No-Fault Case Law

The main issue in this case was whether the insurance company was entitled to summary judgment dismissing the complaint brought by a medical provider to recover assigned no-fault benefits. The court considered the defense raised by the insurance company, which was based on the failure of the plaintiff's assignor to appear for scheduled examinations under oath (EUOs). The insurance company submitted affidavits describing their practices and procedures for mailing the EUO scheduling letters, but the court found that the insurance company did not demonstrate its entitlement to summary judgment. The court also found that the plaintiff's motion for summary judgment should not have been granted, as their moving papers failed to establish that the claims at issue had not been timely denied. Therefore, the court modified the order by denying the insurance company's cross motion for summary judgment dismissing the complaint.

The relevant facts in this case were that Sama Physical Therapy, P.C. was seeking to recover assigned first-party no-fault benefits from American Transit Ins. Co. Plaintiff had moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint. The main issues decided were whether the defendant's actions in changing CPT codes and applying Ground Rule 11 were appropriate, as well as whether the plaintiff had demonstrated entitlement to summary judgment. The holding of the case was that the defendant's cross motion seeking summary judgment dismissing the first through third causes of action should have been denied, as the defendant did not demonstrate that Ground Rule 11 was appropriately applied. The order was modified to provide that the branches of defendant's cross motion seeking summary judgment dismissing the first through third causes of action are denied.

The relevant facts considered by the court were that the appellant, TAM Medical Supply Corp., was seeking to recover first-party no-fault benefits from the respondent, 21st Century Insurance Company. The respondent had moved for summary judgment, arguing that they had fully paid the appellant for the supplies at issue in accordance with the workers' compensation fee schedule, and the Civil Court had granted this motion. The main issue decided was whether the fees charged by the appellant exceeded the amounts set forth in the workers' compensation fee schedule. The court found that the respondent's motion papers failed to establish, as a matter of law, that the fees charged by the appellant exceeded the amounts set forth in the schedule, and therefore the respondent was not entitled to summary judgment. The holding of the case was that the appellate court reversed the lower court's decision and denied the respondent's motion for summary judgment, meaning that the appellant could continue to pursue their claim for first-party no-fault benefits.

The relevant facts of the case were that the plaintiff, Pierre Jean Jacques Renelique, as an assignee of INNIS OSWALD, sought to recover assigned first-party no-fault benefits from the defendant, Allstate Insurance Company. The main issue decided by the court was whether the defendant had demonstrated its entitlement to summary judgment in dismissing the complaint. The court found that the affidavits submitted by the defendant did not sufficiently set forth a standard office practice or procedure that would ensure that the denial of claim form had been timely mailed, thus not demonstrating its entitlement to summary judgment. However, the plaintiff also failed to demonstrate its prima facie entitlement to summary judgment, as the affidavit plaintiff submitted in support of its motion failed to establish 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 providing that the defendant's cross motion for summary judgment dismissing the complaint is denied.

The main issue in this case was whether defendant's cross motion for summary judgment dismissing the complaint should be granted due to plaintiff's assignor's failure to appear for duly scheduled examinations under oath. The court considered the affidavits submitted by both parties and found that defendant did not sufficiently demonstrate its entitlement to summary judgment dismissing the complaint. However, the court also found that plaintiff's motion for summary judgment was properly denied as the affidavit plaintiff submitted failed to establish that the claim at issue had not been timely denied, or that defendant had issued a timely denial of claim that was conclusory, vague or without merit as a matter of law. The holding of the case was that defendant's cross motion for summary judgment dismissing the complaint was denied, and the order was affirmed without costs.

The court considered the defendant's motion for summary judgment dismissing the complaint in a no-fault benefits case, on the grounds that the plaintiff's assignor had failed to appear for scheduled examinations under oath (EUOs). The main issue decided was whether the proof submitted by the defendant was sufficient to give rise to a presumption that the denial of claim forms had been properly mailed, and to demonstrate that the plaintiff's assignor had failed to appear for the EUOs. The court held that the proof submitted by the defendant was indeed sufficient to support these claims, and affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The court considered an action by a provider to recover assigned first-party no-fault benefits. The plaintiff moved for summary judgment, while the defendant cross-moved for summary judgment dismissing the complaint on the ground that the action was premature due to the plaintiff's failure to provide requested verification. The main issue decided was whether the defendant had established the timely mailing of the verification requests, and whether the plaintiff had complied with defendant's requests for verification. The holding was that the court denied plaintiff's motion for summary judgment and made a CPLR 3212 (g) finding in defendant's favor, and held that the only remaining issue for trial was whether plaintiff had complied with defendant's requests for verification. The order was then modified by providing that the CPLR 3212 (g) finding in defendant's favor is vacated.

The court considered the fact that the defendant's claims examiner had established that the defendant first learned of the accident on the date it had received an NF-2 form, which was submitted more than 30 days after the accident had occurred. The main issue decided was whether the defendant had established its entitlement to judgment as a matter of law in an action by a provider to recover assigned first-party no-fault benefits. The holding of the case was that the defendant did establish its entitlement to judgment as a matter of law, and as a result, the order granting the defendant's cross motion for summary judgment dismissing the complaint was affirmed. The burden had shifted to the plaintiff, who in opposition, did not offer any proof to demonstrate the existence of a triable issue of fact.

The relevant facts of this case involved an action by a medical provider to recover assigned first-party no-fault benefits. 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 affirmation submitted by the defendant's doctor was sufficient to establish that the plaintiff's assignor had failed to appear for scheduled independent medical examinations. The holding of the court was that the affirmation submitted by the defendant was indeed sufficient, and therefore the order denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment dismissing the complaint was affirmed.

The court considered an appeal from an order of the Civil Court that denied a provider's motion for summary judgment and granted the insurance company's cross motion for summary judgment to dismiss the complaint. The main issue was whether the insurance company received the claim at issue and whether their time to pay or deny the claim began to run. The court held that there was an issue of fact as to whether the insurance company's time to pay or deny the claim ever began to run, as the affidavit from the provider's owner demonstrated that the claim form had been mailed to the insurance company. Therefore, neither party was entitled to summary judgment, and the court modified the order to deny the insurance company's cross motion for summary judgment dismissing the complaint.