No-Fault Case Law

The court considered a case involving a dispute over first-party no-fault benefits for medical services provided by the plaintiffs. The main issues decided in the case were whether the services rendered on specific dates were medically necessary and whether the defendant insurance company was entitled to summary judgment dismissing the claims for those services. The holding of the court was that the branches of the defendant's cross motion seeking summary judgment dismissing the claims for services rendered on July 23, 2008, and from March 24, 2009, to April 23, 2009 were granted. The court reversed the order of the Civil Court and ruled in favor of the defendant insurance company, granting their motion to dismiss the claims for those specific dates.

The court considered the fact that the plaintiff, AL Acupuncture, P.C., had moved for summary judgment to recover assigned first-party no-fault benefits, while the defendant, Praetorian Insurance Company, cross-moved for summary judgment to dismiss the complaint based on lack of medical necessity. The specific issue at hand was the medical necessity of the claims for services rendered from October 27, 2008 to April 23, 2009. The court ultimately held that the defendant's cross motion seeking summary judgment to dismiss those claims was granted. The court noted that the defendant had submitted a sworn report of an independent medical examination, which demonstrated a lack of medical necessity for the services in question, and the plaintiff had failed to oppose this evidence. As a result, the court found in favor of the defendant and reversed the previous order, granting the branch of the defendant's cross motion seeking summary judgment dismissing the claims in question.

In the case of Matter of Unitrin Advantage Insurance Company v Professional Health Radiology, the court considered Unitrin's petition to vacate a no-fault master arbitration award. The main issue was whether Unitrin failed to establish that it was entitled to deny Professional Health's claims on the ground that the assignors, Nestor and Anggi Camacho did not appear for independent medical examinations. The court held that Unitrin failed to meet the mandatory notice requirements governing insurer requests for independent medical examinations, and that it should pay the attorney's fees in connection with securing payment of the overdue claim. In other words, the court's decision was to deny Unitrin's petition to vacate the no-fault master arbitration award, and to confirm the award in favor of Professional Health Radiology. They also granted the counterclaim for attorney's fees and remanded the matter to the trial court for further proceedings to determine those fees.

The relevant facts in the case of Global Liberty Ins. Co.v W. Joseph Gorum, M.D., P.C. are that the plaintiff, a no-fault insurance carrier, commenced an action for a de novo adjudication of two separate insurance disputes concerning the denial of no-fault claims against W. Joseph Gorum, M.D., P.C., and Laxmidhar Diwan, M.D. Both Gorum and Diwan had been awarded more than $5,000 against the plaintiff as a result of master arbitration awards. The plaintiff moved for leave to enter a default judgment against Gorum, who failed to answer the complaint or appear in the action, and for summary judgment on the complaint insofar as asserted against Diwan. The main issues decided were whether the court erred in denying the motion for leave to enter a default judgment against Gorum and whether the court properly denied the motion for summary judgment against Diwan. The holding of the case was that the court erred in denying the motion for leave to enter a default judgment against Gorum, but properly denied the motion for summary judgment against Diwan, since the plaintiff had failed to sufficiently demonstrate that the surgery performed by Diwan on Jerry Souffront was not medically necessary.

The relevant facts considered by the court in the case of Renelique v American Tr. Ins. Co. were that the plaintiff, Pierre Jean Jacques Renelique, as assignee of Susan Santiago, was seeking to recover assigned first-party no-fault benefits from the defendant, American Transit Ins. Co. The main issue decided was whether the plaintiff's complaint was premature due to the failure to provide requested verification. The holding of the case was that the court reversed the order granting the defendant's motion for summary judgment dismissing the complaint, and denied the defendant's motion for summary judgment dismissing the complaint. The court's decision was based on reasoning similar to a related case and was concurred by Pesce, P.J., Aliotta and Solomon, JJ.

The court considered an appeal from an order of the Civil Court in a case where a medical provider was seeking to recover assigned first-party no-fault benefits from an insurance company. The main issues decided were whether the branches of the plaintiff's motion seeking summary judgment on the first through fifth causes of action should be denied and whether the branches of the defendant's cross motion seeking summary judgment dismissing those causes of action should be granted. The holding of the court was that the branches of the defendant's cross motion seeking summary judgment dismissing the first through fifth causes of action were denied, and the order, insofar as appealed from, was affirmed.

The relevant facts of the case include a dispute between Arguelles, M.D., P.C. as the assignee of Joseph Estimem, and American Transit Ins. Co. regarding the recovery of first-party no-fault benefits. Arguelles, M.D., P.C. appealed the denial of their motion seeking summary judgment on the second through sixth causes of action, while the defendant cross-moved for summary judgment dismissing those causes of action on the grounds that they were premature due to a failure to provide requested verification. The main issue decided by the court was whether the branches of the defendant's cross motion seeking summary judgment dismissing the second through sixth causes of action should be denied or granted. The holding was that the branches of defendant's cross motion seeking summary judgment dismissing the second through sixth causes of action were denied, and the order was affirmed without costs.

The court considered the fact that this was an action by a healthcare provider to recover no-fault benefits and that the defendant had filed a motion for summary judgment to dismiss the complaint on the grounds that the action was premature due to lack of requested verification. The main issue decided was whether the plaintiff's failure to provide requested verification made the action premature and therefore subject to dismissal. The holding of the court was that, in line with a similar decision in another case, the defendant's motion for summary judgment was denied and the order granting it was reversed, allowing the plaintiff's complaint to proceed.

The court considered an appeal from an order of the Civil Court of the City of New York, Queens County, which granted defendant's motion for summary judgment dismissing the complaint by LMS Acupuncture, P.C., as Assignee of Jose Cajas, to recover assigned first-party no-fault benefits. The main issue decided was whether the action was premature because the plaintiff had failed to provide requested verification. The holding of the court was that the order was reversed and defendant's motion for summary judgment dismissing the complaint was denied. The court referenced another case, Performance Plus Med., P.C., as Assignee of Melanna Luckie v Nationwide Ins., and stated that for the reasons stated in that case, the defendant's motion for summary judgment dismissing the complaint was denied.

The relevant facts of the case were that Island Life Chiropractic, P.C. was seeking to recover first-party no-fault benefits as the assignee of Edison Bond, but the Civil Court denied their motion for summary judgment and granted the defendant's cross motion for summary judgment. The main issue decided was whether the action was premature due to the plaintiff's failure to provide requested verification. The holding of the case was that the defendant's cross motion for summary judgment dismissing the complaint was denied, and the order was affirmed with modification. The court found that the action was not premature and the plaintiff was entitled to pursue their claim for first-party no-fault benefits.