No-Fault Case Law

The relevant facts considered by the court were that FEMA Medical Supply, Inc. sought to recover first-party no-fault benefits from Country-Wide Insurance Company. FEMA appealed the denial of their motion for summary judgment. The main issue decided was whether FEMA had established its entitlement to summary judgment by demonstrating that its bills were submitted to the insurer and either not paid or denied within the requisite 30-day period. The holding of the court was that FEMA failed to establish, as a matter of law, that it had mailed its bills to the defendant, and therefore the order denying their motion for summary judgment was affirmed.

The main issues decided in this case were whether a provider could recover assigned first-party no-fault benefits, based on the timely submission of claim forms, and whether the defendant had properly denied the claims at issue. The court considered the evidence of the plaintiff's submission of the claim forms and the defendant's receipt of those claim forms, based on standard mailing practices and procedures. The holding of the court was that the defendant had demonstrated it received the claim forms long after the plaintiff claimed to have mailed them, which raised a triable issue of fact as to whether the plaintiff's practices and procedures resulted in the timely mailing of the claim forms to the defendant. Therefore, the plaintiff was not entitled to summary judgment on the second through fourth causes of action, and the motion for summary judgment was denied.

The court considered the fact that defendant failed to establish the timely and proper mailing of the independent medical examination (IME) scheduling letters to the plaintiff's assignor. Defendant's moving papers stated that the IME scheduling letters were sent to the assignor at an address different from the one indicated by the plaintiff's NF-3 form, and there was nothing in the record to suggest that the plaintiff's assignor was represented by the attorney to whom copies of the IME scheduling letters were sent. The main issue decided was whether the defendant had properly scheduled the IMEs, and the court held that the defendant's moving papers failed to demonstrate that the IMEs had been properly scheduled, and therefore the defendant was not entitled to summary judgment dismissing the complaint. The order denying defendant's motion for summary judgment was affirmed.

The relevant facts of the case include a dispute between Mind & Body Acupuncture, P.C. and Allstate Insurance Company over first-party no-fault benefits. The main issue decided by the court was whether the amounts sought to be recovered by Mind & Body Acupuncture, P.C. for services rendered prior to April 1, 2013 were in excess of the workers' compensation fee schedule. The holding of the case was that the defendant's cross motion for summary judgment dismissing the complaint was denied, as the defendant did not sufficiently demonstrate that the denial of claim forms had been timely mailed and that the claims at issue had not been timely denied. Additionally, the court found that the affidavit submitted by the plaintiff failed to establish that the claims at issue had not been timely denied or that the denial of claim forms issued by the defendant were conclusory, vague or without merit as a matter of law.

The court considered a provider's action to recover assigned first-party no-fault benefits, where the defendant had moved for summary judgment to dismiss the complaint on the grounds that the plaintiff had failed to appear for duly scheduled examinations under oath. The main issue decided was whether the plaintiff's failure to appear for scheduled examinations under oath justified the defendant's motion for summary judgment to dismiss the complaint. The holding of the court was that the order granting the defendant's motion for summary judgment to dismiss the complaint was affirmed, with $25 costs. This decision was based on the reasoning stated in the case Greenway Med. Supply Corp. v American Tr. Ins. Co., where a similar decision had been made.

The relevant facts in the case were that Big Apple Ortho Products, Inc. brought an action to recover assigned first-party no-fault benefits. Allstate Insurance Company moved for summary judgment, claiming that Big Apple Ortho had failed to appear for scheduled examinations under oath. The main issue decided by the court was whether defendant Allstate had sufficiently demonstrated that it was not precluded from asserting its defense. The holding of the court was that Allstate did not demonstrate that it was not precluded from asserting its proffered defense, and therefore was not entitled to summary judgment dismissing the complaint. The court reversed the order granting Allstate's motion for summary judgment, with the costs of $30, and denied the motion for summary judgment dismissing the complaint.

The court considered the fact that the defendant had fully paid the plaintiff for services rendered prior to April 1, 2013, in accordance with the workers' compensation fee schedule. The main issue decided was that the proof submitted by the defendant was sufficient to demonstrate that they had properly used the workers' compensation fee schedule to determine the amount which the plaintiff was entitled to receive for the services at issue. The holding of the court was that the order granting the defendant's motion for summary judgment dismissing the complaint was affirmed, with $25 costs.

The court considered the timely mailing of examination under oath (EUO) and independent medical examination (IME) scheduling letters, as well as the failure of the plaintiff and the plaintiff's assignor to appear for the scheduled EUOs and IMEs. The main issue decided was whether the defendant had established that the EUO and IME scheduling letters had been timely mailed, and whether the plaintiff and the plaintiff's assignor had failed to appear for the scheduled EUOs and IMEs. The court held that the defendant had indeed established that the scheduling letters were timely mailed and that the plaintiff and plaintiff's assignor had failed to appear for the scheduled EUOs and IMEs. Therefore, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The court considered whether the defendant's motion for summary judgment dismissing the complaint should be granted. The main issue decided was whether the defendant had established the timely mailing of its denials and if the defendant was entitled to judgment on the claim for a bill of services rendered on August 23, 2012. The court held that the defendant had fully paid the plaintiff for services rendered on August 23, 2012 in accordance with the workers' compensation fee schedule, and therefore granted the defendant's motion to dismiss that part of the complaint. However, the court also held that the defendant failed to establish that the initial and follow-up letters scheduling independent medical examinations had been timely mailed, and consequently, the defendant was not entitled to summary judgment dismissing the remainder of the complaint. Therefore, the court modified the order to grant the defendant's motion for summary judgment in part, while denying it in part.

The main issues in this case are whether the defendant's proof sufficiently established proper mailing of the EUO scheduling letters and whether the plaintiff failed to appear for the scheduled EUOs. The court considered the evidence presented by both parties and determined that defendant's proof was sufficient to establish proper mailing of the EUO scheduling letters and that the plaintiff had indeed failed to appear for the scheduled EUOs. The holding of the case was that the order of the Civil Court, which granted the defendant's motion for summary judgment dismissing the complaint, was affirmed. Therefore, the defendant succeeded in their motion to dismiss the complaint based on the plaintiff's failure to appear for the scheduled EUOs.