Lead Practice Area: Insurance Fraud
Summary: Our client, Hanover Insurance Company, properly denied claims for medical services submitted by the plaintiff for treatment allegedly provided to its assignor. Plaintiff, the medical provider, sued to recover first party no-fault benefits in the New York County Civil Court. Hanover denied the claims in this matter based upon the plaintiff’s failure to appear for two scheduled Examinations Under Oath (EUO), a condition precedent to coverage under New York no-fault law.
On behalf of Hanover, our firm moved for summary judgment, and the court granted our motion. One of plaintiff’s arguments was that Hanover’s EUO demand letters were defective. The Honorable Tanya R. Kennedy, citing Canarsie Chiropractic, P.C. v. State Farm Mut. Fire Ins. Co., 27 Misc. 3d 1228A (Civ. Ct., Kings County 2010) (a decision also obtained by our office), found that plaintiff was required to communicate any defect in the EUO letters, rather than simply ignoring the requests.
The use of motions for summary judgment is extremely beneficial to insurance companies where the plaintiff, whether it be the medical provider or the eligible injured person, breached a condition precedent to coverage.