No-Fault Case Law

The relevant facts the court considered in this case were that the plaintiff, Hands on Physical Therapy Care, was seeking to recover assigned first-party no-fault benefits from Nationwide Ins. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint on the ground that the plaintiff failed to appear for duly scheduled examinations under oath (EUOs) should be granted, and whether the plaintiff's cross motion for summary judgment should be denied. The holding of the court was that the branches of defendant's motion seeking summary judgment dismissing the first through third causes of action were denied, and the order was modified accordingly. The court determined that the defendant failed to establish that it timely denied the claims underlying the first through third causes of action within 30 days of the second EUO nonappearance. Additionally, the court found that the proof submitted in support of the plaintiff's cross motion failed to establish that the claims had not been timely denied, or that the defendant had issued timely denial of claim forms. The court also determined that the proof submitted by the defendant was sufficient to give rise to a presumption that the EUO scheduling letters and denial of claim forms had been properly mailed. Therefore, the order was modified to deny the branches of the defendant's motion seeking summary judgment dismissing the first through third causes of action.

The court considered the facts that the plaintiff was seeking to recover assigned first-party no-fault benefits and that the defendant had motioned for summary judgment dismissing the complaint on the grounds that the plaintiff's assignor had failed to appear for examinations under oath (EUOs). The main issue decided was whether the insurer had demonstrated, as a matter of law, that it had twice duly demanded an EUO from the assignor, that the assigner had twice failed to appear, and that the denial of the claims was timely. The court held that the insurer had sufficiently established that the EUO scheduling letters had been timely mailed in accordance with the insurer's standard office practices and procedures, and affirmed the order granting the defendant's motion for summary judgment and denying the plaintiff's cross motion for summary judgment.

The court considered the fact that the plaintiff, a medical services provider, was seeking to recover first-party no-fault benefits that had been assigned to them. The main issue decided was whether the defendant's motion for summary judgment to dismiss the complaint on the grounds that the plaintiff had failed to appear for duly scheduled examinations under oath should be granted. The holding of the case was that the order denying the defendant's motion for summary judgment and granting the plaintiff's cross motion for summary judgment was affirmed. The court's decision was based on reasons stated in a previous case, and it was affirmed by all judges.

The court considered a case in which a medical services provider, RA Medical Services, P.C., sought to recover first-party no-fault benefits from Lancer Insurance Co. The main issue in the case was whether Lancer Insurance Co. was entitled to summary judgment dismissing the complaint on the grounds that RA Medical Services had failed to appear for duly scheduled examinations under oath (EUOs). The court held that Lancer Insurance Co. failed to demonstrate that it was entitled to summary judgment dismissing the complaint based on RA Medical Services' failure to appear for EUOs. The court pointed out that the initial EUO request to RA Medical Services had been sent more than 30 days after Lancer Insurance Co. had received the claims at issue, making the requests nullities as to those claims. Therefore, the court affirmed the denial of Lancer Insurance Co.'s motion for summary judgment and granted RA Medical Services' cross motion for summary judgment.

The court considered the fact that the defendant failed to appear or answer the complaint, resulting in a default judgment being entered against them. The defendant claimed that it had not forwarded the complaint to its attorneys, informed the plaintiff that it was not the insurance carrier for the plaintiff's assignor, and promptly referred the matter to its counsel. The main issue decided was whether the defendant demonstrated a reasonable excuse for its default and a meritorious defense to the action. The holding of the case was that the Civil Court affirmed an order granting the defendant's motion to vacate the default judgment, finding that the defendant had demonstrated a reasonable excuse for its default and a potentially meritorious defense to the action. However, there was a dissenting opinion stating that the defendant failed to establish a reasonable excuse for its default, and the motion should have been denied.

The court considered a case in which a provider sought to recover assigned first-party no-fault benefits from MVAIC Insurance Company. MVAIC had denied the claims due to the provider's untimely submissions, but informed the provider that it could excuse the delay if reasonable justification was provided. The main issue decided was whether the provider had provided a reasonable justification for its untimely submission of the claim forms to MVAIC. The court held that the provider did not establish a reasonable justification for its untimely submission, and therefore reversed the lower court's decision, granting MVAIC's motion for summary judgment dismissing the complaint and denying the provider's cross motion for summary judgment.

The main issue in this case was whether the defendant was entitled to summary judgment on the grounds that the plaintiff's assignor failed to appear for Independent Medical Examinations (IMEs). The defendant sought to deny the claim on the basis that the assignor did not attend three scheduled IMEs, and timely denials of the claim were issued. The court considered whether the defendant had properly mailed scheduling letters for the IMEs, and whether the assignor had failed to appear, as well as the timeliness of the denial of claim forms. The court held that the defendant failed to establish that the IME scheduling letters were timely and properly mailed, and also failed to prove that the assignor failed to appear at the IMEs. The court granted the plaintiff's cross-motion for summary judgment, and the defendant's motion for summary judgment was granted only to the extent that it established it timely denied the plaintiff's claim. The court held that the issue left for trial was the defendant's IME no-show defense.

The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, which granted the branches of defendant's motion seeking summary judgment dismissing the first through seventh and tenth causes of action, and denied plaintiff's cross motion for summary judgment. The main issues decided were whether the defendant was entitled to summary judgment dismissing the causes of action and whether the plaintiff was entitled to summary judgment on the eighth and ninth causes of action. The court affirmed the order, ruling that the defendant was entitled to summary judgment dismissing the first through seventh and tenth causes of action, and that the plaintiff's contention lacked merit. Additionally, the court found that the affidavit submitted by the plaintiff's owner was insufficient to give rise to a presumption that the claim forms had been timely mailed to and received by the defendant, and therefore, the branches of plaintiff's cross motion seeking summary judgment on the eighth and ninth causes of action were properly denied.

The court considered an appeal from a provider seeking to recover assigned first-party no-fault benefits, in which the defendant had moved for summary judgment dismissing the complaint on the grounds that the plaintiff's assignor had failed to appear for duly scheduled examinations under oath (EUOs). The court also considered the plaintiff's cross motion for summary judgment. The main issue decided was whether the plaintiff's assignor had failed to appear for the scheduled EUOs, and whether the plaintiff's remaining argument, which was raised for the first time on appeal, should be considered. The court affirmed the lower court's order, holding that the defendant had established that the plaintiff's assignor had failed to appear for the EUOs and declined to consider the plaintiff's remaining argument.

In the case American Tr. Ins. Co. v Mark S. McMahon MD, P.C., the issue involved a special proceeding arising from a no-fault arbitration. Petitioner American Transit Insurance Company (ATIC) sought to vacate the determination of a master arbitrator affirming the award of a no-fault arbitrator, which granted respondent first-party no-fault benefits for arthroscopic surgery performed on Rubin Gomez. ATIC denied the claims based on a peer review report, asserting no medical necessity and no causal relationship between the accident and the shoulder surgery. However, the no-fault arbitrator ruled in favor of respondent, finding that the surgery was medically necessary and causally related to the injury from the accident. Master Arbitrator Robert Trestman affirmed the original arbitrator's award, leading ATIC to commence a proceeding to vacate the master arbitrator's award. The main issue decided by the court was whether the no-fault arbitrator's award was supported by evidence or other basis in reason and whether the master arbitrator exceeded his powers. The court ultimately denied ATIC's petition to vacate the master arbitrator's award, confirming the arbitration award and awarding respondent the disputed amount, interest, and attorney's fees. The court found that the evidence was sufficient to support the arbitrator's determination and that the arbitrator did not exceed their powers. The court also addressed the computation of interest and attorney's fees awarded and confirmed the total amount to be paid to respondent.