No-Fault Case Law

The court considered the facts of a nonjury trial in which the plaintiff, a medical provider, sought to recover assigned first-party no-fault benefits from the defendant insurance company. The only issue to be tried concerned the plaintiff's third cause of action, for which they sought to recover the principal sum of $8,220.17, based on the defense of lack of medical necessity asserted by the defendant. The trial proceeded based on the stipulation that the defendant's witness was an expert, and the Civil Court ultimately found in favor of the plaintiff on the third cause of action. The Appellate Term, Second Department affirmed the judgment, as the record supported the determination of the Civil Court that the defendant failed to demonstrate that the services rendered were not medically necessary. The holding was that there was no basis to disturb the Civil Court's findings, and therefore the judgment in favor of the plaintiff was affirmed.

The court considered the case of Healthway Medical Care, P.C. as Assignee of Marcus Hippolyte v. Country Wide Insurance Company, which involved a dispute over first-party no-fault benefits. The main issue was whether the insurance company had properly denied the claims on the grounds that the assignor had not submitted proper notice of the accident within 30 days, and whether the medical provider had availed itself of the opportunity to provide written proof justifying the failure to provide timely notice. The court held that the insurance company had established its entitlement to judgment as a matter of law by demonstrating that it had timely mailed denial of claim forms and that it had first learned of the accident more than 30 days after it had occurred. The burden then shifted to the medical provider, which did not present any evidence that it had given timely notice or availed itself of the opportunity to provide written proof justifying the failure to do so. Therefore, the court affirmed the denial of the medical provider's motion for summary judgment and the granting of the insurance company's cross 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, which granted a defendant's motion for summary judgment dismissing the complaint. The case involved a provider seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant had timely and properly denied the claims at issue on the ground that the plaintiff had failed to appear for duly scheduled examinations under oath (EUOs). The holding of the court was that the EUO scheduling letters and the denial of claim forms had been timely mailed in accordance with the defendant's standard office practices and procedures, and the defendant's attorney's affirmation was sufficient to establish that the plaintiff had failed to appear. As a result, the order for summary judgment was affirmed.

The court considered a motion made by the defendant pursuant to CPLR 3211(a)(1) and (7) and treated it as a motion for summary judgment without adequate notice to the parties. The main issue was whether the Civil Court erred by treating the defendant's motion as a motion for summary judgment without providing proper notice to the parties. The holding of the court was that the motion should have been denied, and the complaint reinstated. The court found that the complaint was sufficient to state a cause of action for recovery of first-party no-fault benefits pursuant to an automobile insurance policy issued by the defendant. The affidavits submitted in support of the defendant's defense were not considered conclusive and were not properly considered on a motion to dismiss pursuant to CPLR 3211(a)(7). The defendant's remaining contentions were found to be unpreserved and/or without merit.

The main facts considered by the court in this case were that Healthy Way Acupuncture, P.C. brought a claim against Amica Mutual Ins. Company for denying their claim for assigned first-party no-fault benefits on the grounds that the fees charged for acupuncture services exceeded the amount permitted by the worker's compensation fee schedule. The main issue was whether the denial of the claim by Amica Mutual Ins. Company was justified. The court held that the evidence submitted by the defendant in support of their motion for summary judgment established that the denial was justified. The court also held that the mistake in the notary's jurat did not affect any substantial right of a party and was therefore properly disregarded. The court ruled in favor of the defendant and affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The relevant facts considered by the court in EMA Acupuncture v Statewide Ins. Co. include that the defendant appealed from an order of the Civil Court of the City of New York, Bronx County, which granted the plaintiff's motion for summary judgment on the complaint. The main issue decided by the court was whether the defendant had raised a triable issue in opposition to the plaintiff's prima facie showing of entitlement to judgment as a matter of law to recover first-party no-fault benefits. The court held that the defendant failed to raise a triable issue, as the affidavit of the defendant's no-fault claims supervisor was insufficient to raise an issue of fact. Therefore, the court affirmed the order of the Civil Court and granted plaintiff's motion for summary judgment.

The relevant facts of the case were that plaintiff IMA Acupuncture, P.C. sought to recover first-party no-fault benefits that had been assigned to them. Defendant Praetorian Insurance Company cross-moved for summary judgment to dismiss the complaint on the grounds that they had timely and properly denied the claims due to plaintiff's assignor's failure to appear for scheduled independent medical examinations (IMEs). The main issue decided by the court was whether the plaintiff's assignor had failed to appear for the IMEs, and the court held that the only issue for trial was this matter. The court determined that defendant failed to establish its entitlement to summary judgment dismissing the complaint, as they did not provide sufficient evidence to prove the nonappearance of plaintiff's assignor for the IMEs, and therefore, the court affirmed the order denying the defendant's cross-motion for summary judgment.

The relevant facts in this case include a provider's attempt to recover assigned first-party no-fault benefits, and the denial of the motion for summary judgment by the Civil Court, as well as the granting of the defendant's cross motion for summary judgment dismissing the complaint. The main issues decided include whether the first, second, third, and fifth causes of action were dismissed as premature due to the plaintiff's failure to provide requested verification, as well as the dismissal of the fourth cause of action based on the assignor's failure to appear for independent medical examinations and examinations under oath. The holding of the case was that the branches of the defendant's cross motion seeking summary judgment dismissing the first, second, third, and fifth causes of action were denied, and therefore, the order was affirmed with modifications. Additionally, the court found that the defendant was entitled to summary judgment dismissing the fourth cause of action due to the assignor's failure to comply with a condition precedent to coverage.

The court considered a case in which Compas Medical, P.C. was seeking to recover first-party no-fault benefits. They moved for summary judgment, while Farm Family Casualty Insurance Co. cross-moved for summary judgment to dismiss the complaint. The court granted some of Compas Medical's motions but denied others, resulting in a judgment awarding Compas Medical a principal lump sum of $1,255.70. The main issue decided was whether there was an issue of fact as to whether the defendant's time to pay or deny the claim forms ever began to run, and the court found that there was. It was decided that plaintiff was not entitled to summary judgment on certain causes of action and the judgment was modified to vacate the decision in favor of plaintiff on certain causes of action and remitted back to the Civil Court for further proceedings.

The relevant facts considered by the court were that the plaintiff, Alleviation Medical, P.C., as assignee of Clifton Lyons, sought to recover first-party no-fault benefits from the defendant, Allstate Insurance Company. The plaintiff moved for summary judgment, while the defendant cross-moved for summary judgment, claiming that the alleged injuries did not arise out of a covered loss. The Civil Court denied the plaintiff's motion and granted the defendant's cross motion. The main issue decided by the court was whether the alleged injuries suffered by the plaintiff arose out of a covered loss, which would entitle them to first-party no-fault benefits. The court held that the plaintiff's arguments on appeal, which were raised for the first time, were insufficient to defeat the defendant's cross motion, and thus affirmed the lower court's decision. The holding of the case was that the order denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint was affirmed.