No-Fault Case Law

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.

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.