No-Fault Case Law

The court considered a judgment from the Civil Court of the City of New York, Queens County, which awarded the plaintiff, Middle Village Chiropractic, the sum of $2,549.58 after a nonjury trial in a case to recover assigned first-party no-fault benefits from GEICO General Insurance Co. The main issue in this case was whether the Civil Court had improvidently exercised its discretion in denying the defendant's application to adjourn the trial to secure the attendance of expert witnesses. The holding of the court was that, for the reasons stated in a related case, Middle Village Chiropractic, as Assignee of Artur Mujaxhi v Geico Gen. Ins. Co., the judgment was affirmed. Therefore, the decision of the lower court awarding the plaintiff the sum of $2,549.58 was upheld.

The relevant facts the court considered were that the plaintiff, Middle Village Chiropractic, sought to recover assigned first-party no-fault benefits in the sum of $1,549.41. The only issue for trial was whether the services provided by the plaintiff were medically necessary. The defendant's expert witnesses were unable to attend the trial, and the court ordered judgment in favor of the plaintiff. The main issue decided was whether the Civil Court improvidently exercised its discretion in denying the defendant's application to adjourn the trial to secure the attendance of expert witnesses. The holding of the case was that the trial court did not improvidently exercise its discretion in denying the defendant's request for an adjournment, and the judgment in favor of the plaintiff was affirmed.

The court considered the relevant facts of the case, which involved a provider seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the insurance policy in question was a Massachusetts policy and whether Massachusetts law should be applied to the substantive issues of the case. The court held that the insurance policy was indeed a Massachusetts policy, as the accident occurred in Massachusetts, and Massachusetts had significant contacts with the insurance contract. Therefore, the application of Massachusetts law to the substantive issues was deemed proper. The court also held that the defendant's evidence established that the policy limits had been exhausted in accordance with Massachusetts law, and the plaintiff failed to raise a triable issue of fact in opposition. As a result, the court affirmed the order granting the defendant's motion for summary judgment.

The relevant facts in the case Andrew Carothers, M.D., P.C. v Progressive Insurance Company revolved around the formation of a professional service corporation to perform MRI scans in three locations and the subsequent denial of payment by insurance companies, alleging that the corporation was fraudulently incorporated. The primary issue was whether the corporation was fraudulently incorporated, as defined in State Farm Mut. Auto. Ins. Co. v Mallela, which held that insurance carriers may withhold payment for medical services provided by a professional corporation fraudulently incorporated to allow non-physicians to share in its ownership and control. The main holding of the case was that the Defense of fraudulent incorporation recognized by Mallela required the owners of the professional corporation to be licensed professionals and any deviation from this requirement would result in the denial of payment by insurers. The plaintiff's arguments on errors in jury charge and adverse inference drawn from the Fifth Amendment were dismissed as the court ruled that the overwhelming evidence established fraudulent incorporation and the error made was harmless. The court, therefore, affirmed the judgment in favor of the defendant.

The relevant facts of the case are that Excel Surgery Center, L.L.C. sued Fiduciary Insurance Company of America to recover assigned first-party no-fault benefits. The issue was whether the action was premature, as the defendant claimed that the provider had failed to respond to verification requests. The court held that the action was premature, as the plaintiff did not demonstrate that it had sufficiently responded to the defendant's verification requests. Since the defendant demonstrated that it had not received the verification requested and the plaintiff did not show that it had provided defendant with all of the requested verification items, the 30-day period within which the defendant was required to pay or deny the claims did not begin to run. Therefore, the District Court properly granted defendant's motion for summary judgment dismissing the complaint on the ground that the action was premature. The Appellate Term affirmed the order.

The main issue in this case was whether the plaintiff, as the assignee of an individual, was entitled to recover assigned first-party no-fault benefits from the defendant insurance company. The court considered the fact that the defendant had denied the claims at issue based on the assignor's failure to appear for scheduled independent medical examinations (IMEs). The court found that the defendant had timely denied the claims on this basis, and that there was no evidence to show that the IME had been mutually rescheduled. Therefore, the court denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment dismissing the complaint. The holding of the case affirmed the lower court's order, thereby denying the plaintiff the right to recover the assigned no-fault benefits.

The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, which denied the defendant's cross motion for summary judgment dismissing the complaint in an action by a provider to recover assigned first-party no-fault benefits. The main issue decided was whether there were triable issues of fact regarding the insured's alleged material misrepresentations in the procurement of the insurance policy. The court held that the defendant failed to establish its prima facie entitlement to summary judgment dismissing the complaint because it did not demonstrate that it was not precluded from asserting the insured's alleged misrepresentations in connection with the issuance of the policy. Therefore, the order, insofar as appealed from, was affirmed.

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.