No-Fault Case Law

The relevant facts of the case involved an appeal from an order of the Civil Court of the City of New York, Queens County, which granted the branches of defendant's cross motion seeking summary judgment dismissing the first through fifth causes of action. The main issue decided was whether the proof submitted by the defendant was sufficient to warrant the dismissal of the plaintiff's claim for the initial acupuncture visit on July 8, 2010. The holding of the case was that while the defendant's proof was sufficient to demonstrate that they had fully paid the plaintiff for certain services in accordance with the workers' compensation fee schedule, they did not provide enough evidence to justify the dismissal of the claim for the initial acupuncture visit on July 8, 2010, so that branch of the cross motion was denied.

The court considered an appeal from an order granting 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 decided was whether the defendant failed to establish, as a matter of law, its defense that the fees charged exceeded the amounts set forth in the workers' compensation fee schedule. The holding of the court was that the order was reversed, with the defendant's motion for summary judgment dismissing the complaint being denied, as plaintiff properly argued on appeal that the defendant failed to establish its defense. Therefore, the court ruled in favor of the plaintiff's appeal.

The court considered the facts of an action by a medical provider seeking to recover first-party no-fault benefits, in which the defendant insurance company filed a motion for summary judgment to dismiss the complaint. The main issue decided was whether the defendant's proof was sufficient to give rise to a presumption that the verification requests and denial of claim forms had been properly mailed, as well as whether the claims were timely denied. The court held that the defendant's proof was sufficient to establish that the verification requests had been properly mailed and that the claims were timely denied, and therefore affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The court considered a case where a medical services provider, as the assignee of a patient, was seeking to recover first-party no-fault benefits from an insurance company. The insurance company had filed a motion for summary judgment to dismiss the complaint based on the medical provider's failure to appear for scheduled examinations under oath (EUOs). The main issue decided was whether the insurance company had sufficiently established the medical provider's failure to appear for the scheduled EUOs. The court held that the insurance company had indeed established the medical provider's failure to appear, citing previous cases with similar rulings. The court also rejected the medical provider's argument that the motion was premature and that discovery regarding the propriety of the EUO demands was necessary, stating that the medical provider had not responded to the EUO requests and therefore could not raise any objection to their reasonableness. As a result, the court affirmed the order granting the insurance company's motion for summary judgment.

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 main issue decided was whether the proof submitted by the defendant was sufficient to demonstrate that initial and follow-up verifications requests had been properly mailed, and to prove that the defendant had not received the requested verification. The holding of the case was that there was a triable issue of fact as to whether the action was premature, and therefore the defendant's cross motion for summary judgment dismissing the complaint was denied. The order was modified accordingly.

The court considered a motion seeking summary judgment dismissing the second through tenth causes of action in a case where a provider was seeking to recover assigned first-party no-fault benefits from an insurance company. The main issue decided was whether the insurance company had fully paid the plaintiff for the services at issue in accordance with the workers' compensation fee schedule. The court held that the affidavits submitted by the defendant did not sufficiently set forth a standard office practice or procedure that would ensure the timely mailing of denial of claim forms, and therefore, the defendant did not demonstrate entitlement to summary judgment dismissing the second through tenth causes of action. As a result, the defendant's motion was denied, and the order was reversed.

The relevant facts considered by the court included a provider's attempt to recover assigned first-party no-fault benefits from an insurance company. The main issues decided were whether the insurance company had received the claim and verification requests from the provider, and whether the provider had raised a triable issue of fact regarding the mailing of the claim. The court ultimately held that the insurance company had sufficiently described its practices and procedures for receipt of mail, and demonstrated that it had not received the claim. Additionally, the court found that the insurance company's proof in support of its motion was sufficient to give rise to a presumption that initial and follow-up verification requests had been properly mailed, and that the provider's causes of action were premature. As a result, the court affirmed the order granting the insurance company's motion for summary judgment.

The court considered the denial of claim forms at issue and whether they were timely mailed as well as whether the defendant was entitled to summary judgment in dismissing the complaint. The main issue decided was whether the defendant's motion papers had established that the denial of claim forms had been timely mailed and whether the plaintiff had demonstrated its entitlement to summary judgment. The holding of the case was that the defendant's cross motion for summary judgment dismissing the complaint was denied, as the proof submitted did not establish that the denial of claim had been timely or that the denial of claim was conclusory, vague, or without merit as a matter of law. Therefore, the order was modified to provide that the defendant's cross motion for summary judgment dismissing the complaint was denied.

The court considered the case of Liberty Chiropractic, P.C. v 21st Century Ins. Co., in which Liberty Chiropractic, P.C. was seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant, 21st Century Insurance Company, had established its defense that the fees charged exceeded the amounts set forth in the workers' compensation fee schedule. The court held that the defendant failed to establish its defense as a matter of law, as they did not demonstrate that they had used the correct conversion factor in calculating the reimbursement rate. Additionally, the defendant failed to prove that the plaintiff was not entitled to payment for services rendered on specific dates, as the documents relied upon by the defendant were attached to the motion papers without authentication, foundation, or discussion. Therefore, the court reversed the order and denied the defendant's motion for summary judgment dismissing the complaint.

The court considered a motion for summary judgment by the plaintiff, Charles Deng Acupuncture, P.C., who sought to recover assigned first-party no-fault benefits. The defendant, Allstate Insurance Company, cross-moved for summary judgment to dismiss the complaint. The main issue decided was whether the defendant's denial of claim forms had been timely and properly mailed. The holding of the case was that the branch of the defendant's cross-motion seeking summary judgment dismissing plaintiff's first cause of action was denied and the finding that the defendant's denial of claim forms had been timely and properly mailed was vacated. The court also held that the plaintiff had failed to demonstrate its prima facie entitlement to summary judgment. Therefore, the order was modified to deny the branch of the defendant's cross-motion seeking summary judgment and to vacate the finding regarding the defendant's denial of claim forms.