No-Fault Case Law

The court considered the appeal from an order of the Civil Court of the City of New York, where the defendant's motion for summary judgment dismissing the complaint and denying the plaintiff's cross-motion for summary judgment was granted. The main issue decided was whether the trial court erred in granting the defendant's motion for summary judgment and denying the plaintiff's cross-motion. The holding of the case was that the order of the Civil Court was modified to the extent of denying the defendant's motion for summary judgment and reinstating the complaint. The court affirmed the order as modified, with costs.

The court considered the evidentiary proof submitted by the defendant-insurer, which demonstrated a "founded belief" that the injuries sustained in a staged accident. However, the court found that this evidence was insufficient to warrant summary judgment dismissing the complaint. The main issue decided was whether the injuries arose out of an insured incident, and the court held that the first party, no-fault action was not susceptible to summary disposition. As a result, the court modified the order to deny the defendant's motion for summary judgment and reinstated the complaint, affirming it with costs of $10.

The court considered an appeal from an order of the Civil Court 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 defendant had raised a triable issue of fact as to whether it had not received all requested verification, and if this action was premature. The holding of the case was that the defendant did not demonstrate that the action was premature, as its papers did not show that the specific verification at issue had ever been requested from the plaintiff. Therefore, the judgment of the Civil Court was affirmed.

The court considered the fact that Island Life Chiropractic, P.C. (the appellant) was seeking to recover assigned first-party no-fault benefits from Allstate Insurance Company (the respondent), and that the respondent had moved for summary judgment dismissing the complaint on the grounds that they had not issued an insurance policy covering the subject loss. The main issue decided was whether the respondent had issued a policy covering the subject loss, and thus whether the appellant had sued the wrong insurer. The court held that the proof submitted by the respondent was sufficient to establish that they had not issued a policy covering the subject loss, and therefore affirmed the order granting the respondent's motion for summary judgment dismissing the complaint.

The relevant facts considered by the court were that Professional Health Imaging, P.C. sued State Farm Mutual Automobile Ins. Co. to recover assigned first-party no-fault benefits. State Farm Mutual Automobile Ins. Co. moved for summary judgment to dismiss the complaint on the grounds that Professional Health Imaging, P.C. had failed to appear for duly scheduled examinations under oath. In response, Professional Health Imaging, P.C. cross-moved for summary judgment or, in the alternative, to strike State Farm Mutual Automobile Ins. Co.'s answer and to compel them to respond to discovery demands. The main issue decided was whether State Farm Mutual Automobile Ins. Co. was entitled to summary judgment dismissing the complaint due to Professional Health Imaging, P.C.'s failure to appear for examinations under oath, and whether Professional Health Imaging, P.C. was entitled to summary judgment or alternative relief. The holding of the case was that the order granting State Farm Mutual Automobile Ins. Co.'s motion for summary judgment and denying Professional Health Imaging, P.C.'s cross motion was affirmed. The decision was in line with the ruling in Professional Health Imaging, P.C. v State Farm Mut. Auto. Ins. Co., and the costs of $25 were to be paid by Professional Health Imaging, P.C.

The main issue of the case was whether the defendant, Allstate Insurance Company, was entitled to summary judgment dismissing the complaint brought by Compas Medical, P.C. as the assignee of Joseph Raoul, to recover assigned first-party no-fault benefits. The court considered the affidavit submitted by the defendant in support of its motion and found that it did not sufficiently set forth a standard office practice or procedure that would ensure that the denial of claim forms had been timely mailed. As a result, the court reversed the order granting defendant's motion for summary judgment and denied the motion, holding that the defendant did not demonstrate its entitlement to judgment as a matter of law. The appellate term court found in favor of the appellant and ordered that the defendant's motion for summary judgment dismissing the complaint be denied.

The court considered the fact that the plaintiff, a provider, was seeking to recover assigned first-party no-fault benefits, and the defendant had moved for summary judgment dismissing the complaint on the basis that the action was premature due to the plaintiff's failure to provide requested verification. The main issue decided was whether the requested verification remained outstanding. The holding of the court was that while the defendant had made a prima facie showing that it did not receive the requested verification, the affidavit submitted by the plaintiff in opposition to the motion was sufficient to create a presumption that the verification had been mailed to and received by the defendant. Therefore, there was a triable issue of fact as to whether the requested verification remained outstanding, and the Civil Court properly denied the defendant's motion for summary judgment dismissing the complaint as premature. The order was affirmed.

The court considered a dispute between Irina Acupuncture, P.C., and Nationwide Affinity Insurance Company regarding the payment of first-party no-fault benefits. Irina Acupuncture, P.C., sought summary judgment on the first two causes of action, while Nationwide Affinity Insurance Company sought summary judgment dismissing those causes of action. The main issues decided were whether the first independent medical examination had been scheduled to be held within 30 days of the insurance company's receipt of the claims, as required by 11 NYCRR 65-3.5 (d). The court held that the Civil Court properly granted Irina Acupuncture, P.C.'s motion for summary judgment and denied Nationwide Affinity Insurance Company's cross motion on the ground that the first independent medical examination had not been scheduled within the required timeframe. Therefore, the order granting summary judgment to Irina Acupuncture, P.C., was affirmed.

The court considered whether the denial of claim forms had been timely mailed, whether the defendant had fully paid the plaintiff for the services at issue in accordance with the workers' compensation fee schedule, and whether the Civil Court properly reduced the sum due for a specific service billed under a certain CPT code. The main issue decided was whether the defendant had fully paid the plaintiff for the services in accordance with the fee schedule. The court held that the proof submitted by the defendant was sufficient to give rise to a presumption that the denial of claim forms had been timely mailed, and that the defendant had fully paid the plaintiff for the services in accordance with the workers' compensation fee schedule. The court also held that the Civil Court properly reduced the sum due for the specific service billed under the CPT code.

The court considered a case in which Professional Health Imaging, P.C., as the assignee of Raymond St. Bernard, appealed an order from the Civil Court of the City of New York, Kings County, which granted State Farm Mutual Automobile Ins. Co.'s motion for summary judgment dismissing the complaint and denied Professional Health Imaging's cross motion for summary judgment or to strike State Farm's answer and compel them to respond to discovery demands. The main issue was whether the plaintiff had failed to appear for duly scheduled examinations under oath, and whether the defendant had the right to move for summary judgment based on this failure. The court held that the order to grant State Farm's motion for summary judgment and deny Professional Health Imaging's cross motion was affirmed and that the plaintiff had failed to appear for duly scheduled examinations under oath, providing grounds for the dismissal of the complaint.