No-Fault Case Law

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.

The main issue in the case was whether the defendant, Auto One Ins. Co., had a reasonable excuse for its default in a prior order and a meritorious defense to the action in a case where a provider was seeking to recover assigned first-party no-fault benefits. The court considered the fact that the initial order granting the plaintiff's motion for summary judgment was entered without opposition from the defendant and that both sides had agreed to the terms. The defendant subsequently moved to vacate the judgment and the order, arguing for a reasonable excuse for its default and a meritorious defense to the action. However, the court found that the defendant had not provided a reasonable excuse for its default and upheld the initial order on different grounds. The holding of the case was that the order denying the defendant's motion to vacate the judgment and order was affirmed, without costs, as the defendant failed to establish grounds sufficient to set aside the stipulation that was entered on consent. The court ruled in favor of the plaintiff, Healthworx Medical, P.C., as the defendant, Auto One Ins. Co., failed to make a sufficient showing to vacate the prior order.

The relevant facts considered by the court were that Utopia Equipment Inc. appealed a decision from the Civil Court of New York County which granted Chubb Indemnity Insurance Company's motion for summary judgment dismissing the complaint. The main issue decided by the court was whether Chubb had established its entitlement to summary judgment based on Utopia's alleged untimely submission of the no-fault claims beyond the 45-day time limit. The holding of the court was to reverse the order of the Civil Court, deny Chubb's motion for summary judgment, and reinstate the complaint. The court found that Chubb had failed to establish its entitlement to summary judgment because its claims adjuster's affidavit was inadequate to demonstrate that Utopia's bills were not timely received within the 45-day period. Therefore, denial of Chubb's motion was required regardless of the sufficiency of Utopia's opposition papers.

The relevant facts the court considered were that Exultant Medical Diagnostics, P.C. was seeking to recover first-party no-fault benefits as the assignee of two individuals, Devon Crawford and Shatara Griffin. American Commerce Insurance Company had denied the claim on the ground of lack of medical necessity, but failed to establish that the denial of claim forms had been properly and timely mailed. The main issues decided in this case were whether the denial of claim forms had been properly and timely mailed, and whether the defendant had established its prima facie entitlement to summary judgment. The holding of the court was that the order denying the defendant's motion for summary judgment was affirmed, as the defendant had failed to establish its entitlement to summary judgment.