No-Fault Case Law

The main issues in this case were whether the defendant-insurer had met its burden to prove nonappearance at scheduled examinations under oath (EUOs), and whether the defense of failure to appear for EUOs could be asserted regardless of the timeliness of the denial. The court considered the evidence presented by the defendant, which failed to demonstrate personal knowledge of the office procedures when a claimant failed to appear for the EUOs, and noted that the affirmation of defendant's attorney did not state that he was the attorney assigned to conduct the EUOs. The court ultimately decided to affirm the denial of the defendant's motion for summary judgment, as the defendant had failed to meet its burden of proof, and also concluded that the defense of failure to appear for EUOs may be asserted by an insurer regardless of the timeliness of the denial.

The court considered the fact that the plaintiff was seeking recovery of assigned first-party no-fault benefits, and that the defendant had properly mailed notices for independent medical examinations (IMEs) to the plaintiff's assignor and his attorney. However, there were triable issues raised as to whether the assignor failed to appear for the scheduled IMEs, which precluded summary judgment for either party. The main issue decided was whether there were triable issues as to whether the assignor failed to appear for the scheduled IMEs, which would preclude an award of summary judgment to either party. The holding of the case was that the action was not ripe for summary disposition, and the court denied the defendant's motion for summary judgment and reinstated the complaint.

The court considered the defendant insurer's motion for summary judgment dismissing the complaint in a case involving Omega Diagnostic Imaging, P.C. and Praetorian Insurance Company. The defendant insurance company had timely and properly mailed notices for examinations under oath to the plaintiff's assignor, who failed to appear. However, the court found that the limited record presented triable issues as to whether the assignor's failure to appear was excusable, especially given the assignor's incarceration during the relevant time period. The court ultimately affirmed the order denying the defendant's motion for summary judgment, stating that the defendant's moving submission created rather than eliminated genuine triable issues. The main issue decided was whether the assignor's failure to appear at the examinations under oath was excusable, and the holding of the court was that the issue presented triable issues and therefore the order denying the defendant's motion for summary judgment was affirmed.

The relevant facts considered by the court were that Brand Medical Supply, Inc. was seeking to recover first-party no-fault benefits as the assignee of Vladimir Jean. The Civil Court awarded Brand Medical Supply a judgment of $1,150 following a nonjury trial. However, the Appellate Term, Second Department reversed this decision and remitted the matter to the Civil Court for a new trial. The main issue decided was whether Brand Medical Supply, Inc. was entitled to recover the assigned first-party no-fault benefits, and the holding of the court was that the judgment of the Civil Court was reversed and a new trial was ordered.

The main issue in this case was whether the trial court erred in excluding an insurance policy declaration page from evidence. The court considered that the plaintiff had established its prima facie case for recovery of no-fault benefits, and that the defendant unsuccessfully attempted to have the declaration page, which set forth the coverage limits of the policy, admitted into evidence. The court held that the trial court had erred in excluding the insurance policy declaration page from evidence, and that a new trial was warranted. As a result, the judgment was reversed and the matter was remitted to the Civil Court for a new trial.

The court considered the appeal from a provider seeking to recover assigned first-party no-fault benefits. The main issue in the case was whether the defendant was entitled to summary judgment dismissing the portion of the complaint seeking to recover for services billed using CPT code 97026. The court reversed the order and denied the branch of the defendant's motion seeking summary judgement, as the defendant's moving papers failed to demonstrate their entitlement to summary judgement. The holding of the case was that the defendant's motion for summary judgment to dismiss the portion of the complaint seeking to recover for services billed using CPT code 97026 was denied.

The court considered whether a group of plaintiffs were obligated to provide insurance coverage for certain no-fault claims submitted by the defendant. The defendant failed to comply with the provision of the insurance policy which required the defendant submit to an examination under oath (EUO). The plaintiffs moved for summary judgment on the complaint, and the Supreme Court granted the plaintiffs' motion and denied the defendant's cross motion. However, the affirmation of the plaintiffs' counsel contained allegations that were deemed conclusory and failed to establish that the practice and procedure was designed to ensure that the EUO letters were addressed to the proper party and properly mailed. The Appeals court held that the plaintiffs failed to establish their entitlement to judgment. The defendant's opposition papers, however, were also insufficient.

The relevant facts of this case were that the claim one defendants and claim two defendants were in two staged car accidents, and no-fault claims were submitted to the plaintiff, who insured claim one defendants and claim two defendants. The plaintiff insurer then filed for summary judgment in order to declare that it had no obligation to provide coverage for the no-fault claims submitted to it. The court reversed the order stating that the plaintiff had not fully proven that the accidents were staged, as important evidence was inadmissible in court. The defendant failed to justify their claim that insurance contracts were breached and did not establish proof of initial mailing for the required EUOs. Therefore, the holding of this case is that the plaintiff's claim for a judgment against the defendant Sovereign Acupuncture, P.C. was denied and the case was remanded for further proceedings.

The court considered the fact that the plaintiff, Professional Health Imaging, P.C., was seeking to recover first-party no-fault benefits that had been assigned to them by Jennifer Kranwinkel. The main issue decided was whether the plaintiff's failure to appear for scheduled examinations under oath justified the defendant, State Farm Mutual Automobile Ins. Co., being granted summary judgment dismissing the complaint. The holding of the case was that the court affirmed the order granting the defendant's motion for summary judgment and denying the plaintiff's cross motion. The court cited a related case as the basis for their decision.

The court considered the fact that the plaintiff, Professional Health Imaging, P.C., was seeking to recover first-party no-fault benefits as the assignee of Maksim Cela. The main issue decided was whether the plaintiff's failure to appear for scheduled examinations under oath justified the defendant's motion for summary judgment to dismiss the complaint. Additionally, the court had to determine if the plaintiff's cross-motion for summary judgment, or alternatively to strike the defendant's answer and affirmative defenses, and to compel the defendant to respond to discovery demands, was valid. The holding of the case was that the order granting the defendant's motion for summary judgment and denying the plaintiff's cross motion was affirmed, and costs of $25 were awarded.