No-Fault Case Law

The court considered a provider's appeal to recover assigned first-party no-fault benefits and whether the action was premature due to the provider's failure to provide verification as requested by the defendant insurance company. The main issue decided was whether the action to recover payment was premature when the provider had failed to respond to a request for verification. The court held that since a claim need not be paid or denied until all demanded verification is provided, any action to recover payment is premature when the provider has failed to respond to a request for verification. The court reversed the order and denied the defendant's motion for summary judgment dismissing the complaint, as the defendant did not demonstrate that it had not received the requested verification.

The relevant facts considered by the court in this case were that Acuhealth Acupuncture provided health services to an individual injured in a car accident, and Country-Wide Insurance Company denied payment for acupuncture services on the basis that the company was owned and controlled by a person who did not meet the licensing requirements necessary to perform such services in New York. The main issue decided was whether the Master Arbitrator's award should be vacated, and the holding of the court was that the award should not be vacated. The court found that the petitioner did not provide evidence to demonstrate that the arbitrators acted in any way that was against public policy, completely irrational, or manifestly exceeded a specific enumerated limit on the arbitrator's powers. Therefore, the motion to vacate or remand the arbitration award was denied, and the Master Arbitrator's award was confirmed.

The case involved an action for a judgement declaring that the plaintiff is not obligated to pay certain no-fault claims submitted to it by the defendants. The plaintiff argued that the collisions in question were staged as part of an insurance fraud scheme and therefore should not be covered. However, the plaintiff failed to provide evidence from someone with personal knowledge of the mailings of the deposition requests. Further, the police accident reports submitted were not admissible and an unsigned and unsworn deposition transcript was deemed inadmissible. The court found that the plaintiff failed to establish its prima facie entitlement to judgement as a matter of law, and reversed the judgement that had been in its favor.

The court considered whether it had subject matter jurisdiction to adjudicate a no-fault claim pursuant to Insurance Law § 5106 (c) for a de novo determination of a claim for no-fault insurance benefits. The main issue decided was whether the master arbitrator's award, which vacated the arbitrator's award in its entirety, effectively made no monetary award and therefore neither party was entitled to maintain a court action to adjudicate the dispute de novo. The court held that the Supreme Court properly granted the defendant's motion to dismiss the complaint for lack of subject matter jurisdiction, as the master arbitrator's award was less than $5,000, and therefore neither party was entitled to maintain a court action to adjudicate the dispute de novo.

The court considered the fact that the plaintiff, Vital Meridian Acupuncture, P.C., was seeking to recover first-party no-fault benefits for services rendered to its assignor who was allegedly injured in a motor vehicle accident. The defendant, American Transit Ins. Co., had obtained a default judgment in a Supreme Court declaratory judgment action which declared that the plaintiff was not entitled to recover the no-fault benefits. The main issue decided was whether the present action was barred under the doctrine of res judicata due to the default judgment obtained by the defendant in the Supreme Court action. The court held that the present action was indeed barred under the doctrine of res judicata, citing previous cases as precedent. Therefore, the court affirmed the order denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint.

In this case, a provider, Great Health Care Chiropractic, P.C., sought to recover no-fault benefits for services rendered to its assignor following a motor vehicle accident. However, defendant Progressive Insurance Company moved to consolidate the present action with two other actions and for summary judgment dismissing the complaint in each of the three actions, arguing that they were barred by a default judgment in a Supreme Court declaratory judgment action. The Supreme Court declared that the plaintiff and other providers were not entitled to recover no-fault benefits in a judgment entered on default. As a result, the present action is barred under the doctrine of res judicata, and any judgment in favor of the plaintiff in the present action would impair the rights or interests established by the Supreme Court judgment. The Court held that the declaratory judgment was a conclusive final determination, and the order granting the defendant’s motion for summary judgment dismissing the complaint in the present action was affirmed.

The court considered the issue of whether there was a lack of medical necessity for the services provided in a first-party no-fault benefits claim. The defendant submitted two independent medical examination reports, one from a chiropractor and one from an orthopedist, which concluded that there was a lack of medical necessity for the services. However, the medical affidavits submitted by the plaintiffs in opposition were deemed sufficient to raise a triable issue of fact as to the medical necessity of the claims at issue. Ultimately, the court reversed the order and denied the branches of the defendant's motion seeking summary judgment dismissing the plaintiffs' first through eighteenth and twenty-first through thirty-sixth causes of action. Therefore, the holding of the case was in favor of the plaintiffs, allowing their claims to proceed to trial.

The relevant facts the court considered in this case were that the defendant's motion for summary judgment dismissing the plaintiff's complaint was denied by the District Court. The main issue decided was whether the defendant had established its prima facie entitlement to summary judgment. The holding of the case was that defendant's motion for summary judgment dismissing the complaint should have been granted, as the plaintiff failed to submit medical evidence sufficient to raise a triable issue of fact as to medical necessity, and the opposing affirmation of plaintiff's doctor failed to rebut the conclusions set forth in the IME report. Therefore, the order denying the defendant's motion was reversed, and defendant's motion for summary judgment dismissing the complaint was granted.

The relevant facts considered by the court were that the plaintiff, Healthy Way Acupuncture, P.C., filed a lawsuit to recover assigned first-party no-fault benefits from the defendant, State Farm Mutual Automobile Ins. Co. The defendant moved for summary judgment to dismiss the complaint, citing the plaintiff's failure to appear for duly scheduled examinations under oath, with supporting affirmation from their law firm. The plaintiff also cross-moved to disqualify the defendant's law firm, claiming that a member of the firm was a necessary witness in the case. The main issue decided by the court was whether the plaintiff's failure to appear for scheduled examinations under oath provided grounds for the defendant's motion for summary judgment. The court ultimately affirmed the order, granting the defendant's motion for summary judgment and implicitly denying the plaintiff's cross motion to disqualify the defendant's law firm. The holding of the case was in favor of the defendant, State Farm Mutual Automobile Ins. Co., with the order being affirmed by the court.

In this case, GBI Acupuncture, P.C. sought to recover first-party no-fault benefits for services provided to its assignor, who was injured in a motor vehicle accident. However, Nationwide Insurance had previously obtained a default judgment from the Supreme Court stating that it was not obligated to provide no-fault benefits to the plaintiff and its assignor. When the case was brought to the Civil Court, Nationwide moved to dismiss the complaint, arguing that the previous Supreme Court order barred the current action under the doctrines of res judicata and collateral estoppel. The Civil Court granted Nationwide's motion to dismiss, holding that the current action was indeed barred by the previous Supreme Court order. The decision was affirmed by the Appellate Term, Second Department on July 7, 2015. The main issue that was decided in this case was whether the current action seeking first-party no-fault benefits was barred by the previous order from the Supreme Court, and the holding was that it was indeed barred under the doctrine of res judicata.