No-Fault Case Law

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.

The main issue in this case was whether the defendant's motion for summary judgment dismissing the complaint should be denied. The court considered the fact that the defendant's moving papers failed to establish that the plaintiff's assignor had failed to appear for independent medical examinations, and also did not demonstrate timely mailing of the defendant's denial of claim forms. Ultimately, the court affirmed the order, ruling in favor of the plaintiff, K.O. Medical, P.C., as Assignee of JAWARA MILLINGTON, and denying the defendant's motion for summary judgment. The holding of the case was that the Civil Court correctly found that the defendant's moving papers failed to establish as a matter of law that the plaintiff's assignor had failed to appear for independent medical examinations, and did not demonstrate timely mailing of the defendant's denial of claim forms.

The relevant facts considered in this case involved a medical provider's attempt to recover first-party no-fault benefits on behalf of an assignor. The main issues decided by the court included whether the services provided were medically necessary, whether defendant had submitted proof regarding independent medical examinations, and whether there was a triable issue of fact regarding the claims underlying certain causes of action. The holding of the case was that the order was modified to deny the branches of defendant's cross motion seeking summary judgment dismissing the seventh through tenth causes of action, as there was no proof regarding independent medical examinations and a triable issue of fact regarding the claims underlying those causes of action. However, summary judgment was granted on other grounds, and the order was otherwise affirmed.

The court considered the insurer's motion for summary judgment to dismiss a complaint by a medical provider seeking payment of no-fault benefits. The insurer argued that the plaintiff's assignor had failed to appear for an examination under oath (EUO) as required. The main issue was whether the insurer demonstrated, as a matter of law, that it twice duly demanded an EUO from the assignor, that the assignor twice failed to appear, and that the insurer issued a timely denial of the claims arising from the provider's treatment of the assignor. The court held that the insurer failed to establish as a matter of law that its denial of claim forms had been properly and timely mailed, and therefore denied the insurer's motion for summary judgment, and the order was affirmed.

The relevant facts in this case were that the plaintiff, Ortho Passive Motion, Inc., as assignee of Pierre Souffrant, sought to recover first-party no-fault benefits from the defendant, New York Central Mutual Fire Ins. Co. The defendant had denied the claims at issue based on the assignor's failure to appear for duly scheduled independent medical examinations (IMEs) and had timely mailed initial and follow-up requests for written verification. The main issue decided by the court was whether the defendant was entitled to summary judgment dismissing the complaint on the ground that the assignor had failed to appear for the IMEs and whether the defendant had followed all necessary procedures before denying the claims. The holding of the court was that the defendant had established that it had mailed letters scheduling an initial and follow-up IME and that the assignor had failed to appear for the scheduled IMEs. The defendant also demonstrated that it had timely mailed initial and follow-up requests for written verification and had timely denied the claims at issue based upon the assignor's failure to appear for IMEs. As a result, the court reversed the order denying the defendant's motion for summary judgment and granted the defendant's motion for summary judgment dismissing the complaint.

The relevant facts the court considered in this case were that Prime Diagnostic Medical, P.C. was seeking to recover first-party no-fault benefits from State Farm Mutual Automobile Insurance Co. as the assignee of Erika Perez. The main issue decided was whether the provider was entitled to recover the assigned benefits, and the court ultimately affirmed the lower court's decision to grant the defendant's motion for summary judgment dismissing the complaint. The holding of the case was that the order to grant the defendant's motion for summary judgment was affirmed, with the court concurring on this decision.

The relevant facts of this case involve a dispute between NYS Acupuncture, P.C. as the assignee of Barbara Greene and State Farm Mutual Automobile Insurance Co. The issue in question was whether State Farm had fully paid NYS Acupuncture, P.C. for the services provided in accordance with the workers' compensation fee schedule. The Civil Court granted State Farm's motion for summary judgment dismissing the complaint. The main issue in this case was whether State Farm had demonstrated that it had fully paid NYS Acupuncture, P.C. for the services at issue in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors. The holding of the court was that an insurer may use the workers' compensation fee schedule for acupuncture services to determine the amount which a licensed acupuncturist is entitled to receive, and that State Farm had indeed fully paid for the services.

The court considered the fact that the appellant, Compas Medical, P.C., was seeking to recover assigned first-party no-fault benefits from the respondent, American Transit Ins. Co. The main issue at hand was whether the respondent's proof was sufficient to demonstrate that the examination under oath (EUO) scheduling letters had been properly mailed, and whether the appellant's assignor had failed to appear for the EUOs. The court ultimately held that the proof submitted by the respondent was indeed sufficient to give rise to a presumption that the EUO scheduling letters had been properly mailed, and that the appellant's assignor had failed to appear for the EUOs. As a result, the court affirmed the order, with costs.