Thanks for visiting! Welcome to a new way to research case law. You are viewing a free summary from Descrybe.ai. For citation and good law / bad law checking, legal issue analysis, and other advanced tools, explore our Legal Research Toolkit — not free, but close.
Ultra Diagnostics Imaging v. Liberty Mutual Insurance
Citation: 9 Misc. 3d 97
Court: Appellate Terms of the Supreme Court of New York; September 20, 2005; New York; State Appellate Court
The court reversed the lower court's order and granted the plaintiff's motion for summary judgment, remanding the case for the calculation of statutory interest and attorney's fees. The plaintiff successfully established its entitlement to summary judgment by proving that it submitted claims for first-party no-fault benefits, detailing the losses, and demonstrating that payment was overdue. The defendant's denial of the claims was deemed untimely, as it did not conform to the statutory 30-day response period, thus preventing the defendant from raising certain defenses, including issues of nonconformity with workers' compensation schedules and excessive billing. The defendant attempted to assert fraud as a defense based on an affirmation from its attorney and an unsworn report from a handwriting expert, which lacked adequate admissible evidence. The court found this documentation insufficient and ruled that the defendant failed to prove its fraud defense was exempt from the 30-day preclusion rule. Furthermore, it was noted that the defendant could assert a lack of coverage defense only if it was based on an actual belief that the injury did not arise from an insured incident, as outlined in prior case law. The Court differentiated between two defenses presented by the insurer: a lack of coverage defense, which asserts that the injuries are unrelated to the accident and is thus exempt from the preclusion remedy, and a defense of excessive medical treatment, which relates to partial non-payment of no-fault benefits and is subject to preclusion. The lack of coverage defense can also apply to incidents involving insurance fraud, but not to provider fraud if the insurer's denial is untimely. In this case, the defendant failed to establish a valid lack of coverage defense exempt from preclusion. The expert's opinion did not create a factual dispute regarding whether the medical services were linked to an insured incident. Additionally, the alleged fraudulent actions did not sufficiently demonstrate that the accident was part of an insurance fraud scheme to justify the lack of coverage defense. Consequently, the Court granted summary judgment in favor of the plaintiff and remanded the case for the calculation of statutory interest and assessment of attorney’s fees in accordance with Insurance Law § 5106(a). Judges Rudolph, Angiolillo, and Tanenbaum concurred.