No-Fault Case Law

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.

The court in this case considered whether a provider was entitled to recover assigned first-party no-fault benefits when the plaintiff failed to appear for scheduled examinations under oath (EUOs). The main issue decided was whether the defendant had provided sufficient proof to give rise to a presumption that the EUO scheduling letters and the denial of claim forms had been properly mailed. The court found that the proof submitted by the defendant was indeed sufficient, and therefore granted the defendant's cross motion for summary judgment dismissing the complaint. As a result, the order denying plaintiff's motion for summary judgment was affirmed.

The court considered the denial of summary judgment to the appellant and the granting of summary judgment to the respondent in a case where a healthcare provider was seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the respondent had issued an insurance policy covering the subject loss, and the court held that the proof submitted by the respondent was sufficient to demonstrate that no policy had been issued. Therefore, the court affirmed the order denying the appellant's motion for summary judgment and granting the respondent's cross motion for summary judgment dismissing the complaint.

The relevant facts considered in this case involved a provider seeking to recover assigned first-party no-fault benefits. The court considered the denials of claim forms submitted by the defendant, as well as the timeliness of these denials. The main issues decided involved whether the plaintiff's motion for summary judgment on the first, second, and fourth through sixth causes of action, as well as a portion of the third cause of action seeking to recover $295.68, should be granted. Additionally, the court had to determine the validity of the denials of claim forms submitted by the defendant. The holding of the case was that the defendant did not demonstrate that it was not precluded from asserting its defense, and therefore, it was not entitled to summary judgment dismissing certain causes of action and part of the third cause of action. The court also found that the plaintiff's motion seeking summary judgment on the relevant causes of action was properly denied due to the failure to establish that the claims at issue had not been timely denied.