No-Fault Case Law

The court considered the case of Sama Physical Therapy, P.C. v IDS Property Casualty Insurance Company, in which the plaintiff, a provider seeking to recover assigned first-party no-fault benefits, had their claims denied by the defendant based on the plaintiff's failure to appear for duly scheduled examinations under oath (EUOs). The main issue decided by the court was whether the defendant had properly and timely denied the claims based on the plaintiff's failure to comply with a condition precedent to coverage. The court held that the defendant failed to demonstrate that it had properly and timely denied the claims for the first and second causes of action, as the first EUO scheduling letter was not timely with respect to those claims. However, the court also held that the denial of the claim underlying the third cause of action was nevertheless timely, despite the late mailing of the first EUO scheduling letter. Therefore, the court modified the order by denying the branches of the defendant's motion seeking summary judgment dismissing the first and second causes of action.

The relevant facts considered by the court were that a provider was seeking to recover assigned first-party no-fault benefits from an insurance company. The insurance company moved for summary judgment to dismiss the complaint, arguing that the action was premature because the provider had failed to provide requested verification. The main issue decided by the court was whether the action was premature based on the failure to provide requested verification. The holding of the court was that there was a triable issue of fact as to whether the action was premature, as the provider had submitted an affidavit from their owner that gave rise to a presumption that the requested verification had been mailed to and received by the insurance company. As a result, the court reversed the order and denied the insurance company's motion for summary judgment.

The court considered the fact that the defendant had failed to establish that the initial and follow-up independent medical examination (IME) scheduling letters had been timely mailed. As a result, the defendant failed to demonstrate that the IMEs had been properly scheduled. The main issue decided was whether the defendant was entitled to summary judgment dismissing the first and third through sixth causes of action based on the failure of plaintiff's assignor to appear for the scheduled IMEs. The court held that the defendant's cross motion for summary judgment dismissing the complaint was denied due to the failure to properly schedule the IMEs, and that there was a triable issue of fact as to whether the defendant received the claim form underlying the second cause of action. Therefore, the order denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment was modified to provide that defendant's cross motion for summary judgment dismissing the complaint was denied.

The court considered the evidence submitted by the defendant, which showed that the plaintiff had failed to appear for scheduled examinations under oath. The main issue decided was whether the plaintiff's failure to appear for the examinations justified the denial of their claim for first-party no-fault benefits. The court held that the defendant's proof established the plaintiff's failure to appear for the scheduled examinations, and that this justified the denial of their claim. The court also found that the failure to set forth the dates of the scheduled examinations in the denial of claim forms did not render the denials conclusory, vague, or without merit as a matter of law. Therefore, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The court considered the denial of the defendant's motion for summary judgment in a case brought by a medical provider to recover assigned first-party no-fault benefits. The main issue decided was whether the services at issue were medically necessary, and the court found that there was a triable issue of fact regarding the medical necessity of the services. The holding of the case was that the denial of the defendant's motion for summary judgment was affirmed, with a determination that there was a triable issue of fact regarding the medical necessity of the services at issue.

The main issues in this case were whether the provider, Wellness Plaza Acupuncture, P.C., demonstrated prima facie entitlement to summary judgment in a lawsuit to recover assigned first-party no-fault benefits, and whether the defendant, Erie Insurance, was entitled to summary judgment dismissing the complaint on the ground that the plaintiff's assignor had failed to appear for examinations under oath. The court considered the affidavit submitted by the plaintiff in support of its motion for summary judgment, which failed to establish that the claim at issue had not been timely denied or that the defendant had issued a timely denial of the claim. The court also considered the affidavits submitted by the defendant, which did not sufficiently set forth a standard office practice or procedure to ensure the timely mailing of denial of claim forms. Ultimately, the court held that the plaintiff's motion for summary judgment should have been denied, and the defendant did not demonstrate its entitlement to summary judgment dismissing the complaint on the ground of the assignor's failure to appear for examinations under oath.

The court considered the provider's failure to appear for scheduled examinations under oath and the timely denial of claims on those grounds. The main issue decided was whether the provider had failed to comply with the requirements for receiving first-party no-fault benefits and if the denial of the claims was justified. The court held that the provider did fail to appear for scheduled examinations under oath and that the claims had been timely denied on that ground. 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 Civil Court should have compelled the plaintiff to appear for an examination before trial (EBT) in an action by a provider to recover assigned first-party no-fault benefits. The defendant had served the plaintiff with a notice for an EBT, which the defendant argued was material and necessary to their lack of medical necessity defense. The court considered the relevance of the EBT in relation to the defendant's defense, and ultimately held that the branch of the defendant's cross motion seeking to compel the plaintiff to appear for an EBT should have been granted. The court ordered that the examination should be held within 60 days of the date of the decision and at a time and place specified by the defendant or agreed upon by the parties.

The relevant facts considered by the court were that a medical supply company, as an assignee of a patient, was seeking to recover first-party no-fault benefits from an insurance company. The insurance company moved for summary judgment, claiming that the first cause of action was premature due to the failure to provide verification, and that the claim underlying the second cause of action was submitted more than 45 days after the supplies were furnished. The court determined that the insurance company had properly mailed the verification requests and that the first cause of action was premature, but there was a triable issue of fact as to whether the verification had been received. The court also found that the claim underlying the second cause of action had been untimely submitted and the insurance company had timely denied the claim. The holding of the case was a modification of the order to deny the branch of the insurance company's motion seeking summary judgment dismissing the first cause of action.

The court considered the facts of the case where Charles Deng Acupuncture, P.C. sought to recover assigned first-party no-fault benefits in the amount of $2,998.64, $813.80, $222.76, as well as interest and attorney's fees. The main issues decided were whether the defendant's cross motion for summary judgment should be granted, and if the plaintiff should be compelled to comply with the defendant's discovery demands. The court held that the branch of the defendant's cross motion seeking to compel the plaintiff to comply with discovery demands is denied, and the part of the order stating that claims for $80 and $569.66 remained was stricken. The court also granted the branch of the defendant's cross motion seeking summary judgment dismissing the fourth cause of action, which sought interest and attorney's fees.