X

Thank you for sharing!

Your article was successfully shared with the contacts you provided.

Upon the following papers numbered 1-4 read on this motion by defendant:Notice of Motion and supporting papers            1-2Notice of Cross Motion and supporting papersAnswering Affidavits and supporting papers      3Affirmations in Opposition to Motion and Cross-MotionReplying Affidavits and supporting papers         4Filed papers

*1  After due deliberation, it is hereby ORDERED that defendant’s motion for summary judgment is granted solely to the extent that the amount in dispute is reduced to $9,160.08 based upon the uncontested merits of its fee schedule defense. In all other respects, defendant’s motion is denied. Based upon the submissions of the parties, the court finds that plaintiff has established its prima facie case and defendant has established its timely denial of the assigned no-fault benefits at issue. There exists material facts in dispute as to the medical necessity of the treatment provided to plaintiff’s assignor, which must be decided at a trial.This is an action to recover assigned no-fault benefits for treatment rendered to plaintiff’s assignor for injuries claimed to have been sustained in a motor vehicle accident which occurred on December 30, 2012. Defendant’s motion for summary judgment seeks dismissal of the complaint on three separate grounds: (1) lack of medical necessity for the treatment; (2) billing in excess of the applicable fee schedule; and (3) lack of authority to do business in the State of New Jersey where the treatment was rendered, by reason of the failure of plaintiff corporation to obtain a certificate of authority to transact business, prior to the time the treatment was rendered.As to the issue of medical necessity, both sides submitted detailed affidavits of qualified professionals regarding the reasons why the treatment rendered was or was not medically necessary. Based upon a careful review of these affidavits, the court is constrained to rule that relevant and material factual issues exist regarding the medical necessity of the subject services.Regarding the fee schedule defense, defendant submits proof in the form of an affidavit by Timothy Schultz, a certified coder, to establish that the amount allowable by the applicable

 
Reprints & Licensing
Mentioned in a Law.com story?

License our industry-leading legal content to extend your thought leadership and build your brand.

More From ALM

With this subscription you will receive unlimited access to high quality, online, on-demand premium content from well-respected faculty in the legal industry. This is perfect for attorneys licensed in multiple jurisdictions or for attorneys that have fulfilled their CLE requirement but need to access resourceful information for their practice areas.
View Now
Our Team Account subscription service is for legal teams of four or more attorneys. Each attorney is granted unlimited access to high quality, on-demand premium content from well-respected faculty in the legal industry along with administrative access to easily manage CLE for the entire team.
View Now
Gain access to some of the most knowledgeable and experienced attorneys with our 2 bundle options! Our Compliance bundles are curated by CLE Counselors and include current legal topics and challenges within the industry. Our second option allows you to build your bundle and strategically select the content that pertains to your needs. Both options are priced the same.
View Now
September 05, 2024
New York, NY

The New York Law Journal honors attorneys and judges who have made a remarkable difference in the legal profession in New York.


Learn More
July 11, 2024
New York, NY

The National Law Journal Elite Trial Lawyers recognizes U.S.-based law firms performing exemplary work on behalf of plaintiffs.


Learn More
July 22, 2024 - July 24, 2024
Lake Tahoe, CA

GlobeSt. Women of Influence Conference celebrates the women who drive the commercial real estate industry forward.


Learn More

Skolnick Legal Group, P.C., a construction and commercial litigation firm with offices in New Jersey and New York is seeking a Litigation As...


Apply Now ›

Cullen and Dykman is seeking an associate attorney with a minimum of 5+ years in insurance coverage experience as well as risk transfer and ...


Apply Now ›

McCarter & English, LLP is actively seeking a midlevel insurance coverage associate for its Newark, NJ and/or Philadelphia, PA offices. ...


Apply Now ›
06/27/2024
The American Lawyer

Professional Announcement


View Announcement ›
06/21/2024
Daily Business Review

Full Page Announcement


View Announcement ›
06/14/2024
New Jersey Law Journal

Professional Announcement


View Announcement ›