No-Fault Case Law

The relevant facts in this case were that Ther-Ox Home Care, Inc. was seeking to recover assigned first-party no-fault benefits from Praetorian Insurance Company. The main issue decided was that the Civil Court denied defendant's motion for summary judgment dismissing the complaint, but limited the issues for trial to the medical necessity of the supplies in question. The holding of the case was that the Appellate Term, Second Department reversed the order and granted defendant's motion for summary judgment dismissing the complaint, citing that the plaintiff's affidavit from a doctor failed to sufficiently rebut the conclusions set forth in the peer review report provided by the defendant. Ultimately, the court found that there was a lack of medical necessity for the supplies at issue.

The relevant facts considered by the court in Renelique v New York Cent. Mut. Fire Ins. Co. were that the plaintiff, Pierre Jean Jacques Renelique, was seeking to recover assigned first-party no-fault benefits. The defendant, New York Central Mutual Fire Insurance Company, had denied the claims based on the plaintiff's assignor's failure to appear for independent medical examinations. The main issue decided was whether the denial of the claim form was timely and properly mailed by the defendant. The court held that the affidavit submitted by the defendant established the timely and proper mailing of the denial of claim form, and as a result, the court affirmed the order denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint.

The relevant facts that the court considered were that the defendant, Tri State Consumers Ins. Co., had fully paid the plaintiff in accordance with the workers' compensation fee schedule. The main issue decided was whether the defendant had fully paid the plaintiff, who was seeking to recover assigned first-party no-fault benefits. The holding of the case was that the Civil Court granted defendant's motion for summary judgment dismissing the complaint, and this decision was affirmed by the Appellate Term, Second Department in their order.

The relevant fact considered by the court was that the defendant had fully paid the plaintiff in accordance with the workers' compensation fee schedule. The main issue decided was whether the defendant was precluded from raising its defense that the fees charged exceeded the amount allowed by the workers' compensation fee schedule because it was not set forth with sufficient particularity in the denial of claim form. The court held that the defendant was not precluded from raising this defense, and as such, affirmed the lower court's order granting summary judgment in favor of the defendant.

The court considered the motion for summary judgment by the plaintiff, who was seeking to recover first-party no-fault benefits as an assignee of Michelle Thane. The defendant cross-moved for summary judgment, arguing that the plaintiff's assignor had failed to appear for scheduled independent medical examinations (IMEs). The main issue was whether the defendant had established that the assignor had failed to appear for the IMEs, as this was a condition precedent to the insurer's liability on the policy. The court held that the affidavits submitted by the defendant were sufficient to establish that the assignor had failed to appear for the scheduled IMEs, and therefore, the plaintiff's motion for summary judgment was denied and the defendant's cross-motion was granted. The remaining contention raised by the plaintiff was not properly before the court and was declined to be considered.

In this case, MB Advanced Equipment, Inc. brought a lawsuit against New York Central Mutual Fire Insurance Company to recover assigned first-party no-fault benefits. The insurance company had denied the claims at issue based on the failure of the plaintiff's assignors to appear for duly scheduled independent medical examinations (IMEs). The main issue for trial was whether the plaintiff's assignors had failed to appear for the IMEs. The Civil Court made findings in favor of the plaintiff, stating that the insurance company's denial of claim forms had been timely and proper, and that the plaintiff had established its prima facie case. The appellate court affirmed the lower court's decision, stating that the insurance company did not provide sufficient basis to strike the Civil Court's findings. Therefore, the order denying the insurance company's motion for summary judgment was affirmed.

The court considered the facts surrounding the denial of the defendant's motion for summary judgment in a case where a provider was attempting to recover assigned first-party no-fault benefits. The main issue decided in this case was whether the defendant had established its entitlement, as a matter of law, to judgment dismissing the complaint on the ground that the plaintiff's assignor had failed to appear for independent medical examinations (IMEs). The court held that the defendant had failed to establish its entitlement to judgment on this ground, as the doctor who was scheduled to perform the IMEs did not establish that she possessed personal knowledge of the nonappearance of the plaintiff's assignor. Additionally, the court found that there were triable issues of fact regarding the grounds of lack of medical necessity and the amounts sought exceeding the amounts permitted by the workers' compensation fee schedule, based on affidavits submitted by the plaintiff's owner. Therefore, the court affirmed the denial of the defendant's motion for summary judgment.

The court considered the facts of the case, which involved Harvard Medical, P.C. seeking to recover assigned first-party no-fault benefits from Tri State Consumers Ins. Co. The main issue decided was whether the defendant had fully paid the plaintiff in accordance with the workers' compensation fee schedule. The court granted the defendant's motion for summary judgment, dismissing the complaint. The holding of the case was that the order granting the defendant's motion for summary judgment was affirmed. The decision was based on the reasons stated in another case, Renelique, as Assignee of Yvon Delgado v Tri State Consumers Ins. Co., which was decided at the same time.

The relevant facts considered by the court in this case were that GBI Acupuncture, P.C., as the assignee of Sofia Gjonbalaj, brought an action against Tri State Consumers Ins. Co. to recover assigned first-party no-fault benefits. The main issue decided by the court was whether the defendant had fully paid the plaintiff in accordance with the workers' compensation fee schedule. The holding of the case was that the Civil Court granted the defendant's motion for summary judgment, and the Appellate Term affirmed this decision. The court referenced a similar case, Renelique, as Assignee of Yvon Delgado v Tri State Consumers Ins. Co., in making their decision.

The main issue in this case was whether the action to recover assigned first-party no-fault benefits was premature, as the defendant claimed, due to not receiving requested verification. The court considered the fact that the defendant had timely mailed the verification request and follow-up verification request and had not received the requested verification, which would support the defendant's claim. However, the plaintiff submitted an affidavit from the owner, giving rise to a presumption that the requested verification had been mailed to and received by the defendant, creating a triable issue of fact. The court ultimately held that there was a triable issue of fact as to whether the action was premature, and therefore affirmed the lower court's decision to deny the defendant's motion for summary judgment dismissing the complaint.