A.B. Medical Services PLLC v. USAA General Indemnity Co.

13 Citing cases

  1. Jamaica Med. Supply, Inc. v. New York Cent. Mut. Fire Ins. Co.

    34 Misc. 3d 21 (N.Y. App. Div. 2011)   Cited 3 times

    In Roggio, the Court of Appeals held that a claimant who elected to arbitrate disputed claims for first-party no-fault benefits waived the right to commence an action to litigate subsequent claims arising from the same accident ( see also Cortez v. Countrywide Ins. Co., 17 A.D.3d 508, 793 N.Y.S.2d 189 [2005] ). However, a prior arbitration proceeding involving a different claimant provider does not preclude another provider from commencing its own action seeking reimbursement of assigned no-fault benefits, even though the claims may arise from the same accident ( see A.B. Med. Servs. PLLC v. USAA Gen. Indem. Co., 9 Misc.3d 19, 801 N.Y.S.2d 475 [App. Term, 2d & 11th Jud. Dists. 2005] ). “Pursuant to Insurance Law § 5106(b), each claimant provider may independently exercise the right to elect to submit their respective claims to arbitration, and the election to arbitrate by one provider does not bar another provider from resorting to the court in the first instance for resolution of disputed no-fault benefits ... Moreover, in the absence of privity between the providers, the determination in the prior arbitration proceeding cannot be accorded res judicata or collateral estoppel effect against plaintiffs in the instant action” ( id. at 23, 801 N.Y.S.2d 475).

  2. Alev Med. Supply, Inc. v. Allstate Prop. & Cas. Ins. Co.

    36 Misc. 3d 132 (N.Y. App. Div. 2012)   Cited 5 times

    The Civil Court granted defendant's motion on the ground that “a claim for this assignor and accident had been previously submitted to the American Arbitration Association” and, therefore, “a forum has already been chosen” (citing Roggio v. Nationwide Mut. Ins. Co., 66 N.Y.2d 260 [1985] ). A prior arbitration proceeding involving one claimant provider seeking reimbursement of assigned first-party no-fault benefits does not preclude another provider from commencing its own action seeking reimbursement of assigned no-fault benefits, even where the claims have been assigned by the same individual and have arisen from the same accident ( see Jamaica Med. Supply, Inc. v. N.Y. Cent. Mut. Fire Ins. Co., 34 Misc.3d 21, 23 [App Term, 2d, 11th & 13th Jud Dists 2011]; A.B. Med. Servs. PLLC v. USAA Gen. Indem. Co., 9 Misc.3d 19 [App Term, 2d & 11th Jud Dists 2005]; cf. Roggio, 66 N.Y.2d 260 [holding that a claimant who elected to arbitrate disputed claims for first-party no-fault benefits waived the right to commence an action to litigate subsequent claims arising from the same accident] ). Since the arbitration proceeding upon which the court relied had been commenced by a different provider, Alexander Berenblit, M.D., not plaintiff herein, the complaint was improperly dismissed on the ground that arbitration was the proper forum for this dispute.

  3. JAMAICA MED. SUPP. v. NY CTR. MUT. FIRE

    2011 N.Y. Slip Op. 21359 (N.Y. App. Term 2011)

    In Roggio, the Court of Appeals held that a claimant who elected to arbitrate disputed claims for first-party no-fault benefits waived the right to commence an action to litigate subsequent claims arising from the same accident (see also Cortez v Countrywide Ins. Co. , 17 AD3d 508). However, a prior arbitration proceeding involving a different claimant provider does not preclude another provider from commencing its own action seeking reimbursement of assigned no-fault benefits, even though the claims may arise from the same accident (see A.B. Med. Servs. PLLC v USAAGen. Indem. Co. , 9 Misc 3d 19 [App Term, 2d 11th Jud Dists 2005]). "Pursuant to Insurance Law § 5106 (b), each claimant provider may independently exercise the right to elect to submit their respective claims to arbitration, and the election to arbitrate by one provider does not bar another provider from resorting to the court in the first instance for resolution of disputed no-fault benefits . . .

  4. AVA ACUPUNCTURE P.C. v. ELCO ADMIN. SERVS. CO.

    2006 N.Y. Slip Op. 50158 (N.Y. Civ. Ct. 2006)

    The insurer's denial is sufficient evidence that the claim was submitted. ( See A.B. Medical Services PLLC v. USAA General Indemnity Co., 9 Misc 3d 19, 20 [App Term, 2d and 11th Jud Dists 2005].) With the provider's verification of treatment, there is a "presumption of medical necessity" which attaches to "a properly-completed claim form."

  5. Utopia Equip., Inc. v. Maya Assurance Co.

    36 N.Y.S.3d 410 (2d Cir. 2016)

    So much of the appeal as is from the portion of the order that denied the branch of plaintiff's motion seeking reargument is dismissed, as no appeal lies from that portion of the order (see Ireland v. Wilenzik, 296 A.D.2d 771, 773 [2002] ; see also Gosek v. Lunt Theatre Co., 89 AD3d 418, 418 [2011] ; Arab Am. Found. v. Naber, 260 A.D.2d 588 [1999] ; Neff v. Steven Schwartzapfel, P.C., 254 A.D.2d 137 [1998] ).Contrary to plaintiff's argument, Alev Med. Supply, Inc. v. Allstate Prop. & Cas. Ins. Co. (36 Misc.3d 132[A], 2012 N.Y. Slip Op 51294[U] [App Term, 2d, 11th & 13th Jud Dists 2012] ), decided after the determination of defendant's prior motion, did not constitute a change in the law (seee.g. Russell v. New York Cent. Mut. Fire Ins. Co., 11 AD3d 668 [2004] ; Magic Recovery Med. & Surgical Supply Inc. v. State Farm Mut. Auto. Ins. Co., 27 Misc.3d 67 [App Term, 2d, 11th & 13th Jud Dists 2010] ; A.B. Med. Servs. PLLC v. USAA Gen. Indem. Co., 9 Misc.3d 19 [App Term, 2d & 11th Jud Dists 2005] ). Thus, plaintiff failed to demonstrate that there had been a change in the law that would alter the prior determination (see CPLR 2221[e][2] ), and the branch of plaintiff's motion seeking leave to renew was properly denied (see Jackson v. Westminster House Owners Inc., 52 AD3d 404 [2008] ).

  6. Utopia Equip., Inc. v. Maya Assurance Co.

    2016 N.Y. Slip Op. 50463 (N.Y. App. Term 2016)

    So much of the appeal as is from the portion of the order that denied the branch of plaintiff's motion seeking reargument is dismissed, as no appeal lies from that portion of the order (see Ireland v. Wilenzik, 296 A.D.2d 771, 773 [2002] ; see also Gosek v. Lunt Theatre Co., 89 AD3d 418, 418 [2011] ; Arab Am. Found. v. Naber, 260 A.D.2d 588 [1999] ; Neff v. Steven Schwartzapfel, P.C., 254 A.D.2d 137 [1998] ). Contrary to plaintiff's argument, Alev Med. Supply, Inc. v. Allstate Prop. & Cas. Ins. Co. (36 Misc.3d 132[A], 2012 N.Y. Slip Op 51294[U] [App Term, 2d, 11th & 13th Jud Dists 2012] ), decided after the determination of defendant's prior motion, did not constitute a change in the law (seee.g. Russell v. New York Cent. Mut. Fire Ins. Co., 11 AD3d 668 [2004] ; Magic Recovery Med. & Surgical Supply Inc. v. State Farm Mut. Auto. Ins. Co., 27 Misc.3d 67 [App Term, 2d, 11th & 13th Jud Dists 2010] ; A.B. Med. Servs. PLLC v. USAA Gen. Indem. Co., 9 Misc.3d 19 [App Term, 2d & 11th Jud Dists 2005] ). Thus, plaintiff failed to demonstrate that there had been a change in the law that would alter the prior determination (see CPLR 2221[e][2] ), and the branch of plaintiff's motion seeking leave to renew was properly denied (see Jackson v. Westminster House Owners Inc., 52 AD3d 404 [2008] ).

  7. Dayna Physical Therapy, P.C. v. Travelers Ins. Co.

    38 Misc. 3d 146 (N.Y. App. Div. 2013)

    The Civil Court properly denied defendant's motion. As the Civil Court correctly noted, since plaintiff's assignor had executed the assignment of benefits to plaintiff prior to his commencement of his own arbitration, the holding in Roggio (66 N.Y.2d 260) does not apply here and, thus, plaintiff was not precluded from litigating the claims at issue in this action ( see Alev Med. Supply, Inc. v. Allstate Prop. & Cas. Ins. Co., 36 Misc.3d 132 [A], 2012 N.Y. Slip Op 51294[U] [App Term, 2d, 11th & 13th Jud Dists 2012]; Jamaica Med. Supply, Inc. v. N.Y. Cent. Mut. Fire Ins. Co., 34 Misc.3d 21 [App Term, 2d, 11th & 13th Jud Dists 2011]; A.B. Med. Servs. PLLC v. USAA Gen. Indem. Co., 9 Misc.3d 19 [App Term, 2d & 11th Jud Dists 2005] ). However, the Civil Court should have denied plaintiff's cross motion for summary judgment.

  8. WJ Acupuncture, P.C. v. Nationwide Mut. Ins.

    36 Misc. 3d 148 (N.Y. App. Div. 2012)

    The doctrine of collateral estoppel applies only against those who were either a party, or in privity with a party, to a prior proceeding (Russell v. New York Cent. Mut. Fire Ins. Co., 11 AD3d 668 [2004] ). As it has not been demonstrated that plaintiff was either a party, or in privity with a party, to the prior arbitration proceeding, the doctrine of collateral estoppel is inapplicable ( see Alev Med. Supply, Inc. v. Allstate Prop. & Cas. Ins. Co., 36 Misc.3d 132[A], 2012 N.Y. Slip Op 51294[U] [App Term, 2d, 11th & 13th Jud Dists 2012]; Magic Recovery Med. & Surgical Supply Inc. v. State Farm Mut. Auto. Ins. Co., 27 Misc.3d 67 [App Term, 2d, 11th & 13th Jud Dists 2010]; A.B. Med. Servs. PLLC v. USAA Gen. Indem. Co., 9 Misc.3d 19 [App Term, 2d & 11th Jud Dists 2005] ).

  9. Unitrin Advantage v. Bayshore Phys. Therapy

    82 A.D.3d 559 (N.Y. App. Div. 2011)   Cited 291 times
    In Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC (82 AD3d 559, 561 [1st Dept 2011], the First Department ruled that "[p]laintiff satisfied its prima facie burden on summary judgment of establishing that it requested IMEs in accordance with the procedures and time frames set forth in the no-fault implementing regulations, and that defendants' assignors did not appear" (id. at 560).

    There is likewise no merit to defendants' contention that the IME request notices were invalid. Plaintiff satisfied its prima facie burden on summary judgment of establishing that it requested IMEs in accordance with the procedures and time frames set forth in the no-fault implementing regulations, and that defendants' assignors did not appear. In opposition, defendants failed to raise an issue of fact that the requests were unreasonable ( see generally Celtic Med. P.C. v New York Cent. Mut. Fire Ins. Co., 15 Misc 3d 13, 14-15; A.B. Med. Servs. PLLC v USAA Gen. Indem. Co., 9 Misc 3d 19, 21). Defendants' argument that plaintiff was required to demonstrate that the assignors' failure to appear for the IMEs was willful is unpreserved and, in any event, without merit.

  10. A.B. Med. Serv. PLLC v. Prudential Prop. Cas. Ins.

    2006 N.Y. Slip Op. 50504 (N.Y. App. Term 2006)

    Unsatisfied IME requests made prior to a claim's filing remove the presumption of medical necessity which attaches to the claim forms, and absent additional proof of medical necessity, a provider's motion for summary judgment based solely on the proof of claims must be denied ( Stephen Fogel Psychological, P.C. v. Progressive Cas. Ins. Co., 7 Misc 3d 18 [App Term, 2d 11th Jud Dists 2004]). Upon assignor's conceded failure to attend those examinations, there remains a triable issue of claimant's assertion they were improperly sought, and whether plaintiff can offer a valid excuse for the nonattendance, and if not, whether the treatment for said claims was medically necessary ( e.g. A.B. Med. Services PLLC v. USAA Gen. Indem. Co., 9 Misc 3d 19 [App Term, 2d 11th Jud Dists 2005]). Therefore, as to the claims for $1,972.08, $1,999.12, $699.68, $71.06 (submitted 2/24/03), $260.64, $71.06 (submitted 3/31/02), $71.40, $71.06 (submitted 4/28/04), and $62.72, for treatment rendered Guerrier, summary judgment was properly denied.