No-Fault Case Law

The relevant facts of the case included an action for the payment of no-fault benefits and an allegation that the claims were not paid by the defendant, despite being submitted in accordance with the relevant fee schedule. The main issue of the case was the defendant's motion seeking an order for summary judgment and dismissal of the action, based on the argument that they had paid the claims according to the fee schedule and therefore established its fee schedule defense. The holding of the case was that the defendant's motion for summary judgment was granted, with the court stating that failure to deny or pay a claim as required by statutory schedule precluded the defendant from interposing a statutory exclusion defense. Similarly, compliance with the technical requirements of the no-fault law were held as preconditions for payment to a medical provider.

The court considered the fact that Acupuncture Now, P.C. was seeking to recover assigned first-party no-fault benefits from Hereford Insurance Co. following a motor vehicle accident. Hereford Insurance Co. moved for summary judgment to dismiss the complaint on the basis that the insurance policy for the vehicle involved in the accident had been cancelled prior to the accident, and the court upheld this. The main issue decided was whether the cancellation of the insurance policy was effective, and the court held that it was. The court found that the vehicle involved in the accident was a "for hire" vehicle and that the policy insuring the vehicle had been properly and validly cancelled in compliance with Vehicle and Traffic Law. The sending of a notice by the insurance company informing the policyholder of the intended cancellation did not render the cancellation ineffective. Therefore, the court affirmed the order granting defendant's motion for summary judgment dismissing the complaint.

The main issue of the case was whether the plaintiff, TAM Medical Supply Corp., had timely submitted its bills to defendant, Travelers Insurance Company, in an action to recover assigned first-party no-fault benefits. The court considered the defendant's motion for summary judgment to dismiss the complaint on the grounds that the plaintiff had failed to provide requested verification. The court held that while it is the plaintiff's burden at trial to prove its prima facie case, it is the defendant's burden at trial to show it has a meritorious defense and that such a defense is not precluded. Therefore, the court determined that it was improper for plaintiff to have to prove whether it fully complied with defendant's verification requests. The court ultimately affirmed the order with modification and declined plaintiff's request to make a finding in its favor.

The relevant facts considered by the court in this case involved a medical provider seeking to recover first-party no-fault benefits. The issues decided included whether the medical provider was entitled to additional attorney's fees after a final appellate decision in its favor had been made and whether the issues presented in the case were novel or unique enough to warrant an award of excess attorney's fees. The holding of the case was that the court found the issue of whether an affidavit of service from a third-party billing company is sufficient to establish a medical provider's prima facie case to be sufficiently novel so as to warrant consideration of additional attorney's fees in accordance with relevant regulations. As such, a hearing was warranted to determine additional attorney's fees. The decision also noted that the appropriateness of an increased attorney's fee in excess of $850 would be determined based upon applicable considerations of a reasonable fee.

The court considered a motion to vacate a default judgment entered upon the defendant's failure to appear or answer in an action by a provider to recover first-party no-fault benefits. The main issue decided was whether the defendant had a reasonable excuse for the default and the existence of a meritorious defense in order to vacate the default judgment. The court held that the defendant did not provide a "detailed and credible" explanation of the law office failure that had caused the default, and therefore, their conclusory claim of law office failure did not rise to the level of a reasonable excuse. The Civil Court did not improvidently exercise its discretion in denying the defendant's motion to vacate the default judgment.

Facts: Allstate Insurance Company appealed the denial of their petition to vacate a master arbitration award in favor of Longevity Medical Supply, Inc., which awarded Longevity unpaid no-fault benefits in the amount of $1,080.00 and attorney's fees. The arbitration award was based on Longevity's response to verification demands sent by Allstate. Issues: The main issue was whether Allstate had demonstrated sufficient grounds to vacate the master arbitrator's award, and if the master arbitrator's legal analysis of the arbitrator's determination was within the scope of her authority. Holding: The appellate court affirmed the order and judgment, stating that Allstate had failed to demonstrate a ground pursuant to CPLR 7511 to vacate the master arbitrator's award. The court found that there was a rational basis for the master arbitrator's finding that Longevity had sufficiently responded to the verification demands, and that Allstate was required but failed to rebut the presumption of receipt of the verification or show that it timely acted upon receipt. The court held that the master arbitrator's legal analysis was well within her authority and that applying the law to a given set of facts is within the province of a master arbitrator, even if the conclusion differs from that of the arbitrator.

The court considered whether plaintiff's assignor had failed to appear for duly scheduled independent medical examinations (IMEs) and whether plaintiff had made a prima facie showing of entitlement to summary judgment. The main issue decided was whether plaintiff's motion for summary judgment should be granted, and if defendant's cross motion for summary judgment dismissing the complaint should be denied. The court held that plaintiff had failed to establish that its claims had not been timely denied, and that defendant is not entitled to summary judgment dismissing the complaint based on plaintiff's assignor's failure to appear for IMEs. Therefore, the court modified the order by providing that plaintiff's motion for summary judgment is denied, and affirmed the order without costs.

The relevant facts that the court considered in this case were a dispute between Motionpro Physical Therapy and Hereford Insurance Co. regarding first-party no-fault benefits. The main issues decided related to whether plaintiff Motionpro had made a prima facie showing of its entitlement to summary judgment, and whether defendant Hereford had issued timely denial of claim forms. The holding of the case was that the defendant had demonstrated that plaintiff's assignor had failed to appear for duly scheduled independent medical examinations, and that defendant had timely denied the claim underlying the second cause of action on that ground. As a result, the motion for summary judgment by plaintiff was denied and the branch of the defendant's cross-motion seeking summary judgment dismissing the second cause of action was granted.

The court considered the fact that the plaintiff, Active Chiropractic, P.C., filed a lawsuit to recover first-party no-fault benefits, and the defendant, Allstate Insurance, argued that the action was barred by a previous declaratory judgment order. The previous order declared that the defendant was not obligated to provide coverage for the claims arising from the accident in question, and that the plaintiff and its assignor were not entitled to reimbursement for services rendered. The main issue decided was whether the defendant's failure to raise the defense of res judicata in its answer was grounds for dismissing the plaintiff's motion for summary judgment. The holding of the case was that the order granting the plaintiff's motion was reversed, the defendant's answer was deemed amended to assert the affirmative defense of res judicata, and the plaintiff's motion for summary judgment was denied while the defendant's cross motion, in effect, for summary judgment dismissing the complaint was granted.

The relevant facts considered by the court in this case were that plaintiff Active Chiropractic, P.C. sought to recover first-party no-fault benefits from Allstate Insurance. Defendant Allstate Insurance argued that the action was barred by a prior Supreme Court declaratory judgment order, which declared that Allstate was not obligated to provide coverage for the accident in question, and that the plaintiff and its assignor were not entitled to reimbursement for services rendered. The main issue decided by the court was whether the defense of res judicata could be raised by the defendant, as it had not been initially asserted in their answer. The holding of the case was that the order granting the plaintiff's motion for summary judgment was reversed, defendant's answer was deemed amended to assert the affirmative defense of res judicata, and plaintiff's motion for summary judgment was denied while defendant's cross motion for summary judgment dismissing the complaint was granted.