No-Fault Case Law

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.

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.