No-Fault Case Law

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.

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.