No-Fault Case Law

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.

The relevant facts considered by the court were that Island Life Chiropractic, P.C. was seeking to recover assigned first-party no-fault benefits from Country Wide Insurance Company. The main issue decided was whether the insurance policy of Island Life Chiropractic's assignor had been cancelled prior to the accident. The court held that defendant failed to establish prima facie that the notice of cancellation had been mailed to the insured in order to effectuate the cancellation, and therefore was not entitled to summary judgment dismissing the complaint on this basis. The court also found that there was a triable issue of fact as to the submission of the claim form, as plaintiff submitted an affidavit demonstrating that the claim form had been mailed to defendant. As a result, the court modified the order by providing that defendant's cross motion for summary judgment dismissing the complaint is denied.

The relevant facts considered by the court were that CPM Surgical Supply, Inc. was appealing a decision to grant Allstate Property & Casualty Insurance Company's motion for summary judgment dismissing their complaint. The main issue decided was whether defendant's motion for summary judgment was justified based on plaintiff's failure to appear for scheduled examinations under oath, and whether defendant demonstrated its entitlement to summary judgment. The holding of the case was that the order was reversed and defendant's motion for summary judgment dismissing the complaint was denied, as the affidavits submitted by defendant did not sufficiently establish a standard office practice or procedure ensuring timely mailing of the denial of claim form. The court found that the defendant did not demonstrate its entitlement to summary judgment.

The court considered a motion seeking summary judgment to dismiss a complaint brought by a provider to recover assigned first-party no-fault benefits. The main issue decided was whether there was a triable issue of fact regarding the medical necessity of the services at issue. The holding of the court was that they agreed with the Civil Court's determination that there is a triable issue of fact regarding the medical necessity of the services at issue and therefore, the branch of the defendant's motion seeking summary judgment dismissing the complaint was denied. The court noted that there was another branch of the defendant's motion seeking to compel the plaintiff to appear for a deposition, which remained pending and undecided.