No-Fault Case Law

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.

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.