No-Fault Case Law

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.

The case involved a dispute between Midwood Total Rehab, P.C., as Assignee of Dena Bellamy, and GEICO Insurance Company. GEICO moved to dismiss the complaint pursuant to CPLR 3216, as they had not been served with a notice of trial within 90 days of their 90-day written demand. The District Court denied the motion, but the Appellate Term, Second Department reversed the decision and granted GEICO's motion to dismiss the complaint. The court held that once a 90-day demand is served upon a plaintiff, the plaintiff must either comply with the demand by filing a notice of trial within 90 days, or move before the default date either to vacate the demand or to extend the 90-day period pursuant to CPLR 2004. Since the plaintiff failed to do any of these, and did not establish a justifiable excuse for its delay or a meritorious cause of action, the motion to dismiss the complaint pursuant to CPLR 3216 was granted.

The court considered the motion for summary judgment by the defendant to dismiss the complaint brought by Serge Chiropractic Services, P.C., as assignee of Carlos Canela, seeking to recover first-party no-fault benefits. The main issue was whether the insurance policy in question was procured by plaintiff's assignor by making a material misrepresentation as to his place of residence. The court reversed the order of the Civil Court, denying defendant's motion for summary judgment dismissing the complaint. The court's holding was based on similar reasons stated in a related case, Liliya Veksler, LCSW, P.C., as Assignee of Carlos Canela v Ameriprise Ins. Co., and concluded that the defendant's motion for summary judgment should be denied.

The main issue in this case was whether an insurance company was entitled to summary judgment dismissing a complaint brought by a healthcare provider to recover assigned first-party no-fault benefits, on the basis that the plaintiff's assignor had made a material misrepresentation as to his place of residence when procuring the insurance policy. The court considered the definition of a material misrepresentation and the evidence presented by the insurance company regarding its underwriting practices. The court found that the insurance company 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, the misrepresentation by the plaintiff's assignor was not considered material. As a result, the court reversed the order granting the insurance company's motion for summary judgment and denied the motion, allowing the complaint to proceed.

The court considered the appeal of a provider seeking to recover first-party no-fault benefits from an automobile insurance company. The main issue was whether the insurance company's motion for summary judgment, which was granted by the lower court, was justified on the grounds that the provider failed to appear for scheduled examinations under oath (EUOs). The court found that the insurance company's evidence was sufficient to establish that the provider had indeed failed to appear for the EUOs, and the provider failed to raise a triable issue of fact in response. As a result, the court affirmed the lower court's decision to grant the insurance company's motion for summary judgment and dismiss the provider's complaint.

The main issue in this case was whether the defendant was entitled to summary judgment to dismiss the complaint brought by Valdan Acupuncture, P.C. seeking to recover assigned first-party no-fault benefits. The defendant argued that the plaintiff's assignor had failed to appear for independent medical examinations (IMEs) and that the plaintiff was seeking to recover amounts in excess of what was allowed by the workers' compensation fee schedule. The court found that the defendant had established the assignor's failure to appear for the IMEs and that the defendant had properly mailed the IME scheduling letters to the assignor. As a result, the court reversed the order denying the defendant's motion for summary judgment and granted the motion to dismiss the claim seeking to recover $883.80. The remaining issues were remitted to the Civil Court for further determination.

The court considered whether Acupuncture Healthcare Plaza I, P.C. was entitled to recover assigned first-party no-fault benefits from State Farm Mutual Automobile Insurance Co. The main issue was whether the plaintiff failed to appear for duly scheduled examinations under oath (EUOs) and if this failure justified the denial of the motion for summary judgment. The court held 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 costs of $25. The decision was based on the plaintiff's failure to appear for the scheduled EUOs, which was consistent with a previous case, Charles Deng Acupuncture, P.C., as Assignee of Denard, Jean v State Farm Mut. Auto. Ins. Co. The decision was unanimous.

The court considered the facts of a case in which Sama Physical Therapy, P.C. filed a lawsuit to recover first-party no-fault benefits. The plaintiff moved for summary judgment, and the defendant cross-moved for summary judgment dismissing the complaint, claiming that the plaintiff's assignor had been injured during the course of employment. The Civil Court granted the defendant's cross-motion to hold the case in abeyance pending the filing of an application to the Workers' Compensation Board, with the condition that if the plaintiff failed to file proof of such application, the defendant's cross-motion for summary judgment dismissing the complaint would be granted. The plaintiff subsequently moved for leave to renew and, upon renewal, for summary judgement and to deny defendant's cross-motion for summary judgment. The court held that since the plaintiff did not demonstrate compliance with the prior order and a proper application to determine the parties' rights under the Workers' Compensation Law, the defendant's cross-motion for summary judgment dismissing the complaint was affirmed.