No-Fault Case Law

The case involved a dispute over the payment for acupuncture services billed under certain CPT codes by Z.M.S. & Y Acupuncture, P.C. Defendant, GEICO General Insurance Company, cross-moved for summary judgment, arguing that it had fully paid the plaintiff in accordance with the workers' compensation fee schedule. The Civil Court had limited the issues for trial to the proper application of the fee schedule and the defendant appealed the denial of summary judgment dismissing the claims for services billed under certain CPT codes. The defendant was able to demonstrate that it had fully paid the plaintiff for some of the services in accordance with the fee schedule, but failed to establish, as a matter of law, that it had properly paid for services billed under a certain CPT code. The Appellate Term held that defendant's cross motion for summary judgment should have been granted as to some services, but not for others. Therefore, the order denying summary judgment was modified to grant the cross motion in part.

The court considered the fact that the plaintiff had failed to appear for scheduled examinations under oath (EUOs), which led to a motion for summary judgment by the defendant to dismiss the complaint. The main issue decided was whether the defendant's attorney's affirmation was sufficient to establish the plaintiff's failure to appear for the EUOs, and if the proof submitted by the defendant was enough to give rise to a presumption that EUO scheduling letters and the denial of claim forms had been properly mailed. The holding of the case was that the order granting the defendant's motion for summary judgment was affirmed, as the proof submitted was sufficient to establish the plaintiff's failure to appear for the EUOs and give rise to a presumption of proper mailing.

The relevant facts considered by the court in this case were that Right Aid Medical Supply Corp. was seeking to recover assigned first-party no-fault benefits from State Farm Mutual Automobile Insurance Co. State Farm moved for summary judgment, arguing that the action was premature because Right Aid had failed to provide requested verification. The main issue decided was whether the action was premature due to the failure to provide verification. The holding of the case was that there was a triable issue of fact as to whether the action was premature, as Right Aid submitted an affidavit from an employee that was sufficient to give rise to a presumption that the requested verification had been mailed to and received by State Farm. Therefore, the court reversed the order and denied State Farm's motion for summary judgment dismissing the complaint.

The main legal issues in this case revolved around a provider's attempt to recover first-party no-fault benefits from an insurance company. The court considered the provider's motion for summary judgment and the insurance company's cross motion for summary judgment dismissing the complaint. The court ultimately denied the provider's motion and granted the insurance company's cross motion, affirming the order. The holding of the case was that the provider was not entitled to recover the assigned first-party no-fault benefits from the insurance company. This decision was based on reasoning similar to that in a related case, MT Servs. P.T., P.C., as Assignee of Richardson Steven v Country-Wide Ins. Co. The order of the Civil Court of the City of New York, Queens County was affirmed, and the costs were set at $25.

The court considered an action by a provider to recover assigned first-party no-fault benefits. The plaintiff moved for summary judgment while the defendant cross-moved for summary judgment dismissing the complaint. The main issue at hand was the denial of the plaintiff's motion to recover claims for the sums of $246.40 and $985.60, which were granted in favor of the defendant's cross motion. The court affirmed the order in favor of the defendant, citing the reasons stated in a similar case, MT Servs. P.T., P.C., as Assignee of Richardson Steven v Country-Wide Ins. Co. The decision to affirm the order in favor of the defendant was made by the court.

The court considered a motion for summary judgment by the plaintiff, a provider seeking to recover first-party no-fault benefits, as well as a cross motion for summary judgment by the defendant seeking to dismiss the complaint. The main issue decided was whether the plaintiff was entitled to summary judgment and whether the defendant was entitled to dismiss the complaint. The court held that the order denying the plaintiff's motion and granting the defendant's cross motion was affirmed, with the defendant being awarded $25 in costs. The decision was consistent with a similar decision in another case, MT Servs. P.T., P.C, as Assignee of Richardson Steven v Country-Wide Ins. Co, which was decided in the same manner.

The court considered an appeal from an order of the Civil Court of the City of New York, Queens County, 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 provider was entitled to recover assigned first-party no-fault benefits, and the court held that the order denying the plaintiff's motion and granting the defendant's cross motion was affirmed, with $25 costs. The court also referred to a similar case to support their decision, and concluded that the plaintiff's remaining contention lacked merit.

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.