No-Fault Case Law

In the case of PR Medical, P.C. v Praetorian Insurance Company, the court considered whether the defendant's motion for summary judgment to dismiss the complaint and the plaintiff's cross-motion for summary judgment on their claims amounting to $2,005.25 should be granted. The main issue decided was whether the plaintiff's claims were overdue, as they were not "denied or paid" within the prescribed 30-day period. The holding of the court was that the defendant's motion for summary judgment was denied, the complaint reinstated, and the plaintiff's cross-motion for summary judgment in the principal amount of $2,005.25 was granted. The court found that the defendant failed to raise a triable issue as to whether it had timely denied the claims and that the claims at issue were not timely denied, therefore the defendant was precluded from asserting its defense of lack of medical necessity.

The court considered the fact that an automobile accident occurred in New York involving a vehicle insured by the defendant under a Florida automobile insurance policy. The defendant rescinded the policy retroactively based on a material misrepresentation in the insurance application. The main issue was whether the defendant had complied with the requirements of rescinding the policy under Florida law. The holding of the court was that the defendant had demonstrated, through documented evidence, that it had complied with the requirements for rescinding the policy under Florida law, and therefore, it was entitled to summary judgment to dismiss the complaint. The court reversed the lower court’s decision and granted the defendant’s motion for summary judgment, while denying the plaintiff’s cross motion for summary judgment.

The relevant facts that the court considered were that a medical provider was seeking to recover no-fault benefits for acupuncture services rendered to an assignor. The main issue was whether the acupuncture services were medically necessary. The court held that the services in question were, in fact, medically necessary, as the provider demonstrated, by a preponderance of the credible evidence, that the services at issue were medically necessary. The court also precluded the defendant from raising a defense that the assignor may have been eligible for workers' compensation benefits, as the defendant had not denied the claims based upon that eligibility. Therefore, the court affirmed the judgment in favor of the medical provider.

The court considered the motion for summary judgment by the plaintiff to recover assigned first-party no-fault benefits, as well as the cross motion for summary judgment by the defendant to dismiss the complaint. The main issue decided was whether the defendant had timely and properly paid the plaintiff's claims in accordance with the workers' compensation fee schedule. The holding of the court was that the defendant had fully paid the plaintiff for the services at issue in accordance with the fee schedule, as established by the affidavit of the defendant's no-fault examiner and the exhibits annexed in support of the cross motion. Consequently, the Civil Court properly granted the defendant's cross motion and denied the plaintiff's motion, and the order was affirmed.

The relevant facts considered by the court were that Alleviation Medical Services, P.C. was seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the letters scheduling the independent medical examinations had been timely and properly mailed to the assignor. The court held that the defendant's motion for summary judgment dismissing the complaint was denied because they failed to demonstrate that the IMEs had been properly scheduled and that the plaintiff's assignor had failed to comply with a condition precedent to an insurer's liability on a policy. Additionally, the court found that the affirmation of defendant's counsel was insufficient, and defendant could not establish its entitlement to judgment. Therefore, the order was reversed, and defendant's motion for summary judgment dismissing the complaint was denied.

The court considered the timely mailing of a denial of claim form by the defendant, which denied the claim on the grounds of lack of medical necessity. The defendant also submitted an affirmed peer review that provided a factual basis and medical rationale for the determination that there was a lack of medical necessity for the services at issue. In opposition, the plaintiff submitted an affidavit from a doctor that failed to sufficiently rebut the conclusions set forth in the peer review report. The main issue decided was whether the defendant sufficiently established the lack of medical necessity for the services at issue, and the court held that the defendant did establish its entitlement to summary judgment dismissing the complaint. Therefore, the order granting the defendant's motion for summary judgment and denying the plaintiff's cross motion for summary judgment was affirmed.

The relevant facts the court considered in this case are that Vladenn Medical Supply Corp, as the assignee of Donald Audouis, appealed an order denying its motion for summary judgment and granting Travelers Insurance Company's cross motion for summary judgment dismissing the complaint. The main issue decided was whether plaintiff's action to recover assigned first-party no-fault benefits was premature due to failure to provide requested verification. The court held that defendant's cross motion for summary judgment dismissing the complaint was denied, as plaintiff had submitted an affidavit that gave rise to a presumption that the requested verification had been mailed to and received by defendant. Therefore, there was a triable issue of fact as to whether the action was premature.

The main issue in this case was whether the defendant was entitled to summary judgment dismissing the complaint in an action by a provider to recover assigned first-party no-fault benefits. The court considered the timely submission of independent medical examination (IME) requests, the failure of the plaintiff's assignor to appear for scheduled IMEs, and the timely mailing of denial of claim forms based on nonappearance at the IMEs. The court held that the defendant had sufficiently established that the plaintiff's assignor had failed to comply with a condition precedent to coverage, and as the plaintiff failed to raise a triable issue of fact in opposition to the motion, the defendant's motion for summary judgment dismissing the complaint was granted.

The main issue of the case was whether Alleviation Medical Services, P.C was entitled to recover assigned first-party no-fault benefits from Farmers New Century Insurance Co. Alleviation Medical Services, P.C. moved for summary judgment and Farmers New Century Insurance Co. cross-moved for summary judgment dismissing the complaint. The court ultimately granted Alleviation Medical Services, P.C.'s motion for summary judgment upon the first cause of action, and denied Farmers New Century Insurance Co.'s cross motion seeking summary judgment dismissing that cause of action. The court found that Alleviation Medical Services, P.C. had established its prima facie case upon the first cause of action, and that Farmers New Century Insurance Co. was precluded from asserting certain defenses in relation to this claim. As a result, the court held in favor of Alleviation Medical Services, P.C. and remitted the matter to the court for the calculation of statutory interest and an assessment of attorney's fees upon the first cause of action.

The relevant facts considered by the court in this case were that the plaintiff, as the assignee of Mercedes Sandoval, was seeking to recover first-party no-fault benefits from the defendant, New York Central Mutual Fire Insurance Company. The defendant had moved for summary judgment to dismiss the complaint, arguing that it had timely and properly denied the claims due to the plaintiff's assignor's failure to appear for independent medical examinations. The main issue decided by the court was whether the defendant had properly and timely denied the claims based on the assignor's failure to appear for these examinations. The holding of the court was that the defendant had indeed established the timely and proper mailing of the denial of claim form, and as a result, the order granting the defendant's motion for summary judgment dismissing the complaint was affirmed.