No-Fault Case Law

The court considered a motion to dismiss the complaint pursuant to CPLR 3211 (a) (5), which claimed that the plaintiff's cause of action was barred by virtue of an order entered in a Supreme Court declaratory judgment action. The order, entered on default, declared that the plaintiff and its assignor had no right to be reimbursed for services rendered to the assignor and that the defendant had no obligation to provide coverage for no-fault claims with respect to the accident in question. The court held that the present action is barred under the doctrine of res judicata, as any judgment in favor of the plaintiff in this action would destroy or impair rights or interests established by the Supreme Court order. The holding of the case is that the order dismissing the complaint is affirmed. The plaintiff's remaining contentions were not properly before the court, as they were raised for the first time on appeal.

The court considered the denial of the defendant-insurer's motion for summary judgment, which sought to dismiss the complaint. The main issue decided was whether the underlying no-fault claim was precluded by a provision in the insurance policy limiting coverage upon the death of the insured to the "legal representative of the deceased." The holding of the court was to affirm the denial of the defendant's motion for summary judgment, as the defendant failed to provide evidentiary proof in admissible form that the policy contained such a provision. The court did not address whether such a policy provision would, as a matter of law, preclude the underlying no-fault claim, as this issue was not fully briefed by the parties.

The relevant facts that the court considered in this case included the defendant-insurer's timely and proper mailing of notices for independent medical examinations (IMEs) to the plaintiff's assignor, who failed to appear for the IMEs. The main issue decided by the court was whether the defendant was entitled to request the IMEs prior to its receipt of the plaintiff's claim forms, and whether the defendant had the right to deny all claims retroactively to the date of loss when the assignor failed to appear for the requested acupuncture IMEs. The holding of the case was that the defendant-insurer made a prima facie showing of entitlement to summary judgment dismissing the plaintiff-provider's claim for first-party no-fault benefits, and the defendant's motion for summary judgment dismissing the complaint was granted. The court found that the defendant had the right to deny all claims retroactively to the date of loss when the assignor failed to appear for the IMEs.

The court considered an action by a provider to recover assigned first-party no-fault benefits. The plaintiff moved for summary judgment and the defendant cross-moved for summary judgment dismissing the complaint. The main issue was whether the plaintiff was entitled to summary judgment upon the first and third through seventh causes of action, and whether the defendant was entitled to summary judgment dismissing the first and third through sixth causes of action. The holding of the court was that the defendant's cross motion seeking summary judgment dismissing the first and third through sixth causes of action was denied, and there was a triable issue of fact as to whether the causes of action were premature. The order was modified to deny the defendant's motion seeking summary judgment dismissing the first and third through sixth causes of action.

The relevant facts considered by the court were that the plaintiff was seeking to recover assigned first-party no-fault benefits for medical supplies provided to an individual who had been injured in a motor vehicle accident. The defendant had previously obtained a declaratory judgment in a separate action, determining that the medical providers, including the plaintiff, and the injured individual were not entitled to recover benefits related to the accident. The main issue decided by the court was whether the current action was barred by the previous declaratory judgment under the doctrine of res judicata. The holding of the court was that the instant action was indeed barred by the previous declaratory judgment, and therefore the order denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment was affirmed.

The court considered the appeal of a case involving Excel Imaging, P.C. as an assignee of Kenneth Owens against Allstate Insurance Company. Allstate Insurance Company denied the claim due to the assignor's alleged failure to appear at examinations under oath (EUOs). Defendant moved for summary judgment dismissing the complaint, arguing that the assignor had failed to comply with a condition precedent to coverage. However, the court found that there was an issue of fact as to whether the assignor failed to comply with the condition precedent. The court stated that there were details missing from the record, preventing them from determining the reasonableness and timeliness of each party's conduct. Ultimately, the court affirmed the order, ruling in favor of Excel Imaging, P.C. as the plaintiff.

The court considered the fact that the defendant-insurer timely and properly denied the plaintiff's no-fault claims on the ground that the fees charged for the acupuncture services exceeded the amount permitted by the applicable worker's compensation fee schedule. The main issue decided was whether the defendant was entitled to summary judgment dismissing the claims, and the court held that the defendant made a prima facie showing of entitlement to judgment as a matter of law. The court also held that the plaintiff failed to raise a triable issue in opposition, and that the defendant established its entitlement to summary judgment dismissing the claims.

The court considered the evidence submitted by the defendant that established that it timely denied the plaintiff's no-fault claims for services rendered on certain dates, on the ground that the amounts charged were in excess of the fees set forth in the applicable worker's compensation fee schedule. The main issue decided was whether the defendant properly denied the plaintiff's claim for $61.43, billed under a specific CPT code, thus precluding summary judgment dismissing this claim. The holding of the court was that the order of the Civil Court, which granted the defendant partial summary judgment dismissing plaintiff's no-fault claims, was modified to reinstate plaintiff's claim for first-party no-fault benefits billed under the specific CPT code, and as modified, the order was affirmed. The court found triable issues as to whether defendant properly denied the specific claim, and therefore, summary judgment dismissing this claim was precluded.

The court considered the issue of whether the defendant-insurer was entitled to summary judgment dismissing the plaintiff-provider's claim for first-party no-fault benefits. The defendant made a prima facie showing of entitlement to summary judgment by establishing that they properly mailed notices for independent medical examinations to the plaintiff's assignor and her attorney, and that the assignor failed to appear. The plaintiff failed to raise a triable issue with respect to the assignor's nonappearance or the mailing and reasonableness of the notices. Therefore, the court held that the defendant-insurer was entitled to deny all claims retroactively to the date of loss, regardless of whether the denials were timely issued. The court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The relevant facts the court considered included a medical provider’s action against an insurance company to recover first-party no-fault benefits. The insurance company had raised a defense of lack of medical necessity. The main issues decided in the case were whether the insurance company was entitled to conduct a deposition of the plaintiff on the issue of medical necessity, and whether the service of a notice of deposition together with other discovery demands rendered the notice procedurally premature. The holding of the case was that the order striking the notice of deposition and denying the motion to compel the plaintiff to appear for a deposition was reversed. The notice of deposition was reinstated and the motion seeking to compel the plaintiff to appear for a deposition was granted, as the insurance company had preserved its defense of lack of medical necessity and the notice of deposition did not constitute an unreasonable annoyance, cause unnecessary expense, or otherwise prejudice the plaintiff.