No-Fault Case Law

The court considered whether the defendant had properly mailed the independent medical examination (IME) scheduling letters to the plaintiff's assignor. The main issue was whether the defendant had established the timely and proper mailing of the IME scheduling letters, which are necessary for the provider to recover assigned first-party no-fault benefits. The court held that the defendant had failed to establish the timely and proper mailing of the IME scheduling letters. The defendant's moving papers stated that the letters are sent to the address the assignor puts on the NF-2 form or to the address provided by the assignor's counsel, but there was a discrepancy in the address listed on the NF-10 form and where the letter was sent to. The court affirmed the order denying the defendant's motion for summary judgment dismissing the complaint, stating that the defendant's moving papers failed to demonstrate that the IMEs had been properly scheduled.

The court considered the proof submitted by the defendant in support of its cross motion for summary judgment, which did not establish as a matter of law its defense that the plaintiff's assignor's injuries did not arise from a covered incident. The main issue decided was whether defendant's cross motion for summary judgment should have been denied. The holding of the case was that the order, insofar as appealed from, is reversed and defendant's cross motion for summary judgment dismissing the complaint is denied.

The court considered the appeal from an order of the Civil Court of the City of New York which denied defendant's motion for summary judgment dismissing the complaint in the case of Brand Medical Supply, Inc. v Praetorian Insurance Company. The main issue decided was whether defendant demonstrated that plaintiff's assignor had failed to comply with a condition precedent to coverage and that defendant had timely denied the claim on that ground, as well as whether the IME scheduling letters had been timely mailed and the plaintiff's assignor had failed to appear for the scheduled IMEs. The holding of the court was that since defendant demonstrated that plaintiff's assignor had failed to comply with a condition precedent to coverage and that defendant had timely denied the claim on that ground, the Civil Court should have granted defendant's motion for summary judgment. Therefore, the order was reversed and defendant's motion for summary judgment dismissing the complaint was granted.

The court considered an order from the Civil Court of the City of New York, Queens County which denied the branches of the plaintiff's motion seeking summary judgment on the first through fourth causes of action and granted the branches of defendant's cross motion seeking summary judgment dismissing those causes of action. The main issue in the case was whether the defendant had properly used the workers' compensation fee schedule to determine the amount which the plaintiff was entitled to receive for the services at issue in the second and third causes of action, and whether the requested verification had been received by the defendant for the fourth cause of action. The holding of the case was that the defendant had demonstrated that it had not received the requested verification for the fourth cause of action, and that the defendant had properly used the workers' compensation fee schedule for the services at issue in the second and third causes of action. The court affirmed the order with costs.

The court considered the denial of claim forms from the defendant and found that they were sufficient to advise the plaintiff that the claims were partially denied because the fees were not in accordance with the workers' compensation fee schedule. The court also found that the defendant's evidence was sufficient to establish that the independent medical examination (IME) scheduling letters had been timely mailed. However, the court decided that the claims in the sums of $290.74 and $210.72 had not been timely denied and that the defendant had not demonstrated that it was not precluded from asserting its defense that the amounts sought to recover were in excess of the workers' compensation fee schedule. As a result, the court held that the branches of the defendant's motion seeking summary judgment dismissing the claims in the sums of $290.74 and $210.72 were denied.

The court considered an appeal from a provider seeking to recover assigned first-party no-fault benefits. The main issue was whether the defendant was entitled to an examination before trial of the plaintiff's owner, as well as the plaintiff's motion for summary judgment pending the completion of discovery. The court held that the defendant was entitled to an examination before trial of the plaintiff's owner, citing relevant statutes and previous cases. The court affirmed the order of the Civil Court, dismissing the portion of the appeal related to the continuation of plaintiff's motion for summary judgment and ordering the plaintiff to pay $25 in costs.

The relevant facts considered by the court were that the defendant had properly used the workers' compensation fee schedule applicable to chiropractors to reimburse the plaintiff for acupuncture services. The main issue was whether the defendant had fully paid the plaintiff for the services at issue in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors. The holding of the court was that the defendant had established its entitlement to judgment as a matter of law, and that the order of the Civil Court granting the defendant's motion for summary judgment dismissing the complaint was affirmed. Additionally, the court declined to consider a remaining contention from the plaintiff as it was being raised for the first time on appeal.

The court considered the facts of the case, where the defendant failed to appear at trial and a default judgment was entered against them. The main issue decided was whether the defendant's motion to vacate the default judgment should be granted, based on an excusable default and a meritorious defense to the action. The court held that the defendant failed to demonstrate a meritorious defense, as they had denied the claims on the ground that the plaintiff's assignor had failed to appear for scheduled independent medical examinations, but the denial of claim forms were dated more than one month before the defendant had received the claims. The court also found that the defendant's argument that vacatur was warranted because the judgment awarded plaintiff interest which accrued prior to commencement of the action lacked merit. Therefore, the court affirmed the order denying defendant's motion to vacate the default judgment.

Plaintiff VNP Acupuncture, P.C. filed a lawsuit to recover first-party no-fault benefits for services provided to eight different individuals in connection with three separate motor vehicle accidents. The complaint alleged separate causes of action for each person. Defendant American Commerce Insurance Company moved to sever from the action the causes of action related to two of the accidents, arguing that the defenses involved different questions of fact and law. The denial of the claims at issue in the first, third through fifth, and seventh causes of action was based on lack of medical necessity after independent medical examinations and application of the workers' compensation fee schedule, which raised few issues of fact in common with the claims at issue in the second, sixth, and eighth causes of action. The court reversed the lower court's decision and granted defendant's cross motion to sever those causes of action from the case.

The court considered a case in which the plaintiff, Acupuncture Healthcare Plaza I, P.C., sought to recover first-party no-fault benefits from the defendant, Allstate Ins. Co. The defendant moved for summary judgment, claiming the plaintiff's assignor had failed to appear for scheduled examinations under oath (EUOs). The Civil Court granted the defendant's motion and denied the plaintiff's cross motion for summary judgment. However, the Appellate Term, Second Department reversed the decision and granted the plaintiff's cross motion for summary judgment, as the defendant's follow-up EUO scheduling letter had not been timely mailed, resulting in an untimely denial of claim form from the defendant. Therefore, the defendant was precluded from raising its defense, and the plaintiff was entitled to summary judgment. The case was remitted to the Civil Court for the calculation of statutory interest and an assessment of attorney's fees.