No-Fault Case Law

The court considered the appeal from a provider seeking to recover assigned first-party no-fault benefits. The main issue in the case was whether the defendant was entitled to summary judgment dismissing the portion of the complaint seeking to recover for services billed using CPT code 97026. The court reversed the order and denied the branch of the defendant's motion seeking summary judgement, as the defendant's moving papers failed to demonstrate their entitlement to summary judgement. The holding of the case was that the defendant's motion for summary judgment to dismiss the portion of the complaint seeking to recover for services billed using CPT code 97026 was denied.

The court considered whether a group of plaintiffs were obligated to provide insurance coverage for certain no-fault claims submitted by the defendant. The defendant failed to comply with the provision of the insurance policy which required the defendant submit to an examination under oath (EUO). The plaintiffs moved for summary judgment on the complaint, and the Supreme Court granted the plaintiffs' motion and denied the defendant's cross motion. However, the affirmation of the plaintiffs' counsel contained allegations that were deemed conclusory and failed to establish that the practice and procedure was designed to ensure that the EUO letters were addressed to the proper party and properly mailed. The Appeals court held that the plaintiffs failed to establish their entitlement to judgment. The defendant's opposition papers, however, were also insufficient.

The relevant facts of this case were that the claim one defendants and claim two defendants were in two staged car accidents, and no-fault claims were submitted to the plaintiff, who insured claim one defendants and claim two defendants. The plaintiff insurer then filed for summary judgment in order to declare that it had no obligation to provide coverage for the no-fault claims submitted to it. The court reversed the order stating that the plaintiff had not fully proven that the accidents were staged, as important evidence was inadmissible in court. The defendant failed to justify their claim that insurance contracts were breached and did not establish proof of initial mailing for the required EUOs. Therefore, the holding of this case is that the plaintiff's claim for a judgment against the defendant Sovereign Acupuncture, P.C. was denied and the case was remanded for further proceedings.

The court considered the fact that the plaintiff, Professional Health Imaging, P.C., was seeking to recover first-party no-fault benefits that had been assigned to them by Jennifer Kranwinkel. The main issue decided was whether the plaintiff's failure to appear for scheduled examinations under oath justified the defendant, State Farm Mutual Automobile Ins. Co., being granted summary judgment dismissing the complaint. The holding of the case was that the court affirmed the order granting the defendant's motion for summary judgment and denying the plaintiff's cross motion. The court cited a related case as the basis for their decision.

The court considered the fact that the plaintiff, Professional Health Imaging, P.C., was seeking to recover first-party no-fault benefits as the assignee of Maksim Cela. The main issue decided was whether the plaintiff's failure to appear for scheduled examinations under oath justified the defendant's motion for summary judgment to dismiss the complaint. Additionally, the court had to determine if the plaintiff's cross-motion for summary judgment, or alternatively to strike the defendant's answer and affirmative defenses, and to compel the defendant to respond to discovery demands, was valid. The holding of the case was that the order granting the defendant's motion for summary judgment and denying the plaintiff's cross motion was affirmed, and costs of $25 were awarded.

The court considered the fact that the plaintiff, Professional Health Imaging, P.C., was seeking to recover first-party no-fault benefits from the defendant, State Farm Mutual Automobile Ins. Co. Defendant moved for summary judgment to dismiss the complaint on the grounds that the plaintiff had failed to appear for scheduled examinations under oath. Plaintiff cross-moved for summary judgment or, in the alternative, to strike defendant's answer and affirmative defenses, and to compel the defendant to respond to discovery demands. The main issue decided was whether the trial court's order granting defendant's motion and denying plaintiff's cross motion should be affirmed. The holding of the case was that for the reasons stated in a related case, the appellate court affirmed the trial court's order.

The court considered the facts presented in an action by a medical care provider to recover first-party no-fault benefits. The main issue decided was whether the provider's motion for summary judgment should have been granted. The holding of the case was that the provider failed to establish its entitlement to judgment as a matter of law, as it did not prove that the defendant had failed to deny the claim within the required 30-day period. As a result, the court affirmed the order denying the provider's motion for summary judgment.

The court considered whether the defendant had established the plaintiff's failure to appear for duly scheduled EUOs, whether the defendant had properly tolled its time to pay the claims, and whether the defendant's motion was premature in light of outstanding discovery. The main issue was whether the defendant had established that the plaintiff had failed to appear for the two duly scheduled EUOs and whether the defendant had properly tolled its time to pay the two claims in question. The court held that the defendant sufficiently established the plaintiff's failure to appear for the EUOs, and that the defendant had properly tolled its time to pay the claims in question. The court also rejected the plaintiff's contention that the defendant's motion was premature in light of outstanding discovery. Therefore, the order granting the defendant's motion for summary judgment and denying the plaintiff's cross motion for summary judgment was affirmed.

The relevant facts the court considered were that plaintiff, Great Health Care Chiropractic, P.C., was suing defendant, Unitrin Direct Insurance Company, as the assignee of Junior Noel to recover first-party no-fault benefits. The main issue decided was whether defendant's motion for summary judgment dismissing the complaint should be granted on the ground that defendant never received the claim at issue. The holding of the court was that there was a triable issue of fact as to whether the claim at issue was timely submitted to defendant, and thus, the order was reversed and defendant's motion for summary judgment dismissing the complaint was denied.

The relevant facts of this case were that the plaintiff, Urban Well Acupuncture, P.C., was seeking first-party no-fault benefits from the defendant-insurer, Hereford Ins. Co., for acupuncture services rendered to an assignor. The defendant-insurer had timely denied certain claims on the ground that the fees charged by the plaintiff exceeded the amount permitted by the worker's compensation fee schedule. The remaining claims were paid by the defendant pursuant to a settlement agreement. The main issue decided was whether the defendant was entitled to summary judgment dismissing the plaintiff's claims. The holding of the court was that the defendant-insurer made a prima facie showing of entitlement to summary judgment by establishing the timely denial of claims and that the remaining claims were paid pursuant to a settlement agreement, and the plaintiff failed to raise a triable issue in opposition. Therefore, the defendant's motion for summary judgment was properly granted, and the plaintiff's remaining contentions were either without merit or abandoned on appeal.