Tuesday, July 01, 2008
An Appeal of Interest
This morning, the Court of Appeals has granted State Farm leave to appeal the decision of the Appellate Division, Third Department in LMK Psychological Servs., P.C. v State Farm Mut. Auto. Ins. Co., 46 A.D.3d 1290 (3d Dep't, 2007).
Tuesday, November 20, 2007
The Highest Court
Where a carrier fails to timely request verification of an assignment of benefits, that carrier is precluded from contesting the validity of the assignment. Even when the assignment lacks the signature of the assignor. So sayeth the Court of Appeals today in Hospital for Joint Diseases v. Travelers Prop. Cas. Ins. Co., 2007 NY Slip Op 09067 (Ct. of App., 2007). While The Hon. Eugene F. Pigott, Jr. offers a dissent, six other Judges on the Court side with the majority opinion. The opinions serve as a concise primer on both sides of the issue.
This is, to be sure, a rather extreme result of the line of thinking originally set down by the Court of Appeals in Presbyterian Hosp. in City of N.Y. v. Maryland Cas. Co., 90 N.Y.2d 274 (1997). Nevertheless, the Court has obviously looked into the abyss of the last 10 years and still hasn't blinked.
This is, to be sure, a rather extreme result of the line of thinking originally set down by the Court of Appeals in Presbyterian Hosp. in City of N.Y. v. Maryland Cas. Co., 90 N.Y.2d 274 (1997). Nevertheless, the Court has obviously looked into the abyss of the last 10 years and still hasn't blinked.
Friday, November 16, 2007
D'oh-shi
On March 16, 2007, the Appellate Term, 2d Department issued its decision in Doshi Diagnostic Imaging Servs. v State Farm Ins. Co., 16 Misc.3d 42 (App. Term, 2d Dep't, 2007). In sum, the Court held that, where timely claim verification requests are made to a third party, and such verification is never supplied, a provider's suit for reimbursement of such a claim remains premature.
On August 21, 2007, the App. Term denied Doshi Diagnostic's application for leave to appeal to the Appellate Division. See Doshi Diagnostic Imaging Servs. As Assignee of Laticia Vazquez v State Farm Ins. Co., 2007 NYSlipOp 76290(U) (App. Term, 2d Dep't, 2007).
Now, on November 14, 2007, the Appellate Division has likewise denied Doshi Diagnostic's application for leave to appeal. See Doshi Diagnostic Imaging Services v State Farm Insurance, 2007 NYSlipOp 83478(U) (App. Div., 2d Dep't, 2007).
D'oh!
In other news, the App. Div., 2d Dep't also recently issued its decision in Westchester Med. Ctr. v Countrywide Ins. Co., 2007 NY Slip Op 09024 (App. Div., 2d Dep't, 2007). The decision reads as a basic cut-and-paste of various other App. Div. no-fault decisions, containing standard holdings regarding the sufficiency of proof of mailing and waiver of defenses related to assignments of benefits. In the typical fashion of no-fault appellate decisions, without the benefit of seeing the record on appeal, the holding is rather worthless in a vacuum.
On August 21, 2007, the App. Term denied Doshi Diagnostic's application for leave to appeal to the Appellate Division. See Doshi Diagnostic Imaging Servs. As Assignee of Laticia Vazquez v State Farm Ins. Co., 2007 NYSlipOp 76290(U) (App. Term, 2d Dep't, 2007).
Now, on November 14, 2007, the Appellate Division has likewise denied Doshi Diagnostic's application for leave to appeal. See Doshi Diagnostic Imaging Services v State Farm Insurance, 2007 NYSlipOp 83478(U) (App. Div., 2d Dep't, 2007).
D'oh!
In other news, the App. Div., 2d Dep't also recently issued its decision in Westchester Med. Ctr. v Countrywide Ins. Co., 2007 NY Slip Op 09024 (App. Div., 2d Dep't, 2007). The decision reads as a basic cut-and-paste of various other App. Div. no-fault decisions, containing standard holdings regarding the sufficiency of proof of mailing and waiver of defenses related to assignments of benefits. In the typical fashion of no-fault appellate decisions, without the benefit of seeing the record on appeal, the holding is rather worthless in a vacuum.
Friday, November 09, 2007
Edwards Nofaulthands
New York City Civil Court, Kings County Judge, the Honorable Genine D. Edwards, has had two no-fault trial decisions from this week picked up for publication today by the NYS Law Reporting Bureau.
All-Boro Med. Supplies, Inc. v Progressive Northeastern Ins. Co., 2007 NY Slip Op 27458 (Civ. Ct., Kings Cty., 2007), which will be published in the Miscellaneous Reports, concerns EUO requests and also touches on a carrier's burden in proving a lack of medical necessity. Judge Edwards comes to the conclusion that EUO request letters must be sent out within thirty (30) days of receipt of a bill for treatment. Since it seems that the patient actually appeared for the EUO, it's a much tougher call to make than the more often litigated situation of an EUO no-show where non-compliance vitiates coverage.
Delta Diagnostic Radiology, P.C. v MVAIC, 2007 NY Slip Op 52143(U) (Civ. Ct., Kings Cty., 2007), which will not be published in the Miscellaneous Reports, concerns the situation where a carrier issues a proper denial based on a provider's failure to submit a timely claim, containing the requisite language informing the provider that the untimeliness will be excused for reasonable justification, but the provider never actually bothers to submit such information. It appears that the Plaintiff did attempt to submit written justification one month prior to trial, but presumably this would not avoid the conclusion that the Complaint itself remains premature.
FWIW, now might be as good a time as any to mention that I began operations of Law Offices of Damin J. Toell, P.C. a few months ago. For the most part, I'm currently handling no-fault cases on behalf of providers. The business contact info is as follows:
Law Offices of Damin J. Toell, P.C.
P.O. Box 245112
Brooklyn, New York 11224
516-204-4775 (phone)
516-394-0855 (fax)
Business-related email should be directed to: djtoellpc @ gmail . com
Have a good weekend, all.
All-Boro Med. Supplies, Inc. v Progressive Northeastern Ins. Co., 2007 NY Slip Op 27458 (Civ. Ct., Kings Cty., 2007), which will be published in the Miscellaneous Reports, concerns EUO requests and also touches on a carrier's burden in proving a lack of medical necessity. Judge Edwards comes to the conclusion that EUO request letters must be sent out within thirty (30) days of receipt of a bill for treatment. Since it seems that the patient actually appeared for the EUO, it's a much tougher call to make than the more often litigated situation of an EUO no-show where non-compliance vitiates coverage.
Delta Diagnostic Radiology, P.C. v MVAIC, 2007 NY Slip Op 52143(U) (Civ. Ct., Kings Cty., 2007), which will not be published in the Miscellaneous Reports, concerns the situation where a carrier issues a proper denial based on a provider's failure to submit a timely claim, containing the requisite language informing the provider that the untimeliness will be excused for reasonable justification, but the provider never actually bothers to submit such information. It appears that the Plaintiff did attempt to submit written justification one month prior to trial, but presumably this would not avoid the conclusion that the Complaint itself remains premature.
FWIW, now might be as good a time as any to mention that I began operations of Law Offices of Damin J. Toell, P.C. a few months ago. For the most part, I'm currently handling no-fault cases on behalf of providers. The business contact info is as follows:
Law Offices of Damin J. Toell, P.C.
P.O. Box 245112
Brooklyn, New York 11224
516-204-4775 (phone)
516-394-0855 (fax)
Business-related email should be directed to: djtoellpc @ gmail . com
Have a good weekend, all.
Tuesday, September 25, 2007
Fraudulent Fraud
At the suggestion (almost a threat, really) of David M. Gottleib, Esq., I'm reposting a comment of mine from the previous entry. An anonymous insurance defense attorney asked: "Provider fraud should NEVER be waived. When did fraud stop being fraud?" I said:
The better question is actually: when did fraud start being fraud? Answer: when catchphrases got the better of good lawyering.
You won't find the word "fraud" anywhere in the majority or concurring opinions in Central General Hosp. v. Chubb, 90 N.Y.2d 195 (1997). You'll find a single variation of the word, namely "fraudulent" in Presbyterian Hosp. v. Maryland Cas. Co., 90 N.Y.2d 274 (1997), but only in the majority opinion, and not in the way carriers like: "The tradeoff of the no-fault reform still allows carriers to contest ill-founded, illegitimate and fraudulent claims, but within a strict, short-leashed contestable period and process designed to avoid prejudice and red-tape dilatory practices." New York's seminal no-fault cases don't create a solid foundation for anything that should be referred to as a "fraud defense."
Indeed, "fraud" isn't the word you want to use if you're a good insurance defense attorney. You want to say "lack of coverage." The Appellate Division, Second Department has reminded us a few times of this distinction, but it still goes basically unnoticed. Then again, "lack of coverage" isn't a catchphrase that instills fear in anyone's heart.
All of that said, I think there's a solid lack-of-coverage argument to be made in the carriers' favor in Fair Price. Nevertheless, the defense bar is getting itself wrapped up too much in the language of fraud, and to the detriment of their clients' interests.
--
As an addendum to those comments, I'd recommend that eager defense attorneys begin their research with App. Div. decisions such as Matter of Eagle Ins. Co. v. Davis, 22 A.D.3d 846 (2d Dep't, 2005). There, regarding an allegation, made as part of a petition to stay a UM arbitration, that an alleged collision was fraudulent in nature, the Court held: "When a petition raises an issue of fact as to whether the automobile collision giving rise to the underlying request for arbitration was deliberate or intentional, the issue of fraud is subsumed under the coverage issue. Evidence of such fraud should be considered in determining the broader coverage issue." Id. (internal citations omitted).
The better question is actually: when did fraud start being fraud? Answer: when catchphrases got the better of good lawyering.
You won't find the word "fraud" anywhere in the majority or concurring opinions in Central General Hosp. v. Chubb, 90 N.Y.2d 195 (1997). You'll find a single variation of the word, namely "fraudulent" in Presbyterian Hosp. v. Maryland Cas. Co., 90 N.Y.2d 274 (1997), but only in the majority opinion, and not in the way carriers like: "The tradeoff of the no-fault reform still allows carriers to contest ill-founded, illegitimate and fraudulent claims, but within a strict, short-leashed contestable period and process designed to avoid prejudice and red-tape dilatory practices." New York's seminal no-fault cases don't create a solid foundation for anything that should be referred to as a "fraud defense."
Indeed, "fraud" isn't the word you want to use if you're a good insurance defense attorney. You want to say "lack of coverage." The Appellate Division, Second Department has reminded us a few times of this distinction, but it still goes basically unnoticed. Then again, "lack of coverage" isn't a catchphrase that instills fear in anyone's heart.
All of that said, I think there's a solid lack-of-coverage argument to be made in the carriers' favor in Fair Price. Nevertheless, the defense bar is getting itself wrapped up too much in the language of fraud, and to the detriment of their clients' interests.
--
As an addendum to those comments, I'd recommend that eager defense attorneys begin their research with App. Div. decisions such as Matter of Eagle Ins. Co. v. Davis, 22 A.D.3d 846 (2d Dep't, 2005). There, regarding an allegation, made as part of a petition to stay a UM arbitration, that an alleged collision was fraudulent in nature, the Court held: "When a petition raises an issue of fact as to whether the automobile collision giving rise to the underlying request for arbitration was deliberate or intentional, the issue of fraud is subsumed under the coverage issue. Evidence of such fraud should be considered in determining the broader coverage issue." Id. (internal citations omitted).
Saturday, September 22, 2007
More and More Appealing
In a move that likely fell under most radars, the Appellate Division, 2d Department has granted the defendant's motion for leave to appeal their decision in Fair Price Medical Supply Corp. v. Travelers Indem. Co., 42 A.D.3d 277 (2d Dep't, 2007) to the Court of Appeals. The App. Div. has posted the motion decision.
I have a feeling that the judges are going to get less and less sympathetic to the defendant's position the higher up the appeal goes on the food chain. Personally, I don't see the Court of Appeals reconsidering the underlying rationale of Presbyterian Hosp. in City of N.Y. v Maryland Cas. Co., 90 NY2d 274 (1997), no matter how much some of us would like that to occur in light of the state of things ten years on.
I have a feeling that the judges are going to get less and less sympathetic to the defendant's position the higher up the appeal goes on the food chain. Personally, I don't see the Court of Appeals reconsidering the underlying rationale of Presbyterian Hosp. in City of N.Y. v Maryland Cas. Co., 90 NY2d 274 (1997), no matter how much some of us would like that to occur in light of the state of things ten years on.
Tuesday, August 28, 2007
I Always Feel Like Somebody's Watching Me
In Delta Diagnostic Radiology, P.C. v Chubb Group of Ins, 2007 NYSlipOp 27345 (App. Term, 2d Dep't, 2007), the Appellate Term has finally made explicit, as I previously argued on this blog, that a party need not produce an affidavit from someone whose duty it is to ensure compliance with standard procedures when attempting to create a presumption of mailing. Rather than expressly overturning their own prior decisions on the matter, the App. Term simply stated that such prior decisions "should not be interpreted" as saying what they obviously say. In any event, I'm glad that the issue was finally presented for appeal. We'll see how long it takes for this ruling to filter its way down to the Civil and District Courts.
Tuesday, July 24, 2007
Shock the Conscience
In a decision of likely interest to defense counsel, Judge Howard S. Miller of the District Court, Nassau County, Hempstead Part issued a Decision/Order concerning settlement stipulations often done by the law firm of Israel, Israel & Purdy, LLP. See Omega Diagnostic Imaging, P.C. v State Farm Mut. Ins. Co., 2007 NY Slip Op 51405(U) (Dist. Ct., Nass. Cty., 2007). Typically, Israel puts a clause in their settlement stips that provide that, should the settled-for amount not be paid within 30 (or however many) days, judgment will be entered for the full amount demanded in the Complaint, including full statutory interest, et al.
Judge Miller held (correctly, in my opinion) that there is no basis to stay enforcement of the portion of the stipulation in question. The Court cited to ABCO Refrigeration Supply Corp. v Designs by Keiser Corp., 239 A.D.2d 165 (1st Dep't, 1997) for the proposition that, there being no allegation of fraud, mistake, etc., there is no basis to vacate a stipulation that essentially calls for the defendant to pay the full amount of the Complaint.
State Farm, by Picciano & Scahill, P.C., cited to some Second Department case law for the proposition that unconscionable stipulations should not be enforced. Judge Miller found State Farm's cited case law to be distinguishable and/or sui generis. In any event, Judge Miller found that $2,578, the difference between the settled-for amount and the amount of the judgment, did not shock the Court's conscience.
Those Israel settlement stips are potentially dangerous, to be sure, but things would work a lot more smoothly on a lot of fronts if the carriers made payments quickly, anyway.
Judge Miller held (correctly, in my opinion) that there is no basis to stay enforcement of the portion of the stipulation in question. The Court cited to ABCO Refrigeration Supply Corp. v Designs by Keiser Corp., 239 A.D.2d 165 (1st Dep't, 1997) for the proposition that, there being no allegation of fraud, mistake, etc., there is no basis to vacate a stipulation that essentially calls for the defendant to pay the full amount of the Complaint.
State Farm, by Picciano & Scahill, P.C., cited to some Second Department case law for the proposition that unconscionable stipulations should not be enforced. Judge Miller found State Farm's cited case law to be distinguishable and/or sui generis. In any event, Judge Miller found that $2,578, the difference between the settled-for amount and the amount of the judgment, did not shock the Court's conscience.
Those Israel settlement stips are potentially dangerous, to be sure, but things would work a lot more smoothly on a lot of fronts if the carriers made payments quickly, anyway.
Wednesday, July 18, 2007
Barnes & No-fault
According to the sidebar on David M. Gottlieb, Esq.'s blog, No-Fault Paradise, he's currently re-reading David Foster Wallace's 1996 novel 'Infinite Jest'. I admire that Mr. Gottlieb is still able to get any reading done; I have had a tough time of keeping at it since law school. I also admire that he has been able to finish 'Infinite Jest' (more than once?) and wants to go back for more. I tried starting it a few times, the most recent being August 14, 2003, when the Northeast had a blackout. Somehow it fails to grab me enough. I found Wallace's debut novel, 1987's 'The Broom of the System,' to be a bit more agreeable. I think I finished it, or at least came close.
As to my avoidance of 'Infinite Jest,' I would confess that I am afraid of Big Important Novels, but I don't think it's true. I spent much of my law school years (and tapering off thereafter) chewing up books like 'J R' and 'A Frolic of his Own' by William Gaddis (I think I got through the first chapter or two of 'The Recognitions' at one point), most everything by Don DeLillo, Thomas Pynchon's 'V.', most of the core works of Thomas Bernhard (which I guess don't quite qualify as 'big'), and even wannabe fare like Jonathan Franzen's 'The Corrections.' Then again, despite owning perhaps several hundred books, I can no longer seem to sit down and actually read any. Oddly enough, the subway commute I had during most of law school (Williamsburg<-->Greenwich Village) provided an ideal, structured time for plowing through books at a decent pace.
As to my avoidance of 'Infinite Jest,' I would confess that I am afraid of Big Important Novels, but I don't think it's true. I spent much of my law school years (and tapering off thereafter) chewing up books like 'J R' and 'A Frolic of his Own' by William Gaddis (I think I got through the first chapter or two of 'The Recognitions' at one point), most everything by Don DeLillo, Thomas Pynchon's 'V.', most of the core works of Thomas Bernhard (which I guess don't quite qualify as 'big'), and even wannabe fare like Jonathan Franzen's 'The Corrections.' Then again, despite owning perhaps several hundred books, I can no longer seem to sit down and actually read any. Oddly enough, the subway commute I had during most of law school (Williamsburg<-->Greenwich Village) provided an ideal, structured time for plowing through books at a decent pace.
Carsherchesputin
I just wanted to bring to the top a comment posted last night to an old post on this blog:
At Tuesday, July 17, 2007 8:45:00 PM, Anonymous said...
Things have been heating up in the Carothers, Sher, Chess and Rasputin arena as the connections we all know exist are surfacing so ever slightly...What an industry this No Fault Insurance is Very challenging to prosecutors and law enforcement..sometimes too challenging LOL
While one of those references may seem a bit obtuse, it does all fit together, one way or another. I have no clue who our anonymous commenter is, but he/she is more than welcome to continue contributing, preferably to more recent and visible posts. :)
At Tuesday, July 17, 2007 8:45:00 PM, Anonymous said...
Things have been heating up in the Carothers, Sher, Chess and Rasputin arena as the connections we all know exist are surfacing so ever slightly...What an industry this No Fault Insurance is Very challenging to prosecutors and law enforcement..sometimes too challenging LOL
While one of those references may seem a bit obtuse, it does all fit together, one way or another. I have no clue who our anonymous commenter is, but he/she is more than welcome to continue contributing, preferably to more recent and visible posts. :)
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