No-Fault Case Law

The court considered a motion by a provider to recover assigned first-party no-fault benefits and a motion by the defendant to dismiss the complaint on the ground of lack of medical necessity. The defendant moved for summary judgment based on a peer review, and the plaintiff moved to compel disclosure or for alternative relief in response. The main issue decided was whether there was a legitimate need for discovery to respond to the defendant's summary judgment motion, and the holding of the case was that the court affirmed the order granting the plaintiff's motion to compel disclosure, with costs. The court found that the Civil Court did not improvidently exercise its discretion in finding a legitimate need for discovery to respond to the defendant's summary judgment motion, and therefore properly granted the motion to compel disclosure.

The relevant facts the court considered were that the plaintiff, a provider seeking first-party no-fault benefits, appealed from an order of the Civil Court that granted the defendant insurance company's motion for summary judgment dismissing the complaint. The defendant's motion was based on the plaintiff's assignor failing to appear for scheduled independent medical examinations (IMEs). The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint. The court held that while the plaintiff's cross motion for summary judgment was properly denied, the defendant's motion for summary judgment dismissing the complaint should also have been denied because the defendant failed to establish its entitlement as a matter of law to the dismissal of the complaint. Therefore, the order was modified to provide that the defendant's motion for summary judgment dismissing the complaint is denied.

The main issue in this case was whether Liberty Mutual Insurance Company and other appellants were obligated to pay defendant, Five Boro Medical Equipment, Inc., for submitted claims. Plaintiffs, who are no-fault automobile insurers in New York State, suspected that defendant was over-billing them for medical equipment and requested an examination under oath (EUO) to verify the billings. When defendant failed to appear for the scheduled EUOs, plaintiffs commenced a declaratory judgment action and moved for a default judgment. However, the IAS court denied the motion on the grounds that plaintiffs had not submitted sufficient proof of mailing the letters notifying defendant of the scheduled EUOs. The Appellate Division reversed this decision, holding that the affirmation of plaintiffs' counsel adequately set forth the mailing procedures and constituted sufficient proof that the EUO letters were mailed to defendant. As a result, it was declared that plaintiffs were not obligated to pay defendant for the claims at issue.

The Court is deciding on the dismissal of the claim for no-fault benefits, which involves the issue of whether a plaintiff may offer an NF-10 denial of claim form into evidence to prove that it mailed the subject claim form and that the insurer received it. The court considers various precedents, including the recent Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co. The Court affirms that a plaintiff no-fault provider can establish its prima facie entitlement to judgment by successfully submitting proper evidentiary proof that it generated and mailed the prescribed statutory billing forms to the defendant insurer and that the no-fault benefits were overdue. The holding is that a plaintiff medical provider must submit proof of mailing through evidence in admissible form, which evidence may include the verification of treatment form and/or an affidavit from a person knowledgeable of the claim and how it was sent to the insurer.

The court considered a case where the petitioner, a passenger named Fitzgerald, sought Supplementary Uninsured/Underinsured Motorist (SUM) coverage from State Farm after being injured in a police vehicle accident driven by Officer Knauss. Fitzgerald claimed coverage under Knauss's SUM endorsement, while State Farm argued that police vehicles did not fall under the statutory definition of "motor vehicle" in the Insurance Law § 3420 (f) (2) (A). The court examined legislative history and amendments, emphasizing that historically, police vehicles were excluded from civil liability statutes and that SUM coverage extended only to injuries arising from non-police vehicles. The holding reaffirmed the interpretation that SUM coverage did not apply to injuries sustained in police vehicle accidents, in line with the historical exclusion and legislative intent.

The main issues in this case were whether the defendant-insurer made a prima facie showing of entitlement to summary judgment dismissing the action for first-party no-fault benefits by establishing that it timely and properly mailed the notices for independent medical examinations (IMEs) to the plaintiffs' assignor, and whether the assignor failed to appear. The court considered the sworn affidavits of the scheduled examining physician and chiropractor/acupuncturist, attesting to their personal knowledge of their office practices and policies when an assignor fails to appear for a scheduled IME. The court held that the defendant-insurer made a prima facie showing of entitlement to summary judgment dismissing the complaint as the plaintiffs did not specifically deny the assignor's nonappearance or otherwise raise a triable issue with respect thereto, or as to the mailing or reasonableness of the underlying notices. Therefore, the court reversed the order and granted defendant's motion for summary judgment dismissing the complaint.

The main issue decided in this legal case was whether to vacate the master arbitration award that granted the respondent, Professional Chiropractic Care, P.C., an award of $9,221.79, and reinstate the decision of the no-fault arbitrator who dismissed the no-fault claims. The court considered the facts that Thomas Yanick, underwen manipulation under anesthesia as a result of a motor vehicle accident, failed to appear for scheduled IMEs, and the master arbitrator reversed the arbitrator's award and awarded Care $9,221.79 due to petitioner's failure to inform Care with sufficient specificity that the denial of Care's claim was due to Yanick's failure to appear for IMEs. The holding of the case was that the petition was denied, and judgment was rendered in favor of the respondent, Professional Chiropractic Care, P.C. The court found that mere errors of law are insufficient to warrant setting aside the master arbitrator's award, and on questions of substantive law, the determination should be upheld if there is a rational basis for it.

The court considered that plaintiff filed for leave to enter a default judgment against defendants, each of which made claims for services rendered to Naz and Tahir as a result of the alleged accident. The main issue decided was whether plaintiff had sufficient proof to enter a default judgment against all defendants. The holding was that the Supreme Court denied the motion with respect to Bushra Naz, Cliffside Park Imaging & Diagnostic Center and Kimba Medical Supply, LLC, and otherwise granted the motion. The court determined that plaintiff submitted sufficient proof of the facts constituting its claim and also submitted proof of default in the form of an affirmation from its attorney regarding the defendant's default in appearing and answering. However, the plaintiff failed to prove service of the summons properly with respect to Bushra Naz and Kimba Medical Supply, LLC.

The main issue that was decided in this legal case was whether the arbitration award of the arbitrator Thomas should be vacated, as petitioned by New Century Acupuncture, P.C. The court considered the grounds for vacating an arbitration award as set forth in CPLR § 7511 (b)(1), and the limited review grounds of CPLR §7511 that apply to a no-fault arbitration award. The main holding of the case was that the court found no basis for disturbing the award and therefore denied the petitioner's motion to vacate the award. The court confirmed the award and allowed the respondent to enter judgment pursuant to CPLR § 7514. The court rejected the petitioner's argument that the arbitrator improperly applied the "preponderance" standard of proof to the respondent's defense and affirmed the arbitrator's report in its entirety. The petitioner's motion, based on various grounds, was ultimately denied.

The main issue in this case was whether the defendant-insurer was entitled to summary judgment dismissing the first-party no-fault claims of plaintiff L.N.L. Physical Therapy Rehabilitation in the amount of $2,220. The defendant made a prima facie showing of entitlement to summary judgment by establishing that it timely denied the claims based on the independent medical examination report and follow-up report of its examining orthopedic doctor. In opposition, the plaintiff failed to raise a triable issue, as the affidavit of plaintiff's treating physical therapist failed to meaningfully address the contrary findings made by the defendant's examining doctor. The court ultimately held that the defendant's motion for summary judgment was granted and the no-fault claims of plaintiff L.N.L. Physical Therapy Rehabilitation in the amount of $2,220 were dismissed.