No-Fault Case Law

The relevant facts considered by the court were that Ultimate Health Products, Inc. was seeking to recover first-party no-fault benefits as the assignee of Kerwin Boyea, and had moved for summary judgment. Allstate Insurance Company had cross-moved for summary judgment dismissing the complaint, arguing that the action was premature because Ultimate Health Products, Inc. had failed to provide requested verification. The main issue decided by the court was whether the defendant's cross motion for summary judgment dismissing the complaint should be granted. The court held that the defendant's cross motion for summary judgment dismissing the complaint was denied, reversing the decision of the Civil Court. The court reasoned that the decision in a similar case, Great Health Care Chiropractic, P.C. v Hereford Ins. Co., led them to conclude that the defendant's cross motion should be denied. In summary, the court considered the failure to provide requested verification and determined that the defendant's cross motion for summary judgment dismissing the complaint should be denied.

The relevant facts of the case involved a medical supply company, New Way Medical Supply Corp., seeking to recover first-party no-fault benefits that had been assigned to them. The company moved for summary judgment, while the defendant, Praetorian Ins. Co., cross-moved for summary judgment on the basis that the action was premature due to the plaintiff failing to provide requested verification. The Civil Court denied the plaintiff's motion and granted the defendant's cross-motion, but the appellate court modified the order by denying the defendant's cross-motion for summary judgment dismissing the complaint. The main issue decided in the case was whether the defendant's cross-motion for summary judgment dismissing the complaint should be granted, based on the plaintiff's alleged failure to provide requested verification. The holding of the case was that the appellate court modified the lower court's decision by denying the defendant's cross-motion for summary judgment dismissing the complaint. This decision was based on reasons stated in a similar case, Great Health Care Chiropractic, P.C., as Assignee of Carlos Thomas v Hereford, Ins. Co., and was concurred by Pesce, P.J., Aliotta and Solomon, JJ.

The court considered a provider's claim to recover assigned first-party no-fault benefits. The defendant had denied the claim on the grounds of lack of medical necessity for the supplies provided and because the plaintiff's assignor had failed to appear for independent medical examinations (IMEs). The court granted the defendant's motion for summary judgment dismissing the complaint based on the assignor's failure to appear for the IMEs. The defendant submitted an affirmed peer review report to support its motion, which outlined the lack of medical necessity for the supplies. In opposition, the plaintiff submitted an affidavit from a doctor, but it failed to sufficiently rebut the conclusions set forth in the peer review report. Therefore, the court affirmed the order granting summary judgment to the defendant on the ground of lack of medical necessity.

The court considered the plaintiff's motion for summary judgment and the defendant's cross motion for summary judgment in a dispute over first-party no-fault benefits. The main issue decided was whether the defendant had timely and properly denied the claim based on the plaintiff's assignor's failure to appear for examinations under oath (EUOs). The court held that while the defendant had timely mailed the EUO scheduling letters, they had failed to submit proof by someone with personal knowledge of the nonappearance of the plaintiff's assignor for the EUOs, establishing their entitlement to summary judgment. The court also held that the plaintiff's moving papers failed to establish that the defendant had failed to deny the claim within the requisite 30-day period, or that the defendant had issued a timely denial of claim that was conclusory, vague, or without merit as a matter of law, therefore the plaintiff did not establish their entitlement to summary judgment. Therefore, the court affirmed the order but modified it to deny the defendant's cross motion for summary judgment dismissing the complaint.

The court considered the fact that the defendant failed to establish, as a matter of law, its entitlement to summary judgment dismissing the complaint as the initial affirmation submitted in support of the defendant's cross motion was not made on personal knowledge. Additionally, the court found that the plaintiff failed to demonstrate its prima facie entitlement to summary judgment, as it did not establish that the defendant's defense lacked merit as a matter of law. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint, which the court determined they were not. The holding of the case was that the order was modified by providing that plaintiff's motion for summary judgment was denied, and the order was affirmed as modified.

The court considered the appeal of an order from the Civil Court of the City of New York, Queens County, which granted the defendant's motion for summary judgment dismissing the complaint in an action to recover assigned first-party no-fault benefits. The main issue decided was whether the action was premature because the provider had failed to provide requested verification. The holding of the court was that the order granting the defendant's motion for summary judgment was reversed, with the defendant's motion being denied. The court cited the reasons stated in a similar case, Renelique, as Assignee of Allen Haynes v Travelers Ins. Co., in support of its decision. The three presiding judges all concurred with this decision.

The court considered a provider's attempt to recover assigned first-party no-fault benefits from an insurance company. The insurance company had denied the claims based on the failure of the provider's assignors to appear for independent medical examinations. The main issue decided was whether the denial of the claims by the insurance company was justified due to the assignors' failure to attend the scheduled examinations. The holding was that the insurance company's motion for summary judgment dismissing the complaint was granted, reversing the Civil Court's decision. The court concluded that the insurance company was justified in denying the claims based on the assignors' failure to attend the scheduled medical examinations.

The court considered the fact that the defendant denied the claims at issue based on the plaintiff's assignor's failure to appear for independent medical examinations. However, the defendant failed to submit proof by someone with personal knowledge of the nonappearance of the plaintiff's assignor for the IMEs in question. As a result, the defendant failed to establish its prima facie entitlement to summary judgment. The main issue decided was whether the defendant had provided sufficient evidence to establish its entitlement to summary judgment. The holding of the case was that the order granting defendant's motion for summary judgment dismissing the complaint was reversed, and defendant's motion for summary judgment dismissing the complaint was denied.

The relevant facts the court considered in this case were that the plaintiff, Pierre Jean Jacques Renelique, was seeking to recover assigned first-party no-fault benefits from Travelers Insurance Company. The main issue decided by the court was whether the action was premature because the plaintiff had failed to provide requested verification. The court ultimately held that there was a triable issue of fact as to whether the action was premature, as the plaintiff had submitted an affidavit from the owner that gave rise to a presumption that the requested verification had been mailed to, and received by, the defendant. As a result, the court reversed the order granting summary judgment to the defendant and denied their motion to dismiss the complaint.

The relevant facts considered in this case were that an action was brought by a provider to recover assigned first-party no-fault benefits. The Civil Court denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment dismissing the complaint on the basis that the action was premature due to the plaintiff's failure to provide requested verification. The main issue decided was whether the action was premature, and the holding of the case was that there was a triable issue of fact as to whether the action was premature, and as a result, the defendant's cross motion for summary judgment dismissing the complaint was denied.