No-Fault Case Law

The relevant facts of the case are that Excel Surgery Center, L.L.C. sued Fiduciary Insurance Company of America to recover assigned first-party no-fault benefits. The issue was whether the action was premature, as the defendant claimed that the provider had failed to respond to verification requests. The court held that the action was premature, as the plaintiff did not demonstrate that it had sufficiently responded to the defendant's verification requests. Since the defendant demonstrated that it had not received the verification requested and the plaintiff did not show that it had provided defendant with all of the requested verification items, the 30-day period within which the defendant was required to pay or deny the claims did not begin to run. Therefore, the District Court properly granted defendant's motion for summary judgment dismissing the complaint on the ground that the action was premature. The Appellate Term affirmed the order.

The main issue in this case was whether the plaintiff, as the assignee of an individual, was entitled to recover assigned first-party no-fault benefits from the defendant insurance company. The court considered the fact that the defendant had denied the claims at issue based on the assignor's failure to appear for scheduled independent medical examinations (IMEs). The court found that the defendant had timely denied the claims on this basis, and that there was no evidence to show that the IME had been mutually rescheduled. Therefore, the court denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment dismissing the complaint. The holding of the case affirmed the lower court's order, thereby denying the plaintiff the right to recover the assigned no-fault benefits.

The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, which denied the defendant's cross motion for summary judgment dismissing the complaint in an action by a provider to recover assigned first-party no-fault benefits. The main issue decided was whether there were triable issues of fact regarding the insured's alleged material misrepresentations in the procurement of the insurance policy. The court held that the defendant failed to establish its prima facie entitlement to summary judgment dismissing the complaint because it did not demonstrate that it was not precluded from asserting the insured's alleged misrepresentations in connection with the issuance of the policy. Therefore, the order, insofar as appealed from, was affirmed.

The case involved an action by a medical provider to recover no-fault benefits from an insurance company. The insurance company had denied the claim, arguing that the insured had fraudulently obtained the insurance policy and that the injuries did not arise from an insured incident. The court found that the insurance company had not presented evidence that the plaintiff's assignor was aware of or participated in the insured's alleged fraudulent scheme to obtain the insurance policy. Additionally, the court determined that the insurance company's evidence was insufficient to establish, as a matter of law, that the injuries did not arise from an insured incident. As a result, the court reversed the lower court's decision and denied the insurance company's motion for summary judgment dismissing the complaint.

In this case, Clinton Place Medical, P.C. filed a lawsuit to recover no-fault benefits for supplies provided to its assignor after a motor vehicle accident. Allstate Insurance Company appealed from an order denying its motion to vacate a default judgment. The main issue decided by the court was whether Allstate had a reasonable excuse for failing to submit written opposition to plaintiff’s motion for summary judgment, and if there was a potentially meritorious opposition to the motion. The court held that Allstate failed to demonstrate a reasonable excuse for its default and that there was a pattern of neglect, therefore affirming the order denying Allstate’s motion to vacate the default judgment.

The court considered an appeal from an order of the Civil Court of the City of New York, Queens County, which denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant had made a prima facie showing of its entitlement to summary judgment dismissing the complaint, and whether the plaintiff's submissions were sufficient to rebut the conclusions set forth in the peer review report submitted by the defendant. The holding of the court was that the defendant had timely mailed its denial of claim form, and the peer review report submitted by the defendant demonstrated that the injury treated by the plaintiff was not causally related to the accident in question. As a result, the court affirmed the order denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint.

The facts in the case of Alleviation Medical Services, P.C. v Allstate Insurance Company involve a lawsuit by a medical provider seeking to recover assigned first-party no-fault benefits that were denied by the insurance company. The insurance company had denied the claim on the ground of lack of medical necessity. The main issue decided by the court was whether the insurance company's denial of the claim on the grounds of lack of medical necessity precluded the provider from recovering the benefits. The court held that the insurance company's argument that it need not pay the claim because it had paid other claims after denying the instant claim, which subsequent payments exhausted the available coverage, lacked merit. Therefore, the court affirmed the order denying the insurance company's motion for summary judgment dismissing the complaint.

The court considered the plaintiff's claim for first-party no-fault benefits and the defendant's motion for summary judgment. The main issue decided was whether the defendant's proof was sufficient to establish that the amounts charged by the plaintiff for services rendered exceeded the rates set forth in the workers' compensation fee schedule. The court held that the action was not ripe for summary disposition, as the defendant's proof was insufficient to establish this. Additionally, the court found that the plaintiff's bill for services in the amount of $1,495 was timely denied as the 30-day statutory period was tolled by the defendant's timely verification and follow-up requests. Therefore, the court affirmed the order of the Civil Court, denying the defendant's motion for summary judgment.

The relevant facts considered by the court in this case included an automobile accident involving Bujar Kaziu, who began to receive no-fault benefits but failed to appear for an independent medical examination (IME) as requested by the plaintiff, Allstate Insurance Company. The plaintiff rescheduled the IME after Kaziu had surgery on his right shoulder. The insurance regulations required that an IME be scheduled within a 30-day period from the receipt of the claim. The court found that in this case, the delay letter sent by the plaintiff was later than the period allowed to seek verification under the statute, and as a result, the denial of the claim was untimely. However, the defense of excessive fees was not subject to preclusion, and the defendant was entitled to the portion of the claim that was undisputedly pursuant to the fee schedule. The main issues decided by the court were whether the denial of the claim by Allstate Insurance Company was timely, whether the rescheduling of the IME was done with consent, and the reimbursement amount to the defendant, Health East Ambulatory Surgical Center, for the services rendered after the automobile accident. The holding of the court was that plaintiff's motion for summary judgment was denied, and defendant's cross-motion for summary judgment was granted. The defendant was entitled to a total amount of $21,903.93 for the services rendered, taking into consideration the proper fee schedule and the timeliness of the denial of the claim.

The court considered whether an automobile insurance policy had been properly rescinded ab initio according to Florida law, and whether there was coverage available to the plaintiff's assignor. The main issue decided was whether the defendant-insurer's motion for summary judgment should have been granted in the first-party no-fault action. The holding of the case was that the defendant's motion for summary judgment should have been granted, and the complaint was dismissed. The court found that the defendant established, prima facie, that the Florida automobile insurance policy had been properly rescinded according to Florida law, and there was no coverage available to the plaintiff's assignor. Additionally, the court found that the plaintiff failed to raise a triable issue of fact in opposition to the defendant's showing.