MIRACLE HEALTH SERVICES, INC., A/A/O KIRENIA TAMAYO, vs PROGRESSIVE SELECT INSURANCE COMPANY, No. 3D21-14 I really find the analysis here telling and quite biting. (1) “Miracle Health sent Progressive four sets of bills for Tamayo’s treatment, which Progressive received on May 21, 2014, June 2, 2014, June 23, 2014 and July 18, 2014, respectively. On […]
Colin Clarke, M.D., P.C. v MVAIC, 2021 NY Slip Op 50729(U)(App. Term 2d Dept 2021) (1) “The complaint alleges that the claims arose out of six separate accidents which occurred on six different dates.” (2) “A review of the denial of claim forms, explanations of review and correspondence pertaining to the claims at issue reflects […]
Matter of Philadelphia Ins. Indem. Co. v Kendall, 2021 NY Slip Op 04284 (1st Dept, 2021), It is always an interesting issue that is presented: Will an email satisfy the writing requirement of CPLR 2104? The answer used to be it depends: “Supreme Court relied on the Second Department’s decision in Forcelli v Gelco Corp. (109 AD3d […]
While the insurance carriers do not generally have bad faith in New York and the statutory attorneys fees are anemic, the rule on preclusion in the no-fault sphere acts often times acts as the great equalizer. That said, the preclusion remedy over time has been chipped away, but the “nuts and bolts” no-fault defenses still […]
Nieva-Silvera v Katz, 2021 NY Slip Op 04144 (2d Dept. 2021) Cervical fusion, arthroscopic surgery, verdict reduced to 2 million. Plaintiff appealed and received another $570,000 from the Second Department. Would you have appealed for the extra $570,000? I can tell you if I walked home with $2 million from a runaway jury after reductions […]
ASSOCIATES IN FAMILY PRACTICE OF BROWARD, LLC a/a/o YVETTE BROWN v. ALLSTATE FIRE AND CASUALTY INSURANCE COMPANY, 4D21-173 (Fla. 4th DA 2021) (1) “Provider billed Allstate using four different Current Procedural Terminology (“CPT”) codes as published in the American Medical Association’s CPT Manual, two of which are relevant to this case: CPT code 99205-25 (“the […]
Geico Indmenity Co. v. Muransky Chiropractic, P.A., No, 4D21-457 (Fla. 4th DCA 2021) When a no-fault statute gives the carrier an option to write in terms, we end up with messes. The Gecko did this in the within case. Under Florida’s statute, payment is limited to 80% of 200% of Medicare Part B of the […]
UNITED AUTOMOBILE INSURANCE COMPANY, vs CHIROPRACTIC CLINICS OF SOUTH FLORIDA, PL, A/A/O MICHAEL AKINS, No. 3D21-111 Florida’s version of American Transit Ins. Co., United Auto Ins. Co, disclaimed benefits on the basis of a purported material misrepresentation that was made on the insurance application. United later realized there was no material misrepresentation and they were […]
One of the things that I find readily amazing is that notwithstanding a veto proof progressive majority, bad faith reform cannot pass the Legislature. The current law, which comes from the 1994 Pavia standard, on third-party claims requires an almost criminal indifference before bad faith is actionable. In my thinking, the only sure fire way […]
Lenox Hill Radiology & MIA, P.C. v Hereford Ins. Co., 2021 NY Slip Op 21157 (Civ. Ct. NY Co. 2021) “Although plaintiff submitted decisions from no-fault arbitrations where the arbitrators ruled that the provider’s responses to demand payment of reproduction costs complied with the insurer’s verification requests (see plaintiff’s supplemental affirmation in opposition, arbitration awards), this […]