No-Fault Case Law
Prime Diagnostic Med., P.C. v Liberty Mut. Fire Ins. Co. (2016 NY Slip Op 51612(U))
November 1, 2016
The court considered the fact that Prime Diagnostic Medical, P.C., as the assignee of Khadine Isaac, was seeking to recover first-party no-fault benefits from Liberty Mutual Fire Ins. Co. The main issues decided were whether defendant had timely mailed requests and follow-up requests for verification, and whether plaintiff had failed to respond to those requests. The holding of the case was that the affidavit of defendant's claim specialist established that the requests were timely mailed, and that plaintiff had failed to respond to those requests. As a result, the court affirmed the order granting defendant's motion for summary judgment dismissing the complaint.
Art of Healing Medicine, P.C. v Utica Mut. Ins. Co. (2016 NY Slip Op 51611(U))
November 1, 2016
The court considered a case in which Art of Healing Medicine, P.C., as assignee of KEMAR GAYLE, was seeking to recover first-party no-fault benefits from Utica Mutual Insurance Company. The main issue was whether the plaintiff's assignor had failed to appear for duly scheduled examinations under oath. The court decided to affirm the order granting the defendant's motion for summary judgment dismissing the complaint, citing a similar case for the reasons for the decision. The holding of the case was that the plaintiff's assignor's failure to appear for examinations under oath justified the dismissal of the complaint seeking to recover first-party no-fault benefits.
Art of Healing Medicine, P.C. v Utica Mut. Ins. Co. (2016 NY Slip Op 51610(U))
November 1, 2016
The court considered the plaintiff's appeal from an order granting the defendant's motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant had sufficient evidence to demonstrate that the plaintiff's assignor had failed to appear for examinations under oath (EUOs), and whether there was lack of medical necessity for the claims. The court held that the proof submitted by the defendant was sufficient to give rise to a presumption that the EUO scheduling letters and denial of claims forms had been timely mailed, and to demonstrate that the plaintiff's assignor had failed to appear for the EUOs. The court also held that the plaintiff's remaining contentions were either academic or raised for the first time on appeal and therefore not properly before the court. Therefore, the order granting the defendant's motion for summary judgment was affirmed.
Art of Healing Medicine, P.C. v Utica Mut. Ins. Co. (2016 NY Slip Op 51608(U))
November 1, 2016
The court considered the appellant's appeal from an order of the Civil Court of the City of New York, Queens County granting the defendant's motion for summary judgment dismissing the complaint. The main issue decided was whether the plaintiff's assignor had failed to appear for scheduled examinations under oath. The holding was that the order granting the defendant's motion for summary judgment dismissing the complaint was affirmed. The court found that the plaintiff's assignor had failed to appear for duly scheduled examinations under oath, and therefore, the defendant's motion for summary judgment was granted.
Omphil Care, Inc. v Allstate Ins. Co. (2016 NY Slip Op 51607(U))
November 1, 2016
The court considered the case of Omphil Care, Inc. as Assignee of Paolo Poponneau v Allstate Insurance Company, in which the plaintiff was seeking first-party no-fault benefits. The main issue was whether the provider failed to appear for scheduled examinations under oath, which the defendant used as grounds for dismissing the complaint. The Civil Court initially denied the plaintiff's motion for summary judgment and granted the defendant's cross motion. However, the Appellate Term, Second Department modified the order and denied the defendant's cross motion for summary judgment dismissing the complaint. The holding of the case was that the defendant's cross motion for summary judgment dismissing the complaint was denied.
Omphil Care, Inc. v Allstate Ins. Co. (2016 NY Slip Op 51606(U))
November 1, 2016
The relevant facts of the case involved Omphil Care, Inc., as the assignee of Paul Fabiola, seeking to recover assigned first-party no-fault benefits from Allstate Insurance Company. Plaintiff moved for summary judgment, while defendant cross-moved for summary judgment, arguing that the plaintiff had failed to appear for duly scheduled examinations under oath. The Civil Court denied plaintiff's motion and granted defendant's cross motion. The main issue decided was whether the defendant's cross motion for summary judgment dismissing the complaint should be granted. The holding of the case was that the order was modified by providing that defendant's cross motion for summary judgment dismissing the complaint is denied.
Omphil Care, Inc. v Allstate Ins. Co. (2016 NY Slip Op 51605(U))
November 1, 2016
The relevant facts considered by the court were that Omphil Care, Inc., as the assignee of Asuncion Villagra, had moved for summary judgment to recover first-party no-fault benefits from Allstate Insurance Company. Allstate had cross-moved for summary judgment to dismiss the complaint on the grounds that Omphil Care had failed to appear for scheduled examinations under oath. The main issue decided was whether Allstate's cross motion for summary judgment should be granted, and the holding of the court was that the cross motion was denied. The court affirmed the denial of Omphil Care's motion for summary judgment, but modified the order to deny Allstate's cross motion for summary judgment. Therefore, the court's decision allowed Omphil Care to continue with its lawsuit to recover the no-fault benefits.
Omphil Care, Inc. v Allstate Ins. Co. (2016 NY Slip Op 51604(U))
November 1, 2016
The court considered a case where Omphil Care, Inc. as the assignee of Rocio Cruz, was seeking to recover first-party no-fault benefits from Allstate Insurance Company. The main issue decided was whether Allstate had the grounds to dismiss the complaint on the basis that Omphil Care, Inc. had failed to appear for scheduled examinations under oath. The court ultimately held that Allstate's cross motion for summary judgment dismissing the complaint was denied, affirming the decision of the lower court. The court cited the reasons stated in a similar case, Omphil Care, Inc., as Assignee of Paul Fabiola v Allstate Ins. Co., as the basis for their decision. The appellate term judges Pesce, Aliotta, and Solomon all concurred with the decision.
Omphil Care, P.C. v Allstate Ins. Co. (2016 NY Slip Op 51603(U))
November 1, 2016
The relevant facts considered by the court were that the plaintiff, Omphil Care, P.C., sought to recover assigned first-party no-fault benefits from the defendant, Allstate Insurance Company. The plaintiff had moved for summary judgment, while the defendant had cross-moved for summary judgment, arguing that the plaintiff had failed to appear for duly scheduled examinations under oath. The main issue decided by the court was whether the defendant's cross motion for summary judgment dismissing the complaint should be denied. The holding of the court was that the defendant's cross motion for summary judgment dismissing the complaint was denied, and the order was affirmed with the modification. The decision date for this case was November 1, 2016.
Omphil Care, Inc. v Allstate Ins. Co. (2016 NY Slip Op 51602(U))
November 1, 2016
The relevant facts the court considered in this case were that the plaintiff, Omphil Care, Inc., as the assignee of Paul Fabiola, sought to recover first-party no-fault benefits from Allstate Insurance Company. The main issue decided was whether the denial of claim form had been timely mailed. The court held that the defendant's cross-motion for summary judgment dismissing the complaint was denied. The court found that the defendant failed to demonstrate that the denial of claim form had been timely mailed, and therefore, the defendant was not entitled to summary judgment. Additionally, the court found that the plaintiff failed to demonstrate its entitlement to summary judgment, as the affidavit submitted by the plaintiff did not establish that the claim at issue had not been timely denied. Therefore, the court modified the order by providing that the defendant's cross-motion for summary judgment dismissing the complaint is denied.