No-Fault Case Law

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.

The court considered the defendant's motion for summary judgment to dismiss the complaint on the basis that all claims were timely and properly denied due to the plaintiff's assignor's failure to attend scheduled independent medical examinations, as well as the argument that the fees sought exceeded the amounts permitted by the workers' compensation fee schedule. The main issue decided was whether the defendant had proper grounds to deny the claims and to reduce the amount of the claims based on the fee schedule. The court held that the defendant failed to establish its entitlement to judgment as a matter of law due to the lack of personal knowledge of the nonappearance of the plaintiff's assignor for the examinations, and that there was a triable issue of fact with respect to whether the reductions were proper based on the fee schedule. The court affirmed the denial of the defendant's motion for summary judgment.

In this case, Encompass Insurance Company (respondent) sought to vacate the master arbitration decision of Frank G. Godson and reinstate the award of arbitrator Laura Yantsos. The main issue was whether petitioner's second follow-up request for an examination under oath was timely, as it was sent 11 days after the respondent failed to appear on the date set in the first request, with the 10th day falling on a Sunday. The court unanimously affirmed the order and judgment of Supreme Court, New York County, which vacated the master arbitration decision and reinstated the award of the arbitrator Laura Yantsos. The court held that plaintiff was entitled to an extension of time to send its second follow-up request, in accordance with General Construction Law § 25-a, and that the second request was therefore timely.

The court in this case considered a motion for de novo review of a master arbitrator's findings and summary judgment by the plaintiff. The main issue decided was whether the plaintiff satisfied the requirements for a de novo adjudication of the dispute under Insurance Law §5106 (c). The holding of the court was that the plaintiff was entitled to a de novo review of the arbitrator's findings and an extension of time to send its second follow-up request for an examination under oath, based on General Construction Law §25-a. The court modified the lower court's decision to reinstate the complaint and grant the part of the motion seeking de novo review of the arbitrator's findings and affirmed the decision without costs.

The relevant facts considered by the court in Meridian Psychological Services, P.C. v Allstate Insurance Company included a nonjury trial of the action by a provider to recover assigned first-party no-fault benefits. The main issues decided in this case were the timeliness and proper mailing of defendant's letters scheduling examinations under oath (EUOs) and the proof that plaintiff's assignor had failed to appear for the EUOs. The holding of the court was that the defendant failed to establish that the EUO scheduling letters had been timely and properly mailed to plaintiff's assignor, and that the defendant also failed to prove that plaintiff's assignor had failed to appear for the two duly scheduled EUOs. As a result, the judgment awarding the plaintiff the principal sum of $1,365.21 was affirmed.

The main issue in this case was whether the defendant was entitled to summary judgment dismissing the complaint filed by the plaintiff, who sought to recover assigned first-party no-fault benefits. The court considered whether the defendant had timely denied the claim in question and whether the plaintiff had demonstrated its entitlement to summary judgment. The court held that the defendant's motion for summary judgment dismissing the complaint was denied, as the defendant had failed to establish its entitlement to judgment as a matter of law. However, the court also held that the plaintiff had also failed to demonstrate its entitlement to summary judgment, as it did not establish that the claim had not been timely denied or that the defendant had issued a timely denial of the claim. Therefore, the court modified the order to deny the defendant's motion for summary judgment.

The relevant facts the court considered were related to a dispute between New Way Medical Supply Corp. and American Transit Insurance Co. regarding the payment of first-party no-fault benefits. The main issue decided was whether the plaintiff had failed to comply with a condition precedent to coverage by not appearing for scheduled examinations under oath (EUOs). The holding of the court was that the defendant had timely mailed the EUO scheduling letters and the plaintiff's assignor had failed to appear for the scheduled EUOs, thus failing to comply with a condition precedent to coverage. As a result, the defendant was entitled to summary judgment dismissing the complaint. The court affirmed the order, with the plaintiff having to pay $25 in costs.

The relevant facts in this case were that Tam Medical Supply Corp., as assignee of DOR GUY MARCEL, appealed from an order of the Civil Court of the City of New York, Queens County, which denied plaintiff's motion for summary judgment and granted defendant's cross motion for summary judgment dismissing the complaint. The main issue decided by the court was whether the action by the provider to recover assigned first-party no-fault benefits was premature due to the failure to provide requested verification. The holding of the court was that there is a triable issue of fact as to whether the action is premature because plaintiff had submitted an affidavit from the owner, which was sufficient to give rise to a presumption that the requested verification had been mailed to and received by defendant. Therefore, the court modified the order by providing that defendant's cross motion for summary judgment dismissing the complaint is denied.