No-Fault Case Law

The court considered a case in which Compas Medical, P.C. as assignee of Julissa Fernandez appealed from an order denying their motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was whether there was an issue of fact as to whether the defendant had received the claim, and whether the defendant's time to pay or deny the claim had begun to run. The holding of the court was that as to plaintiff's second cause of action, there was an issue of fact as to whether the defendant had received the claim, and as to the remaining causes of action, neither party was entitled to summary judgment as there was a triable issue of fact as to whether the plaintiff had responded to the verification requests. Therefore, the order was modified by providing that the defendant's cross motion for summary judgment dismissing the complaint is denied.

The court considered a motion for summary judgment by the plaintiff in a no-fault benefits case. The plaintiff sought to recover assigned first-party no-fault benefits from the defendant insurance company, but the defendant had denied the claim. The main issue decided was whether the defendant's denial of the claim was valid and whether the cancellation of the insurance policy was effective. The court held that the plaintiff had failed to establish that the defendant's denial of the claim was conclusory, vague, or without merit, so the motion for summary judgment was properly denied. However, the defendant also failed to demonstrate that the cancellation of the insurance policy was effective with respect to the plaintiff's assignor, so the defendant's cross motion for summary judgment dismissing the complaint was also denied.

The main issue in this case was whether the denial of claim forms had been timely and properly mailed, and whether the fees charged by the medical providers exceeded the amount set forth in the workers' compensation fee schedule. The court considered the lack of evidence provided by the defendant to demonstrate that the denial of claim forms had been timely and properly mailed, as well as the failure to establish as a matter of law that the fees charged exceeded the amount set forth in the workers' compensation fee schedule. The court held that with respect to the bills sued upon by Neomy Medical, P.C., the defendant failed to demonstrate that the denial of claim forms had been timely and properly mailed, while with respect to the bills sued upon by Perfect Point Acupuncture, P.C., the defendant failed to establish as a matter of law that the fees charged exceeded the amount set forth in the workers' compensation fee schedule. Therefore, the Civil Court properly denied the defendant's 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, granting the defendant's motion for summary judgment dismissing the complaint and denying the plaintiff's cross motion for summary judgment. The main issue was whether the defendant was entitled to summary judgment dismissing the complaint based on the plaintiff's assignor's failure to appear for examination under oath. The holding of the case was that the defendant's motion for summary judgment was denied because their papers failed to make a prima facie showing that the plaintiff's assignor had failed to appear for the scheduled examination under oath. The plaintiff's cross motion for summary judgment was also denied because they failed to show that their assignor had appeared for the examination. Therefore, the court modified the order by providing that the defendant's motion for summary judgment was denied.

The case involved a dispute over first-party no-fault benefits between GBI Acupuncture, P.C., as Assignee of EARLLYNDA WHITTAKER-THOMPSON, and 21st Century Insurance Company. GBI Acupuncture sought to recover assigned first-party no-fault benefits, but the Civil Court denied their motion for summary judgment and granted 21st Century Insurance's cross motion for summary judgment dismissing the complaint. 21st Century Insurance submitted affidavits that established the timely mailing of the denial of claim forms and the proper use of the workers' compensation fee schedule to determine the amount owed to GBI Acupuncture. As a result, the court found that GBI Acupuncture's papers failed to raise a triable issue of fact in opposition to 21st Century Insurance's cross motion, and therefore affirmed the denial of GBI Acupuncture's motion and granted 21st Century Insurance's cross motion.

The court considered a motion for summary judgment in a case where a medical provider was seeking to recover first-party no-fault benefits from an insurance company. The insurance company argued that there was a lack of medical necessity for the treatment provided. The main issue decided by the court was whether there were triable issues of fact regarding the defense of lack of medical necessity. The court held that there were indeed triable issues of fact, and therefore, the insurance company's motion for summary judgment was denied. The order of the Civil Court denying the motion for summary judgment was affirmed by the Appellate Term.

The court considered the plaintiff's motion for summary judgment and the defendant's cross motion for summary judgment in an action to recover assigned first-party no-fault benefits. The main issue was whether the defendant had timely and properly denied the claims at issue based on the plaintiff's failure to appear for scheduled examinations under oath. The holding of the court was that the denial of claim form had been timely mailed to the plaintiff, and as the plaintiff failed to submit an affidavit in opposition to the defendant's cross motion, the defendant's proof was unrebutted. Therefore, the court reversed the order and granted the defendant's cross motion for summary judgment dismissing the complaint.

The court considered the evidence submitted by the defendant in support of its motion seeking summary judgment in a case brought by a medical provider to recover assigned first-party no-fault benefits. The evidence established that the defendant had timely mailed the denial of claim forms, which were based on lack of medical necessity, and also submitted an affirmed peer review report supporting this determination. The plaintiff did not submit any medical evidence in opposition to rebut the defendant's showing. As a result, the court reversed the order of the Civil Court and granted the defendant's motion for summary judgment, dismissing the complaint. The main issue decided in this case was whether the defendant's evidence established a prima facie showing of lack of medical necessity for the services at issue. The holding of the court was that the defendant had indeed made a prima facie showing, and the plaintiff's failure to submit any medical evidence in opposition resulted in the granting of the defendant's motion for summary judgment.

The main issue in this case was whether the plaintiff provider was entitled to recover assigned first-party no-fault benefits from the defendant insurance company. The court considered the arguments presented by both parties and ultimately decided that the order granting the defendant's motion for summary judgment and denying the plaintiff's cross-motion for summary judgment should be affirmed. The court found that the arguments raised by the plaintiff on appeal were not properly before the court as they were being raised for the first time, and therefore declined to consider them. The holding of the case was that the order granting the defendant's motion for summary judgment and denying the plaintiff's cross-motion for summary judgment was affirmed.

The main issue in the case was whether the provider could recover assigned first-party no-fault benefits, as the defendant had timely and properly denied the claim based on the assignor's failure to appear for scheduled independent medical examinations (IMEs). The court considered evidence submitted by the defendant that demonstrated the denial of the claim form had been timely mailed and that the assignor had failed to appear for the IMEs, which the court found to be sufficient. Since the assignor's appearance at the scheduled IMEs was a condition precedent to the insurer's liability on the policy, the Civil Court properly denied the plaintiff's motion for summary judgment and granted the defendant's cross motion. As a result, the court affirmed the order of the Civil Court.