No-Fault Case Law

The relevant facts considered by the court in EMA Acupuncture v Statewide Ins. Co. include that the defendant appealed from an order of the Civil Court of the City of New York, Bronx County, which granted the plaintiff's motion for summary judgment on the complaint. The main issue decided by the court was whether the defendant had raised a triable issue in opposition to the plaintiff's prima facie showing of entitlement to judgment as a matter of law to recover first-party no-fault benefits. The court held that the defendant failed to raise a triable issue, as the affidavit of the defendant's no-fault claims supervisor was insufficient to raise an issue of fact. Therefore, the court affirmed the order of the Civil Court and granted plaintiff's motion for summary judgment.

The relevant facts of the case were that plaintiff IMA Acupuncture, P.C. sought to recover first-party no-fault benefits that had been assigned to them. Defendant Praetorian Insurance Company cross-moved for summary judgment to dismiss the complaint on the grounds that they had timely and properly denied the claims due to plaintiff's assignor's failure to appear for scheduled independent medical examinations (IMEs). The main issue decided by the court was whether the plaintiff's assignor had failed to appear for the IMEs, and the court held that the only issue for trial was this matter. The court determined that defendant failed to establish its entitlement to summary judgment dismissing the complaint, as they did not provide sufficient evidence to prove the nonappearance of plaintiff's assignor for the IMEs, and therefore, the court affirmed the order denying the defendant's cross-motion for summary judgment.

The relevant facts in this case include a provider's attempt to recover assigned first-party no-fault benefits, and the denial of the motion for summary judgment by the Civil Court, as well as the granting of the defendant's cross motion for summary judgment dismissing the complaint. The main issues decided include whether the first, second, third, and fifth causes of action were dismissed as premature due to the plaintiff's failure to provide requested verification, as well as the dismissal of the fourth cause of action based on the assignor's failure to appear for independent medical examinations and examinations under oath. The holding of the case was that the branches of the defendant's cross motion seeking summary judgment dismissing the first, second, third, and fifth causes of action were denied, and therefore, the order was affirmed with modifications. Additionally, the court found that the defendant was entitled to summary judgment dismissing the fourth cause of action due to the assignor's failure to comply with a condition precedent to coverage.

The court considered a case in which Compas Medical, P.C. was seeking to recover first-party no-fault benefits. They moved for summary judgment, while Farm Family Casualty Insurance Co. cross-moved for summary judgment to dismiss the complaint. The court granted some of Compas Medical's motions but denied others, resulting in a judgment awarding Compas Medical a principal lump sum of $1,255.70. The main issue decided was whether there was an issue of fact as to whether the defendant's time to pay or deny the claim forms ever began to run, and the court found that there was. It was decided that plaintiff was not entitled to summary judgment on certain causes of action and the judgment was modified to vacate the decision in favor of plaintiff on certain causes of action and remitted back to the Civil Court for further proceedings.

The relevant facts considered by the court were that the plaintiff, Alleviation Medical, P.C., as assignee of Clifton Lyons, sought to recover first-party no-fault benefits from the defendant, Allstate Insurance Company. The plaintiff moved for summary judgment, while the defendant cross-moved for summary judgment, claiming that the alleged injuries did not arise out of a covered loss. The Civil Court denied the plaintiff's motion and granted the defendant's cross motion. The main issue decided by the court was whether the alleged injuries suffered by the plaintiff arose out of a covered loss, which would entitle them to first-party no-fault benefits. The court held that the plaintiff's arguments on appeal, which were raised for the first time, were insufficient to defeat the defendant's cross motion, and thus affirmed the lower court's decision. The holding of the case was 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 case involved a dispute between Alleviation Medical Services, P.C., as an assignee of a patient, and American Transit Insurance Company over the recovery of first-party no-fault benefits. Alleviation Medical Services moved for summary judgment, but the motion was denied by the court, which found that American Transit Insurance had demonstrated the existence of a triable issue of fact. The main issue decided was whether Alleviation Medical Services had demonstrated its entitlement to summary judgment by showing that the insurance company had failed to pay or deny the claim within the required 30-day period, or that the denial of the claim was conclusory, vague, or without merit. Ultimately, the court held that Alleviation Medical Services had failed to establish its entitlement to summary judgment, as it did not prove that the insurance company had not paid or denied the claim within the given time frame or issued a timely denial of claim that was conclusory, vague, or without merit. Therefore, the burden did not shift to the insurance company, and the denial of Alleviation Medical Services' motion for summary judgment was affirmed.

The court considered the claims of New Way Medical Supply Corp. as Assignee of Jacqueline Rivera against State Farm Mutual Automobile Ins. Co. for supplies furnished on September 7, 2010 and November 9, 2010. State Farm Mutual Automobile Ins. Co. had denied the claims under the workers' compensation fee schedule. The main issue decided was whether the defendant had received the verification requested with respect to the claim for supplies furnished on November 9, 2010 and whether the denial of the claims for supplies furnished on September 7, 2010 and November 9, 2010 was proper. The holding of the court was that the defendant demonstrated prima facie that it had not received the verification for the claim for supplies furnished on November 9, 2010, and that the affidavit by the defendant's claims representative was sufficient to demonstrate prima facie that the denial of the claims for supplies furnished on September 7, 2010 and November 9, 2010 was proper. Therefore, the order of the Civil Court granting the defendant's cross motion for summary judgment was affirmed.

The relevant facts in this case include Bay LS Medical Supplies, Inc. seeking to recover assigned first-party no-fault benefits from Allstate Insurance Company. The main issues were whether the denial of claim form had been timely and properly mailed to the plaintiff and whether the defendant was entitled to judgment dismissing the first cause of action. The holding of the court was that the branch of plaintiff's motion seeking summary judgment on the second cause of action was vacated and denied, and the branch of defendant's cross motion seeking summary judgment dismissing the first cause of action was granted. The court found that the plaintiff did not establish its entitlement to summary judgment, and the proof submitted by the defendant regarding the mailing of the denial of claim form was unrebutted. Therefore, the judgment in favor of the plaintiff was reversed, and the judgment in favor of the defendant was granted.

The relevant facts of the case are that the plaintiff, a medical supplies provider, was seeking to recover first-party no-fault benefits from the defendant, an insurance company. Plaintiff moved for summary judgment and defendant cross-moved for summary judgment dismissing the complaint. The Civil Court made findings in plaintiff's favor and denied defendant's cross motion, holding that the only remaining issue for trial was defendant's proof of mailing of the denial of claim form. On appeal, the court found that defendant failed to establish that it had properly mailed its denial of claim form to plaintiff, and therefore the order, insofar as appealed from, was affirmed. The main issue decided in the case was whether the defendant had properly mailed the denial of claim form to the plaintiff as part of the first-party no-fault benefits claim. The court held that the defendant had failed to establish that it had properly mailed the denial of claim form to the plaintiff, and therefore the order was affirmed with costs. The holding of the case was that the order of the Civil Court, which made findings in plaintiff's favor and denied defendant's cross motion for summary judgment, was affirmed. The defendant failed to properly establish that it had mailed the denial of claim form to the plaintiff, and as a result, the court decided in favor of the plaintiff, affirming the decision of the Civil Court.

The court considered the fact that the plaintiff sought $879.73 for health services provided to Sakeena Carter as a result of injuries sustained in an automobile accident. The defendant, USAA, had previously obtained a judgment in a Supreme Court action, determining that the accident in question was intentional and not covered, and that USAA had no duty to provide no-fault coverage. The plaintiff and Sakeena Carter were both named in the declaratory judgment action, but Carter had not been served with the summons and complaint. The defendant sought summary judgment, arguing that the plaintiff was collaterally estopped from relitigating the issue of coverage. The court granted the defendant's motion to the extent that both parties were directed to appear for a conference. The main issue decided by the court was whether the plaintiff was entitled to recover for health services provided to Sakeena Carter as a result of an automobile accident, and whether the plaintiff was collaterally estopped from relitigating the issue of coverage based on a previous judgment obtained by the defendant in a Supreme Court action. The holding of the case was that the defendant's motion for summary judgment was granted to the extent that both parties were directed to appear for a conference before the court.