Article 51 of the insurance law mandates that injured parties in motor vehicle accidents may be compensated for basic economic loss, which is defined as losses up to $50,000 for certain necessary expenses such as medical costs.
No-fault cases revolve around the same repetitive issues—Medical Necessity, IME or EUO no-show, fee schedule, the prima facie case etc. Once in a while, a decision from the appellate courts would come along and have an impact on how different no-fault issues are decided. Issues influenced by case law include fraud (Fair Price Med. Supply v. Travelers Indem., 10 N.Y.3d 556 (2008), State Farm Mut. Auto. Ins. Co. v. Mallela, 4 N.Y.3d 313, 319 (2005)), precludable defenses (Fair Price Med. Supply Corp. v. Travelers Indem. Co, A.M. Med. Servs., P.C. v. Progressive Cas. Ins. Co., 101 A.D.3d 535 (2012)), conditions precedent to coverage (Unitrin Advantage Ins. Co. v. Bayshore Physical Therapy, 82 A.D.3d 559 (1st Dept. 2011), Westchester Med. Ctr. v. Lincoln Gen. Ins. Co., 60 A.D.3d 1045 (2009)), the prima facie case (Viviane Etienne Med. Care, P.C. v. Country-Wide Ins. Co., 25 N.Y.3d 498 (2015)), and fee schedule (Great Wall Acupuncture v. GEICO Gen. Ins. Co., 16 Misc.3d 23 (App. Term, 2d & 11th Jud. Dists. 2007), Gaba Medical P.C. v. Progressive Specialty Ins. Co., 2012 NY Slip Op 51448(U) (App. Term, 2d & 11th Jud. Dists. 2012)). For some of these issues, there are differing opinions between judicial departments.
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