No-Fault Case Law

The main issue in this case was whether the defendant failed to make a prima facie showing of lack of medical necessity for acupuncture services provided. The court considered the affirmed independent medical examination (IME) report from the doctor who had performed the IME, as well as the IME reports and accompanying affidavits executed by the chiropractor and acupuncturist who had also performed IMEs, which set forth a factual basis and a medical rationale for the IME providers' determinations that there was no medical necessity for the acupuncture services at issue. The court ultimately held that the defendant's cross motion was properly granted, as the plaintiff's arguments lacked merit, and the affidavit by an acupuncturist submitted by the plaintiff failed to meaningfully refer to or rebut the conclusions of the IME doctors. Therefore, the court affirmed the order, dismissing the complaint insofar as it sought to recover upon claims for dates of service May 21, 2008 through July 31, 2008.

The court considered the motion for summary judgment brought by the plaintiff, a no-fault insurer, to declare that its policy does not provide coverage to the individual defendant for a specific accident due to her failure to appear for scheduled examinations under oath (EUO). The defendants argued that the plaintiff had not established that it had requested the EUO within the time frame set by the no-fault regulations. In response, the plaintiff failed to supply evidence bearing on whether the EUO had been requested within the appropriate time frame. The main issue decided by the court was whether the plaintiff had properly requested the EUO within the time frame set by the no-fault regulations in order to deny coverage. The holding of the case was that the plaintiff's motion for summary judgment was properly denied because it failed to supply evidence showing that the EUO had been requested within the appropriate time frame.

The main issue in American Tr. Ins. Co. v Vance was whether defendant KHL Acupuncture, P.C. was entitled to receive no-fault benefits from the plaintiff. The court considered the fact that KHL's assignor, Shateahah Vance, did not appear for scheduled independent medical examinations (IMEs). The court held that the plaintiff failed to establish that it was entitled to deny KHL's claim because the scheduling of the IMEs did not comply with the procedures and time frames set forth in the No-Fault implementing regulations. The court reversed the lower court's decision, denied the plaintiff's motion for summary judgment, and vacated the declaration that KHL was not entitled to receive no-fault benefits. In a dissenting opinion, Judge Friedman disagreed with the reversal of summary judgment, arguing that the issue of whether the IMEs were scheduled to be held within the 30-day time frame prescribed by Insurance Department Regulations was raised for the first time on appeal. Judge Friedman suggested that if the issue had been raised before the motion court, the plaintiff may have been able to establish that the IMEs had been scheduled in compliance with the regulation. Furthermore, he stated that it seemed unfair to reverse the motion court's decision based on an issue that was not raised in the defendant's opposition to the motion.

Facts: American Transit Insurance Company appealed the denial of its motion for summary judgment for no-fault coverage to defendant Longevity Medical Supply, Inc. after a motor vehicle accident. Longevity argued that American Transit Insurance Company was not entitled to summary judgment because it failed to establish that independent medical examinations were scheduled within a 30-day time frame by regulations. Issues: The main issue was whether the plaintiff established compliance with Insurance Department Regulations and that the notices of scheduled IMEs were timely, as required by the regulations. The dissent argued that Longevity should have raised the issue in opposition to the summary judgment motion and that the 30-day period for the IME was measured from the date on which plaintiff received the prescribed verification form. The dissent highlighted that Longevity should have raised the issue of timely scheduling in their opposition to the motion. Decision: The holding of the case was that the plaintiff failed to establish compliance with the regulation regarding timing of independent medical examinations and was not entitled to summary judgment. The court affirmed the denial of summary judgment to the plaintiff insurer. The dissent mentioned that the issue was not properly raised and was only brought up for the first time in Longevity's brief opposing the plaintiff's appeal.

The relevant facts considered in this case were that plaintiff American Transit Insurance Company filed a motion for summary judgment against defendant Sky Acupuncture, P.C. and declared that the defendant was not entitled to no-fault insurance coverage for a motor vehicle accident. The issue was whether plaintiff was entitled to deny defendant Sky Acupuncture's claim due to the assignor, defendant Clark, not appearing for independent medical examinations (IMEs). The main holding of the case was that the order of the Supreme Court, New York County, which granted the plaintiff's motion for summary judgment against defendant Sky Acupuncture, P.C. and declared that they were not entitled to no-fault insurance coverage, was reversed on the law, and the declaration was vacated. The court found that plaintiff failed to establish prima facie that it was entitled to deny defendant Sky Acupuncture's claim due to the scheduling of the IMEs not complying with Insurance Department Regulations.

The court in this case considered a subpoena duces tecum served by the defendant on TD Bank, seeking documents related to a medical corporation's claim for first-party no-fault benefits. The plaintiffs, as the assignees of the medical services recipient, moved to quash the subpoena on the grounds that it was not properly served, failed to provide traveling expenses to the witness, and was overly broad and amounted to a 'fishing expedition'. The defendant, on the other hand, argued that the subpoena was properly served, and the demanded documents were material and necessary for its defense under the Mallela doctrine, which deals with fraudulently incorporated medical corporations. The court granted the motion to quash the subpoena due to the defendant's failure to provide the required notice to the nonparty witness, but denied the plaintiffs' request for a protective order, ruling that the subpoena was not unduly restrictive or prejudicial. The defendant was allowed to serve the subpoena again, this time accompanied by the required notice.

The court considered an action to recover assigned first-party no-fault insurance benefits, where three medical providers sought reimbursement for services rendered to the assignor as a result of an automobile accident. The insurance carrier denied payment of the benefits due to material misrepresentations in securing the policy. The main issue decided by the court was whether a Rhode Island automobile insurance policy issued by the Rhode Island Automobile Insurance Plan could be terminated ab initio. The court held that Rhode Island law does not permit termination of an automobile insurance policy ab initio, and as such, the automobile liability insurance policy here may not be rescinded. Therefore, the plaintiffs were entitled to judgment for reimbursement for the services rendered, as well as costs, statutory interest, and attorney's fees.

The relevant facts the court considered in this case were that Queens Medical Supply, Inc. was seeking to recover first-party no-fault benefits from IDS Property & Casualty Insurance Company and that defendant had not paid or denied the claims within 30 days of their receipt. Plaintiff moved for summary judgment, which was granted, and defendant's cross motion for summary judgment dismissing the complaint was denied. The main issue decided was whether plaintiff had demonstrated its entitlement to summary judgment and whether defendant's time limit to pay or deny the claims had been tolled. The holding of the case was that plaintiff had demonstrated its prima facie entitlement to summary judgment, and as defendant failed to demonstrate that the claims had been timely denied, plaintiff's motion for summary judgment was properly granted and defendant's cross motion for summary judgment was properly denied.

The court considered the facts surrounding a case between Village Chiropractic, the plaintiff, and Geico Insurance Company, the defendant, regarding the recovery of No-Fault benefits for medical services provided to the plaintiff's assignor, IRIZARRY, KENNY, following a motor vehicle accident. The main issues addressed in the case were whether there were triable issues of fact concerning the No-Fault benefits, medical necessity, and fee schedules, and whether summary judgment was appropriate for either party. The court held that the plaintiff's claims were dismissed with prejudice, except for five claims that were reduced by the defendant, Geico, based on applicable fee schedules, as there were issues of fact requiring a trial. The court also ruled that the defendant, Geico, was entitled to partial summary judgment due to lack of medical necessity based on independent medical examination reports.

The main issues in this case were whether the defendant was entitled to summary judgment and whether the provider's assignor had failed to appear for scheduled independent medical examinations (IMEs). The defendant appealed from an order of the Civil Court which denied defendant's motion for summary judgment dismissing the complaint. In support of its motion, the defendant submitted evidence that the IME scheduling letters had been timely mailed and that the assignor had failed to appear for the scheduled IMEs. The Court held that since appearance at a duly scheduled IME is a condition precedent to an insurer's liability on a policy, the Civil Court should have granted the defendant's motion for summary judgment. Therefore, the Court reversed the order and granted defendant's motion for summary judgment dismissing the complaint.