No-Fault Case Law

The case involved a dispute between 525 EVM, Inc. and GEICO General Insurance Company regarding the recovery of first-party no-fault benefits that had been assigned to 525 EVM, Inc. The Civil Court denied both parties' motions for summary judgment, finding that there were triable issues of fact. 525 EVM, Inc. appealed, arguing that the Civil Court should have found, pursuant to CPLR 3212 (g), that certain facts had been established for all purposes in the action. The appellate court affirmed the lower court's decision, citing a similar case that had been decided with it. The holding of the case was that the appellate court affirmed the lower court's decision to deny both parties' motions for summary judgement.

The main issues considered in this case were whether an insurer was allowed to use the workers' compensation fee schedule for acupuncture services performed by chiropractors to determine the amount a licensed acupuncturist is entitled to receive, and whether defendant's fee reductions were proper in accordance with the workers' compensation fee schedule. The court held that an insurer may use the workers' compensation fee schedule for acupuncture services performed by chiropractors to determine the amount which a licensed acupuncturist is entitled to receive for such acupuncture services. Therefore, the court affirmed the order granting defendant's motion for summary judgment dismissing the complaint.

The court considered the denial of Compas Medical, P.C.'s motion for summary judgment and the granting of American Transit Ins. Co.'s cross motion for summary judgment, which sought to dismiss the first cause of action in a lawsuit involving the recovery of first-party no-fault benefits. The main issue decided was whether the defendant had fully paid the plaintiff for the claim underlying the first cause of action in accordance with the workers' compensation fee schedule, and whether the plaintiff had established its prima facie entitlement to summary judgment. The holding of the court was that the branch of the defendant's cross motion seeking summary judgment dismissing the first cause of action should have been denied, and that the plaintiff had failed to establish its entitlement to summary judgment. Therefore, the order was modified to deny the branch of the defendant's cross motion seeking summary judgment dismissing the first cause of action.

The relevant facts of the case were that the plaintiff, Pierre Jean Jacques Renelique, was seeking to recover assigned first-party no-fault benefits from Allstate Insurance Company. Plaintiff had moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint on the grounds that they had already paid the provider for the services at issue in accordance with the workers' compensation fee schedule. The main issue decided by the court was whether the defendant had properly applied the workers' compensation fee schedule to calculate the amount due for services billed, and whether the plaintiff's argument with respect to a specific CPT code was properly raised. The holding of the case was that the defendant had demonstrated that they had properly applied the workers' compensation fee schedule and the plaintiff had failed to rebut this showing. As a result, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The court considered a provider's attempt to recover assigned first-party no-fault benefits from an insurance company, with the insurance company seeking summary judgment to dismiss the complaint. The main issue decided was whether the insurance company had paid the underlying claims in full and whether the provider had provided sufficient verification of the claims. The court held that while the insurance company had demonstrated payment of some claims, there was a triable issue of fact as to whether the provider had provided sufficient verification for the second cause of action, and therefore, the motion for summary judgment on that cause of action should have been denied. Overall, the court modified the order by denying the motion to dismiss the second cause of action and affirmed the decision in all other respects.

The court considered the case of Logic Chiropractic, P.C., as the assignee of Lambert Eva, appealing a decision from the Civil Court of the City of New York, Queens County. The issue at hand was the provider's attempt to recover assigned first-party no-fault benefits, with the defendant, American Transit Ins. Co., moving for summary judgment to dismiss the complaint. The main issue decided was whether the proof submitted by the defendant established that it had fully paid the plaintiff for the claims at issue. The court affirmed the order from the Civil Court, ruling in favor of the defendant and dismissing the complaint, with the justices concurring with the decision.

The court considered a case where Compas Medical, P.C. was seeking to recover first-party no-fault benefits that had been assigned to them. American Transit Ins. Co. filed a motion for summary judgment to dismiss the complaint, which was granted by the Civil Court. Compas Medical, P.C. appealed the decision, and the Appellate Term, Second Department found that there was sufficient proof that American Transit Ins. Co. had not received the claim form for the first cause of action, so that part of the motion to dismiss was upheld. However, the Appellate Term found that American Transit Ins. Co. did not establish as a matter of law that the fees charged by Compas Medical, P.C. exceeded the amounts allowed by the workers' compensation fee schedule. Therefore, the branch of the motion seeking summary judgment dismissing the second cause of action was denied, and the order was modified accordingly.

The court considered whether the plaintiff, LMS Acupuncture, P.C., had failed to appear for scheduled examinations under oath (EUOs) as required by the defendant, State Farm Mutual Automobile Ins. Co., in order to recover first-party no-fault benefits. The defendant appealed from an order of the Civil Court denying their motion for summary judgment dismissing the complaint. The main issue decided was whether the plaintiff had failed to appear for the EUOs, and if so, whether the claims had been timely denied on that ground. The holding of the case was that the defendant was entitled to summary judgment dismissing the complaint, as the plaintiff had failed to raise a triable issue of fact in opposition to the defendant's motion. Therefore, the defendant's motion for summary judgment was granted and the order of the Civil Court was reversed.

The main issue in this case was whether the plaintiff's assignor had failed to appear for two properly scheduled independent medical examinations (IMEs) and if that justified the dismissal of the complaint. The court considered whether the defendant had established that it had mailed letters scheduling the IMEs, as required by law. The court found that the defendant had not established that it had mailed the scheduling letters and therefore the branch of the defendant's motion seeking summary judgment dismissing the complaint on this ground should not have been granted. The court also noted that the defendant's motion was based on the additional ground that it had paid the plaintiff for the services at issue in accordance with the workers' compensation fee schedule, but this branch of the defendant's motion was not decided by the Civil Court. The court held that the matter should be remitted for a determination of that branch of the defendant's motion. Therefore, the court reversed the order and remitted the matter to the Civil Court for a determination on the remaining branch of the defendant's motion.

The main issue in this case was whether the defendant, Allstate Insurance Company, should be allowed to vacate a default judgment entered in favor of the plaintiff, Bayshore Chiropractic, P.C., as Assignee of Isabella Cifone. The defendant argued that its failure to oppose the plaintiff's motion for summary judgment and the resulting default judgment was due to law office failure during the transfer of the case file from prior counsel. However, the court found that the defendant's claim of law office failure was insufficient to constitute a reasonable excuse for the default, as it was ultimately the result of attorney neglect. Since the defendant did not have a reasonable excuse for the default, the court did not consider whether the defendant demonstrated the existence of a potentially meritorious defense to the action. Therefore, the order denying the defendant's motion to vacate the default judgment was affirmed.