No-Fault Case Law

The case involved an appeal from a judgment of the Civil Court of the City of New York, Queens County, where a provider sought to recover assigned first-party no-fault benefits for medical supplies provided to an assignor. The defendant, GEICO Insurance Company, appealed a judgment awarding the plaintiff, Staten Island Advanced Surgical Supply, $1,698.30 after a nonjury trial. The main issue of the case was whether the defendant's expert medical witness should have been permitted to testify as to her opinion about the lack of medical necessity of the supplies at issue, even though she was not the person who had prepared the peer review report. The court held that the defendant's expert medical witness should have been allowed to testify, and therefore reversed the judgment and remitted the matter to the Civil Court for a new trial.

The case involved an appeal from an order of the Civil Court of the City of New York, Kings County, that granted the defendant's motion for summary judgment dismissing the complaint brought by a provider to recover assigned first-party no-fault benefits. The main issue was whether the defendant demonstrated that it was entitled to summary judgment dismissing the complaint, as the plaintiff's assignor had failed to appear for duly scheduled examinations under oath. The court found that the defendant had failed to demonstrate this entitlement and that the EUO requests had been sent more than 30 days after the defendant had received the bills, making them nullities with respect to those bills. As a result, the branches of the defendant's motion seeking summary judgment dismissing those portions of the complaint should have been denied. The holding of the case was that the order was modified by providing that the branches of the defendant's motion seeking summary judgment dismissing so much of the complaint as sought to recover on bills received by the defendant between January 26, 2012, and March 8, 2012 are denied.

The court considered the fact that plaintiff, Z. M. S. & Y Acupuncture, P.C., was seeking to recover assigned first-party no-fault benefits from defendant, GEICO General Insurance Company. The main issue was whether defendant had fully paid plaintiff for the services rendered in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors. Defendant demonstrated that it had fully paid plaintiff for the services at issue, and as plaintiff failed to rebut defendant's showing, the court held that the branches of defendant's cross motion seeking summary judgment dismissing so much of the complaint as sought to recover for services billed under certain CPT codes should have been granted. Therefore, the order, insofar as appealed from, was reversed, and the branches of defendant's cross motion seeking summary judgment dismissing so much of the complaint as sought to recover for services billed under certain CPT codes were granted.

The main issues in this case were whether the plaintiff had failed to appear for examinations under oath and whether he had failed to provide requested verification, as claimed by the defendant. The court reversed the order granting the defendant's motion for summary judgment and denying the branch of the defendant's motion seeking summary judgment dismissing the complaint on the ground that the plaintiff had failed to appear for examinations under oath. The court found that the defendant had failed to submit proof by someone with personal knowledge attesting to the plaintiff's failure to appear for examinations under oath. As a result, the branch of the defendant's motion seeking summary judgment dismissing the complaint on the ground that the plaintiff had failed to appear for duly scheduled examinations under oath was denied. The court remitted the matter to determine the undecided branch of the defendant's motion, seeking summary judgment dismissing the complaint on the ground that the plaintiff had failed to provide requested verification.

The court considered a case where a provider sought to recover assigned first-party no-fault benefits, and the main issue was whether the defendant received timely notice of the accident. The court ultimately affirmed the order of the Civil Court, which denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment dismissing the complaint. The holding of the case was that the defendant had not received timely notice of the accident, and therefore the plaintiff's motion was denied and the defendant's motion was granted.

The relevant facts that the court considered in this case are that the plaintiff, a provider, was seeking to recover assigned first-party no-fault benefits from the defendant, an insurance company. The plaintiff's motion for summary judgment was denied, and the defendant's cross motion for summary judgment was granted by the Civil Court on the basis that the defendant had not received timely notice of the accident. The main issue decided by the court was whether the proof submitted by the defendant was sufficient to give rise to a presumption that the denial of claim forms had been properly mailed. The holding of the case was that 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 was affirmed. The court found that the proof submitted by the defendant was sufficient, and declined to consider any arguments raised by the plaintiff for the first time on appeal.

The court considered a case in which a provider was seeking to recover assigned first-party no-fault benefits. The defendant argued that they had either paid the plaintiff for the services at issue in accordance with the workers' compensation fee schedule or had denied the claims on the ground of lack of medical necessity. The main issue decided was that defendant's motion for summary judgment dismissing the complaint was denied, but the only remaining issues for trial were medical necessity and the reduction of plaintiff's claims in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors. The holding of the court was that the branches of defendant's motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the unpaid portion of claims for services rendered from specific dates were granted, as defendant demonstrated that it had fully paid plaintiff for the services in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors.

The court considered an appeal from an order of the Civil Court of the City of New York, which denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant's cross motion for summary judgment dismissing the complaint should be denied. The holding of the case was that the defendant's cross motion for summary judgment dismissing the complaint is denied.

The main issue in this case was whether the defendant insurance company was entitled to summary judgment dismissing the complaint by a provider seeking to recover assigned first-party no-fault benefits. The court considered whether the affidavits submitted by the defendant sufficiently set forth a standard office practice or procedure that would ensure that the denial of claim form had been timely mailed, as well as whether the plaintiff's affidavit failed to establish that the claim at issue had not been timely denied. The court held that the defendant's cross motion for summary judgment dismissing the complaint is denied, as the defendant did not demonstrate that it is not precluded from asserting its proffered defense, and the plaintiff's motion for summary judgment was properly denied. Therefore, the order was modified to provide that the defendant's cross motion for summary judgment dismissing the complaint is denied.

The court considered an appeal from a denial of a motion for summary judgment in a case involving a provider seeking to recover first-party no-fault benefits. The main issue at hand was whether the defendant's motion papers established the proper mailing of the denial of claim forms and whether the amount sought to be recovered for services rendered was in excess of the workers' compensation fee schedule. The court ultimately held that the defendant had made a prima facie showing that the amount sought by the plaintiff was in excess of the fee schedule, and the plaintiff failed to present evidence to raise a triable issue of fact in opposition. Therefore, the order was reversed and the motion seeking summary dismissal of the complaint was granted.