No-Fault Case Law

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.

The court considered whether the defendant's motion for summary judgment dismissing the complaint should be granted due to the plaintiff's failure to appear at duly scheduled examinations under oath. The main issue decided was whether the scheduling letters for the examinations under oath were timely with respect to the bills at issue, as required by the No-Fault Regulations. The court held that the defendant did not request the examinations under oath within the required time frame, and therefore, the motion for summary judgment was properly denied. Additionally, the court found that the defendant did not demonstrate any toll of the 30-day period within which it was required to pay or deny the bills at issue. As a result, the plaintiff's cross motion for summary judgment was properly granted.

The court considered the appeal from an order of the Civil Court of the City of New York, which 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 was whether defendant's denial of the claim was timely and without merit as a matter of law, and whether the insurance policy at issue had been cancelled. The holding was that the plaintiff's motion for summary judgment was properly denied as it failed to establish that defendant had issued a timely denial of claim that was conclusory, vague or without merit. However, the defendant's cross motion for summary judgment dismissing the complaint was denied due to the lack of sufficient proof that the insurance policy at issue had been cancelled. Therefore, the order was modified to deny defendant's cross motion for summary judgment.

The relevant facts in this case were that IDF Diagnostic Medical, P.C. was seeking to recover first-party no-fault benefits as the assignee of two individuals. The defendant, New York Central Mutual Fire Insurance Company, moved for summary judgment dismissing plaintiff's first cause of action on the ground of lack of medical necessity. Plaintiff opposed the motion on the ground that the defendant had failed to respond to discovery demands, and that the responses were necessary to oppose the motion. In response, the defendant provided the discovery responses in its reply papers. The main issue decided by the court was whether there was an issue of fact as to medical necessity because the defendant had failed to provide, in a timely manner, the medical records which the plaintiff had sought. The court held that since the defendant had annexed its discovery responses to its reply papers, plaintiff's cross motion to compel disclosure was moot and there was an issue of fact as to medical necessity. The holding of the case was that defendant was not entitled to summary judgment dismissing plaintiff's first cause of action because the defendant had failed to provide the requested discovery in a timely manner. Therefore, the order denying the defendant's motion seeking summary judgment dismissing plaintiff's first cause of action was affirmed.