No-Fault Case Law

The case involved an action by a medical provider to recover no-fault benefits from an insurance company. The insurance company had denied the claim, arguing that the insured had fraudulently obtained the insurance policy and that the injuries did not arise from an insured incident. The court found that the insurance company had not presented evidence that the plaintiff's assignor was aware of or participated in the insured's alleged fraudulent scheme to obtain the insurance policy. Additionally, the court determined that the insurance company's evidence was insufficient to establish, as a matter of law, that the injuries did not arise from an insured incident. As a result, the court reversed the lower court's decision and denied the insurance company's motion for summary judgment dismissing the complaint.

In this case, Clinton Place Medical, P.C. filed a lawsuit to recover no-fault benefits for supplies provided to its assignor after a motor vehicle accident. Allstate Insurance Company appealed from an order denying its motion to vacate a default judgment. The main issue decided by the court was whether Allstate had a reasonable excuse for failing to submit written opposition to plaintiff’s motion for summary judgment, and if there was a potentially meritorious opposition to the motion. The court held that Allstate failed to demonstrate a reasonable excuse for its default and that there was a pattern of neglect, therefore affirming the order denying Allstate’s motion to vacate the default judgment.

The court considered an appeal from an order of the Civil Court of the City of New York, Queens County, which denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant had made a prima facie showing of its entitlement to summary judgment dismissing the complaint, and whether the plaintiff's submissions were sufficient to rebut the conclusions set forth in the peer review report submitted by the defendant. The holding of the court was that the defendant had timely mailed its denial of claim form, and the peer review report submitted by the defendant demonstrated that the injury treated by the plaintiff was not causally related to the accident in question. As a result, the court affirmed the order denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint.

The facts in the case of Alleviation Medical Services, P.C. v Allstate Insurance Company involve a lawsuit by a medical provider seeking to recover assigned first-party no-fault benefits that were denied by the insurance company. The insurance company had denied the claim on the ground of lack of medical necessity. The main issue decided by the court was whether the insurance company's denial of the claim on the grounds of lack of medical necessity precluded the provider from recovering the benefits. The court held that the insurance company's argument that it need not pay the claim because it had paid other claims after denying the instant claim, which subsequent payments exhausted the available coverage, lacked merit. Therefore, the court affirmed the order denying the insurance company's motion for summary judgment dismissing the complaint.

The court considered the plaintiff's claim for first-party no-fault benefits and the defendant's motion for summary judgment. The main issue decided was whether the defendant's proof was sufficient to establish that the amounts charged by the plaintiff for services rendered exceeded the rates set forth in the workers' compensation fee schedule. The court held that the action was not ripe for summary disposition, as the defendant's proof was insufficient to establish this. Additionally, the court found that the plaintiff's bill for services in the amount of $1,495 was timely denied as the 30-day statutory period was tolled by the defendant's timely verification and follow-up requests. Therefore, the court affirmed the order of the Civil Court, denying the defendant's motion for summary judgment.

The relevant facts considered by the court in this case included an automobile accident involving Bujar Kaziu, who began to receive no-fault benefits but failed to appear for an independent medical examination (IME) as requested by the plaintiff, Allstate Insurance Company. The plaintiff rescheduled the IME after Kaziu had surgery on his right shoulder. The insurance regulations required that an IME be scheduled within a 30-day period from the receipt of the claim. The court found that in this case, the delay letter sent by the plaintiff was later than the period allowed to seek verification under the statute, and as a result, the denial of the claim was untimely. However, the defense of excessive fees was not subject to preclusion, and the defendant was entitled to the portion of the claim that was undisputedly pursuant to the fee schedule. The main issues decided by the court were whether the denial of the claim by Allstate Insurance Company was timely, whether the rescheduling of the IME was done with consent, and the reimbursement amount to the defendant, Health East Ambulatory Surgical Center, for the services rendered after the automobile accident. The holding of the court was that plaintiff's motion for summary judgment was denied, and defendant's cross-motion for summary judgment was granted. The defendant was entitled to a total amount of $21,903.93 for the services rendered, taking into consideration the proper fee schedule and the timeliness of the denial of the claim.

The court considered whether an automobile insurance policy had been properly rescinded ab initio according to Florida law, and whether there was coverage available to the plaintiff's assignor. The main issue decided was whether the defendant-insurer's motion for summary judgment should have been granted in the first-party no-fault action. The holding of the case was that the defendant's motion for summary judgment should have been granted, and the complaint was dismissed. The court found that the defendant established, prima facie, that the Florida automobile insurance policy had been properly rescinded according to Florida law, and there was no coverage available to the plaintiff's assignor. Additionally, the court found that the plaintiff failed to raise a triable issue of fact in opposition to the defendant's showing.

The relevant facts considered by the court in this case included the motion for summary judgment filed by the defendant-insurer in a first-party no-fault action. The main issue decided by the court was whether the defendant's motion for summary judgment should have been granted, and if the defendant had submitted competent proof of the assignor's nonappearance at scheduled independent medical examinations (IMEs). The holding of the court was that the defendant's motion for summary judgment should have been denied because it failed to submit competent proof of the assignor's nonappearance at the scheduled IMEs. The court found that the conclusory affirmation of the defendant's IME doctor lacked probative value, as she failed to adequately state the basis of her recollection that the assignor did not appear on the scheduled IME dates. Therefore, the court reversed the order granting the defendant's motion for summary judgment and denied the motion.

This case involves an insurance company's petition to vacate an arbitration award in favor of a physical therapy provider for no-fault compensation. The insurance company had refused to pay for certain physical therapy services on the grounds that it had already reimbursed a different provider for services on the same dates. The arbitration resulted in an award in favor of the physical therapy provider, but the insurance company appealed, arguing that the physical therapy provider did not adequately preserve their defense. The master arbitrator wrongly found that the lower arbitrator had considered the fee schedule defense and determined that the physical therapy provider failed to provide evidence as to the other provider, leading to the reversal of the lower court's decision. The Appellate Division reversed the lower court's decision and remanded the matter to a different arbitrator for arbitration of the fee schedule defense on the merits. Therefore, the holding of the case was in favor of the insurance company, vacating the arbitration award and remanding the case for further arbitration.

The court in this case considered the motion for reargument of the defendant's motion to sever the breach of contract cause of action, or, in the alternative, for a stay of the severance order pending appeal. The main issue was whether the breach of contract cause of action, which contained 198 unrelated no-fault claims, raised common issues of fact or law that justified severing the claims. The court held that the breach of contract cause of action should be severed, as the claims raised no common issues of fact or law. The court also held that the defense of fraudulent incorporation did not present common factual and legal issues, as the defendant had indicated that it did not intend to pursue that defense. Finally, the court held that adjudication of the separate breach of contract claims in Civil Court was not dependent on a determination of the declaratory judgment cause of action.