No-Fault Case Law

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.

The relevant facts considered by the court were that Easy Care Acupuncture, P.C. was seeking to recover assigned first-party no-fault benefits from 21 Century Advantage Ins. Co. The main issue decided was whether plaintiff's opposition to defendant's motion for summary judgment raised a triable issue of fact. The holding of the court was that the papers submitted by the plaintiff did not raise a triable issue of fact, and therefore the order granting defendant's motion for summary judgment dismissing the complaint was affirmed.

The court considered the dispute between Charles Deng Acupuncture, P.C. and Unitrin Auto and Home Insurance Company over first-party no-fault benefits. Charles Deng Acupuncture, P.C. moved for summary judgment, while Unitrin Auto and Home Insurance Company cross-moved for summary judgment dismissing the complaint. The main issue decided was whether the affidavit submitted by Unitrin Auto and Home Insurance Company was sufficient to demonstrate that the independent medical examination scheduling letters had been timely mailed. The court held that the affidavit submitted by Unitrin Auto and Home Insurance Company was indeed sufficient, and therefore affirmed the order, denying the branch of plaintiff's motion seeking summary judgment upon the second cause of action and granting the branch of defendant's cross motion seeking summary judgment dismissing that cause of action.

The court considered the untimeliness of the denial of claim forms with respect to the first four causes of action, as well as the propriety of the fee reductions in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors. The main issues decided were the timeliness of the denial of claim forms and whether the fee reductions were proper. The holding of the case was that the branches of the defendant's motion seeking summary judgment dismissing the first four causes of action were denied, as the denial of claim forms were untimely on their face and the fee reductions were found to be proper in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors.