No-Fault Case Law

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.

The court considered the denial of the plaintiff's motion for summary judgment and the grant of the defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was the failure of the plaintiff to appear for duly scheduled examinations under oath (EUOs) and the sufficiency of proof submitted by the defendant in support of its cross motion. The court held that the proof submitted by the defendant was not sufficient to demonstrate proper mailing of the EUO scheduling letters and, therefore, the defendant's cross motion for summary judgment dismissing the complaint was denied. Additionally, the court held that the plaintiff failed to demonstrate its entitlement to summary judgment as the proof submitted failed to establish that the claim forms had not been timely denied or that the defendant had issued timely denial of claim forms. Therefore, the order was modified to deny the defendant's cross motion for summary judgment dismissing the complaint.

The case involves Professional Health Imaging, P.C. suing State Farm Mutual Automobile Insurance Co. as the assignee of Alaur Abdalla. State Farm moved for summary judgment, arguing that Professional Health Imaging failed to appear for scheduled examinations under oath. Professional Health Imaging cross-moved for summary judgment or, in the alternative, to strike State Farm's answer and to compel State Farm to respond to discovery demands. The Civil Court granted State Farm's motion and denied Professional Health Imaging's cross motion. On appeal, the Appellate Term affirmed the lower court's decision. The main issue decided was whether Professional Health Imaging failed to comply with the requirement of appearing for scheduled examinations under oath, and the holding was that the lower court's decision was affirmed.

The court considered an action by a provider to recover assigned first-party no-fault benefits. The defendant moved for summary judgment claiming that it had timely paid the plaintiff for the services at issue in accordance with the workers' compensation fee schedule, and that the services at issue lacked medical necessity. The court found that there was a triable issue of fact as to the medical necessity of the services at issue, but reduced the amount in controversy on those claims to a total of $647.53. Plaintiff's cross motion for summary judgment was denied. The court held that the defendant did not demonstrate, as a matter of law, that it had timely denied the claims, and that the plaintiff failed to demonstrate its prima facie entitlement to summary judgment. Therefore, the court modified the order to provide that the branches of the defendant's motion seeking summary judgment are denied.