No-Fault Case Law

The relevant facts the court considered were that the defendant, an insurance company, had denied a claim for first-party no-fault benefits based on the plaintiff's assignor's failure to appear at examinations under oath (EUOs). The main issue decided was whether there was an issue of fact as to whether the plaintiff's assignor had failed to appear for the scheduled EUOs. The holding of the case was that the defendant's cross motion for summary judgment dismissing the complaint was granted, as the defendant had sufficiently established that the assignor had failed to comply with a condition precedent to coverage and that the claim had been timely denied on that ground. As a result, the court reversed the lower court's decision and granted the defendant's motion for summary judgment.

The relevant facts considered by the court in this case included a dispute over first-party no-fault benefits between Compas Medical, P.C., as an assignee of Jean Guillaume, and Praetorian Ins. Co. Both parties moved for summary judgment, with Compas Medical seeking to recover assigned benefits and Praetorian seeking to dismiss the complaint. The court examined whether the IME and EUO scheduling letters had been timely mailed, and whether the assignor had failed to appear for the scheduled IMEs and EUOs. The main issues decided were that Praetorian was entitled to summary judgment dismissing the first, second, and fourth through eighth causes of action due to the assignor's failure to comply with a condition precedent to coverage. However, the court held that Compas Medical was entitled to summary judgment upon its third cause of action, as the claim at issue was not denied within 30 days of its receipt and Praetorian did not demonstrate that the 30-day claim determination period had been tolled. As a result, the court remitted the matter to the Civil Court for the calculation of statutory interest and an assessment of attorney's fees with respect to this cause of action.

The court considered that the complaint was brought by the plaintiff, seeking no fault benefits under an insurance policy issued by the defendant to D & M Collision, Inc., following an accident involving a vehicle owned by D & M. The defendant moved for summary judgment dismissing the complaint, arguing that the vehicle involved in the accident was not owned by D & M and thus not covered by the policy. The main issue decided was whether the vehicle in question was owned by D & M at the time of the accident and therefore covered by the insurance policy. The court held that there is a factual issue as to whether D & M owned the vehicle and therefore the denial of the defendant's motion for summary judgment was affirmed. The court cited evidence that the vehicle was bought with D & M's dealer credentials, D & M had title to the vehicle and its dealer plates were on the vehicle at the time of the accident to support its decision.

The relevant facts that the court considered in this case were that Great Health Care Chiropractic, P.C. sought to recover no-fault benefits from Travelers Insurance Company, but defendant had denied the claim on the grounds that the plaintiff had failed to appear at scheduled examinations under oath (EUOs). The main issue decided by the court was whether the denial of the claim was valid based on the plaintiff's failure to comply with the EUO requirement. The holding of the court was that the denial of the claim was not valid because the defendant had failed to schedule the EUOs within the required time frame, and therefore had not demonstrated that the denial of the claim was based on a failure to comply with a condition precedent to coverage. The court reversed the previous order and denied the defendant's motion for summary judgment dismissing the complaint.

The court considered the fact that the plaintiff in this case, a medical provider, was seeking to recover first-party no-fault benefits from the defendant insurance company. The main issue in the case was whether the defendant had properly established that the scheduling letters for an independent medical examination and examination under oath had been timely mailed, and whether the plaintiff's assignor had failed to comply with these requirements. The court held that the scheduling letters were not mere delay letters, that the plaintiff's assignor had failed to appear for the scheduled examinations, and that the defendant had timely denied the claims at issue. As a result, the court affirmed the order granting the defendant's motion for summary judgment and dismissing the complaint.

The court considered the facts of a nonjury trial in which the plaintiff, a medical provider, sought to recover assigned first-party no-fault benefits from the defendant insurance company. The only issue to be tried concerned the plaintiff's third cause of action, for which they sought to recover the principal sum of $8,220.17, based on the defense of lack of medical necessity asserted by the defendant. The trial proceeded based on the stipulation that the defendant's witness was an expert, and the Civil Court ultimately found in favor of the plaintiff on the third cause of action. The Appellate Term, Second Department affirmed the judgment, as the record supported the determination of the Civil Court that the defendant failed to demonstrate that the services rendered were not medically necessary. The holding was that there was no basis to disturb the Civil Court's findings, and therefore the judgment in favor of the plaintiff was affirmed.

The court considered the case of Healthway Medical Care, P.C. as Assignee of Marcus Hippolyte v. Country Wide Insurance Company, which involved a dispute over first-party no-fault benefits. The main issue was whether the insurance company had properly denied the claims on the grounds that the assignor had not submitted proper notice of the accident within 30 days, and whether the medical provider had availed itself of the opportunity to provide written proof justifying the failure to provide timely notice. The court held that the insurance company had established its entitlement to judgment as a matter of law by demonstrating that it had timely mailed denial of claim forms and that it had first learned of the accident more than 30 days after it had occurred. The burden then shifted to the medical provider, which did not present any evidence that it had given timely notice or availed itself of the opportunity to provide written proof justifying the failure to do so. Therefore, the court affirmed the denial of the medical provider's motion for summary judgment and the granting of the insurance company's cross motion for summary judgment dismissing the complaint.

The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, which granted a defendant's motion for summary judgment dismissing the complaint. The case involved a provider seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant had timely and properly denied the claims at issue on the ground that the plaintiff had failed to appear for duly scheduled examinations under oath (EUOs). The holding of the court was that the EUO scheduling letters and the denial of claim forms had been timely mailed in accordance with the defendant's standard office practices and procedures, and the defendant's attorney's affirmation was sufficient to establish that the plaintiff had failed to appear. As a result, the order for summary judgment was affirmed.

The court considered a motion made by the defendant pursuant to CPLR 3211(a)(1) and (7) and treated it as a motion for summary judgment without adequate notice to the parties. The main issue was whether the Civil Court erred by treating the defendant's motion as a motion for summary judgment without providing proper notice to the parties. The holding of the court was that the motion should have been denied, and the complaint reinstated. The court found that the complaint was sufficient to state a cause of action for recovery of first-party no-fault benefits pursuant to an automobile insurance policy issued by the defendant. The affidavits submitted in support of the defendant's defense were not considered conclusive and were not properly considered on a motion to dismiss pursuant to CPLR 3211(a)(7). The defendant's remaining contentions were found to be unpreserved and/or without merit.

The main facts considered by the court in this case were that Healthy Way Acupuncture, P.C. brought a claim against Amica Mutual Ins. Company for denying their claim for assigned first-party no-fault benefits on the grounds that the fees charged for acupuncture services exceeded the amount permitted by the worker's compensation fee schedule. The main issue was whether the denial of the claim by Amica Mutual Ins. Company was justified. The court held that the evidence submitted by the defendant in support of their motion for summary judgment established that the denial was justified. The court also held that the mistake in the notary's jurat did not affect any substantial right of a party and was therefore properly disregarded. The court ruled in favor of the defendant and affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.