No-Fault Case Law

The main issue in this case was whether the plaintiff, Healthy Way Acupuncture, P.C., had failed to provide requested verification for a claim to recover assigned first-party no-fault benefits, which led to the dismissal of the complaint as premature. The court considered the follow-up verification requests issued by the defendant and determined that they were proper under the law. The court also acknowledged that any confusion on the part of the plaintiff as to what was being sought should have been addressed by further communication, not inaction. Ultimately, the court affirmed the order of the Civil Court, granting defendant's motion for summary judgment and dismissing the complaint, while also denying plaintiff's cross motion for summary judgment.

The relevant facts considered by the court were that the plaintiff, a provider seeking to recover assigned first-party no-fault benefits, had filed a motion for summary judgment, which was granted by the Civil Court. The defendant, an insurance company, had filed a cross motion for summary judgment to dismiss the complaint, which was denied. The main issue decided was whether the defendant's evidence was sufficient to establish that the plaintiff's assignor's alleged injuries did not arise from an insured incident so as to warrant the dismissal of the complaint. The holding of the court was that the defendant's evidence was insufficient to establish this as a matter of law and that there was a triable issue of fact, so the plaintiff was not entitled to summary judgment. The court modified the order to provide that the plaintiff's motion for summary judgment was denied, with the appellate judges concurring.

The court considered the motion for summary judgment by the defendant to dismiss the complaint on the grounds that the plaintiff's assignor failed to appear for independent medical examinations (IMEs). The plaintiff had also cross-moved for summary judgment. The main issues decided were whether the defendant's IME scheduling letters were properly mailed and whether the plaintiff's assignor had failed to appear for the IMEs. The holding of the court was that the only issues for trial were the mailings of the IME scheduling letters and the failure of the plaintiff's assignor to appear for the IMEs. The court affirmed the order with the costs of $25.

The court considered the fact that Island Life Chiropractic, P.C. was appealing the denial of its motion for summary judgment to recover assigned first-party no-fault benefits from 21st Century Insurance Company. The main issue decided was whether Island Life Chiropractic had established its prima facie entitlement to summary judgment, and if the claims at issue had been timely denied. The court held that Island Life Chiropractic failed to establish its entitlement to summary judgment, as the proof it submitted did not establish that the claims had not been timely denied or that 21st Century Insurance Company had issued timely denial of claim forms that were conclusory, vague, or without merit as a matter of law. Therefore, the court affirmed the decision denying Island Life Chiropractic's motion for summary judgment.

The main issue in this case was whether a provider could recover assigned first-party no-fault benefits from an insurance company when the plaintiff's assignor failed to appear for independent medical examinations (IMEs). The court considered denial of claims forms which timely denied the plaintiff's claims on the ground that the assignor did not appear for scheduled IMEs, and the plaintiff failed to establish that its assignor had appeared for the IMEs or that the denials lacked merit as a matter of law. As a result, the court held that the plaintiff failed to establish its prima facie entitlement to summary judgment and affirmed the Civil Court's decision to deny the plaintiff's cross motion for summary judgment. The holding of the court was that, because the plaintiff failed to prove that its assignor had appeared for the IMEs or that the denials lacked merit as a matter of law, the plaintiff's motion for summary judgment was properly denied. Therefore, the order was affirmed, and the plaintiff's remaining contentions were deemed to lack merit.

The court considered the denial of first-party no-fault benefits by the defendant in this case. The main issue was whether the defendant's affidavits sufficiently demonstrated that the denial of claim forms had been timely mailed, and whether the plaintiff's motion for summary judgment should be granted. The court held that the defendant did not sufficiently demonstrate that it was not precluded from asserting its defense that the amounts sought to be recovered were in excess of the workers' compensation fee schedule. However, the court also held that the plaintiff failed to establish that the claims at issue had not been timely denied, and therefore their motion for summary judgment was properly denied. As a result, the order was modified to deny the defendant's cross motion for summary judgment dismissing the complaint.

The main issue in this case was whether Island Life Chiropractic, P.C. could recover assigned first-party no-fault benefits from 21st Century Insurance Company. Island Life Chiropractic, P.C. appealed from an order of the Civil Court that denied their motion for summary judgment. The court found that Island Life Chiropractic, P.C. failed to establish its entitlement to summary judgment, as the proof it submitted did not establish that the claims at issue had not been timely denied. The court also found that defendant had issued timely denial of claim forms that were not conclusory, vague, or without merit as a matter of law. The holding of the case was that the order denying Island Life Chiropractic, P.C.'s motion for summary judgment was affirmed.

The court considered the fact that the defendant had fully paid the plaintiff for the services at issue in accordance with the workers' compensation fee schedule. The main issue decided was whether the proof submitted by the defendant was sufficient to establish the proper mailing of the denial of claim forms at issue. The court held that the proof submitted by the defendant was indeed sufficient to establish proper mailing, and that the plaintiff's remaining contention lacked merit. Therefore, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The main issue in this case was whether the defendant insurance company was precluded from raising its defense that verification had not been provided, because it had not timely denied the plaintiff's claims on that ground. The court considered the fact that the defendant had moved for summary judgment dismissing the complaint on the ground that the plaintiff had failed to provide requested verification, and the plaintiff had cross-moved for summary judgment. The court ultimately held that the defendant was not precluded from raising its defense and granted defendant's motion for summary judgment dismissing the complaint, while denying plaintiff's cross motion for summary judgment. The judgment in favor of the plaintiff in the principal sum of $2,353 was reversed.

The court considered the fact that the defendant had timely mailed initial and follow-up requests for verification, and that it had not received the requested verification. The main issue decided was whether the defendant was precluded from raising its defense that verification had not been provided because it had not timely denied the plaintiff's claims on that ground, and whether the plaintiff's cross motion for summary judgment should be granted. The holding of the case was that the judgment was reversed, the order denying the defendant's motion for summary judgment was vacated, the defendant's motion for summary judgment dismissing the complaint was granted, and the plaintiff's cross motion for summary judgment was denied. As a result, the plaintiff was not entitled to recover the assigned first-party no-fault benefits.