No-Fault Case Law

The case involved an appeal from a judgment in an action by a New Jersey facility to recover assigned first-party no-fault benefits from an insurance company. The insurance company had issued a timely denial of the claim based on a lack of medical necessity, which was determined after an independent medical examination (IME) by a licensed chiropractor. The Civil Court initially found for the plaintiff, awarding them the principal sum of $7,790.60. However, the Appellate Court reversed the judgment, determining that the chiropractor's testimony at the IME demonstrated a lack of medical necessity for the procedure. As the plaintiff did not present any evidence to rebut this, the court held that the complaint should have been dismissed. The Appellate Court did not address the issue of whether chiropractors are allowed to perform the specific procedure in New York and remitted the matter back to the Civil Court for the entry of a judgment in favor of the defendant.

The relevant facts the court considered in this case are that DJS Medical Supplies, Inc. was seeking to recover first-party no-fault benefits for medical supplies that it had provided to its assignor. The trial was based on defendant's defense of lack of medical necessity, with plaintiff failing to call any witness to rebut defendant's doctor's testimony. The Civil Court directed the entry of a judgment in favor of plaintiff in the principal sum of $181.50 for a massager, and also found that defendant had demonstrated that the remaining supplies in question were not medically necessary. The main issue decided was whether the judgment dismissing the complaint, except for $181.50, should be reversed. The holding of the case was that the judgment was reversed and the matter was remitted to the Civil Court for the entry of a judgment in favor of plaintiff in the principal sum of $181.50, together with costs, plus statutory interest and attorney's fees due pursuant to Insurance Law § 5106 (a) and the regulations promulgated thereunder.

The relevant facts the court considered were that the plaintiff sought to recover first-party no-fault benefits for medical supplies provided to its assignor after a motor vehicle accident. The defendant had commenced a declaratory judgment action seeking a declaration that it was not obligated to pay the plaintiff's claims due to the plaintiff's failure to comply with a condition precedent. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint based on the preclusive effect of the judgment in the declaratory judgment action. The holding of the case was that the Civil Court properly granted the defendant's motion for summary judgment under the doctrine of res judicata, as any judgment in favor of the plaintiff in this action would destroy or impair rights or interests established by the judgment in the declaratory judgment action. The order granting the defendant's motion for summary judgment was affirmed.

The court considered the fact that Island Life Chiropractic, P.C. had commenced an action to recover first-party no-fault benefits for services provided to its assignor as a result of injuries sustained in a motor vehicle accident which had occurred on April 6, 2012. The insurer identified itself as Kemper Independence Insurance Company and argued that Island Life's action was barred by collateral estoppel and res judicata. Before Island Life commenced its action, a declaratory judgment action had been commenced in the Supreme Court by Kemper claiming that the assignor had breached the terms of an insurance policy. The Supreme Court declared that Island Life was "not entitled to no-fault reimbursements or benefits for the motor vehicle accident that occurred on April 6, 2012 under policy FZ717084." As a result, the Civil Court granted the insurer's motion for summary judgment, dismissing the complaint. The main issue decided in the case was whether the action brought by Island Life Chiropractic, P.C. was barred by res judicata due to the declaratory judgment action that had been determined in favor of the insurer. The court ultimately held that the action was indeed barred by res judicata and affirmed the order of the Civil Court granting the insurer's motion for summary judgment.

The relevant facts considered by the court were that Atlantic Chiropractic, P.C. was trying to recover assigned first-party no-fault benefits from Liberty Mutual Fire Insurance Co., but Liberty Mutual claimed the action was barred by res judicata. This was based on a previous declaratory judgment in the Supreme Court, Bronx County, which declared that Liberty Mutual was not obligated to pay the benefits due to the assignor's failure to appear for scheduled examinations under oath. The main issue was whether the default declaratory judgment in the Supreme Court action was valid, as the Civil Court had denied Liberty Mutual's motion for summary judgment on the grounds that the judgment had not been entered and served. The holding of the court was that the default declaratory judgment was valid based on res judicata and defendant's motion for summary judgment was granted, while plaintiff's cross motion for summary judgment was denied.

The relevant facts in this case included a lawsuit by a medical provider to recover first-party no-fault benefits, and a declaratory judgment in Supreme Court, Bronx County declaring that the defendant had no obligation to pay the claims due to the failure of the plaintiff's assignor to attend examinations under oath. The main issue decided was whether the defendant's action was barred by res judicata, and whether the defendant's failure to include res judicata as an affirmative defense in its answer was sufficient reason to grant summary judgment. The holding of the case was that the defendant's answer was deemed amended to include the affirmative defense of res judicata, and the defendant's motion for summary judgment dismissing the complaint was granted, while the plaintiff's cross motion for summary judgment was denied.

The relevant facts under consideration include an action, pursuant to Insurance Law § 5106 (c), for a de novo determination of a no-fault insurance dispute between plaintiff AutoOne Insurance Company and defendant Eastern Island Medical Care, P.C. The main issue decided by the court concerns the erroneous denial of the plaintiff's motion for summary judgment on the complaint, cross motion to confirm the master arbitrator's award, and other motions seeking to dismiss different affirmative defenses. The holding of the case is in favor of AutoOne Insurance Company, the no-fault insurance carrier, finding that it was entitled to commence the action to compel de novo adjudication, as the master arbitrator’s award exceeded the statutory threshold amount of $5,000. The court determined that the plaintiff timely invoked its right to a de novo review, rendering the defendant’s claim that the plaintiff failed to exhaust its administrative remedies or satisfy a condition precedent without merit. The court reversed the judgment, granted the plaintiff's motion to dismiss the affirmative defenses, and remitted the matter for a determination on the remaining branches of the plaintiff's motion.

The court considered multiple cases consolidated for trial, all involving disputes over first-party no-fault benefits under the same insurance policy. The main issue decided was whether or not unsworn transcripts of examinations under oath (EUO) were admissible as business records. The court found that the transcripts were admissible as business records under CPLR 4518 (a), due to their reliability, the requirements and licensing of notaries in the State of New York, and the consequences to the attorney and notary if they mislead the court. The court weighed the evidence, including the transcripts and testimony regarding the defendant's policies and procedures, and ultimately found that the defendant had proven by a preponderance of the evidence that the providers failed to appear for their scheduled EUOs, resulting in a final judgment in favor of the defendant and dismissal of the complaint.

The court considered the evidence provided by both the plaintiff and the defendant in relation to the plaintiff's claims for first-party no-fault benefits for services rendered within specific dates. The main issue decided was whether the defendant was entitled to partial summary judgment dismissing the plaintiff's no-fault claims for certain services. The holding of the court was that the defendant made a prima facie showing of entitlement to partial summary judgment dismissing the claims for services rendered within certain dates based on medical evidence, but there were still triable issues remaining in connection with the plaintiff's claims for services rendered within a different set of dates. Therefore, the court modified the order to reinstate certain claims for first-party no-fault benefits and affirmed the order with costs.

The court considered the facts of a case in which an insurance company moved for summary judgment to dismiss a complaint brought by healthcare providers seeking to recover no-fault benefits. The insurance company argued that the healthcare provider's assignor had failed to appear for scheduled examinations under oath (EUO), and therefore, the claim for benefits should be dismissed. The main issue decided by the court was whether the healthcare provider's assignor had failed to comply with the scheduled EUO requirements. The court held that the healthcare provider's assignor had failed to comply with the scheduled EUO requirements and therefore affirmed the lower court's decision to grant the insurance company's motion for summary judgment and deny the healthcare provider's cross motion for summary judgment.