No-Fault Case Law

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.

The main issue in this case was whether the defendant's motion to vacate an order granting the plaintiff's motion for summary judgment should be granted. The court considered the fact that the defendant had failed to submit opposition papers to the plaintiff's motion for summary judgment, but later moved to vacate the order based on law office failure. The defendant's counsel and a paralegal from the counsel's office provided a detailed and credible excuse for the default, which was considered sufficient to excuse the default. Additionally, the defendant demonstrated a meritorious defense by submitting a copy of the motion papers that it had submitted in support of its separate motion for summary judgment. As a result, the court held that the defendant's motion to vacate the order was granted and the plaintiff's motion for summary judgment was denied.

The court considered the motion for summary judgment by the defendant to dismiss the complaint, which was on the grounds that the plaintiff had failed to appear for scheduled examinations under oath. The plaintiff had also filed a cross motion for summary judgment, or in the alternative, to strike the defendant's answer and affirmative defenses, and to compel the defendant to respond to discovery demands. The main issue decided was whether the defendant's motion for summary judgment to dismiss the complaint was granted, and if the plaintiff's cross motion for summary judgment or alternative relief was denied. The holding of the case was that the court affirmed the order, with costs of $25, on the basis of the reasons stated in another similar case, and the decision date was June 23, 2016.

The court considered the fact that the plaintiff, a medical provider, was seeking to recover assigned first-party no-fault benefits from the defendant, an insurance company. The main issue before the court was whether the plaintiff had failed to appear for scheduled examinations under oath, which was grounds for the defendant's motion for summary judgment. The court also considered the plaintiff's cross motion for summary judgment or to compel the defendant to respond to discovery demands. 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's decision was based on the same reasons stated in another case, Professional Health Imaging, P.C., as Assignee of Luis Lopez v State Farm Mut. Auto. Ins. Co., and the order was affirmed with $25 costs.

The relevant facts considered by the court were the failure of the plaintiff to appear for scheduled examinations under oath (EUOs) as required by the defendant. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint based on the plaintiff's failure to appear for the EUOs was justified. The holding of the court was that the defendant sufficiently proved the plaintiff's failure to appear for the scheduled EUOs, and the plaintiff failed to respond to the EUO requests at issue. As a result, the court affirmed the order granting the defendant's motion for summary judgment and denying the plaintiff's cross motion.

The court considered the fact that the defendant had served the plaintiff with a notice for an examination before trial, which was material and necessary to the defendant's defense in an action by a provider to recover assigned first-party no-fault benefits. The main issue before the court was whether the branch of the defendant's motion seeking to compel the plaintiff to appear for an examination before trial should be granted. The court held that the branch of the defendant's motion seeking to compel the plaintiff to appear for an examination before trial should have been granted as the examination was material and necessary to the defendant's defense, and therefore reversed the order, granting the branch of defendant's motion and ordering the examination to be held within 60 days.

The relevant facts the court considered in this case were that S & R Medical, P.C. sought to recover assigned first-party no-fault benefits from GEICO General Insurance Company. Plaintiff motioned for summary judgment, and defendant cross-motioned for summary judgment dismissing the complaint. The Civil Court denied both motions, finding that there were triable issues of fact. The main issue decided was whether the Civil Court should have made findings, pursuant to CPLR 3212 (g), that plaintiff had established certain facts for all purposes in the action. The holding of the court was that the order denying plaintiff's motion for summary judgment was affirmed, as the court declined to limit the issues for trial.