No-Fault Case Law

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.

The main issue in this case was whether a declaratory judgment action brought by the defendant in the Supreme Court, Nassau County had preclusive effect in the instant no-fault action. The defendant sought summary judgment dismissing the complaint in the case at bar on the ground that the action was barred by the doctrines of res judicata and collateral estoppel by virtue of the March 2010 Supreme Court order in the declaratory judgment action. However, the appellate court held that the March 2010 Supreme Court order in the declaratory judgment action cannot be considered a conclusive final determination and, thus, can have no preclusive effect in the instant no-fault action. The order, insofar as appealed from, was affirmed.

The court considered the facts surrounding a motor vehicle accident in which the plaintiff's assignor was injured while riding in a vehicle insured by a New Jersey automobile insurance policy issued by the defendant. Plaintiff filed a lawsuit to recover first-party no-fault benefits for services rendered to its assignor, alleging that its claims were unpaid. The main issues decided were whether New Jersey law and the insurance policy in question required arbitration, and whether the court had jurisdiction over the case. The holding of the case was that the defendant's cross motion for summary judgment dismissing the complaint was denied, as the court found that the case was properly before the court and that arbitration was not required under New Jersey law.

The court considered the case of Natural Therapy Acupuncture, P.C. v Geico Ins. Co., where plaintiff's assignor was injured in a motor vehicle accident while riding in a vehicle insured by a New Jersey automobile insurance policy issued by the defendant. Plaintiff sought to recover first-party no-fault benefits for the services it had rendered to its assignor, alleging that its claims were unpaid. Defendant argued that New Jersey law and the insurance policy required arbitration and that the case was not properly before the court as it had no jurisdiction. The main issue decided was whether the matter should be submitted to arbitration under New Jersey law and the insurance policy, and whether the court had jurisdiction. The holding was that the defendant's cross motion for summary judgment dismissing the complaint was denied, and the court affirmed the order with modifications.

The court considered an appeal from an order in a case where Prepetit Medical, P.C. sought to recover assigned first-party no-fault benefits from Allstate Insurance Company. The main issue was whether the lower court properly granted the branch of defendant's motion seeking to compel the plaintiff to appear for a deposition. The court's holding was that the order, insofar as appealed from, is affirmed, with $25 costs. This decision was based on the reasoning and decision in a previous case involving similar circumstances, Farshad D. Hannanian, M.D., P.C. v Allstate Ins. Co., and was supported by the concurring judges.

The case involved Natural Therapy Acupuncture, P.C., as Assignee of Leila Milfort, who sought to recover no-fault benefits for services it provided. The car accident occurred in New Jersey, and the vehicle involved was insured by a New Jersey automobile insurance policy issued by the defendant, Geico Ins. Co. Plaintiff filed a motion for summary judgment, while Geico filed a cross-motion for summary judgment to dismiss the complaint, arguing that the dispute had to be resolved by arbitration under New Jersey law which was denied. The court held that since the insurance policy in question contains a provision to interpret pursuant to the laws of the state of New Jersey, New Jersey law applies. The court also held that the existence of an option to arbitrate is not a ground for dismissal of a court action, but the defendant’s option, if exercised by way of a motion to compel arbitration, is a ground to stay the court action. Since the defendant has not moved to compel arbitration, defendant's cross-motion for summary judgment dismissing the complaint should have been denied. The defendant's cross motion was denied and the Civil Court's order was affirmed, without costs.

The court took into consideration whether a fee-sharing arrangement between a medical service provider and a management company was considered unprofessional conduct. The issue at hand was determining if the fee-sharing arrangement constituted a valid defense to a no-fault action. The court decided that while the fee-sharing arrangement may have constituted unprofessional conduct, it did not serve as a defense to a no-fault action. The court denied the petition to vacate the arbitrator's award and ultimately confirmed the said award, thereby affirming the decision of the Supreme Court.

The court considered an action by a medical provider to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant's requests and follow-up requests for additional verification of the claims were timely mailed, and whether the plaintiff had provided the requested verification. The holding of the court was that the defendant had timely mailed its requests and follow-up requests for additional verification, and the plaintiff did not oppose the defendant's cross motion. Consequently, the 30-day period within which the defendant was required to pay or deny the claims did not begin to run, and the first through seventh and the ninth causes of action in the complaint were considered premature. The judgment of the Civil Court granting parts of the plaintiff's motion for summary judgment was reversed, and the judgment in favor of the plaintiff was vacated. The matter was remitted to the Civil Court for the entry of a judgment in favor of the defendant dismissing the first through seventh and the ninth causes of action and in favor of the plaintiff on the eighth cause of action.