No-Fault Case Law

The case Metro Health Products, Inc. v Nationwide Ins. involved a dispute over first-party no-fault benefits for medical supplies provided to an individual injured in an automobile accident. Defendant insurer sought a declaration in Supreme Court that they were not obligated to pay any of the outstanding claims. The Supreme Court granted their motion for a default judgment due to a lack of opposition from plaintiff. However, the court determined that the order did not make a conclusive final determination and therefore had no preclusive effect on the instant no-fault action. Plaintiff had failed to demonstrate their prima facie entitlement to summary judgment as they did not establish that the claims at issue had not been timely denied. As a result, the court modified the order to provide that defendant's cross motion for summary judgment dismissing the complaint is denied.

The court considered a motion for summary judgment by the defendant-insurer to dismiss the plaintiff's no-fault claims for acupuncture treatment rendered to the plaintiff's assignor. The defendant submitted an independent medical examination (IME) report of its examining acupuncturist, which concluded that no further acupuncture treatment was medically necessary. The plaintiff's opposing submissions, consisting of an attorney's affirmation and the report of its examining doctor, did not address the medical necessity of the acupuncture services rendered. The court ruled that the defendant made a prima facie showing of entitlement to summary judgment dismissing the claims for acupuncture services. However, the court also ruled that the conflicting medical expert opinions submitted by the parties raised a triable issue as to the medical necessity of the remaining medical services underlying the plaintiff's claims. The holding of the case was that the defendant was granted partial summary judgment dismissing the portion of the claims seeking reimbursement for acupuncture services, and the matter was remanded for further proceedings to determine the amount of the claims for acupuncture services. The defendant's motion for summary judgment dismissing the remaining no-fault claims was denied, and the case was remanded for further proceedings.

The relevant facts considered in this case included a declaratory judgment action instituted by the defendant, and a Supreme Court order that granted a default judgment against the plaintiff's assignor and various medical providers. The plaintiff sought to recover for supplies provided to the assignor for injuries sustained in a motor vehicle accident, but the defendant argued that a prior Supreme Court order barred the instant action under the doctrines of res judicata and collateral estoppel. The main issue decided was whether the instant action was barred by the prior Supreme Court order. The holding of the case was that the Civil Court correctly determined that the instant action was barred under the doctrine of res judicata by virtue of the prior Supreme Court order, and therefore, 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.

The relevant facts of this case involved a medical provider, Viviane Etienne Medical Care, P.C., seeking no-fault insurance benefits from an insurance company, Country-Wide Insurance Company, for services provided to an individual involved in a car accident. The insurer failed to respond to most of the claims submitted and denied payment on one claim, citing lack of proper proof of loss. The medical provider moved for summary judgment, arguing that it had demonstrated that payment of benefits was overdue. The main issue decided in this case was what proof a medical provider must provide to demonstrate entitlement to summary judgment in a no-fault insurance action. The court held that a plaintiff demonstrates entitlement to summary judgment by submitting evidence that payment of no-fault benefits are overdue, and proof of its claim, using the statutory billing form, was mailed to and received by the defendant insurer. The court found that the medical provider demonstrated entitlement to summary judgment and affirmed the Appellate Division's decision.

The court considered the fact that New York Diagnostic Medical Care, P.C. was seeking to recover first-party no-fault benefits from Country-wide Insurance Company, but the action was deemed premature because the plaintiff had not provided verification as requested by the defendant. The main issue decided was whether the plaintiff adequately responded to the defendant's verification requests, and the court found that triable issues of fact existed, therefore neither party was entitled to summary judgment. The holding of the case was that the defendant's cross motion for summary judgment dismissing the complaint was denied, and the order was modified accordingly.

The court considered an appeal from an order of the Civil Court of the City of New York denying the plaintiff's motion for summary judgment and granting the defendant reverse summary judgment dismissing the complaint. The main issue decided was whether there was a triable issue of fact as to whether the claims at issue had been submitted to the defendant. The holding of the case was that on the record before them, the court found that there was a triable issue of fact as to whether the claims had been submitted to the defendant, and therefore, neither party was entitled to summary judgment. The court modified the order by striking the provision which granted the defendant reverse summary judgment dismissing the complaint.

The court considered whether the defendant had timely and properly denied first-party no-fault benefits claims based on the plaintiff's assignor's failure to appear for examinations under oath (EUOs). The main issue was whether the defendant had demonstrated that the EUO scheduling letters had been timely mailed and that the assignor had failed to appear for the scheduled EUOs. The court held that the defendant had established that the scheduling letters had been timely mailed and that the assignor had failed to appear for the scheduled EUOs, which was a condition precedent to coverage. Therefore, the defendant was entitled to summary judgment dismissing the complaint. The court affirmed the denial of the plaintiff's motion for summary judgment and the granting of the defendant's cross motion for summary judgment dismissing the complaint.

The court considered a case in which Bay LS Medical Supplies, Inc. sought to recover assigned first-party no-fault benefits from Allstate Insurance Company. Bay LS Medical Supplies, Inc. moved for summary judgment, and the Civil Court granted the motion, awarding Bay LS Medical Supplies, Inc. $930. Allstate Insurance Company appealed the decision, arguing that Bay LS Medical Supplies, Inc. did not establish entitlement to summary judgment and that reverse summary judgment was not appropriate. The Appellate Term, Second Department agreed with Allstate Insurance Company, finding that Bay LS Medical Supplies, Inc. had not made a prima facie showing of entitlement to summary judgment and reversed the judgment, vacated the order granting the motion for summary judgment, and denied Bay LS Medical Supplies, Inc.'s motion.

The main issue in this case was whether the plaintiff responded to the defendant's verification requests in a timely manner, as failure to do so would render the action premature. The court made findings in plaintiff's favor and denied the defendant's cross motion for summary judgment. The only remaining issue for trial was determined to be whether the plaintiff had responded to defendant's verification requests. The court found that there was a triable issue of fact as to whether the plaintiff responded to the verification requests, and the order was affirmed with costs. The holding of the case was that the plaintiff's motion for summary judgment was denied, and the only remaining issue for trial was whether the plaintiff had responded to the defendant's verification requests.

The court considered the appeal of Jaime G. Gutierrez, as the assignee of Mustafa Arslan, from an order of the Civil Court denying plaintiff's motion for summary judgment in a case to recover assigned first-party no-fault benefits from Allstate Insurance Company. The main issue decided was whether plaintiff's moving papers had established that the defendant failed to pay or deny the claim within the requisite 30-day period, or that the defendant had issued a timely denial of claim that was conclusory, vague, or without merit as a matter of law. The holding of the court was that plaintiff's moving papers failed to establish defendant's failure to pay or deny the claim within the required period, or that defendant had issued a timely denial of claim that was conclusory, vague, or without merit as a matter of law, and therefore, plaintiff had failed to establish its entitlement to summary judgment. The court affirmed the order of the Civil Court denying plaintiff's motion for summary judgment.