No-Fault Case Law

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.

The court considered the fact that the plaintiff, a provider seeking to recover first-party no-fault benefits, failed to oppose the defendant's motion for summary judgment dismissing the complaint on the ground of lack of medical necessity. The Civil Court had granted the defendant's motion on default and dismissed the complaint with prejudice. The main issue was whether the plaintiff's claim of law office failure constituted a reasonable excuse for the default under CPLR 5015(a). The holding of the court was that the Civil Court did not improvidently exercise its discretion in denying the plaintiff's motion, as the claim of law office failure was conclusory and unsubstantiated, and did not constitute a reasonable excuse for the default. Therefore, the order denying the plaintiff's motion was affirmed.

The relevant facts the court considered in this case were that Lenox Hill Radiology and Mia, P.C. (doing business as Regency Medical Imaging) sought to recover assigned first-party no-fault benefits from Great Northern Insurance Company. Great Northern Insurance Company appealed an order of the District Court that denied its motion for summary judgment dismissing the complaint. The main issue decided was whether there was a triable issue of fact as to the submission of the claim form, as defendant claimed it had not received the form, while the affidavit of the mailing supervisor in plaintiff's attorneys' offices established that the claim at issue had been mailed to defendant. The holding of the case was that the Appellate Term affirmed the order, without costs, as there was a triable issue of fact as to the submission of the claim form, and untimely submission in and of itself does not entitle defendant to summary judgment dismissing the complaint.

The relevant facts the court considered involved a provider seeking to recover no-fault benefits from an insurance company, with the insurance company arguing that the provider failed to establish its entitlement to judgment as a matter of law. The main issues decided by the court were whether the provider made a prima facie showing of entitlement to summary judgment and whether the insurance company had established proof of its defenses against the claims. The holding of the case was that the provider did make a prima facie showing, while the insurance company failed to raise a triable issue of fact. Therefore, the court reversed the lower court's order and granted the provider's motion for summary judgment.