ins. Co., 2016 N.Y. Slip Op. 50846(U) This was a case of first impression, whether an insurer, when receiving a bill from a medical provider, who rendered services in New Jersey and is making a claim for New York no-fault benefits, is requi
Allstate Property and Casualty Insurance Company v. Northeast Anesthesia and Pain Management, 2016 N.Y. Slip Op. 50828(U) The Appellate Term ruled that: An arbitrator’s award directing payment in excess of the monetary limit of a no-fault insurance policy exceeds the arbitrator’s power and co
BIG APPLE ORTHO PRODUCTS, INC. v. STATE FARM MUTUAL AUTOMOBILE INS. CO., No. CV–037717–13/KI. Another example of a motion lacking proper evidence. In this case insurer denied provider’s claim because the accident occurred in Georgia. The Court stated as follows: According to the Affidavi
ACTIVE CARE MEDICAL SUPPLY CORP. v. HARTFORD INSURANCE COMPANY, CV–027848–14/KI This case represents a lesson for all attorneys that when making motions, you must establish the facts with adequate proof, not simply an affidavit from an attorney. In this case the insurer made a motion for summ