No-Fault Case Law

The main issue in this case was whether a provider could recover assigned first-party no-fault benefits when they had failed to appear for duly scheduled examinations under oath by the insurance company. The court considered the fact that the plaintiff had failed to appear for the scheduled examinations under oath, and defendant's cross motion for summary judgment dismissing the complaint was granted. The main holding of the court was that the order denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment dismissing the complaint was affirmed, with $25 costs. The court's decision was based on the fact that the plaintiff's failure to appear for the examinations under oath was a valid reason for denying their motion for summary judgment.

The court considered the fact that the plaintiff, Gentlecare Ambulatory Anesthesia Services, had moved for summary judgment to recover first-party no-fault benefits, and that the defendant, GEICO Ins. Co., had cross-moved for summary judgment to dismiss the complaint on the basis that the plaintiff had failed to appear for scheduled examinations under oath. The main issue decided was whether the plaintiff's failure to appear for scheduled examinations under oath justified the dismissal of their complaint. The holding of the case was that 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, with $25 in costs. The decision was based on similar reasoning as another case, Gentlecare Ambulatory Anesthesia Servs. etc., as Assignee of Saint-Louis, Lydia v GEICO Ins. Co., which was decided herewith.

The main issue in the case was whether the plaintiff had failed to appear for scheduled examinations under oath, as alleged by the defendant, and if so, whether that failure justified the denial of no-fault benefits. The court considered the facts of the case, including the plaintiff's motion for summary judgment and the defendant's cross motion for summary judgment dismissing the complaint. The court ultimately held that the order denying the plaintiff's motion and granting the defendant's cross motion was affirmed, and that the plaintiff had indeed failed to appear for the scheduled examinations under oath, justifying the denial of no-fault benefits.

The court considered the fact that the plaintiff had failed to appear for duly scheduled examinations under oath (EUOs), as well as the proof submitted by the defendant in support of its cross motion, which demonstrated that the EUO scheduling letters and denial of claim form had been timely mailed and that plaintiff had failed to appear for the EUOs. The main issue decided was whether the defendant had established its entitlement to summary judgment by demonstrating that it twice duly demanded an EUO from the plaintiff, that the plaintiff failed to appear, and that the defendant issued a timely denial of the claim. The holding of the case was that the defendant had met its burden to establish entitlement to summary judgment, and the court affirmed the order denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint.

The main issue in this case was whether the provider, Gentlecare Ambulatory Anesthesia Services, was entitled to recover assigned first-party no-fault benefits from GEICO Ins. Co. The court considered the fact that the plaintiff had failed to appear for duly scheduled examinations under oath, which was the grounds on which the defendant filed a cross motion for summary judgment dismissing the complaint. The court ultimately affirmed the order of the Civil Court, denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint. The holding of the case was that the plaintiff's failure to appear for scheduled examinations under oath provided valid grounds for the defendant to dismiss the complaint, and therefore the provider was not entitled to recover the no-fault benefits from the defendant.

The main factual scenario of the case was the issuance of a large number of personal automobile insurance policies that included a Mandatory Personal Injury Protection Endorsement. As well, there was a refusal by the supplier of the Kit to disclose its acquisition costs and other pricing information for 120 days under the rule in the statute. The main issue was the legality of such refusal, as well as the determination to deny the claims by the arbitrator as incorrect under the 120-day rule. The court held that the master arbitrator properly exercised his authority and limited his review to whether the awards were incorrect as a matter of law and whether the arbitrator had misapplied the 120-day rule. Therefore, the court affirmed the denial of the petition to vacate the master arbitration awards.

The Appellate Division, First Department, considered the case of Matter of Country-Wide Ins. Co. v Bay Needle Care Acupuncture, P.C., which involved an appeal related to a dispute between an insurance company and a health care provider. The health care provider, as assignee of an individual injured in a motor vehicle accident, sought reimbursement for health care services provided. The insurance company raised a Mallela defense, asserting that it could withhold payment due to fraudulent incorporation of the health care provider. After a hearing, an arbitrator and the master arbitrator both found in favor of the health care provider. The insurance company appealed, arguing that the standard of proof applied was incorrect and that the arbitrator's determination was irrational. The Appellate Division affirmed the judgment, and also remanded for a determination of the health care provider's reasonable attorney's fees for the appeal. The court clarified that Supreme Court has authority to award attorneys fees in appeals from master arbitration awards, as provided by relevant laws and regulations.

In the case of Vitality Chiropractic, P.C. v. Countrywide Insurance, the court considered an order granting the defendant's posttrial motion to toll the accrual of no-fault statutory prejudgment interest based upon the plaintiff's delay in the prosecution of the action, and held that interest shall accrue from December 18, 2014. The main issue decided in this case was the accrual date for no-fault statutory prejudgment interest. The holding of the court was that the order was modified to provide that no-fault statutory prejudgment interest shall accrue from January 23, 2014, rather than the original date of December 18, 2014. The court's decision was affirmed, without costs. The reasons for the modification were stated in a related case, and all the judges concurred with the decision.

The main issues that were decided in this case were whether the defendant was entitled to summary judgment dismissing the complaint based on the plaintiff's assignor's failure to appear for independent medical examinations (IMEs) and the fee schedule defense, and whether the plaintiff was entitled to summary judgment for the recovery of assigned first-party no-fault benefits. The court considered the evidence provided by both parties, including affidavits, to determine whether the defendant was precluded from asserting its defenses and if the claims at issue had been timely denied. The court held that the defendant's cross motion for summary judgment dismissing the complaint was denied, as the defendant did not sufficiently demonstrate that it was not precluded from asserting its defenses and that the claims had been timely denied. Therefore, the order denying plaintiff's motion for summary judgment was affirmed, with the defendant not entitled to summary judgment dismissing the complaint.

The court considered whether the defendant's motion for summary judgment dismissing the complaint on the ground that the action was premature due to the plaintiff's failure to provide requested verification should be granted. The main issue decided was whether the defendant's proof was sufficient to demonstrate that it had properly mailed the verification requests and had not received the requested verification, making the action premature. The holding of the court was that the defendant's motion for summary judgment dismissing the complaint was denied, as there was a triable issue of fact as to whether the action was premature. Therefore, the order was modified to provide that defendant's motion for summary judgment dismissing the complaint was denied.