No-Fault Case Law

The court considered the fact that the plaintiff, Compas Medical, P.C., was seeking to recover first-party no-fault benefits on behalf of an assignor, and that the defendant, Praetorian Ins. Co., had denied the claims due to the assignor's failure to appear for independent medical examinations and examinations under oath. The main issues decided were whether the plaintiff was entitled to summary judgment and whether the defendant was entitled to summary judgment dismissing the complaint. The holding of the court was that the defendant was entitled to summary judgment dismissing the first through fifth, and seventh causes of action because the assignor had failed to comply with a condition precedent to coverage by not appearing for the scheduled examinations, and the defendant had timely denied the claims on that ground. The court affirmed the order in this regard.

The relevant facts considered in this case were that a medical supplier was seeking to recover first-party no-fault benefits as the assignee of an individual. The main issues decided were whether the defendant insurance company had timely mailed verification requests and if the plaintiff's second cause of action was premature. The holding of the case was that the defendant's motion for summary judgment was denied and the branch of the plaintiff's cross-motion seeking summary judgment upon the first cause of action was granted. This decision was based on the fact that the defendant did not timely deny the claim or seek verification, and therefore, the plaintiff was entitled to summary judgment.

The main issues in this case were whether the trial court erred in denying the defendant's motion for summary judgment seeking to dismiss a claim for $677.21 in first-party no-fault benefits. The defendant had argued that the plaintiff's assignor failed to appear for examinations under oath (EUOs), which was a condition precedent to the insurer's liability on the policy. The court held that the defendant did not need to demonstrate objective reasons for the requested EUOs as part of its prima facie showing of entitlement to judgment as a matter of law. The court reversed the trial court's decision and granted the defendant's motion for summary judgment, dismissing the claim for $677.21 in first-party no-fault benefits.

The relevant facts considered by the court were that Delta Diagnostic Radiology, P.C. was seeking to recover first-party no-fault benefits as an assignee of Philip Owusu-Afriyie. The main issue decided was whether the lower court erred in denying Delta Diagnostic's motion for summary judgment and granting Praetorian Ins. Co.'s cross motion for summary judgment dismissing the complaint. The holding of the court was that while Praetorian Ins. Co. was not entitled to summary judgment because they did not provide sufficient evidence that the assignor failed to appear for scheduled examinations, Delta Diagnostic also failed to demonstrate its prima facie entitlement to summary judgment as their affidavit did not establish that the claim at issue had not been timely denied. Therefore, the order was modified to provide that Praetorian's cross motion for summary judgment was denied.

The relevant facts in the case were that plaintiff Compas Medical, P.C. was seeking recovery of first-party no-fault benefits as the assignee of Masse Innocent. The defendant, American Transit Ins. Co., argued that the action should be stayed pending a determination by the Workers' Compensation Board of the parties' rights under the Workers' Compensation Law, based on the assignor's alleged eligibility for workers' compensation benefits. The main issue decided was whether there was an issue as to whether the assignor had been acting in the course of his employment at the time of the accident, and therefore whether workers' compensation benefits might be available. The holding of the court was that the order denying plaintiff's motion for summary judgment was modified to hold the motion in abeyance pending a determination by the Workers' Compensation Board of the parties' rights under the Workers' Compensation Law. The issue of whether the assignor was acting as an employee at the time of the accident had to be resolved by the Workers' Compensation Board, and therefore the court did not express views on the matter pending that determination.

The court considered the facts of an action by a provider to recover assigned first-party no-fault benefits. Plaintiff moved for summary judgment and defendant cross-moved for summary judgment dismissing the complaint. The Civil Court denied plaintiff's motion and granted defendant's cross motion, finding that plaintiff's assignor was not entitled to receive no-fault benefits from defendant because the assignor had been injured while driving a vehicle insured by a different insurer. The main issue decided was whether defendant was entitled to summary judgment dismissing the complaint. The court held that defendant's cross motion for summary judgment dismissing the complaint should have been denied because the evidence presented was insufficient to establish, as a matter of law, that defendant did not insure the vehicle in which plaintiff's assignor was riding when the accident occurred. The court also held that plaintiff failed to establish as a matter of law that there was coverage by defendant of plaintiff's assignor's claims. Therefore, the order was modified to provide that defendant's cross motion for summary judgment dismissing the complaint is denied.

The main issue in this case was whether plaintiff T & J Chiropractic, P.C. was entitled to recover assigned first-party no-fault benefits from defendant American Transit Ins. Co. Plaintiff had moved for summary judgment, while defendant cross-moved for summary judgment dismissing the complaint on the grounds that plaintiff had failed to provide requested verification. The court considered the affidavits submitted by both parties, with defendant demonstrating prima facie that it had not received the requested verification, and plaintiff's owner submitting an affidavit to give rise to a presumption that the verification had been mailed to and received by defendant. The court held that there was a triable issue of fact as to whether the action was premature, and thus modified the order by providing that defendant's cross motion for summary judgment dismissing the complaint was denied. Therefore, the court affirmed the order, with the modification, without costs.

The main issue in the case was whether the insurance company had properly denied the claims on the grounds that the plaintiff's assignor had failed to appear for scheduled IMEs. The court considered the evidence submitted by the defendant to show that the IME scheduling letters and denial of claim forms had been timely mailed, as well as proof that the plaintiff's assignor had not appeared for the scheduled IMEs. The court found that the insurance company had demonstrated that the assignor had failed to comply with a condition precedent to coverage, and as the plaintiff failed to raise a triable issue of fact in opposition, the defendant's cross motion was properly granted. Therefore, the court held that the order denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint was affirmed.

The court considered the fact that Compas Medical, P.C. had moved for summary judgment to recover first-party no-fault benefits, but defendant American Transit Ins. Co. had cross-moved for summary judgment to dismiss the complaint. The main issue decided was whether plaintiff's assignor had failed to comply with a condition precedent to coverage by not appearing for examinations under oath (EUOs) and independent medical examinations (IMEs). The court held that defendant had timely mailed the EUO scheduling letters and that plaintiff's assignor had failed to appear for the duly scheduled EUOs, which demonstrated non-compliance with a condition precedent to coverage. As a result, the court affirmed the order denying plaintiff's motion for summary judgment and granted the branches of defendant's cross motion seeking summary judgment dismissing the claims in question.

The court considered the appeal of an order from the Civil Court of the City of New York, Kings County, which denied the plaintiff's motion for summary judgment and granted partial summary judgment to the defendant. The main issue decided was whether the defendant's defense based on the workers' compensation fee schedule was appropriate. The holding of the court was that while the court has the power to award summary judgment to a nonmoving party, in this case, the issue of medical necessity was not the subject of the plaintiff's motion for summary judgment. Thus, the court modified the order by striking the provision granting partial summary judgment to the defendant and affirmed the order without costs.