No-Fault Case Law
Neptune Med. Care, P.C. v Dairyland Ins. Co. (2016 NY Slip Op 51705(U))
November 25, 2016
The relevant facts considered by the court in this case were that Neptune Medical Care, P.C. was seeking to recover assigned first-party no-fault benefits in the amount of $2,279.17. The main issue decided was whether the defendant, Dairyland Ins. Co., had paid the claim at issue in a timely manner. The holding of the court was that an issue of fact existed as to whether the defendant had timely paid the claim, and therefore, neither party was entitled to summary judgment. The court ordered that the defendant's cross motion for summary judgment dismissing the complaint be denied. Therefore, the order denying the plaintiff's motion for summary judgment and granting the defendant's cross-motion for summary judgment was affirmed in part and modified in part, with the defendant's cross-motion being denied.
Golden Earth Chiropractic & Acupuncture, PLLC v Global Liberty Ins. Co. of N.Y. (2016 NY Slip Op 26395)
November 25, 2016
The court considered the case of a chiropractic and acupuncture office that had submitted a no-fault benefits claim to an insurance company after the claim had been denied due to the assignor's failure to appear at scheduled independent medical examinations. The main issue decided was whether the master arbitrator exceeded his power by vacating the arbitration award in favor of the provider, upon a determination that the award was not supported by sufficient evidence and was incorrect as a matter of law. The holding of the court was that the master arbitrator did not exceed the scope of his authority, as he did not weigh or independently evaluate issues of credibility or engage in any factual analysis. The court ultimately reversed the lower court's decision and denied the petition to vacate the master arbitrator's award, while granting the cross petition to confirm the master arbitrator's award.
Hu-Nam-Nam v Infinity Ins. Co. (2016 NY Slip Op 51702(U))
November 21, 2016
The court considered an action brought by a provider to recover assigned first-party no-fault benefits. The automobile insurance policy in question had been issued in Florida, and the defendant moved for summary judgment dismissing the complaint on the ground that, based upon a conflict-of-law analysis, Florida law applied, pursuant to which there was a lack of coverage due to the valid rescission of the policy. Defendant contended that it made a prima facie showing of its defense of rescission of the underlying insurance policy in accordance with Florida law and that its motion for summary judgment dismissing the complaint should have been granted. The court held that based on evidence provided by the defendant, it properly voided the motor vehicle insurance policy ab initio, in accordance with Florida law, and granted the defendant's motion for summary judgment dismissing the complaint.
M.H.Z. Physical Therapy, P.C. v Allstate Ins. Co. (2016 NY Slip Op 51701(U))
November 21, 2016
The relevant facts considered by the court were that plaintiff was seeking to recover first-party no-fault benefits as an assignee of Kevindale Nurse. The main issue decided was whether defendant provided insurance coverage for the vehicle involved in the accident. The holding of the court was that defendant's affidavit demonstrated prima facie that plaintiff's claim did not arise out of a covered incident, and as plaintiff failed to raise a triable issue of fact, the court properly denied plaintiff's motion for summary judgment and granted defendant's cross motion for summary judgment dismissing the complaint. Therefore, the order was affirmed.
Art of Healing Medicine, P.C. v Allstate Ins. Co. (2016 NY Slip Op 51685(U))
November 17, 2016
The court considered the denial of the plaintiff's motion for summary judgment and the granting of the defendant's cross motion for summary judgment in a case involving a provider seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant's cross motion for summary judgment dismissing the complaint should be granted. The holding of the court was that the defendant's cross motion for summary judgment dismissing the complaint is denied, and the order is affirmed as modified.
Art of Healing Medicine, P.C. v Allstate Ins. Co. (2016 NY Slip Op 51684(U))
November 17, 2016
The court considered the denial of plaintiff's motion for summary judgment and granting of defendant's cross motion for summary judgment in a case involving recovery of assigned first-party no-fault benefits. The main issue decided was whether plaintiff, as the assignee of an individual, was entitled to recover these benefits from the defendant insurance company. The holding was that the defendant's cross motion for summary judgment dismissing the complaint was denied, effectively allowing the plaintiff to proceed with their claim to recover the no-fault benefits.
Fontanella v Allstate Ins. Co. (2016 NY Slip Op 51679(U))
November 17, 2016
The court considered the appeal from an order of the Civil Court that denied the defendant's motion for leave to renew its previous motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant had established its entitlement to summary judgment based on the provider's failure to appear for duly scheduled examinations under oath. The holding of the case was that the court affirmed the denial of the defendant's motion for summary judgment on different grounds than those stated by the Civil Court, as the defendant failed to establish the timely denials of claims and the nonappearance of the plaintiff at the examinations under oath.
Art of Healing Medicine, P.C. v Allstate Ins. Co. (2016 NY Slip Op 26387)
November 17, 2016
In Art of Healing Medicine, P.C. v Allstate Ins. Co., the court considered an action by a provider to recover first-party no-fault benefits on behalf of an assignee. The insurance company, defendant, cross-moved for summary judgment to dismiss the complaint on the grounds that the insurance policy for the vehicle in question had been terminated prior to the accident in question. The main issues involved the sufficiency of the defendant's notice of termination to the Department of Motor Vehicles (DMV) and the plaintiff's demonstration of entitlement to judgment as a matter of law. The court held that defendant's cross motion for summary judgment dismissing the complaint was denied, as the notice of termination had not been properly filed with the DMV. Additionally, the court found that the plaintiff's motion for summary judgment was properly denied, as the proof submitted in support of the motion failed to establish that the claims at issue had not been timely denied or that the denials issued by the defendant were conclusory, vague, or without merit as a matter of law.
New Capital Supply, Inc. v Chubb Ins. Co. (2016 NY Slip Op 51677(U))
November 15, 2016
The court considered an action by a provider to recover first-party no-fault benefits on three claims. Defendant moved for summary judgment based on lack of medical necessity, supported by two peer review reports. Plaintiff moved for summary judgment and opposed defendant's motion. The main issue was whether there was an issue of fact as to the medical necessity of the supplies at issue. The court held that plaintiff failed to establish their entitlement to summary judgment on the claim for $591.10, and neither of the peer review reports submitted by the defendant established that the supplies at issue were not medically necessary. Therefore, the court reversed the judgment and denied the branch of plaintiff's motion seeking summary judgment on the claim for $591.10, while affirming the order in all other respects.
North Bronx Med. Health Care v Auto One Ins. Co. (2016 NY Slip Op 51625(U))
November 1, 2016
The main issue in this case was whether the defendant, Auto One Insurance Company, was entitled to summary judgment dismissing the complaint or if they should be allowed to compel the plaintiff's treating doctor to appear for a deposition. The trial court had denied the defendant's motion for summary judgment, limiting the remaining issue for trial to the medical necessity of the claims at issue. Upon review, it was found that there was a triable issue of fact regarding medical necessity, so the branch of the defendant's motion seeking summary judgment was properly denied. However, the Appellate Court found that the deposition of the plaintiff's treating doctor was material and necessary to the defendant's defense, and as such, they were entitled to such discovery. Therefore, the holding of the case was that the order of the trial court was modified to grant the branch of the defendant's motion seeking to compel a deposition of the plaintiff's treating doctor.