Author Archives: Leon Kucherovsky
Metropolitan Diagnostic Medical Care, P.C. v. Erie Insurance Company of New York, 2016 NY Slip Op 51815(U) At a nonjury trial, the sole issue was the medical necessity of the MRIs of plaintiff’s assignor’s cervical and thoracic spines. The only witness was defendant’s doctor, a b
SURE WAY NY, Inc. v. TRAVELERS INSURANCE COMPANY 2016 WL 7233969 The issue in this case was whether a no fault insurer must request EUO’s of all conceivable entities within 15 calendar days of receipt of a written notice of claim, in accordance with 11 NYCRR 65–3.5(b), or whether its 15 da
GOLDEN NEEDLE ACUPUNCTURE P.C., v. MAPFRE INS. CO., 2016 WL 7233877 Defendant insurer alleges that it timely requested “recorded statements” from plaintiff which it effectively claimed tolled the time by which defendant had to either pay or deny. The Court said as follows: The q
Blackman v. Allstate Ins. Co., 26470/15, NYLJ 1202775250364 The Court ruled that when a provider bills a BR code, burden of proving the merits of the service pursuant to ground rule 10 to support the service only shifts to provider when a verification request is issued by the insurer. This diver
In Renelique v. Lancer Insurance Company, 53 Misc.3d 145, the Appellate Term affirmed the lower Court’s dismissal of Plaintiff medical provider’s Summons and Complaint for failing to comply with court ordered discovery, after single default. Specifically, the Civil Court granted defend
As part As part of its 2017 Medicare Physician Fee Schedule update, the Center for Medicare and Medicaid Services (CMS) reissued its prohibition on certain unit-based rental arrangements with referring physicians, adopted updates to the list of CPT/HCPCS codes (Code List) defining certain of the St
Today’s New York Law Journal had a good policy exhaustion case. NYU Hospitals Center-Hospital v. State Farm Mutual Automobile Ins. Co., 000091/16, NYLJ 1202771102250, at *1 (Sup., NA, Decided October 26, 2016). State Farm denied the hospital bill based on a fee schedule defense and policy exha
Five Boro Medical Equipment, Inc., v. Praetorian Ins. Co., Slip Copy, 2016 WL 6106195 (Table), 2016 N.Y. Slip Op. 51481(U) Insurer sough to dismiss the claim based upon 2 IME no shows. The Court found insurer’s proof to be defective, saying: The conclusory affidavits of defendant’s IME
Bronx Acupuncture Therapy, P.C., v. Hereford Ins. Co., Slip Copy, 2016 WL 6106132 (Table), 2016 N.Y. Slip Op. 51479(U) Defendant moved to dismiss the claim based upon the assignor’s failure to appear at the IME’s. The Court ruled that Defendant’s IME notices were not timely,
Bob Acupuncture, P.C., v. New York Central Mutual Fire Insurance Company, 2016 N.Y. Slip Op. 51434(U) plaintiff established the submission of the claim forms to defendant by virtue of the defendant, insurer’s denial. The Court said as follows: As plaintiff argues, the submission of the cl