No-Fault Case Law

The court considered the fact that defendant timely denied plaintiff's no-fault claims on the grounds that the fees for the acupuncture services exceeded the amount permitted by the worker's compensation fee schedule. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint should be granted, and the court held that it should. The court found that the defendant's evidence established that they timely denied the claims, and plaintiff failed to raise a triable issue regarding the efficacy of the denial or the calculation of the fee. Therefore, the defendant's motion for summary judgment dismissing the claim was granted.

The court considered the defendant's appeal from an order of the Civil Court, which denied its motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant was entitled to summary judgment dismissing the plaintiff's claim for first-party no-fault benefits billed under certain CPT codes. The holding of the court was that the defendant was entitled to partial summary judgment dismissing the plaintiff's claim for benefits billed under CPT codes 97813 and 97814, as they exceeded the fees set forth in the applicable worker's compensation fee schedule, and the defendant timely denied these claims. However, there were triable issues as to whether the defendant properly denied plaintiff's claim for $70 billed under CPT code 99202, thus precluding summary judgment dismissing this claim. The court concluded that the remaining arguments from the plaintiff were either unpreserved or lacking in merit.

The main issue decided in this case was whether the defendant was entitled to summary judgment dismissing the complaint brought by the plaintiff, a provider seeking recovery of first-party no-fault benefits. The relevant facts considered by the court included the defendant's argument that it had fully paid the plaintiff for the services at issue in accordance with the workers' compensation fee schedule. On appeal, the plaintiff argued that the defendant had not sufficiently demonstrated that its denial of claim forms had been timely mailed. The court ultimately held that the defendant did not demonstrate its entitlement to summary judgment, reversed the lower court's order, and denied the defendant's motion for summary judgment dismissing the complaint.

The court considered the appeal from an order of the Civil Court granting the defendant's motion for summary judgment dismissing the complaint. The main issue decided was whether the provider, TAM Medical Supply Corp., could recover assigned first-party no-fault benefits. The holding of the court was that the order granting the defendant's motion for summary judgment was affirmed, with $25 costs, for the same reasons as stated in a previous case, Metro Health Prods., Inc. v State Farm Mut. Auto. Ins. Co. The decision was reached by Pesce, P.J., Aliotta and Solomon, JJ. on September 15, 2016.

The facts of the case involved Restoration Chiropractic, P.C. seeking to recover assigned first-party no-fault benefits from New York Central Mutual Fire Insurance Company. The defendant had denied the plaintiff's claims on the basis that the assignor had failed to appear for independent medical examinations (IMEs) that were scheduled. The main issue decided by the court was whether the defendant's motion for summary judgment dismissing the complaint was justified based on the assignor's failure to appear for the scheduled IMEs. The court held that the proof submitted by the defendant was sufficient to establish that the IME scheduling letters and denial of claim forms had been properly mailed, and that the assignor had indeed failed to appear for the IMEs. As a result, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The court considered the denial of a motion for summary judgment in a case where a chiropractic office sought to recover assigned first-party no-fault benefits from an insurance company. 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 there was, in fact, a triable issue of fact regarding the medical necessity of the services, and as a result, the order denying the motion for summary judgment was affirmed. The case was decided on September 15, 2016, by the Appellate Term, Second Department.

The court considered the fact that the plaintiff, a provider seeking to recover assigned first-party no-fault benefits, had moved for summary judgment, and the defendant had cross-moved for summary judgment dismissing the complaint on the ground that the plaintiff's assignor had failed to appear for independent medical examinations (IMEs). The main issue decided was whether the defendant had established the timely and proper mailing of the IME scheduling letters and the denial of claim forms. The holding of the case was that the Civil Court denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment, and the Appellate Term affirmed this decision, with costs. The court found that the defendant had submitted affidavits that established the timely and proper mailing of the IME scheduling letters and denial of claim forms, and as a result, there was no basis to disturb the order.

The relevant facts considered by the court were that DAC Medical, P.C./Timothy Mosomillo, D.O. was seeking to recover first-party no-fault benefits from Allstate Insurance Company. The main issue decided was whether there was a triable issue of fact regarding the medical necessity of the services at issue. The court held that there was a triable issue of fact regarding the medical necessity of the services at issue and affirmed the order denying plaintiff's motion for summary judgment. The decision was made by the Supreme Court, Appellate Term, Second Department, with Pesce, P.J., Aliotta and Solomon, JJ., concurring.

The court considered a case where New Way Medical Supply Corp, as the assignee of Kathleem Long, was seeking to recover first-party no-fault benefits from State Farm Mutual Automobile Insurance Co. The main issue decided in this case was whether the defendant's motion for summary judgment dismissing the complaint should be granted. The holding of the court was that the order granting the defendant's motion for summary judgment to dismiss the complaint was affirmed. The court cited a previous case, Metro Health Prods., Inc. v State Farm Mut. Auto. Ins. Co. to support their decision, and the judges Pesce, Aliotta, and Solomon all concurred with the decision.

The court considered the defendant's motion for summary judgment dismissing the complaint from the plaintiff, a provider seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the plaintiff's claims had been timely and properly denied on the ground that the plaintiff's assignor had failed to appear for duly scheduled independent medical examinations (IMEs). The court held that the address to which the IME scheduling letters were addressed improperly including an apartment number was not properly before the court as it was not raised in the plaintiff's opposition to the motion. The court also found no merit to the arguments raised by the plaintiff regarding the sufficiency of the defendant's proof of timely and proper mailing of the IME scheduling letters and denial of claim forms, and that the plaintiff's assignor had failed to appear for the duly scheduled IMEs. Therefore, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.