No-Fault Case Law

The relevant facts of the case include a dispute over a settlement dating back to 2008, where NCT Diagnostics, Inc. sought to recover no-fault benefits that had been assigned to them. The plaintiff received a judgment for the principal amount of $992.20, but also sought statutory no-fault interest from the date of the settlement in 2008. The main issue at hand was whether the defendant was obligated to pay the settlement amount to the plaintiff without the need for a demand, and whether there was any evidence to show that the plaintiff had prevented the defendant from making the payment. The holding of the case was that the Civil Court had erred in tolling the accrual of interest, and the matter was remitted for the entry of a new judgment in accordance with the decision and order. The judgment, insofar as appealed from, was reversed and the matter was remitted to the Civil Court for the entry of a new judgment.

The court considered the fact that the plaintiff, Heal-Rite, P.T., P.C., as Assigned of Mark Lee, had failed to appear for scheduled examinations under oath (EUOs), which resulted in the denial of the claims by defendant, State Farm Mutual Auto. Ins. Co. The main issue decided was whether plaintiff's failure to appear for the EUOs warranted summary judgment in favor of the defendant. The court held that defendant had established its prima facie entitlement to summary judgment by providing evidence that the EUO scheduling letters and denial of claim forms had been timely mailed and that the plaintiff had failed to appear as affirmed by the defendant's attorney. Since plaintiff failed to raise a triable issue of fact in opposition to defendant's motion, the Civil Court properly granted defendant's motion for summary judgment dismissing the complaint. Therefore, the order granting defendant's motion for summary judgment dismissing the complaint was affirmed.

The court considered the evidence provided by Country-Wide Insurance Company, including the policy declaration page, an affidavit by its no-fault claim supervisor, and a payment ledger showing $50,000 was paid to Elmhurst Hospital Center. The main issue decided was whether Country-Wide Insurance Company owed further duty to pay any no-fault claims with respect to a specified motor vehicle accident. The holding of the court was that Country-Wide was under no further obligation to pay defendants once the policy limits were exhausted, and that the affidavit by the no-fault claim supervisor was sufficient to lay a foundation for admission of the documents as business records under CPLR 4518 (a). Additionally, the court held that defendants failed to submit any evidence to establish the existence of material issues of fact requiring a trial, and rejected their suggestion that Country-Wide was required to show compliance with 11 NYCRR 65-3.15's priority of payment rule to make its prima facie case.

The court considered the medical necessity of the treatment received by Joshua Lessy, as well as the expert qualifications of licensed Chiropractor Dr. Todd Aordkian and the documents he reviewed. The main issue decided was whether the treatment provided by the Plaintiff, Longevity Medical Supply Inc, was medically necessary. The holding was that the Defendant, Travelers Insurance Company, met its burden of establishing that the services were not medically necessary, and the Plaintiff failed to present any evidence to rebut the showing of lack of medical necessity. As a result, the court dismissed the complaint. The court found that the Defendant provided sufficient proof that the procedures were not medically necessary, and the Plaintiff failed to demonstrate its entitlement to judgment or otherwise rebut Defendant's showing.

The court considered an action by a provider to recover assigned first-party no-fault benefits. The defendant moved for summary judgment dismissing the complaint on the grounds that the plaintiff had failed to provide requested verification, and the plaintiff opposed the motion and cross-moved for summary judgment. The Civil Court granted the defendant's motion and denied the plaintiff's cross-motion. The main issue decided in this case was whether the plaintiff had provided the requested verification for the first-party no-fault benefits, and the court affirmed the order granting the defendant's motion for summary judgment and denying the plaintiff's cross-motion. The holding of the case was that the order of the Civil Court was affirmed, and the defendant's motion for summary judgment was granted.

The court considered the fact that Jules Francois Parisien, M.D. had commenced an action against Kemper Insurance Company to recover first-party no-fault benefits for services provided to his assignor, Joshua David, who had been injured in an accident. Unitrin Direct Insurance Company appeared in the action and brought a declaratory judgment action against Parisien and David, pertaining to the same accident, and moved for summary judgment against Parisien. Unitrin's attorney alleged that plaintiff sued a non-existent entity and that the complaint should be dismissed on that basis alone. The main issue decided was whether the May 11, 2020 Supreme Court order should have res judicata effect on the action, warranting the dismissal of the complaint. The court held that Unitrin was the proper defendant and that any judgment in favor of the plaintiff in this action would impair rights or interests established by the order in the declaratory judgment action. Therefore, the court affirmed the order granting Unitrin's motion to dismiss the complaint and denied the plaintiff's cross motion for summary judgment.

The main issue in this case was whether the insurance company was entitled to summary judgment dismissing the complaint brought by a provider to recover assigned first-party no-fault benefits, based on the provider's failure to appear for duly scheduled examinations under oath (EUOs). The court considered the fact that the insurer had twice duly demanded an EUO from the provider, that the provider twice failed to appear, and that the insurer issued a timely denial of the claim(s) on that ground. The court held that the insurer had established its prima facie entitlement to summary judgment dismissing the complaint. The court also rejected the provider's contention that the insurer could not deny the claims based on the failure to appear for EUOs that occurred prior to the submission of the claims at issue, and that the insurer needed to schedule additional EUOs after the submission of the claims. Therefore, the court reversed the denial of the insurer's motion for summary judgment and granted the motion to dismiss the complaint.

The court considered the fact that Longevity Medical Supply, Inc. was seeking to recover assigned first-party no-fault benefits. The main issue decided was whether defendant State Farm Mutual Automobile Insurance Company had previously paid another provider for the same piece of medical equipment that was the basis for the claim at issue in this case. The holding was that the affidavit executed by defendant's claims specialist, along with the relevant supporting documents, demonstrated that defendant had indeed previously paid another provider for the same medical equipment, establishing its prima facie entitlement to summary judgment dismissing the complaint. As a result, plaintiff failed to raise a triable issue of fact, and the order granting defendant's motion for summary judgment and denying plaintiff's cross motion for summary judgment was affirmed.

The court considered the motion for summary judgment and cross motion for summary judgment in an action by a provider to recover assigned first-party no-fault benefits. The main issue decided was whether to grant leave to renew the plaintiff's prior motion and opposition to the defendant's cross motion. The holding of the court was that the plaintiff failed to demonstrate any basis upon which to grant him leave to renew, as the affidavits he submitted in support of his motion asserted no new facts, and he failed to provide a reasonable justification for failing to submit the affidavits in support of his original motion for summary judgment and in opposition to defendant's cross motion for summary judgment. Therefore, the order, insofar as appealed from, was affirmed.

The court considered the issue of whether a medical supply company, as assignee of a customer injured in a car accident, had fully responded to the insurance company's verification requests for first-party no-fault benefits. The court also considered whether verification was still outstanding before the insurance company issued a denial of the claim. After a nonjury trial, the Civil Court dismissed the complaint, finding that the insurance company had proven that the medical supply company had not fully responded to the verification requests and that verification was still outstanding before the denial was issued. The Appellate Term, Second Department affirmed the judgment, determining that the trial court's assessment of the evidence supported their findings regarding the medical supply company's responses and the timing of the denial of the claim. Therefore, the judgment was affirmed.