No-Fault Case Law

The relevant facts in the case include an action by a provider to recover assigned first-party no-fault benefits, in which the defendant appealed from an order that granted the plaintiff's motion for summary judgment and denied the defendant's cross motion for summary judgment dismissing the complaint. The defendant submitted proof that independent medical examination (IME) scheduling letters and denial of claim forms, which denied the claims on the ground that the plaintiff's assignor had failed to appear for duly scheduled IMEs, had been timely mailed. The defendant also demonstrated that the plaintiff's assignor had not appeared for the duly scheduled IMEs, indicating a failure to comply with a condition precedent to coverage. As a result, the court reversed the judgment, vacated the order, denied the plaintiff's motion for summary judgment, and granted the defendant's cross motion for summary judgment dismissing the complaint. The main issue decided in this case was whether the plaintiff had complied with the conditions precedent to coverage, specifically in relation to appearing for scheduled IMEs, and whether there was sufficient proof to establish this non-compliance. The holding of the case was that the plaintiff had not raised a triable issue of fact, and therefore the defendant's cross motion for summary judgment dismissing the complaint was granted.

The relevant facts in this case involved a disagreement between Metro Health Products, Inc. and State Farm Mutual Automobile Insurance Co., with Metro Health Products seeking to recover assigned first-party no-fault benefits. State Farm had denied the claims on the basis that Metro Health had failed to comply with a condition precedent to coverage, specifically failing to attend scheduled examinations under oath (EUOs). The main issue decided by the court was whether State Farm's denial of the claims was justified, and whether Metro Health's objections to the EUO requests were valid. The holding of the case was that State Farm had timely and properly denied the claims, as they had demonstrated that the EUO scheduling letters and denial of claim forms had been timely mailed according to their standard office practices, and that Metro Health had failed to appear for the scheduled EUOs, therefore affirming the lower court's decision to grant State Farm's motion for summary judgment.

The court considered the fact that the plaintiff, Sunlight Medical Care, P.C., was seeking to recover first-party no-fault benefits as an assignee of Jazmin Ford-Campbell. Defendant Esurance Insurance Company argued that the assignor had failed to appear for scheduled examinations under oath (EUOs). The main issue decided was whether Esurance had properly notified the assignor of the EUOs. The court held that Esurance had indeed mailed the EUO scheduling letters to the address provided by the plaintiff and the assignor on their prescribed application for no-fault benefits and signed assignment of benefits. Therefore, the court denied plaintiff's motion for summary judgment and granted Esurance's cross motion for summary judgment dismissing part of the complaint. The court also noted that plaintiff's claim against its assignor was not properly based upon the assignment, and affirmed the lower court's decision.

The court considered the fact that the defendant's claims adjuster's affidavit established that the defendant did not receive the claims at issue. However, the affidavit by the plaintiff's billing manager demonstrated that the claim forms had been mailed to the defendant, leading to an issue of fact as to whether the defendant's time to pay or deny these claims ever began to run. The main issue decided was whether the defendant had received the claims at issue and whether their time to pay or deny the claims had begun. The holding of the case was that there was an issue of fact as to whether the defendant's time to pay or deny the claims ever began to run, and the Civil Court properly denied the defendant's motion for summary judgment dismissing the complaint.

The relevant facts the court considered were that Compas Medical, P.C., as assignee of Mitchelle Paul, brought an action to recover assigned first-party no-fault benefits from Praetorian Ins. Co. Plaintiff moved for summary judgment, which was denied by the Civil Court. The court granted defendant's cross motion for summary judgment dismissing the complaint, as plaintiff had failed to provide requested verification and failed to comply with a condition precedent to coverage. Plaintiff's assignor also failed to appear for independent medical examinations and examinations under oath. The main issue decided was whether plaintiff had provided the requested verification and complied with the conditions precedent to coverage, and whether the assignor had failed to attend scheduled examinations. The holding of the case was that the order denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment dismissing the complaint was affirmed.

The Court considered the issue of whether the denial of claim forms at issue were untimely, and if the defendant had established its entitlement to summary judgment by sending timely examination under oath (EUO) scheduling letters to the plaintiff. The main issue was whether the defendant had failed to establish its entitlement to summary judgment by failing to demonstrate that it had tolled its time to pay or deny the claims at issue by sending timely examination under oath scheduling letters to the plaintiff. The Court held that the EUO scheduling letters annexed in support of defendant's motion did not include the necessary information to establish as a matter of law that it had tolled its time to pay or deny the claims at issue, and therefore the motion for summary judgment was denied.

The relevant facts considered by the court were that the plaintiff, Ultimate Health Products, Inc., was seeking to recover first-party no-fault benefits as the assignee of Seraphin Pierre. The main issue decided was whether the defendant, American Transit Insurance Company, had timely and properly denied the claims based on the assignor's failure to appear for examinations under oath (EUOs). The court held that the defendant had established that the EUO scheduling letters had been timely mailed, and therefore affirmed the order denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint.

The relevant facts considered by the court were that Compas Medical, P.C. filed a motion for summary judgment to recover first-party no-fault benefits. The court granted the defendant's cross motion for summary judgment dismissing the claims. The main issues decided were whether the defendant had timely mailed verification requests and scheduling letters for an independent medical examination and examination under oath, and whether the plaintiff's assignor had failed to appear for the scheduled appointments. The holding of the case was that the defendant had timely mailed the verification requests and scheduling letters, and the plaintiff's assignor had failed to appear for the scheduled appointments, therefore entitling the defendant to summary judgment dismissing the claims. The court affirmed the order in favor of the defendant.

The relevant facts considered by the court were that the plaintiff, a medical provider, was seeking to recover assigned first-party no-fault benefits from the defendant, an insurance company. The defendant moved for summary judgment dismissing the complaint, claiming that the medical services at issue were not medically necessary. The main issue decided by the court was whether the defendant was entitled to summary judgment dismissing the complaint. The court held that the defendant's motion for summary judgment dismissing the complaint was granted, as the plaintiff failed to provide sworn or signed letters of medical necessity to rebut the defendant's prima facie showing that the services were not medically necessary. Therefore, the defendant was entitled to judgment.

The court considered the motion for summary judgment by the defendant to dismiss the complaint, which was based on the plaintiff's failure to appear for scheduled examinations under oath (EUOs). The main issue decided was whether the defendant had timely and properly denied the claims at issue due to the plaintiff's nonappearance for the EUOs. The court held that the defendant's motion was properly denied because it failed to submit proof by someone with personal knowledge of the plaintiff's nonappearance for the EUOs in question. The order denying the defendant's motion for summary judgment was affirmed by the court.