No-Fault Case Law

The main issue in this case was whether the defendant-insurer's motion for summary judgment dismissing the underlying first-party no-fault action should have been granted. The court considered the fact that the defendant failed to submit competent proof of the assignor's nonappearance at scheduled independent medical examinations (IME), and that the conclusory affidavits of defendant's IME doctors lacked probative value. The court held that the defendant's motion for summary judgment should have been denied, as there was insufficient evidence to support their claim. The decision was reversed, with the defendant's motion denied, and the case was remanded for further proceedings.

The main issue in this case was whether the plaintiff had established, for all purposes in the action, the submission to the defendant of the claim forms at issue. The court found that the submission of the claim forms had been established by the denials that were annexed by both the defendant and the plaintiff, which admitted the receipt of those claim forms. The court also found that in the particular circumstances of the case, including the fact that the Civil Court had made an implicit CPLR 3212 (g) finding as to the timely mailing of the denials and had limited the issues for trial, a finding should have been made pursuant to CPLR 3212 (g), that the plaintiff had established, for all purposes in the action, the submission of the claim forms to the defendant. Therefore, the court reversed the decision of the Civil Court and granted the branch of the plaintiff's cross motion seeking a finding that the plaintiff had established, for all purposes in the action, the submission to the defendant of the claim forms.

The court considered a dispute between Compas Medical, P.C. and American Transit Ins. Co. regarding the payment of assigned first-party no-fault benefits. Compas Medical, P.C. appealed from an order of the Civil Court which denied their motion for summary judgment on the first, second, and fifth causes of action and granted defendant's cross motion for summary judgment dismissing the first and fifth causes of action. The main issue decided was whether defendant had received requested verification and whether the claim underlying the second cause of action was received by defendant. The holding of the case was that the branches of defendant's cross motion seeking summary judgment dismissing the first and fifth causes of action were denied, as there was a triable issue of fact as to whether these causes of action were premature. The court also found that defendant had sufficiently described its practices and procedures for the receipt of mail, raising an issue of fact as to whether it received the claim underlying the second cause of action.

The case involved an appeal from a provider seeking to recover no-fault benefits. The defendant moved for summary judgment to dismiss parts of the complaint, specifically claims which had been denied due to the plaintiff's assignor failing to appear for independent medical examinations (IMEs). The Civil Court denied the motion, leaving the reasonableness of the IME requests as the only remaining issue for trial. On appeal, the Appellate Term reversed the decision, holding that the defendant's motion seeking to dismiss the claims based on the assignor's failure to appear for the IMEs should have been granted. The court found there was a question as to the reasonableness of the IME requests, but ultimately the no-fault regulations state that an eligible injured person "shall submit" to IMEs "when, and as often as, the Company may reasonably require." Therefore, the denial of the claim based on the assignor's failure to appear for the IMEs was appropriate.

The relevant facts considered by the court were that Quality Health Products, Inc. brought a claim to recover assigned first-party no-fault benefits and moved for summary judgment, while Geico General Insurance Co. cross-moved for summary judgment based on lack of medical necessity. The main issue decided was whether there was a triable issue of fact regarding the medical necessity of the supplies at issue. The holding of the court was that there was indeed a triable issue of fact regarding the medical necessity, and therefore the order denying the cross motion for summary judgment by Geico General Insurance Co. was affirmed.

The court considered the denial of defendant's motion for summary judgment dismissing the complaint, as the issues for trial were in effect limited to medical necessity. Defendant appealed from the order denying its motion. The court found that the doctor's independent medical examination (IME) report provided a factual basis and medical rationale for the lack of medical necessity for further treatment. Plaintiff did not rebut defendant's prima facie showing, and the court found that defendant was otherwise entitled to judgment. As a result, the court granted defendant's motion for summary judgment dismissing the complaint. The holding was that defendant's motion for summary judgment was granted, and the order denying it was reversed.

The relevant facts considered by the court were that EMA Acupuncture, P.C. sought to recover first-party no-fault benefits as the assignee of Rafael Parra, and the defendant, New York Central Mutual Fire Insurance Company, moved for summary judgment to dismiss the complaint on the ground that Parra failed to appear for independent medical examinations (IMEs). The main issue decided by the court was whether the proof submitted by the defendant was sufficient to demonstrate that Parra had failed to appear for the scheduled IMEs. The holding of the court was that the proof submitted by the defendant was indeed sufficient to give rise to a presumption that the IME scheduling letters had been properly mailed and that Parra had failed to appear for the IMEs, therefore affirming the order granting summary judgment to dismiss the complaint.

The court considered an appeal from an order of the Civil Court that had granted the plaintiff's motion for summary judgment. The main issue that was decided was whether the plaintiff had demonstrated its prima facie entitlement to summary judgment in an action to recover assigned first-party no-fault benefits. The court ultimately held that the plaintiff had failed to demonstrate its entitlement to summary judgment, as the affidavit submitted in support of its motion 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 order granting summary judgment to the plaintiff was reversed and the plaintiff's motion for summary judgment was denied.

The main issue of the case was to determine whether the defendant was entitled to summary judgment dismissing the complaint brought by the plaintiff, a medical supply corporation seeking to recover assigned first-party no-fault benefits. The court considered the fact that the affidavit submitted by the defendant in support of its cross motion did not establish a standard office practice or procedure for mailing letters scheduling the plaintiff's assignor for independent medical examinations. As a result, the court held that the defendant had not demonstrated its entitlement to summary judgment. However, the court also found that the plaintiff had failed to establish its entitlement to summary judgment, as the affidavit submitted in support of its motion did not prove that the claim at issue had not been timely denied or that the defendant had issued a timely denial of claim. Therefore, the court modified the order by denying the defendant's cross motion for summary judgment dismissing the complaint and affirmed the order, without costs.

The main issues in this case were whether the plaintiff was entitled to summary judgment on the fourth through sixth causes of action to recover assigned first-party no-fault benefits and whether the defendant's cross motion seeking summary judgment to dismiss those causes of action should be granted. The court considered the fact that the plaintiff's assignor had failed to appear for duly scheduled independent medical examinations (IMEs), and that the plaintiff had failed to demonstrate that the claims had not been timely denied or that the defendant had issued timely denials that were conclusory, vague, or without merit as a matter of law. The holding of the court was that the branches of the defendant's cross motion seeking summary judgment dismissing the fourth through sixth causes of action were denied, and the order was affirmed, without costs. Therefore, the plaintiff was not entitled to summary judgment, but the defendant's motion to dismiss the causes of action was also denied.