No-Fault Case Law
Acupuncture Approach, P.C. v NY Cent. Mut. Fire Ins. Co. (2018 NY Slip Op 51601(U))
November 9, 2018
The court considered the fact that the plaintiff was seeking to recover assigned first-party no-fault benefits, and that the defendant had motioned for summary judgment, claiming that the plaintiff's assignor had failed to appear for independent medical examinations (IMEs). The plaintiff argued that the defendant did not mail the IME scheduling letters to the correct address, but the defendant demonstrated that the letters had been sent to the attorney representing the plaintiff's assignor. Additionally, the defendant provided proof that the assignor had indeed failed to appear for the IMEs. The main issue decided was whether the defendant had properly sent the IME scheduling letters and whether the plaintiff's assignor had failed to appear for the IMEs. The holding of the court was that the order granting the defendant's motion for summary judgment and dismissing the complaint, while denying the plaintiff's cross motion for summary judgment, was affirmed.
T & S Med. Supply Corp. v Travelers Ins. Co. (2018 NY Slip Op 51597(U))
November 9, 2018
The main issue in the case was whether the action by a medical supply corporation to recover assigned first-party no-fault benefits was premature because the plaintiff failed to provide requested verification. The defendant argued that the action was premature because the plaintiff had not provided the requested verification, and the Civil Court granted the defendant's motion for summary judgment dismissing the complaint. However, in opposition to the motion, the plaintiff submitted an affidavit from the owner, which gave rise to a presumption that the requested verification had been mailed to and received by the defendant. The court held that there was a triable issue of fact as to whether the action was premature, and therefore the order was reversed, and the defendant's motion for summary judgment dismissing the complaint was denied.
Acupuncture Now, P.C. v Tri State Consumers Ins. Co. (2018 NY Slip Op 51596(U))
November 9, 2018
The court considered whether a provider could recover first-party no-fault benefits when the assignor failed to appear for scheduled independent medical examinations (IMEs). The main issue was whether the defendant's proof sufficiently established the proper mailing of the IME scheduling letters and whether the assignor failed to appear for the scheduled IMEs. The court held that the defendant's proof did establish the proper mailing of the IME scheduling letters and the assignor's failure to appear for the scheduled IMEs. Therefore, the court affirmed the order, denying the plaintiff's motion for summary judgment and granting the defendant's cross-motion for summary judgment to dismiss the complaint.
Island Life Chiropractic Pain Care, PLLC v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51595(U))
November 9, 2018
The court considered that the plaintiff, Island Life Chiropractic Pain Care, PLLC, was seeking to recover assigned first-party no-fault benefits from the respondent, State Farm Mutual Automobile Ins. Co. The main issue decided was that the defendant's motion for summary judgment to dismiss the complaint was granted on the grounds that the plaintiff had failed to appear for duly scheduled examinations under oath. The holding of the case was that the order to grant the defendant's motion for summary judgment dismissing the complaint was affirmed, and the plaintiff was ordered to pay $25 in costs. The court cited a similar case, Island Life Chiropractic Pain Care, PLLC, as Assignee of Cooper, Kadeem v State Farm Mut. Auto. Ins. Co., in support of its decision.
Island Life Chiropractic Pain Care, PLLC v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51594(U))
November 9, 2018
The court considered a provider's attempt to recover assigned first-party no-fault benefits from an insurance company. The main issue at hand was whether the insurance company's motion for summary judgment, which was granted, dismissing the provider's complaint on the grounds of the provider's failure to appear for duly scheduled examinations under oath (EUOs), was appropriate. The court held that the insurer had provided sufficient proof demonstrating the provider's failure to appear for the EUOs, and that the insurer was not required to provide objective reasons for requesting the EUOs in order to establish its entitlement to summary judgment. As a result, the court affirmed the order granting the insurer's motion for summary judgment dismissing the complaint.
All Healthy Style Med., P.C. v 21st Century Ins. Co. (2018 NY Slip Op 51592(U))
November 9, 2018
The case involved a dispute over an insurance claim for first-party no-fault benefits, in which the plaintiff appealed an order granting the defendant's motion for summary judgment dismissing the complaint. The defendant argued that the plaintiff's assignor had made a material misrepresentation regarding his place of residence when procuring the insurance policy in question. The main issue decided was whether the misrepresentation was material, as the insurer would not have issued the policy if it had known the true facts. The court held that the defendant failed to establish as a matter of law that it would not have issued the policy in question if the correct information had been disclosed, and therefore did not demonstrate that the misrepresentation was material. As a result, the court reversed the order and denied the defendant's motion for summary judgment.
Active Care Med. Supply Corp. v Hartford Ins. Co. (2018 NY Slip Op 51591(U))
November 9, 2018
The court considered the fact that the Workers' Compensation Board had awarded workers' compensation benefits to the plaintiff's assignor for injuries sustained in the accident, leading to the claims at issue. The main issue decided was whether the lack of coverage defense could be raised without regard to the propriety or timeliness of an insurer's denial of claim form. The court held that the lack of coverage defense could be raised without regard to any issue as to the propriety or timeliness of an insurer's denial of claim form, citing previous case law to support this decision. Ultimately, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint, as the plaintiff failed to demonstrate the existence of a triable issue of fact.
Active Care Med. Supply Corp. v Hartford Ins. Co. (2018 NY Slip Op 51590(U))
November 9, 2018
The court considered the facts that the defendant had been awarded workers' compensation benefits for injuries sustained in an accident. The main issue decided was whether the defendant was entitled to coverage for no-fault benefits, given the workers' compensation award. The holding of the court was that the defendant had demonstrated there was no coverage for no-fault benefits due to the workers' compensation award, and therefore affirmed the dismissal of the complaint and denial of the plaintiff's cross motion for summary judgment.
LVOV Acupuncture, P.C. v Hereford Ins. Co. (2018 NY Slip Op 51589(U))
November 9, 2018
The court considered the facts of an action by healthcare providers seeking to recover first-party no-fault benefits, wherein the defendant insurance company had moved for summary judgment dismissing the complaint on the grounds that the insured vehicle was not involved in the accident. The main issue in the case was whether the insured vehicle was involved in the accident for which the plaintiffs were seeking benefits. The court ultimately affirmed the order granting the defendant's motion for summary judgment and denying the plaintiffs' cross-motion for summary judgment, holding that the insured vehicle was not involved in the alleged accident and therefore the plaintiffs were not entitled to the benefits they were seeking.
Gentlecare Ambulatory Anesthesia Servs. v GEICO Ins. Co. (2018 NY Slip Op 51588(U))
November 9, 2018
The case involved a medical service provider seeking first-party no-fault benefits from an insurance company. The plaintiff filed a motion for summary judgment, while the defendant filed a cross-motion for summary judgment, claiming lack of medical necessity. The court found that the defendant's submission of a sworn peer review report was enough to presume that the denial of claim form had been timely mailed. The plaintiff's opposition failed to sufficiently rebut the conclusions set forth in the peer review report. The court upheld the denial of the plaintiff's motion and granting of the defendant's cross motion. However, the court vacated an award of fees to the defense counsel, as the opportunity to be heard was not provided, and modified the order accordingly.