No-Fault Case Law

The relevant facts in this case involved an action by a medical supply provider to recover assigned first-party no-fault benefits. The Civil Court denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment on the basis that the action was premature due to the plaintiff's failure to provide requested verification. The main issue decided was whether the plaintiff's action was premature, with the defendant demonstrating that it had timely mailed its verification request and follow-up verification request, and had not received the requested verification. In opposition, the plaintiff submitted an affidavit from the owner, giving rise to a presumption that the requested verification had been received by the defendant. The holding of the case was that there was a triable issue of fact as to whether the action was premature, and the order was modified to provide that the defendant's cross motion for summary judgment dismissing the complaint was denied.

The main issue in this case was whether an action to recover assigned first-party no-fault benefits was premature because the plaintiff had failed to provide requested verification. 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 dismissing the complaint. The holding of the case was that the defendant's cross motion for summary judgment dismissing the complaint was denied, thereby modifying the original order. The court provided this ruling based on the reasoning stated in a similar case, TAM Med. Supply Corp., as Assignee of Shameca Dudley v National Liab. & Fire Ins. Co., decided herewith. The order was affirmed with modifications and without costs.

The main issue in this case was whether the provider had provided requested verification for a first-party no-fault benefits claim. The court considered the fact that the defendant had demonstrated that they had not received the requested verification, leading to their argument that the action was premature. The plaintiff argued that an affidavit submitted by the owner of the plaintiff company was sufficient to presume that the verification had been mailed to and received by the defendant. The court ultimately held that there was a triable issue of fact as to whether the action was premature, and reversed the order granting the defendant's motion for summary judgment, denying the motion to dismiss the complaint.

The relevant facts considered by the court include an action by a provider to recover assigned first-party no-fault benefits. The plaintiff had appealed from an order of the Civil Court which 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 because the plaintiff had failed to provide requested verification. The holding of the court was that the defendant's cross motion for summary judgment dismissing the complaint was denied. The decision was made by Pesce, P.J., Aliotta, and Solomon, JJ., and was handed down on October 11, 2016.

The court considered the appeal from a judgment of the Civil Court of the City of New York which granted the defendant's motion for summary judgment, dismissing the complaint in an action by a provider to recover assigned first-party no-fault benefits. The main issue was whether the defendant's motion for summary judgment, which sought to dismiss the complaint on the grounds that the plaintiff had failed to appear for examinations under oath, should have been granted. The court held that the defendant's motion for summary judgment dismissing the complaint should have been denied, as they had failed to submit proof by someone with personal knowledge of the plaintiff's nonappearance. As a result, the judgment was reversed, the order granting summary judgment was vacated, and the defendant's motion for summary judgment was denied.

The main issue considered in this case was whether the defendant, Mercury Insurance Group, was entitled to summary judgment dismissing the complaint brought by High Quality Medical Supplies, Inc., as assignee of Charles Botwee, seeking to recover assigned first-party no-fault benefits. The court affirmed the order denying the defendant's motion for summary judgment, stating that the "NYS Medicaid DME Services Fee Schedule" being adopted as the Durable Medical Goods Fee Schedule for Workers' Compensation is not a basis to hold that billing for durable medical equipment not included within the fee schedule is not compensable. The court also referred to 11 NYCRR 65-3.16 (a) regarding payment of "medical expenses," which shall be in accordance with fee schedules contained in 11 NYCRR 68, and noted that reimbursement for durable medical equipment is regularly treated as interchangeable with reimbursement for healthcare services under the No-Fault Regulations. Therefore, the order denying the defendant's motion for summary judgment was affirmed.

The court considered the denial of defendant's motion for summary judgment dismissing a complaint brought by a provider to recover assigned first-party no-fault benefits. The main issues decided were whether the defendant demonstrated its entitlement to summary judgment dismissing the first cause of action, and whether the plaintiff's attempt to recover upon the claims underlying the remaining two causes of action was premature due to outstanding verification. The holding of the case was that the order denying defendant's motion for summary judgment was affirmed, with the court finding that the defendant had not demonstrated its entitlement to summary judgment dismissing the first cause of action, and that the defendant had not established as a matter of law that verification requests had been mailed, and thus was not entitled to summary judgment dismissing the second and third causes of action.

The court considered the fact that Compas Medical, P.C., as the assignee of Kevin Jacques, was seeking to recover first-party no-fault benefits from Travelers Insurance Company. The main issue decided was whether plaintiff had failed to provide requested verification, leading to the dismissal of the sixth through eighth causes of action. The holding of the case was that the order granting the branches of defendant's motion seeking summary judgment dismissing the sixth through eighth causes of action was affirmed, with $25 costs. The court referenced a previous case, Compas Med., P.C., as Assignee of Kevin Jacques v Travelers Ins. Co., in rendering its decision.

The court considered that in this action by a provider to recover assigned first-party no-fault benefits, the defendant was not required to pay or deny the plaintiff's claims upon receipt of a "partial response" to defendant's verification requests. The main issue decided was whether defendant was required to pay or deny plaintiff's claims upon receipt of a "partial response" to defendant's verification requests. The court held that contrary to plaintiff's contention, defendant was not required to pay or deny plaintiff's claims upon receipt of a "partial response" to defendant's verification requests. The court affirmed an order of the Civil Court granting defendant's motion for summary judgment dismissing the complaint, and ordered the plaintiff to pay $25 costs.

The court considered the defendant-insurer's motion for summary judgment dismissing the action for first-party no-fault benefits, and plaintiff's cross motion for summary judgment. The main issue decided was whether the defendant-insurer was entitled to summary judgment, and the holding was that the defendant made a prima facie showing of entitlement to summary judgment by establishing that it timely and properly mailed the notices for independent medical examinations to the plaintiff's assignor, and that the assignor failed to appear. The court found that the defendant submitted competent evidence of the assignor's nonappearance, and the plaintiff did not raise a triable issue in opposition. Therefore, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.