No-Fault Case Law

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.

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.