No-Fault Case Law
Compas Med., P.C. v American Tr. Ins. Co. (2017 NY Slip Op 51193(U))
September 15, 2017
The court considered a motion for summary judgment in an action by a healthcare provider to recover assigned first-party no-fault benefits. The main issues decided were whether the provider's assignor was eligible for workers' compensation benefits and whether the provider had filed the claims underlying the causes of action with the Workers' Compensation Board. The court held that the defendant's proof raised an issue of fact as to whether they had received the claims underlying some of the causes of action, and that if the provider failed to file proof within 90 days showing that it had filed the claims with the Workers' Compensation Board, those causes of action would be dismissed. The court affirmed the denial of the provider's motion for summary judgment and granted the branches of the defendant's cross motion seeking summary judgment dismissing several causes of action. The court found that the remainder of the order was also correctly decided and deemed the plaintiff's remaining contentions to be academic.
Compas Med., P.C. v American Tr. Ins. Co. (2017 NY Slip Op 51192(U))
September 15, 2017
The relevant facts of this case involved an action by a medical provider to recover no-fault benefits, with the defendant arguing that the plaintiff's assignor may have been eligible for workers' compensation benefits. The main issue before the court was whether there was sufficient evidence to support the contention that the assignor had been acting as an employee at the time of the accident and whether workers' compensation benefits might be available. It was decided that the defendant proffered sufficient evidence to support this contention and that the issue of eligibility for workers' compensation benefits must be resolved in the first instance by the Workers' Compensation Board. The holding of the case was that the order, insofar as appealed from, was affirmed.
Compas Med., P.C. v American Tr. Ins. Co. (2017 NY Slip Op 51191(U))
September 15, 2017
The court considered an appeal from an order by the Civil Court denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint in a dispute over first-party no-fault benefits. The main issue decided was whether the defendant had received timely notice of the accident, as required by 11 NYCRR 65-1.1 (d). The court held that the defendant had not received timely notice of the accident, as proven by the evidence submitted by the defendant and not rebutted by the plaintiff. Therefore, the court affirmed the order, ruling in favor of the defendant and dismissing the complaint.
Compas Med., P.C. v American Tr. Ins. Co. (2017 NY Slip Op 51190(U))
September 15, 2017
The main issues decided in this case involved an action by a medical provider to recover assigned first-party no-fault benefits, with the court considering whether the defendant had received timely notice of the accident and whether the proof submitted by the defendant raised an issue of fact as to whether the claim had been received. The court ultimately denied the plaintiff's motion for summary judgment and granted the defendant's cross motion seeking summary judgment, dismissing several causes of action. The holding of the case was that the defendant's proof was sufficient to raise an issue of fact as to whether the claim had been received, and as a result, the defendant's cross motion for summary judgment was granted, and the plaintiff's motion was denied. As a result, the order was affirmed, and the plaintiff's remaining arguments were deemed academic.
Charles Deng Acupuncture, P.C. v New S. Ins. Co. (2017 NY Slip Op 51189(U))
September 15, 2017
The court considered the denial of plaintiff's motion for summary judgment and the granting of defendant's cross motion for summary judgment dismissing the complaint in an action to recover assigned first-party no-fault benefits. The main issue decided was whether the denial of plaintiff's motion for summary judgment and the granting of defendant's cross motion for summary judgment dismissing the complaint was proper. The holding of the court was that the denial and granting of the motions were affirmed, with $25 costs. The court found that plaintiff's arguments as to defendant's cross motion either lacked merit or were not properly before the court, as they were being raised for the first time on appeal. Therefore, the order was affirmed.
Healthway Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51187(U))
September 15, 2017
The court considered that the plaintiff, Healthway Medical Care, P.C., as an assignee of an individual, was seeking to recover assigned first-party no-fault benefits from the defendant, New York Central Mutual Fire Insurance Company. The main issue that was decided was whether the defendant's motion for summary judgment dismissing the complaint should be granted, based on the fact that the plaintiff's assignor had failed to appear for scheduled independent medical examinations. The court held that the order granting the defendant's motion for summary judgment dismissing the complaint was affirmed, with the reasons for the decision stated in another case, Sama Physical Therapy, P.C., as Assignee of Sherod, Hill v New York Cent. Mut. Fire Ins. Co. The decision was made by Justices Pesce, Aliotta, and Solomon.
Sama Physical Therapy, P.C. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51186(U))
September 15, 2017
The main issue in this case was whether the defendant's motion for summary judgment, which dismissed the complaint of the plaintiff, should be granted. The court considered the fact that the plaintiff's assignor had failed to appear for scheduled independent medical examinations (IMEs), and the proof submitted by the defendant was sufficient to give rise to a presumption that the IME scheduling letters and denial of claim forms had been properly mailed. The court ultimately held that the order granting the defendant's motion for summary judgment was affirmed, with the plaintiff's remaining arguments being deemed moot or lacking merit. Therefore, the defendant's motion for summary judgment was upheld, and the complaint was dismissed.
Fema Med. Supply, Inc. v American Commerce Ins. Co. (2017 NY Slip Op 51160(U))
September 8, 2017
The court considered that in an action by a medical provider to recover assigned first-party no-fault benefits, the plaintiff's motion for summary judgment was denied by the Civil Court. The main issue decided was whether the defendant had failed to deny the claims at issue within the required 30-day period, or whether the defendant had issued timely denials of claim that were conclusory, vague, or without merit as a matter of law. The court held that the plaintiff's motion was properly denied, as they did not demonstrate that the defendant had failed to deny the claims within the required time period or that the denials of claim were conclusory, vague, or without merit as a matter of law. Therefore, the court affirmed the order of the Civil Court.
Chiroworks Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51159(U))
September 8, 2017
The court considered a provider's action to recover assigned first-party no-fault benefits and the defendant's motion for summary judgment dismissing the complaint. The main issue was whether the defendant had submitted sufficient evidence to establish that the plaintiff's assignor had failed to appear for independent medical examinations. The court held that there was no merit to the plaintiff's arguments regarding the sufficiency of the proof submitted by the defendant. Additionally, the court found that the plaintiff's remaining contention lacked merit. Therefore, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.
Island Life Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51157(U))
September 8, 2017
The court considered the motion by defendant State Farm Mutual Automobile Insurance Company for summary judgment to dismiss the complaint filed by Island Life Chiropractic, P.C., as assignee of Blake Brenderline, in an action to recover assigned first-party no-fault benefits. The main issue decided was whether the fees charged by the plaintiff exceeded the amounts permitted by the workers' compensation fee schedule. The court held that the defendant's motion papers failed to establish, as a matter of law, that the fees charged by the plaintiff exceeded the amounts permitted by the workers' compensation fee schedule. As a result, the court reversed the order granting defendant's motion for summary judgment and denied the motion to dismiss the complaint. The decision was made by Judges Pesce, Aliotta, and Solomon, and the order was reversed with costs.