No-Fault Case Law

The court considered the facts of the case, where a provider was seeking to recover assigned first-party no-fault benefits from an insurance company. The insurance company had moved for summary judgment, claiming that the action was premature because the provider had failed to provide requested verification. The main issue decided was whether the insurance company's motion for summary judgment should be granted or denied. The court held that the insurance company's motion for summary judgment dismissing the complaint was denied, reversing the previous order, and stating that the action was not premature.

The court considered the timely and proper denial of claims by the defendant on the basis that the plaintiff had failed to comply with a condition precedent to coverage by not appearing for scheduled examinations under oath (EUOs). The main issue was whether the defendant had proven that the EUO scheduling letters and denial of claim forms were timely mailed, and that the plaintiff had failed to appear for the EUOs. The holding of the case was that the defendant had established, through affidavits and an affirmation from their attorney, that the plaintiff had failed to appear for the scheduled EUOs, and that the EUO scheduling letters and denial of claim forms had been timely mailed. The court also cited a previous case to support the decision, which held that a provider's argument for the denial of a motion on the basis of inadequate discovery regarding the reasonableness of the insurer's EUO requests was insufficient without establishing what information they hoped to discover that would demonstrate a triable issue of fact. Therefore, the order granting the defendant's motion for summary judgment dismissing the complaint was affirmed.

The relevant facts considered by the court were that Island Life Chiropractic, P.C., as an assignee of Patrick Joseph, brought an action to recover assigned first-party no-fault benefits from National Liability & Fire Insurance Company. Plaintiff moved for summary judgment, but defendant cross-moved for summary judgment dismissing the complaint on the grounds that the action was premature due to plaintiff's failure to provide requested verification. The main issue decided was whether the action was premature and if plaintiff's failure to provide requested verification warranted the dismissal of the complaint. The holding of the court was that the defendant's cross motion for summary judgment dismissing the complaint was denied, and the order was modified to reflect this decision, without costs. The court's decision was based on a similar case, Great Health Care Chiropractic, P.C., as Assignee of Carlos Thomas v Hereford Ins. Co.

The court considered the case of IMA Acupuncture, P.C. v Allstate Ins. Co. in which the plaintiff sought to recover assigned first-party no-fault benefits. Plaintiff moved for summary judgment, while the defendant cross-moved for summary judgment dismissing the complaint on the grounds that the plaintiff's assignor had failed to appear for examinations under oath (EUOs). The Civil Court granted the plaintiff's motion and denied the defendant's cross motion, awarding the plaintiff the principal sum of $3,092.34. The appellate court reversed the judgment, vacated the order granting plaintiff's motion for summary judgment, and denied plaintiff's motion for summary judgment. The court held that defendant had failed to establish, as a matter of law, its entitlement to summary judgment dismissing the complaint, and that plaintiff had failed to demonstrate its prima facie entitlement to summary judgment.

The court considered the fact that Longevity Medical Supply, Inc. was seeking to recover first-party no-fault benefits from Praetorian Insurance Company. The main issue decided was whether or not Praetorian Insurance Company had properly denied the claims at issue based on the failure of Longevity's assignor to appear for scheduled independent medical examinations (IMEs). The court held that defendant was entitled to summary judgment dismissing the complaint, as they had submitted sufficient evidence, including affidavits from the doctors who were to perform the IMEs, to establish that the plaintiff's assignor had failed to appear for the scheduled examinations. Therefore, the court reversed the order and granted defendant's motion for summary judgment.

The relevant facts of the case were that New Way Medical Supply Corp, as the assignee of Kadeem Anderson, appealed from an order of the Civil Court of the City of New York, Kings County, which granted the defendant's motion for summary judgment dismissing the complaint. The main issue decided was whether the provider was entitled to 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 reversed, with the defendant's motion for summary judgment dismissing the complaint denied. The court's decision was based on the reasoning stated in a similar case, Alleviation Med. Servs., P.C., as Assignee of Kadeem Anderson v State Farm Mut. Auto. Ins. Co., and all judges concurred with the decision.

The court considered the defendant's motion for summary judgment dismissing the complaint in an action brought by a medical provider to recover no-fault benefits. The main issue decided was whether the defendant, an insurance company, was entitled to judgment dismissing the complaint on the ground that the plaintiff's assignor had failed to appear for independent medical examinations (IMEs) as required. The court held that the defendant failed to establish its entitlement to judgment as a matter of law, as the doctor who was supposed to perform the IMEs did not have personal knowledge of the nonappearance of the plaintiff's assignor. Additionally, there was an issue of fact as to whether the assignor received notice of both scheduled IMEs, as the scheduling letters were mailed to different addresses. Therefore, the court reversed the order granting the defendant's motion for summary judgment and denied the motion.

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.