No-Fault Case Law

The main issue in this case was whether or not the defendant properly used the workers' compensation fee schedules to reimburse the plaintiff for acupuncture services rendered. The court considered the affidavit of the defendant's litigation examiner and exhibits annexed in support of the defendant's motion, which established that the defendant had fully paid the plaintiff in accordance with the workers' compensation fee schedules for the services provided. Additionally, the sworn report of the defendant's expert established a lack of medical necessity for certain services for which the defendant had denied reimbursement. The court found that the plaintiff failed to raise a triable issue of fact in opposition to the defendant's motion with respect to either of the proffered defenses. Therefore, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The relevant facts considered by the court were that Exon Medical Equipment, Inc. was seeking to recover no-fault benefits as an assignee of MADIKABA TOUNKARA, but the defendant, State Farm Mutual Automobile Ins. Co., had filed a motion for summary judgment dismissing the complaint on the grounds that the plaintiff had failed to provide requested verification. The main issue decided was whether the plaintiff had provided the necessary verification to support their claim for no-fault benefits. The holding of the court was that the order granting the defendant's motion for summary judgment was affirmed, without costs, on the basis that the plaintiff had indeed failed to provide the required verification. This decision was made in concurrence by the appellate judges.

The main issue in this case was whether the defendant insurance company had issued a timely denial of claim that was conclusory, vague, or without merit as a matter of law, which is a requirement under Insurance Law. The court found that the plaintiff had failed to establish a prima facie case in this regard, and that the defendant's papers did not establish that the plaintiff's assignor had failed to appear for two duly scheduled examinations under oath (EUOs). As a result, the Civil Court correctly found that the defendant had failed to establish its entitlement to summary judgment dismissing the complaint. The holding of the court was that the judgment in favor of the plaintiff was reversed, the order granting plaintiff's motion for summary judgment was vacated, and plaintiff's motion was denied.

The court considered an appeal from an order of the Civil Court of the City of New York, Queens County, which granted the defendant's motion to dismiss the complaint and denied the plaintiff's cross motion for leave to renew its prior motion for summary judgment. The main issue decided in the case was whether the provider could recover assigned first-party no-fault benefits. The court affirmed the order, stating that for the reasons stated in a similar case, the order is affirmed. The holding of the case was that the order granting the defendant's motion to dismiss the complaint and denying the plaintiff's cross motion for leave to renew its prior motion for summary judgment was affirmed.

The court considered that the plaintiff, Flatbush Chiropractic, P.C., had moved for summary judgment to recover first-party no-fault benefits, but the defendant, American Transit Ins. Co., argued that there was a question as to whether the assignor had been injured during the course of his employment, which should be submitted to the Workers' Compensation Board. The Civil Court initially denied plaintiff's motion for summary judgment and granted defendant's cross motion, finding that resolution from the Board was required. The court further stated that the action may be dismissed if the matter was not filed with the Board within 90 days. Defendant later moved to dismiss the complaint based on plaintiff's failure to comply with the Civil Court's order, and plaintiff cross-moved for leave to renew its motion for summary judgment based on new evidence. The court found that plaintiff did not demonstrate that the assignor had made a proper application for workers' compensation benefits and denied plaintiff's cross motion for leave to renew and granted defendant's motion to dismiss the complaint. Therefore, the court affirmed the order.

The court considered the appeal from an order of the District Court of Suffolk County, which granted defendant's motion for summary judgment dismissing the complaint in a case brought by a provider to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant had taken an adversarial position during claims processing in violation of 11 NYCRR 65-3.2 (b). The court held that there was no merit to the plaintiff's argument on appeal that the defendant had clearly taken an adversarial position during claims processing and affirmed the order of the District Court.

The court considered the case of Bronx Acupuncture Therapy, P.C. v Hereford Ins. Co. in which the appellant sought to recover assigned first-party no-fault benefits. The main issue decided by the court was whether the defendant was entitled to summary judgment dismissing the complaint based on the argument that it had fully paid the plaintiff for the services at issue in accordance with the workers' compensation fee schedules. The court held that the defendant was not entitled to summary judgment because the workers' compensation fee schedules did not assign a relative value to the services at issue, and the defendant did not request additional verification from the plaintiff as required in order to review the claims for those services. Therefore, the branches of defendant's motion seeking summary judgment dismissing the complaint as it related to these services were denied.

The relevant facts of this case involved an action by medical providers to recover assigned first-party no-fault benefits, in which the defendant moved for summary judgment dismissing the complaint on the ground that there was no coverage for the accident which allegedly occurred on February 13, 2013. The defendant submitted the transcript of the examination under oath of the driver of the insured vehicle in support of its motion, and the driver testified that he had rented the insured vehicle, which he drove as a livery vehicle, that the assignors had been passengers in his vehicle on February 13, 2013, and that the vehicle had not been involved in an accident on that date. The main issue decided in this case was whether the alleged injuries arose out of an insured incident, and the court held that the defendant had established its entitlement to summary judgment dismissing the complaint by showing that the injuries did not arise out of an insured incident, and that the plaintiffs failed to raise a triable issue of fact in opposition. The court affirmed the order granting defendant's motion for summary judgment dismissing the complaint.

The court considered an action by a provider to recover assigned first-party no-fault benefits. The main issue was whether the provider had failed to appear for duly scheduled examinations under oath. The holding was that the judgment was reversed, the order entered November 1, 2013 was vacated, the provider's motion for summary judgment was denied, and the insurer's cross motion for summary judgment dismissing the complaint was granted. The court found in favor of the insurer, reversing the lower court's decision and denying the provider's motion for summary judgment.

The main issue in this case was whether the automobile insurance policy in question was issued in Florida, and, if so, whether Florida law applied, pursuant to which there was a lack of coverage due to the rescission of the automobile insurance policy. The court found that the automobile was insured by the defendant under a Florida automobile insurance policy, and was being driven by the policyholder, the plaintiff's assignor. Despite the defendant's argument that the policy was validly rescinded pursuant to Florida law, the court ruled that the defendant failed to show that it had voided the policy ab initio pursuant to Florida law. As a result, the appellate court affirmed the order which denied the defendant's cross motion for summary judgment dismissing the complaint. In summary, the court considered the issue of whether the Florida automobile insurance policy was validly rescinded, and the holding was that the defendant failed to demonstrate that it had voided the policy ab initio pursuant to Florida law, thus the order denying the defendant's motion for summary judgment dismissing the complaint was affirmed.