Progressive Advanced Insurance Co. v. Gwendolyn McAdam, et al., defendants, Sovereign Acupuncture, P.C., 2016 WL 2337947 Insurance company brought a DJ action against a medical provider alleging that the accidents were intentionally staged and fraudulent.  Appellate Division reversed the lower cou

Big Apple Ortho Medical Supply, Inc. v. Allstate Ins. Co., 3141/2011, NYLJ 1202756440119, at *1 (Civ., BX, Decided April 5, 2016) Attorneys for insurance carrier sought to modify judgment pursuant to CPLR 5019 and 5240, normally used to correct clerical errors, to assert the argument of policy cance

Lotus Acupuncture, P.C. a/a/o Marilyn Rivera v. Unitrin Advantage Ins. Co, 51 Misc.3d 139 Insurer made a motion for summary judgment based on the lack of medical necessity.  Appellate Term reversed the lower court saying: the peer review report pertaining to acupuncture services rendered November

Flushing Traditional Acupuncture, P.C. v. Auto Club Ins. Association, 2014-1266 K C, NYLJ 1202755803082, at *1 (App. Tm., 2nd, Decided April 11, 2016): Medical provider appealed from a Civil Court order which dismissed the complaint on the ground of lack of insurance coverage. Insurer argued the co

Beal-Medea Prods., Inc. v Geico Gen. Ins. Co. 2016 NY Slip Op 50594(U) Appellate Term confirms, post Vivienne Etienne that an assignment is not part of Plaintiff’s prima facia case.  Plaintiff moved to have its assignment of benefits admitted into evidence, the lower Court denied and instead

CONTEMPORARY ACUPUNCTURE, P.C., v. ALLSTATE INSURANCE COMPANY,  51 Misc.3d 132 Insurance company must show it timely mailed EUO notices and timely denials as part of its prima facia case with respect to an EUO no show defense. This case is along the same rationale as Progressive Cas. Ins. Co. v.

EAST COAST ACUPUNCTURE, P.C. v. HEREFORD INSURANCE COMPANY, 26 N.Y.S.3d 684 Civil Court, City of New York, Kings County. The insurance carrier alleged that Plaintiff now has an additional requirement in its prima facia case; of proving that a bill complies with the fee schedule as was imposed by

GEICO v. Avanguard, 2016 WL 1247701 The Court of Appeals issued its ruling in this long awaited matter on the question of whether an Office Based Surgery Practice (OBS) can recover a facility fee.  Unfortunately for OBS practices, the Court held that the “regulatory framework” does not mandate

In the Matter of American Independent Insurance Co., v. Nova Acupuncture, P.C., WL 1234587 (N.Y.A.D. 2 Dept.), 2016 N.Y. Slip Op. 02357 How many cases have been discontinued throughout the years against American Independent Insurance Co. for lack of jurisdiction?  Well, no more, looks like they m

Alleviation Medical Services, P.C. v. Farmers New Century Insurance Co., Slip Copy, 2016 WL 1189935 (Table), 2016 N.Y. Slip Op. 50379(U).  Although insurer proved timely mailing, the Court nevertheless ruled that it could not use the No Show defense: However, with respect to the first cause of act