No-Fault Case Law

The relevant facts considered by the court were the denial of plaintiff's motion for summary judgment and the granting of defendant's cross motion for summary judgment dismissing the complaint. The main issue decided by the court was whether the provider was entitled to recover assigned first-party no-fault benefits, and the holding of the court was that the order denying plaintiff's motion and granting defendant's cross motion was affirmed. The court referenced a similar case, MT Servs. P.T., P.C., as Assignee of Richardson Steven v Country-Wide Ins. Co., and based its decision on the reasons stated in that case. Therefore, the court affirmed the decision of the Civil Court to deny the plaintiff's motion and to grant the defendant's cross motion for summary judgment.

The court considered the fact that the plaintiff, MT Services P.T., P.C., was seeking to recover assigned first-party no-fault benefits and had moved for summary judgment, while the defendant, Country-Wide Ins. Co., had cross-moved for summary judgment dismissing the complaint. The main issue decided was whether the defendant had timely mailed initial and follow-up requests for written verification, and whether the plaintiff had provided the requested verification to the defendant prior to the commencement of the action. The holding of the case was that the defendant had indeed established that it had timely mailed initial and follow-up requests for written verification, and as the plaintiff did not show that the verification had been provided to the defendant prior to the commencement of the action, the 30-day period within which the defendant was required to pay or deny the claims did not begin to run. Therefore, the order denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint was affirmed.

The case involves a dispute between Active Chiropractic, P.C. and Country-Wide Ins. Co., regarding the recovery of assigned first-party no-fault benefits. Active Chiropractic, P.C. appealed from an order of the Civil Court that denied the branch of its motion seeking summary judgment to recover a claim for the sum of $290.64, and granted the branch of defendant's cross-motion seeking summary judgment dismissing that portion of the complaint. The main issue decided was whether defendant had timely mailed initial and follow-up requests for written verification after receiving the $290.64 claim, and whether plaintiff provided the verification requested by defendant prior to the commencement of the action. The court held that defendant established that it had timely mailed initial and follow-up requests for verification, and that plaintiff did not provide the verification requested by defendant prior to the commencement of the action, so the 30-day period within which defendant was required to pay or deny the claim did not begin to run. The appellate court affirmed the order.

The court considered the facts of a nonjury trial in an action by a medical care provider to recover assigned first-party no-fault benefits. The court determined that the defendant demonstrated, prima facie, through credible expert witness testimony, that the medical services at issue had not been medically necessary and that the plaintiff had not rebutted the defendant's case. Despite this, the Civil Court awarded judgment to the plaintiff in the principal sum of $3,119.44, which contradicted the court's findings. The main issue decided was that a new trial is warranted due to the contradiction between the Civil Court's findings and its award. The holding of the case was that the judgment is reversed and the matter is remitted to the Civil Court for a new trial.

The court considered the fact that the plaintiff was seeking to recover assigned first-party no-fault benefits, but the defendant had denied claims on the ground that the plaintiff's assignor had failed to attend independent medical examinations (IMEs). The main issue decided was whether the defendant had demonstrated its entitlement to summary judgment based on the failure of the plaintiff's assignor to attend IMEs. The holding of the case was that the affidavit submitted by the defendant in support of its motion did not sufficiently set forth a standard office practice or procedure that would ensure that its letters scheduling the plaintiff's assignor for IMEs had been properly mailed. Therefore, the defendant did not demonstrate its entitlement to summary judgment, and the branch of the defendant's motion seeking summary judgment was denied.

The court considered that the defendant failed to establish that the plaintiff was not entitled to no-fault insurance benefits from the Motor Vehicle Accident Indemnification Corporation. Plaintiff was seeking a declaration that the Corporation was required to provide him with such benefits. The main issue was whether plaintiff was a qualified person for the purposes of receiving basic economic loss arising out of the use or operation of an uninsured motor vehicle. The Corporation argued that plaintiff was not entitled to the benefits because he was not the owner of the uninsured vehicle. The court held that, since there was conflicting evidence of ownership, the issue must be resolved by a trier of fact. The burden never shifted to plaintiff, and the denial of the motion for summary judgment was required regardless of the sufficiency of the opposing papers.

The court considered the fact that Island Life Chiropractic, as the assignee of Gilbert, Anthony, had moved for summary judgment to recover assigned first-party no-fault benefits, while the defendant, National Liability & Fire Insurance Company, had cross-moved for summary judgment to dismiss the complaint based upon plaintiff's assignor's failure to appear for independent medical examinations (IMEs). The main issue decided was whether or not the defendant's cross motion for summary judgment dismissing the complaint should be granted, and the court held that the defendant's cross motion for summary judgment dismissing the complaint was denied. The court also found that the defendant failed to demonstrate that the letters scheduling the IMEs of plaintiff's assignor had been properly mailed, and the plaintiff failed to demonstrate its entitlement to summary judgment, as it failed to establish that the claims at issue had not been denied timely or that defendant had issued timely denial of claim forms that were conclusory, vague, or without merit as a matter of law. Therefore, the order was modified to provide that defendant's cross motion for summary judgment dismissing the complaint was denied.

The relevant facts considered in this case were that Compas Medical, P.C. filed a lawsuit to recover first-party no-fault benefits and the defendant, Allstate Insurance Company, moved for summary judgment to dismiss the complaint based on the plaintiff's assignor's failure to attend scheduled examinations under oath. The main issue decided was whether the defendant's affidavit sufficiently demonstrated that their denial of claim forms had been timely mailed. The holding of the case was that the order granting the defendant's motion for summary judgment was reversed, and the defendant's motion for summary judgment was denied, as the defendant did not demonstrate its entitlement to summary judgment.

The court considered the issue of whether an action by providers to recover assigned first-party no-fault benefits was premature because the plaintiffs had failed to provide requested verification. The main issue was whether the plaintiffs had provided all of the requested verification, as required by law. The court held that the action was indeed premature, as the record demonstrated that the defendant had not received all of the requested verification. Therefore, the court affirmed the order of the Civil Court, which had granted the defendant's cross motion for summary judgment dismissing the complaint.

The relevant facts considered by the court were that Jamaica Medical Plaza was seeking to recover first-party no-fault benefits and the issue in question was the medical necessity of the services provided. The court found that the testimony of the defendant's expert witness, who was not the expert who prepared the peer review report, should have been permitted to testify about the lack of medical necessity of the services. The court reversed the judgment and remitted the case to the Civil Court for a new trial, stating that the expert witness's testimony should be limited to the basis for the denial as set forth in the original peer review report. The holding of the case was that the judgment was reversed and a new trial was ordered.