No-Fault Case Law

The main issue in this case was whether the plaintiff had failed to appear for duly scheduled examinations under oath, which would result in the dismissal of the complaint. The court considered the fact that the plaintiff was seeking to recover assigned first-party no-fault benefits and had failed to appear for the scheduled examinations. The court ultimately held that the order granting the defendant's motion for summary judgment dismissing the complaint was affirmed, with the plaintiff being required to pay $25 in costs. The court's decision was based on the plaintiff's failure to comply with the requirement to appear for the examinations under oath, as stated in an earlier case, Pavlova, as Assignee of Scurry, Kevin v State Farm Mut. Auto. Ins. Co. The appellate court judges unanimously concurred with the decision.

The court considered a provider's attempt to recover assigned first-party no-fault benefits from an automobile insurance company. The main issue decided in this case was whether the plaintiff failed to appear for duly scheduled examinations under oath, which resulted in the defendant's motion for summary judgment dismissing the complaint being granted by the Civil Court of the City of New York, Kings County. The holding of this case was that the order granting the defendant's motion for summary judgment dismissing the complaint was affirmed, with $25 costs. This decision was based on the plaintiff's failure to appear for examinations under oath, as discussed in a related case, Pavlova, as Assignee of Scurry, Kevin v State Farm Mut. Auto. Ins. Co.

The court considered the fact that the plaintiff, a provider seeking first-party no-fault benefits, failed to appear for scheduled examinations under oath (EUOs) as requested by the defendant, an insurance company. The main issue was whether the defendant had provided sufficient proof that the plaintiff had failed to appear for the EUOs, and whether the defendant was required to provide objective reasons for requesting the EUOs in order to establish entitlement to summary judgment. The court held that the proof submitted by the defendant was sufficient to demonstrate that the plaintiff had failed to appear for the EUOs, and that the defendant was not required to set forth objective reasons for requesting the EUOs in order to establish entitlement to summary judgment. Therefore, the court affirmed the order of the Civil Court granting the defendant's motion for summary judgment dismissing the complaint.

The court considered a case in which a medical professional corporation submitted claims for no-fault benefits to an insurance carrier but failed to appear for scheduled examinations under oath (EUOs). The insurer, Nationwide, sought a declaratory judgment claiming that the failure to appear for the EUOs breached a material condition precedent to coverage. The main issue decided by the court was whether an insurer could be precluded from asserting a defense based on the failure to appear at an EUO if the insurer did not timely deny coverage. The court held that such a defense is subject to preclusion and, since the insurer, Nationwide, failed to establish that it issued timely denials, its motion for summary judgment was denied, and the declarations were vacated. In summary, the court determined that the defense based on nonappearance at an EUO is subject to the preclusion remedy and that the insurer must establish that it issued timely denials. Since the insurer did not meet its burden of proof, the judgment was reversed, and the motion was denied.

The court considered an action by a provider to recover assigned first-party no-fault benefits. The main issue was whether the provider had failed to appear for duly scheduled examinations under oath (EUOs), which would justify the denial of the claim. The court held that the affidavits submitted by the defendant did not sufficiently demonstrate that the denial of the claim form had been timely mailed, and therefore, the defendant was not entitled to summary judgment. However, the affidavit submitted by the plaintiff failed to establish that the claim at issue had not been timely denied or that the denial of claim was conclusory, vague, or without merit as a matter of law. Therefore, the plaintiff's motion for summary judgment was properly denied. Ultimately, the court modified the order by providing that defendant's cross motion for summary judgment dismissing the complaint was denied.

The court considered the facts that the plaintiff, Noel Blackman, M.D., was seeking to recover first-party no-fault benefits as the assignee of Tyshaun Owens. The defendant, State Farm Mutual Automobile Insurance Company, moved for summary judgment to dismiss the complaint on the basis that Owens had failed to appear for scheduled examinations under oath (EUOs). The court found that the defendant had provided sufficient proof of the proper mailing of the EUO scheduling letters and that Owens had indeed failed to appear for the EUOs. As a result, the court affirmed the order to dismiss the complaint, with $25 costs. The main issue decided in this case was whether the defendant had provided sufficient proof of the proper mailing of the EUO scheduling letters and whether Owens had failed to appear for the EUOs. The holding of the case was that the defendant did indeed provide sufficient proof, and as a result, the court affirmed the order to dismiss the complaint.

The main issue decided in this case was whether the defendant was entitled to summary judgment dismissing the complaint and if the plaintiff was entitled to summary judgment in an action to recover assigned first-party no-fault benefits. The court held that the defendant's motion for summary judgment was denied and the plaintiff's cross motion for summary judgment was granted. The defendant's motion for summary judgment was based on an "affidavit" from the claim representative that was not properly sworn to before a notary public, and therefore could not be relied upon to raise an issue of fact as to the timeliness of the defendant's denial of claim forms. The court affirmed the order and concluded that the plaintiff was entitled to summary judgment based on the facts and evidence presented.

The court considered a motion for summary judgment by the plaintiff, who sought to recover assigned first-party no-fault benefits. Additionally, the defendant cross-moved for summary judgment to dismiss the complaint based on lack of medical necessity and the plaintiff not being entitled to be paid for services billed under a specific CPT code pursuant to the workers' compensation fee schedule. The main issue decided was whether the plaintiff was entitled to be paid for services billed under a specific CPT code and whether those services lacked medical necessity. The holding of the case was that the branch of the defendant's cross-motion seeking summary judgment to dismiss the complaint regarding the services billed under the CPT code was denied. The matter was remitted to the Civil Court for a determination of the branch of defendant's cross-motion seeking summary judgment dismissing the complaint for services billed under the CPT code on the ground that those services lacked medical necessity. The plaintiff's motion for summary judgment was properly denied as well.

The court considered the facts that the plaintiff, Pugsley Chiropractic, PLLC, was seeking to recover assigned first-party no-fault benefits from State Farm Mutual Automobile Insurance Co. The main issue decided was whether plaintiff had failed to appear for two scheduled examinations under oath (EUOs). The holding of the case was that defendant had sufficiently established plaintiff's failure to appear for the EUOs, and therefore the court granted defendant's motion for summary judgment dismissing the complaint and denied plaintiff's cross motion for summary judgment. The order was affirmed, and the court declined to review the defendant's argument that the appeal was untimely based on dehors-the-record allegations.

The court considered a case in which a provider was seeking to recover assigned first-party no-fault benefits. The main issue was whether the amounts the provider sought to recover for services rendered after April 1, 2013 exceeded the workers' compensation fee schedule. The court decided that since 11 NYCRR 65-3.8 (g) (1) (ii), effective April 1, 2013, provides that no payment shall be due for services that exceed the charges permissible under Insurance Law sections 5108 (a) and (b) and the regulations promulgated thereunder, the provider's claim was without merit. Therefore, the court affirmed the order that granted the defendant's motion for summary judgment dismissing the complaint and denied the plaintiff's cross motion for summary judgment.