No-Fault Case Law

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.

The main issue in this case was an appeal from an order entered by the Civil Court of the City of New York, Queens County, denying the defendant's motion seeking summary judgment dismissing the complaint and granting the plaintiff's cross motion seeking summary judgment with respect to the reimbursement for services rendered between December 2008 and February 2009. The court determined that the affidavit submitted by plaintiff was sufficient to establish plaintiff's prima facie entitlement to summary judgment with respect to the services at issue. Additionally, the defendant failed to demonstrate that its denials were timely with respect to the bills at issue, and based on relevant regulations, defendant was required to deny each of the bills at issue within 30 days of receipt or 30 days after a specific date. The court affirmed the order and awarded $25 in costs.

The case involved a dispute over first-party no-fault benefits for medical services provided by Starlite Acupuncture, P.C. as assignee of Fatima Horton. Starlite Acupuncture moved for summary judgment, claiming that it had mailed three bills to Praetorian Ins. Co. on March 5, 2010, and that the defendant had not timely paid or denied them. Defendant claimed that it had received one bill on April 5, 2010, and the other two on October 8, 2010, and that it had timely denied the bills due to the assignor's failure to appear for scheduled examinations under oath and independent medical examinations. The court found that defendant had not rebutted plaintiff's showing that the bills had been submitted and not timely denied, and therefore, plaintiff was entitled to summary judgment on the first and second causes of action. However, with a triable issue of fact regarding when the defendant received the bill for the third cause of action, the branch of defendant's cross motion seeking summary judgment to dismiss it was denied. The court also rejected plaintiff's argument for a protective order. The decision was modified to grant summary judgment to plaintiff on the first and second causes of action and deny defendant's motion for summary judgment dismissing the complaint.

The court considered the fact that the defendant had submitted affidavits from the president of the company responsible for scheduling independent medical examinations (IMEs), as well as affidavits from the healthcare professionals who were to perform the IMEs, which established that the plaintiff's assignor had failed to appear for the duly scheduled IMEs. The court also considered an affidavit executed by the defendant's claims examiner, which described the standard mailing practices and procedures to establish the timely mailing of the denial of claim form. The main issue decided was whether defendant's motion for summary judgment dismissing the complaint should be granted. The holding of the case was that since an assignor's appearance at an IME is a condition precedent to the insurer's liability on the policy, the defendant's motion for summary judgment dismissing the complaint should have been granted. Therefore, the court reversed the order and granted defendant's motion for summary judgment dismissing the complaint.

The relevant facts in this case involve a taxi insured by Fiduciary Insurance Company that was involved in a collision with a horse, causing serious injuries. Fiduciary then sought reimbursement of the no-fault benefits paid to the rider from American Bankers Insurance Company of Florida, the carrier that provided commercial liability coverage to the stables where the horse was boarded. The main issue decided was whether American Bankers was an insurer subject to the mandatory arbitration provisions of Insurance Law § 5105, given the accident involving a horse and not a motor vehicle. The court held that American Bankers did not meet the definition of an insurer or self-insurer under the No-Fault Law and its regulations, and thus, the claims against it were not subject to compulsory arbitration. Therefore, the court affirmed the order denying the petition to vacate the arbitrator's award and granting the cross petition to confirm the award.

The relevant facts the court considered in this case were that Delta Diagnostics Radiology, P.C. (the plaintiff) filed a lawsuit to recover assigned first-party no-fault benefits from Delos Insurance Company (the defendant). The defendant served demands for discovery, including a notice for a deposition of the plaintiff, but the plaintiff failed to appear for the deposition scheduled by the defendant. The defendant then moved to compel the plaintiff to appear for a deposition, but the Civil Court denied the defendant's motion on the ground that the defendant had failed to proffer an affidavit from an investigator in support of its motion. The main issue decided by the court was whether the Civil Court properly exercised its discretion in denying the defendant's motion to compel the plaintiff to appear for a deposition. The holding of the case was that the Civil Court did not improvidently exercise its discretion in denying the defendant's motion to compel the plaintiff to appear for a deposition. Therefore, the order was affirmed.

The main issues in this case involved a dispute over the disclosure of the plaintiff's assignor's treating provider for a deposition in a first-party no-fault benefits action. The court considered the arguments made by the plaintiff that the disclosure was stayed under CPLR 3214(b) and that the notice to take the deposition was palpably improper. The court held that under CPLR 3101(a), parties are entitled to full disclosure of all material and necessary matter in the prosecution or defense of an action, and in this case, the deposition of the treating provider was deemed to be material and necessary to the defendant's defense. As a result, the court affirmed the order that compelled the plaintiff's treating provider to appear for a deposition and denied the plaintiff's cross motion for a protective order and sanctions.

The court considered the appeal from an order of the Civil Court, Queens County, which denied the defendant's motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant's motion for summary judgment was untimely, as it was not made within 60 days of the filing of the notice of trial, as required by the rules of Part 41 of the Civil Court. The holding of the case was that the Civil Court properly denied the defendant's motion as untimely, as they failed to offer any explanation for the delay. The appellate court affirmed the order, stating that arguments or factual assertions raised for the first time on appeal were not considered.