No-Fault Case Law

The court considered the facts of a provider seeking to recover assigned first-party no-fault benefits, where the assignor had failed to appear for scheduled examinations under oath. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint was justified based on the assignor's failure to comply with examinations under oath. The holding of the case was that the order granting the defendant's motion for summary judgment was affirmed, with the court determining that the assignor's failure to appear for scheduled examinations under oath justified the dismissal of the complaint.

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 seeking summary judgment dismissing various causes of action in a case by a healthcare provider to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant insurance company was entitled to summary judgment dismissing the causes of action on the ground that the plaintiff's assignor had failed to appear for duly scheduled examinations under oath. The holding of the court was that the order of the Civil Court was affirmed, with the court determining that the defendant was entitled to summary judgment dismissing the causes of action based on the failure of the plaintiff's assignor to appear for the scheduled examinations under oath.

The court considered the fact that the plaintiff, Omphil Care, Inc., as Assignee of ALTON ELLIS, had moved for summary judgment to recover assigned first-party no-fault benefits, while the defendant, Allstate Insurance Company, had cross-moved for summary judgment on the ground that the plaintiff had failed to appear for duly scheduled examinations under oath. The main issue that was decided was whether the defendant's cross motion for summary judgment dismissing the complaint should be granted or denied. The court held that the defendant's cross motion for summary judgment dismissing the complaint was denied, thus affirming the modified order. The holding of the case was that the defendant's cross motion for summary judgment dismissing the complaint was denied, as the court found that the plaintiff's failure to appear for examinations under oath was not sufficient grounds to dismiss the complaint.

The court considered the fact that the plaintiff was seeking to recover assigned first-party no-fault benefits, but the defendant had moved for summary judgment dismissing the complaint on the ground that the plaintiff's assignor had failed to appear for scheduled examinations under oath. The main issue decided by the court was whether the plaintiff's assignor's failure to appear for examinations under oath entitled the defendant to summary judgment dismissing the complaint. The holding of the case was that, for the reasons stated in a similar case, the order granting the defendant's motion for summary judgment was affirmed, and the plaintiff's complaint was dismissed.

The court considered the facts that the plaintiff, as assignee of Edwitch Denis, was seeking to recover first-party no-fault benefits from the defendant, National Liability & Fire Insurance Company. The main issue decided was whether the defendant's cross motion for summary judgment dismissing the complaint should be granted, based on the plaintiff's assignor making a material misrepresentation as to his place of residence when procuring the insurance policy. The holding of the court was that the defendant's cross motion for summary judgment dismissing the complaint was denied, as the defendant failed to establish as a matter of law that the misrepresentation by the plaintiff's assignor was material. However, the court also held that the plaintiff failed to demonstrate its prima facie entitlement to summary judgment, as the affidavit submitted in support of its motion failed to establish that the claim had not been timely denied or that the defendant had issued a timely denial of claim that was conclusory, vague, or without merit as a matter of law.

The relevant facts considered by the court were that ABC Physical Therapy, P.C. was seeking to recover assigned first-party no-fault benefits from Utica Mutual Insurance Company, but the defendant had filed a motion for summary judgment dismissing the complaint on the grounds that the plaintiff's assignor had failed to appear for duly scheduled examinations under oath. The main issue decided by the court was whether the plaintiff's assignor's failure to appear for examinations under oath was a valid reason for the defendant to deny the claim for no-fault benefits. The court held that the order granting the defendant's motion for summary judgment was affirmed, with the reasoning stated in a concurrent case, Art of Healing Medicine, P.C., as Assignee of Owen Minns v Utica Mut. Ins. Co. The decision was made on November 1, 2016.

The court considered the motion for summary judgment by the plaintiff to recover assigned first-party no-fault benefits and the cross-motion by the defendant for summary judgment dismissing the complaint. The main issue decided was whether the defendant was entitled to summary judgment based on the assignor's failure to appear for independent medical examinations (IMEs). The court held that the defendant failed to demonstrate that the IMEs had been properly scheduled and, therefore, was not entitled to summary judgment dismissing the complaint. However, the plaintiff also failed to demonstrate its entitlement to summary judgment as it did not establish that the claim at issue had not been timely denied, or that the defendant had issued a timely denial of claim that was conclusory, vague, or without merit as a matter of law. Therefore, the court modified the order to deny the defendant's cross-motion for summary judgment dismissing the complaint.

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.

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.

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.