No-Fault Case Law

The court considered the fact that the plaintiff was seeking first-party no-fault benefits for medical supplies provided to its assignor who sustained injuries in a motor vehicle accident. The defendant moved for summary judgment dismissing the complaint on the grounds of res judicata and collateral estoppel based on a previous order obtained in a Supreme Court declaratory judgment action. The court granted the defendant's motion for summary judgment, denied the plaintiff's cross motion, and awarded defense counsel $250 in fees. The main issue decided was the dismissal of the appeal. The holding was that no appeal as of right lies from the portion of an order that is decided sua sponte, and the appeal was dismissed.

The relevant facts in this case involve Harden Street Medical, P.C. seeking payment for medical services rendered as a result of a car accident under New York's No-Fault Law. The defendant, Charter Oak Fire Insurance Company, served a subpoena duces tecum on the plaintiff's non-party bank, J.P. Morgan Chase Bank, seeking bank records related to the plaintiff for the years 2012 through the present. The plaintiff sought a protective order to quash the subpoena, arguing it was overbroad and improperly served, while the defendant moved to strike the plaintiff's Notice of Trial and Certificate of Readiness, claiming the plaintiff had not complied with discovery demands. The main issues decided in this case were whether the subpoena duces tecum issued by the defendant to the plaintiff's bank was valid and enforceable, and whether the plaintiff's Notice of Trial and Certificate of Readiness should be struck due to noncompliance with discovery demands. The court held that the subpoena was valid and enforceable, as the defendant had demonstrated that its discovery demands were material and necessary. As a result, the motion to quash the subpoena was denied. Additionally, the court granted the defendant's motion to strike the Notice of Trial and Certificate of Readiness, ordering the action to be stricken from the trial calendar. Overall, the court's holding in this case was in favor of the defendant, permitting the enforcement of the subpoena and striking the action from the trial calendar due to the plaintiff's failure to comply with discovery demands.

The court considered the fact that the plaintiff had initiated an action to recover assigned first-party no-fault benefits for medical supplies provided to its assignor, who had been injured in a motor vehicle accident. The defendant then commenced a declaratory judgment action in Supreme Court, seeking a declaration that they were not obligated to pay any of the plaintiff's claims due to the plaintiff's failure to comply with conditions precedent. The Supreme Court granted the defendant a declaratory judgment on default, and then the defendant moved in Civil Court for summary judgment, which was granted. The main issue decided was whether there was a preclusive effect from the declaratory judgment, and the holding was that the Civil Court properly granted the defendant's motion under the doctrine of res judicata. The order was affirmed.

The court considered the fact that the plaintiff had moved for summary judgment and the defendant failed to submit written opposition, resulting in a default judgment being entered against the defendant. The main issue was whether the defendant had a reasonable excuse for their default and a meritorious defense to the action that would warrant vacating the judgment. The court held that the defendant did not provide a reasonable excuse for their default and therefore the Civil Court did not improvidently exercise its discretion in denying the defendant's motion. The order denying the defendant's motion was affirmed.

The District Court granted defendant's motion for summary judgment dismissing the complaint and denied plaintiff's cross motion for summary judgment in an action to recover assigned first-party no-fault benefits. The court ruled that the defendant did not establish that the plaintiff had failed to comply with a condition precedent to coverage, as there was no evidence of a failure to appear at both an initial and a follow-up independent medical examination (IME). The court also found that there was a triable issue of fact as to the submission of a $1,019.62 claim, as the affidavit of plaintiff's employee was sufficient to give rise to the presumption that the claim had been received by the defendant. Therefore, the court modified the order to deny defendant's motion for summary judgment dismissing the complaint.

The main issue in this case was whether the defendant had properly denied payment for services billed under CPT codes 97026 and 97016 in accordance with the workers' compensation fee schedule. The court considered the motion for summary judgment filed by the defendant, which argued that it had paid the plaintiff for the services at issue in accordance with the fee schedule. The holding of the court was that the defendant failed to demonstrate, prima facie, that it had properly denied payment for the unpaid portions of the bills for services billed under the CPT codes 97026 and 97016 in accordance with the fee schedule. Therefore, the amended order granting the defendant's motion in its entirety was reversed, and the branches of the defendant's motion seeking summary judgment dismissing the complaint were denied.

The court considered a motion for summary judgment in a case where a provider was seeking to recover assigned first-party no-fault benefits from an insurance company. The insurance company argued that it had paid the provider for the services at issue in accordance with the workers' compensation fee schedule. The provider contested this, specifically disputing the application of a certain CPT code to the services billed. The main issue was whether the insurance company had properly applied the CPT code to the services billed by the provider, and whether there was a triable issue of fact in relation to this. The court held that the insurance company had sufficiently demonstrated, prima facie, that it had properly applied the CPT code to the services billed by the provider, and that the provider failed to raise a triable issue of fact in this regard. As a result, the court affirmed the order granting the insurance company's motion for summary judgment.

The court considered the fact that Dynasty Medical Care, P.C. was seeking to recover first-party no-fault benefits from 21st Century Advantage Insurance Company. The insurance company had paid the medical care provider for the services at issue based on the workers' compensation fee schedule. The main issue decided was whether the insurance company had properly applied the fee schedule and whether the medical care provider had raised a triable issue of fact in this regard. The court held that the insurance company had sufficiently demonstrated that it had properly applied the fee schedule, and that the medical care provider had failed to raise a triable issue of fact. Therefore, the amended order granting the insurance company's motion for summary judgment dismissing the complaint was affirmed.

The relevant facts in this case include a dispute over whether a provider of first-party no-fault benefits had complied with its obligations under the insurance regulations, specifically regarding examinations under oath (EUOs). The defendant insurance company filed a motion for summary judgment to dismiss the complaint on the grounds that the plaintiff's assignor failed to appear for the scheduled EUOs. The main issues decided were whether the plaintiff had complied with its obligations under the regulations and whether the failure to appear for scheduled EUOs was justified. The holding of the court was that the defendant's motion for summary judgment was granted, and the complaint was dismissed with prejudice as the plaintiff had failed to appear for the scheduled EUOs, constituting a condition precedent to the insurer's liability on the policy. The court also noted that the order was made in accordance with CPLR 2219(a), the applicable statute, and not in violation of CPLR 4213(b).

The petitioner appealed to the Supreme Court to vacate two arbitration awards made in favor of the respondent, Hereford Insurance Company. The awards related to a loss-transfer claim pursuant to Insurance Law § 5105, which stemmed from a collision between two vehicles insured by the petitioner and the respondent, respectively. The petitioner claimed it had rescinded its policy retroactively to the date of the accident, meaning it provided no coverage at the time. The Supreme Court rejected the petitioner's contention, finding that the arbitrator was not divested of jurisdiction. The court also held that the arbitrator's application of New York law, rather than Pennsylvania law, did not warrant vacatur of the arbitration awards. Therefore, the court affirmed the judgment in favor of the respondent.