No-Fault Case Law

The court considered the fact that in a no-fault benefits case, Plaintiff timely submitted the bills at issue to Defendant, and that the burden shifted to the Defendant to show that its Examination Under Oath (EUO) requests were timely mailed and that the assignor failed to appear for the EUOs. Defendant produced a witness who testified regarding their office procedures when scheduling EUOs and when an assignor failed to appear for an EUO. The court found that the witness did not have personal knowledge of the assignor's failures to appear based solely on her review of the file, and therefore, judgment was awarded in favor of Plaintiff for $785.12 plus interest, attorneys' fees, and statutory costs and disbursements. The main issue decided was whether the Defendant was able to prove that its EUO requests were timely mailed and that the assignor failed to appear for the EUOs. The holding of the case was that the court did not find that the Defendant's witness had personal knowledge of the assignor's failures to appear based solely on her review of the file, and therefore, judgment was awarded in favor of Plaintiff.

The court considered the insurance policy application submitted by the plaintiff’s assignor-insured, Tammy Murphy, and two motor vehicle accident reports from the New York State Department of Motor Vehicles. The main issue was whether Murphy misrepresented her address on the insurance application, which would determine if the defendant insurance company had the right to deny the claim for medical services. The holding of the court was that the defendant insurance company failed to meet its burden of proof that Murphy provided a false and fraudulent residential address on her insurance application and, therefore, the plaintiff was entitled to a money judgment in the amount of $1,979.30, plus costs and disbursements and statutory interest.

The court considered the motion by the defendant for an order of dismissal due to the plaintiff's non-compliance with interrogatories and combined discovery demands, as well as the defendant's alternative motion to compel the plaintiff's owner to appear for an examination before trial. The main issues decided were whether the plaintiff had complied with the defendant's discovery demands and whether the defendant's requests for discovery concerning the plaintiff's incorporation and eligibility to recover no-fault benefits were material and necessary to the defense. The holding of the court was to deny the motion to strike the plaintiff's Notice of Trial and dismiss the complaint, conditional upon the plaintiff providing specific and meaningful responses to the defendant's discovery demands, and to grant the defendant's alternative motion to compel the plaintiff's owner to appear for an examination before trial. The court also denied the plaintiff's cross-motion for a protective order and their request to compel the defendant to produce their SIU Investigator and claims representative for deposition.

The court considered the fact that the defendant had scheduled an initial and follow-up independent medical examination (IME) for the plaintiff's assignor, which the assignor failed to appear for. The main issue decided was whether the failure to appear for the scheduled IMEs constituted a failure to comply with a condition precedent to coverage, and whether the defendant had timely denied the claims 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 comply with a condition precedent to coverage, and the defendant had timely denied the claims on that ground. Therefore, the court reversed the order and granted the defendant's motion for summary judgment dismissing the complaint.

The relevant facts the court considered in the case of Greenway Med. Supply Corp. v Hartford Ins. Co. were that the insurance company had scheduled independent medical examinations (IMEs) for the plaintiff's assignor, but the assignor failed to appear for the scheduled IMEs. The main issue decided in this case was whether the insurance company was liable to pay first-party no-fault benefits to the provider, despite the assignor's failure to appear for the scheduled IMEs. The holding of the court was that an assignor's appearance at an IME is a condition precedent to the insurer's liability on the policy, and since the assignor failed to appear for the scheduled IMEs, the insurance company was not liable to pay the no-fault benefits to the provider. Therefore, the court reversed the order, granted the insurance company's motion for summary judgment, and dismissed the complaint.

The main issue in this case was whether the action by a provider to recover assigned first-party no-fault benefits was premature due to the plaintiff's failure to provide requested verification. The court considered the fact that the defendant had moved for summary judgment dismissing the complaint on the ground that the verification had not been provided. The court found that the defendant's moving papers demonstrated that it had not received the requested verification, and the plaintiff did not show that the requested verification had been provided prior to the commencement of the action. Therefore, the court held that the action was indeed premature, and defendant's motion for summary judgment dismissing the complaint was granted.

The court considered the fact that the plaintiff had moved for summary judgment to recover assigned first-party no-fault benefits, and the defendant had cross-moved for summary judgment, claiming the action was premature because they had requested verification that had not been provided. The main issue decided was whether the defendant had received the requested verification, which would start the 30-day period within which they were required to pay or deny the claims. The holding of the court was that as the defendant demonstrated they had not received the verification, and the plaintiff did not show it had been provided, the action was considered premature. Therefore, the defendant's cross motion for summary judgment to dismiss the complaint was granted.

The court considered the appeal of the Civil Court of the City of New York, Kings County, which had granted the defendant's motion for summary judgment dismissing the complaint by Mind & Body Acupuncture, P.C., as assignee of Jessica Torres, seeking to recover assigned first-party no-fault benefits. The defendant alleged that the claims had been properly denied because the plaintiff's assignor had failed to appear at duly scheduled examinations under oath (EUOs). However, the defendant failed to establish that the initial and follow-up EUO scheduling letters had been timely mailed, and therefore failed to demonstrate that the EUOs had been properly scheduled. Consequently, the defendant was not entitled to summary judgment dismissing the complaint. The Appellate Term, Second Department reversed the order and denied the defendant's motion for summary judgment.

The relevant facts the court considered were that Jaga Medical Services, P.C. filed a motion for summary judgment to recover assigned first-party no-fault benefits, and American Transit Ins. Co. filed a cross motion for summary judgment to dismiss several causes of action. The main issues decided by the court were whether the amounts sought in the unpaid portions of the claims exceeded the amounts permitted by the workers' compensation fee schedule, and whether there was a lack of medical necessity for the services at issue. The holding of the case was that the court affirmed the order, denying the branches of plaintiff's motion seeking summary judgment and granting the branches of defendant's cross motion seeking summary judgment dismissing the causes of action. The court found that the defendant had properly used the workers' compensation fee schedule to determine the amount the plaintiff was entitled to receive and that there was a lack of medical necessity for the services at issue.

The court considered a motion for summary judgment by a medical provider to recover first-party no-fault benefits, and a cross-motion for summary judgment by the insurance company to dismiss the complaint based on the assignor's failure to appear for scheduled independent medical examinations. The main issue decided was whether the denial of claim forms had been timely and properly mailed by the insurance company. The court held that the insurance company's submissions were sufficient to presume that the denial of claim forms had been timely and properly mailed, and therefore affirmed the order denying the provider's motion for summary judgment and granting the insurance company's cross-motion.