No-Fault Case Law

The main issue in this case was whether the plaintiff, Compas Medical, P.C., was entitled to recover assigned first-party no-fault benefits from the defendant, American Transit Ins. Co. The court considered whether there were triable issues of fact with respect to the causes of action brought by the plaintiff, specifically the second through seventh causes of action. The court ultimately held that there were triable issues of fact with respect to the causes of action, and the branches of defendant's cross motion seeking summary judgment dismissing the third through seventh causes of action were denied. The court also determined that plaintiff had not established its prima facie entitlement to summary judgment on the sixth and seventh causes of action, as the proof submitted failed to establish that the claims had not been timely denied or that defendant had issued timely denial of claim forms. Therefore, the branches of defendant's cross motion seeking summary judgment dismissing the third through seventh causes of action were denied.

The case involved an appeal from the Civil Court of the City of New York, where TAM Medical Supply Corp. was seeking to recover first-party no-fault benefits as an assignee of Wilman Martinez. 21st Century Insurance Company had moved for summary judgment to dismiss the complaint on the ground of lack of medical necessity. The main issue before the court was whether the denial of claim forms had been properly mailed, with the defendant arguing that they had established proper mailing of the forms. The court found that the proof submitted by the defendant was sufficient to establish that the denial of claim forms had been properly mailed, and therefore affirmed the order granting the branch of the defendant's motion seeking summary judgment dismissing the second cause of action. The court also found, pursuant to CPLR 3212 (g), that the defendant had established proper mailing of the denial of the claim form underlying the first cause of action.

The court considered an appeal from an order of the Civil Court denying a provider's motion for summary judgment to recover first-party no-fault benefits. The court also looked at a cross motion seeking summary judgment by the defendant to dismiss some of the claims based on the workers' compensation fee schedule. The main issue decided was whether the denial of claim forms were properly mailed by the defendant, and whether the defendant's application of the workers' compensation fee schedule was valid. The holding of the case was that the defendant had established the timely denials of the claims underlying that portion of the complaint, and the court affirmed the order in favor of the defendant.

The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, which granted the defendant's motion for summary judgment dismissing the complaint. The main issue decided in this case was whether the defendant's proof was sufficient to demonstrate that the plaintiff's assignor had failed to appear for examinations under oath (EUOs), a requirement for recovery of assigned first-party no-fault benefits. The court held that the proof submitted by the defendant was indeed sufficient to demonstrate the assignor's failure to appear for the EUOs, and therefore affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The Court considered the facts surrounding a provider's attempt to recover assigned first-party no-fault benefits, specifically focusing on the timeliness of the submission of the claim. The main issue decided was whether the plaintiff had timely submitted the claim, as the defendant argued that the complaint should be dismissed based on the untimeliness of the submission. The holding of the case was that the Civil Court properly found that there was a triable issue of fact as to whether the plaintiff had timely submitted the claim at issue, and therefore the branch of defendant's cross motion seeking summary judgment dismissing the complaint was denied. The order was affirmed by the Appellate Term, Second Department.

The relevant facts considered by the court were that Vladenn Medical Supply Corp. sought to recover assigned first-party no-fault benefits and moved for summary judgment, while American Transit Ins. Co. cross-moved for summary judgment dismissing the complaint. The main issue decided was whether the defendant had received timely notice of the accident and whether the claim had been untimely submitted. The court held that the defendant had not received timely notice of the accident, the claim at issue had been untimely submitted, and the defendant had timely denied the claim at issue. Therefore, the court affirmed the order that denied the branch of the plaintiff's motion seeking summary judgment and granted the branch of the defendant's cross-motion seeking summary judgment.

The court considered the fact that plaintiff was seeking to recover assigned first-party no-fault benefits from the defendant insurance company. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint based on the plaintiff's assignor failing to appear for scheduled examinations under oath (EUOs). The court held that defendant failed to demonstrate it was entitled to summary judgment dismissing the first through third causes of action because the EUO requests had been sent more than 30 days after defendant had received the claims underlying those causes of action, making the requests nullities with respect to those claims. However, the court also held that defendant did establish it had timely mailed the initial and follow-up EUO scheduling letters and denials of the claims underlying the fourth through sixth causes of action, so the dismissal of those causes of action was upheld.

The Court considered the facts of a case brought by a medical provider to recover assigned first-party no-fault benefits. The provider moved for summary judgment, and the insurance company cross-moved for summary judgment to dismiss the complaint on the basis that it had fully paid the provider for the services or had not received the remaining claims. The main issues decided were whether the insurance company had fully paid the provider in accordance with the workers' compensation fee schedule and whether the denial of one of the claims was timely. The holding of the case was that the insurance company failed to establish that its denial of the claim in question was timely, and therefore, its fee schedule defense as to that claim is not precluded. However, the provider failed to demonstrate its entitlement to summary judgment on the claim, and there was found to be a triable issue of fact as to whether the insurance company received the claims underlying the other causes of action.

The court in this case considered the denial of a no-fault claim by the defendant-insurer for acupuncture services billed under CPT code 97039. The main issue decided was whether the defendant properly denied the claim, and if there were triable issues of fact raised to preclude summary judgment. The court held that there were triable issues of fact as to whether the service was reimbursable, and the defendant failed to establish prima facie that the service was not reimbursable. The court also held that the remaining claims at issue were properly dismissed as premature, as the plaintiff failed to respond to duly issued verification requests. Therefore, the order of the Civil Court was modified by reinstating the plaintiff's claim for first-party no-fault benefits billed under CPT code 97039.

The court considered a case involving a provider attempting to recover assigned first-party no-fault benefits from an insurance company. The insurance company had demanded discovery and depositions, and when the provider failed to comply, the insurance company moved to dismiss the complaint. The court found that the only issues for trial would be the medical necessity of the services and the proper billing according to the workers' compensation fee schedule. The court denied the insurance company's motion to dismiss the complaint, instead precluding the provider from offering testimony at trial regarding the medical necessity of the services and the billing according to the fee schedule. The court held that the trial court has broad discretion in overseeing the discovery process and the determination of the type and degree of sanctions to impose for noncompliance. Therefore, the order was affirmed, and the insurance company's appeal was dismissed.