No-Fault Case Law

The court considered the denial of summary judgment by the Civil Court as well as the granting of defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was whether the plaintiff was entitled to summary judgment in an action to recover assigned first-party no-fault benefits, and whether the denial of the claim was timely. The court held that the defendant failed to establish that it had timely denied the claim underlying the sixth cause of action, so the branch of defendant's cross motion seeking summary judgment dismissing that cause of action should have been denied. The order was affirmed as to the remaining causes of action, and it was modified to provide that the branch of defendant's cross motion seeking summary judgment dismissing the sixth cause of action is denied.

The main issue in this case was whether plaintiff was entitled to recover first-party no-fault benefits for services rendered from July 8, 2008 to September 5, 2008, and from September 8, 2008 to September 25, 2008. The court held that defendant had timely denied the claims for services rendered from July 8, 2008 to September 5, 2008 and had fully paid plaintiff for the services at issue in those claims. As a result, the court granted defendant's cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon these claims. However, the court found that the defendant was not entitled to summary judgment on the claim for services rendered from September 8, 2008 to September 25, 2008 due to issues with the IME scheduling letters, and so the branch of plaintiff's motion seeking summary judgment on this claim was denied.

The court considered a case in which TAM Medical Supply Corp. appealed an order granting New York Central Mutual Fire Insurance Company's motion for summary judgment dismissing the complaint. The main issue decided was whether the action was premature due to the plaintiff's failure to provide requested verification for a no-fault benefits claim. The court held that there was a triable issue of fact as to whether the action was premature, as the plaintiff's affidavit gave rise to a presumption that the requested verification had been mailed to and received by the defendant. Therefore, the order granting the defendant's motion for summary judgment was reversed and the motion was denied.

The relevant facts considered in this case involve an action by a provider to recover assigned first-party no-fault benefits. The court considered whether the defendant had timely and properly denied the claim based on the plaintiff's failure to provide requested verification within 120 days of the initial verification request. The main issue decided was whether the defendant had received the requested verification, as well as whether the affidavit submitted by the plaintiff in opposition to the defendant's motion was sufficient to give rise to a presumption that the requested verification had been mailed to and received by the defendant. The holding of the case was that there was a triable issue of fact as to whether the plaintiff provided the requested verification, and as a result, the court reversed the order and denied the defendant's motion for summary judgment dismissing the complaint.

The court considered an appeal from an order of the Civil Court which granted the defendant's motion for summary judgment dismissing the complaint in this action by a provider to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant's proof sufficiently established proper mailing of the denials and verification requests and if the plaintiff had failed to appear for the scheduled examinations under oath (EUOs). The court held that the defendant's proof did establish proper mailing of the denials and verification requests and that the plaintiff had failed to appear for the scheduled EUOs, therefore affirming the order granting summary judgment in favor of the defendant.

The court considered the fact that the plaintiff, an assignee of a provider, was seeking to recover first-party no-fault benefits from the defendant insurance company. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint on the grounds that the plaintiff had failed to appear for duly scheduled examinations under oath should be granted. The court held that the order granting the defendant's motion for summary judgment was affirmed, with $25 costs, based on the plaintiff's failure to appear for the examinations under oath. The court referenced a similar case, Laga, as Assignee of Mondestin, Liliane v Lancer Ins. Co., in which the same decision was made, in support of their holding.

The court considered the fact that the plaintiff, T & S Medical Supply Corp., was seeking to recover assigned first-party no-fault benefits. The main issue that was decided was whether the defendant, State Farm Mutual Automobile Ins. Co., properly tolled its time to pay or deny the claim at issue through its initial and follow-up EUO (examinations under oath) scheduling letters. The court ultimately held that the defendant did properly toll its time to pay or deny the claim, and affirmed the order granting the defendant's motion for summary judgment dismissing the complaint. Therefore, the plaintiff's appeal was unsuccessful and the order to dismiss the complaint was affirmed by the court.

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.