No-Fault Case Law

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.

The main issues in the case were whether the plaintiff had failed to appear for scheduled examinations under oath (EUOs) and if the defendant's motion for summary judgment dismissing the complaint should be granted. The court considered the evidence submitted by the defendant, including an affirmation by an attorney who was assigned to conduct the EUOs of the plaintiff. However, the plaintiff argued that the defendant's motion should be denied because there was no proof that the defendant's counsel was present on the dates of the scheduled EUOs. The court held that the defendant's motion for summary judgment should be denied because the defendant failed to submit proof by someone with personal knowledge of the nonappearance of the plaintiff for the EUOs. Additionally, the court held that the plaintiff's cross motion for summary judgment was properly denied because the plaintiff failed to show that it had appeared for either of the EUOs. Therefore, the court modified the order by providing that the defendant's motion for summary judgment dismissing the complaint is denied.

The court considered the appeal of a provider seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the provider's motion for summary judgment should have been granted. The court held that the plaintiff failed to establish its entitlement to judgment as a matter of law, as it did not show that the defendant had failed to deny the claim within the 30-day period required by law or that the denial of claim was conclusory, vague, or without merit. Therefore, the court affirmed the lower court's order denying the motion for summary judgment.

The relevant facts considered by the court included the plaintiff's motion for summary judgment to recover assigned first-party no-fault benefits, and the defendant's cross motion for summary judgment dismissing the complaint based on the plaintiff's assignor's failure to appear for examinations under oath (EUOs). The main issue decided was whether the defendant had timely and properly denied the claim based on the assignor's failure to appear for scheduled EUOs. The holding of the court was that the defendant had demonstrated that the EUO scheduling letters had been timely mailed and that the assignor had failed to appear for the scheduled EUOs, which was a failure to comply with a condition precedent to coverage. Therefore, the defendant was entitled to summary judgment dismissing the complaint. The court affirmed the order, with $25 costs.