No-Fault Case Law

The relevant facts the court considered in this case were that the defendant insurer moved for summary judgment to dismiss the complaint brought by the plaintiff provider, who was seeking to recover assigned first-party no-fault benefits on behalf of Jose Espinosa. The insurer argued that it had timely and properly denied the claim because the plaintiff's assignor had failed to appear for scheduled independent medical examinations (IMEs). The main issue decided by the court was whether the insurer had properly scheduled the IMEs and whether they had been timely mailed. The holding of the court was that the defendant had failed to establish that the letters scheduling the IMEs had been timely mailed, and therefore had not demonstrated that the IMEs had been properly scheduled. As a result, the court affirmed the order denying the insurer's motion for summary judgment.

The court considered the facts of an action by a provider to recover assigned first-party no-fault benefits. The defendant had moved for summary judgment dismissing the complaint, alleging that the claims at issue had been timely and properly denied on the ground that the plaintiff's assignor had failed to appear at duly scheduled examinations under oath (EUOs). The main issue decided was whether the defendant had properly scheduled the EUOs, and thus, whether the plaintiff's assignor had failed to appear at the examinations. The holding was that the defendant failed to establish that the initial and follow-up EUO scheduling letters had been timely mailed and failed to demonstrate that the EUOs had been properly scheduled, therefore the defendant was not entitled to summary judgment dismissing the complaint. As a result, the order was reversed, and the defendant's motion for summary judgment dismissing the complaint was denied.

The relevant facts the court considered in the case of Acupuncture Healthcare Plaza I, P.C. v Truck Ins. Exch. involved a dispute over first-party no-fault benefits for acupuncture services rendered by the plaintiff. The defendant argued that they had properly used the workers' compensation fee schedule applicable to chiropractors who provide similar services to reimburse the plaintiff for the acupuncture services. The main issue decided by the court was whether the defendant had properly reimbursed the plaintiff for the services rendered. The holding of the case was that the defendant had established that the denial of the claim form had been timely mailed and that they had fully paid the plaintiff in accordance with the workers' compensation fee schedule for acupuncture services provided by chiropractors. Therefore, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The relevant facts considered by the court in this case include the defendant's motion for summary judgment dismissing the complaint on various grounds, including failure of the plaintiff's assignor to appear for scheduled independent medical examinations (IMEs) and the allegation that the fees sought exceeded the amounts permitted by the workers' compensation fee schedule. The court also considered the defendant's contention that the claim underlying one of the causes of action had been untimely submitted. The main issues decided by the court were whether the defendant had established its entitlement to judgment as a matter of law on the grounds raised in its motion for summary judgment, and whether there was a triable issue of fact as to whether the claim at issue was timely submitted to the defendant. The holding of the case was that the order of the Civil Court denying the defendant's motion for summary judgment was affirmed, with the court finding that the defendant had failed to establish its entitlement to judgment as a matter of law in dismissing the claims on the grounds brought forth.

The relevant fact the court considered in this case was a provider's attempt to recover assigned first-party no-fault benefits from an insurance company. The main issue decided was whether the insurance company was entitled to summary judgment dismissing the complaint based on the alleged failure of the plaintiff's assignor to appear for duly scheduled examinations under oath (EUOs). The holding of the court was that the insurance company failed to establish a prima facie showing of its entitlement to summary judgment, as it did not prove that the EUO notices and the denial of claim forms had been properly and timely mailed. Therefore, the court affirmed the order denying the insurance company's motion for summary judgment.

The main facts of the case involved New Millennium Medical Imaging, P.C. suing American Transit Insurance Company to recover first-party no-fault benefits for medical services provided to their assignor after an automobile accident. American Transit had previously obtained a declaratory judgment in Supreme Court, New York County, declaring that they had no duty to pay no-fault claims for a collision on April 2, 2012. American Transit then moved for summary judgment in Civil Court to dismiss New Millennium's complaint, arguing that the action was barred by the declaratory judgment. The Civil Court denied American Transit's motion, finding that there was an issue of fact as to whether the Supreme Court judgment applied to the present litigation. The main issue decided was whether res judicata, or claim preclusion, applied, and the holding of the court was that American Transit failed to establish its entitlement to summary judgment due to conflicting dates of the accident presented in their own papers, and therefore the order denying the motion for summary judgment was affirmed.

The court considered the fact that the action by a provider to recover assigned first-party no-fault benefits was "marked off" the trial calendar after the plaintiff's witness was unavailable and unable to appear for trial. The main issue in the case was whether the plaintiff's motion to restore the action to the trial calendar should be granted. The court held that the plaintiff's motion was properly denied, as it failed to provide a satisfactory explanation for the action having been stricken from the calendar. The court also noted that the motion was made within one year after the action had been "marked off" the trial calendar, and that CPLR 3404 does not apply to cases in the Civil Court. Therefore, the order denying plaintiff's motion to restore the action to the trial calendar was affirmed.

The relevant facts the court considered in this case were related to a provider's attempt to recover assigned first-party no-fault benefits from an insurance company. The main issue decided was whether the insurance company was entitled to deny the benefits based on the insured's alleged fraudulent procurement of the insurance policy. The holding of the case was that the insurance company's denial of the benefits was not established as a matter of law, as there was at least a triable issue of fact as to whether the insured had made material misrepresentations to obtain the insurance policy at reduced premiums. Therefore, the court modified the order to provide that the insurance company’s cross motion for summary judgment dismissing the complaint was denied.

The court considered whether the defendant had failed to pay or deny the claim within the requisite 30-day period, and whether the defendant had issued a timely denial of claim that was conclusory, vague, or without merit as a matter of law. The main issue decided was whether the plaintiff failed to demonstrate its prima facie entitlement to summary judgment, and whether the defendant had timely denied the claims on the grounds that no one on plaintiff's behalf had complied with 11 NYCRR 65-1.1. The holding of the court was that defendant's cross motion for summary judgment dismissing the complaint was denied, and the order was affirmed without costs.

The relevant facts considered by the court in this case included Metropolitan Diagnostic Medical Care, P.C. (Metropolitan) suing American Commerce Insurance Company (ACIC) to recover first-party no-fault benefits for services provided to its assignor as a result of injuries sustained in a motor vehicle accident. ACIC had commenced a declaratory judgment action in Supreme Court, New York County, alleging that the assignor breached the terms of the insurance policy and obtained a default judgment declaring that it had no obligation to pay for any claims for no-fault benefits. The main issue decided was whether Metropolitan's action was barred under the doctrines of res judicata and collateral estoppel. The court held that in light of the "order and judgment" in the declaratory judgment action, the present action was indeed barred under the doctrine of res judicata. The court also found no merit in Metropolitan's equitable estoppel argument and concluded that Metropolitan's remaining arguments similarly lacked merit. As a result, the order granting summary judgment dismissing the complaint was affirmed.