No-Fault Song Parody Contest. (Seriously.)

I'm inclined to question the fitness to practice law of my friend Matthew S. Lerner, Esq. of the New York Civil Law blawg.

Today, he announced a no-fault-based song parody contest. He also points out that Deney Terrio's last name rhymes with the last name of former NYS Insurance Department Superintendent Gregory V. Serio (as in Med. Soc'y v. Serio, 100 N.Y.2d 854 (2003)). I'm a bit frightened to even mention that he (allegedly) makes something else rhyme with the last name of Dr. Robert Chandran Mallela, M.D. (as in State Farm v. Mallela, 4 N.Y.3d 313 (2005)).

I may just close down this blog entirely if anyone starts rhyming Frances J. Roggio (as in Roggio v. Nationwide Mut. Ins. Co., 66 N.Y.2d 260 (1985)); Karen DeGuisto (as in Presbyterian Hosp. a/a/o DeGuisto v. Maryland Cas. Co., 90 N.Y.2d 274 (1997)); or Pamela Mandresh (as in Central Gen. Hosp. a/a/o Mandresh v. Chubb Group of Ins. Cos., 90 N.Y.2d 195 (1997)).

Which Judicial District's Grievance Committee should I be contacting for Matthew? ;)

We've Gone on Holiday by Mistake

Sorry about the recent lull in updates. Between the holidays, and then a post-holiday excursion to Vegas (and the post-excursion crush of work that followed it), things have been a bit diffuse. Anyway, with some luck, more regular updates will be resuming.

As far as the pending matters involving the EBT of Andrew Carothers, M.D. as ordered by Civil Court, Richmond County last year (see order here), another decision and order is pending, and an update on same will come at the appropriate time.

And five points to whoever spots the source of the quote for this post's title. ;)

Bring the Beat Back

Perhaps the Appellate Division, Second Department is reading this blog. Probably not. Either way, though, the App. Div. has overturned the decision by Justice Phelan of Supreme Court, Nassau County wherein it was held that insurance carriers were precluded from raising the defense of a lack of medical necessity as against a no-fault claim brought by an MRI provider. See Long Is. Radiology v Allstate Ins. Co., 2007 NY Slip Op 00496 (App. Div., 2d Dep't, 2007). You can see Justice Phelan's original order here.

As one might suspect, I think the App. Div. got it very, very right. And while they're surely not reading this blog, they did cite to two different cases I've discussed on the topic (see West Tremont Med. Diagnostic, P.C. v Geico Ins. Co., 2006 NYSlipOp 51871(U) (App. Term, 2d Dep't, 2006), and Precision Diagnostic Imaging, P.C. v Travelers Ins. Co., 8 Misc 3d 435 (Civ. Ct., Kings Cty., 2005)).

The core of the App. Div.'s new decision is as follows:

An assignee stands in the shoes of an assignor and thus acquires no greater rights than its assignor. Since the defense of lack of medical necessity may indisputably be raised by the defendants against the injured party, it is available as against radiologists who accept assignments of no-fault benefits. (Citations and internal quotation marks omitted.)

The various insurance defense firms who prosecuted the Long Is. Radiology appeal should be commended for their fine work.

2007: What the *%$! is Going On?

The reader is directed to No-Fault Paradise, a new entry in the highly-specific genre of New York no-fault automobile insurance law blogs from David M. Gottlieb, Esq., an attorney at Edward Shapiro, P.C., a prolific no-fault plaintiff's firm. Mr. Gottlieb's Civil Court, Queens County, Room 101 Seating Chart is both completely accurate and incredibly funny.

Thanks much also to a recent anonymous poster for some lively debate on the recent Appellate Division, 2d Dep't decision in Fogel v. Progressive.

In a bit of housekeeping news, please note that Erik B. Lutwin, Esq. has moved on in his professional career. Your humble blawger wishes Mr. Lutwin well. For the time being, I am the sole contributor to this blawg, but Mr. Lutwin was the one who got the ball rolling here, and he also devised the catchy title. Not having a fellow contributor makes the device of using the royal "we" that much more of a contrivance, so you'll forgive me if I continue to do so now and again.

Happy various holidays to all, and a Happy New Year, as well. Thanks especially to the two biggest long-running supporters of my site, Matthew S. Lerner, Esq. of New York Civil Law and Nicole L. Black, Esq. of Sui Generis. They provide much more traffic my way than the other way around, I'm sure, and I'm grateful for how often they feature my posts.

--

It's that time again, right
Kick out the old, welcome the new
Make your New Year's resolutions now!

...Go!

(And a very Happy New Year from BBC1)

Fogel: Out

As 2006 draws to a close, the Appellate Dvision, 2d Department has given us one of the most important no-fault decisions of the year. In Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 2006 NY Slip Op 09604 (App. Div, 2d Dep't, 2006), a unanimous Court overturned that portion of the prior Appellate Term, 2d Dep't decision that held that an assignor's failure to appear for an independent medical examination ("IME") prior to the subject services having been rendered results only in a rebuttal of the presumption of medical necessity in the favor of the plaintiff provider. Instead, although agreeing with the concurrence/dissent of Golia, J. in the App. Term Fogel case and the Appellate Term, 1st Department decision in Inwood Hill Med., P.C. v General Assur. Co., 2005 NYSlipOp 25437 (App. Term, 1st Dep't, 2005), the App. Div. has gone even further. They now hold that failure to appear at an IME is a violation of a condition precedent to no-fault coverage, regardless of when the no-show occurred as compared with the date(s) of service of a given claim. Indeed, the App. Div. now holds that a carrier may deny claims "retroactively to the date of loss" when a no-show occurs.

This has numerous potential implications. A denial of coverage retroactive to the date of the loss should render the defense one that survives preclusion regardless of whether it is preserved in a timely denial of claim form. See generally, Central General v. Chubb, 90 N.Y.2d 195 (1997). Other explicit conditions precedent to coverage listed in the PIP Endorsement (11 NYCRR § 65-1.1) should also be subject to the same rule.

Misunderestimated

A special thanks to JDjive for passing along a bunch of traffic this morning to my incredibly lame blog. Many of the visitors who clicked over here have spent a significant amount of time looking at various posts, reading the cited case law, etc. I'm thinking the intended insult had the opposite effect, but I'm sure I'm too lame to understand the difference...

In other news, the Appellate Division, Second Department will hear the appeals in Fair Price a/a/o Novelo v. Travelers on 12/14/06 and Mandarino v. Travelers on 12/19/06.

Keeping It Real, Part II

By way of a long-overdue sequel in this occasional series of posts, the reader is directed to the recently-published decision in Dan Med., P.C. v New York Cent. Mut. Fire Ins. Co., 2006 NYSlipOp 26483 (App. Term, 2d Dep't, 2006) as the latest example of the Appellate Term applying real law rather than fashioning some other rule purportedly designed to conform to the legislative intent of no-fault.

In particular, the Dan Med. decision stands for the proposition that a motion for summary judgment must be supported by evidence in admissible form sufficient to demonstrate the absence of any triable issues of fact. As a result, in order to demonstrate prima facie entitlement to summary judgment, a no-fault plaintiff must proffer the relevant claim forms in a manner that complies with the business record exception to hearsay in CPLR R. 4518. Upon a failure to proffer such evidence in support of plaintiff's motion for summary judgment, same is to be denied. This is true regardless of whether plaintiff has proven that such forms were submitted to and received by the insurance carrier; while something may have been submitted and received, that something must also be put forth in admissible form.

Note that, in order for the issue to be preserved for appeal, a defendant must raise those defects in plaintiff's proof in their written opposition. Should defendant fail to raise such defects on the record, an appellate court is unable to review a lower court's determination that plaintiff's motion was sufficient. See Bath Med. Supply, Inc. v Allstate Indem. Co., 2006 NYSlipOp 52273(U) (App. Term, 2d Dep't, 2006), concurring opinion of Weston Patterson, J.

On the other hand, in certain circumstances, the Appellate Term still continues to impose artificial (unreal?) law that appears to have no particular basis in statutory law or the regulations, and indeed may even be contrary to the plain text of such. See, e.g., Boai Zhong Yi Acupuncture Servs. P.C. v Progressive Cas. Ins. Co., 2006 NYSlipOp 26485 (App. Term, 2d Dep't, 2006). The reader is directed in particular to the lengthy (purported) concurrence therein of Golia, J.

'Blawg' sounds somewhat onomatopoeic

The reader is directed to the search engines at Blawg.com and Justia Blawg Search, both of which have been kind (smart? gullible?) enough to list us.

I hope everyone had a nice Thanksgiving, but sadly it's time to hunker down and deal with a month's worth of rush items until things quiet down once again at the end of December. Of course, we'll continue to provide all relevant updates, but there has not been much to report as of late.

Updates on the ongoing litigation in Matter of Carothers v Insurance Cos. Represented by Bruno Gerbino & Soriano LLP & Freiberg & Peck LLP will be forthcoming as appropriate.

Yeah, well, you know, that's just, like, your opinion, man.

The reader is directed to an Opinion Letter from the Office of the General Counsel to the NYS Insurance Department, entitled "Electronic Record Retention of No-Fault Insurance Claim Forms," and dated October 25, 2006.

The following is an excerpt from the Opinion, and presents the basic issues involved:

Questions Presented:

1. Do the New York State Electronic Signatures and Records Act ("ESRA") and the federal Electronic Signatures in Global and National Commerce Act (E-Sign) obligate an insurer to accept electronic records and signatures in connection with No-Fault insurance claim forms?

2. May a digitally reproduced NF-AOB serve as an original document for purposes of a verification request by an insurer under Section 65-3.11(c) of N.Y. Comp. Codes R. & Regs. tit. 11, Part 65 (Regulation 68)?

Conclusions:

1. No. Neither E-Sign nor ESRA obligates an insurer to accept electronic records or signatures.

2. Yes, provided that it is accurate and accessible as required under Section 7001(d)(1) of E-Sign and the insurer consents to the use of an electronic record as an original document.

The Opinion is rather thorough, so all interested are recommended to read it in full. Note that the question is presented on behalf of "MRI Corporation X" and that particular entity uses digital signatures of its doctors to 'sign' various documents. "MRI Corporation X" basically appears to be asking for permission to use scanned-in signatures of its doctors, a practice it is already admittedly employing. One can only wonder who "MRI Corporation X" is.

On what is surely an entirely unrelated matter, here is an update for all those interested regarding Andrew Carothers, M.D., P.C. Please note that the plaintiff in Matter of Carothers v Insurance Cos. Represented by Bruno Gerbino & Soriano LLP & Freiberg & Peck LLP, 2006 NY Slip Op 26372 (Civ. Ct., Richmond Cty., 2006) recently brought a motion, by Order to Show Cause, described therein as one to renew and reargue said decision. Prior to the return date (this past Friday, November 17, 2006 at 2:30 PM), however, plaintiff withdrew the motion. Both a Notice of Appeal and a purported Amended Notice of Appeal are currently pending. No stay has been granted either by the Appellate Term or the Civil Court. Under the terms of the subject Order, today is the final day by which Dr. Carothers is to be produced for an EBT. Anyone taking bets?

Far to Go

Sorry for the lack of recent updates, but the undersigned has been swamped this week, and there haven't been any developments of note. The Appellate Term, 2d Department, for example, hasn't published any decisions since October 25. Wherefore art thou, Golia? (And Pesce, and McCabe, and Weston Patterson, and Belen, and Rudolph, and...)