No-Fault Case Law

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.

The relevant facts considered in this case were that Xvv, Inc. was seeking to recover assigned first-party no-fault benefits as the assignee of Jerome Barrow from New York Central Mutual Fire Insurance Company. The main issue decided was whether there was a lack of medical necessity for the supplies provided, which was the ground for the defendant's motion seeking summary judgment to dismiss the complaint. The holding of the case was that there was a triable issue of fact as to whether there was a lack of medical necessity for the supplies provided, and as a result, the defendant's motion was properly denied. The order was affirmed, and the decision was made on May 18, 2015.

The relevant facts the court considered were that Bay LS Medical Supplies, Inc. was seeking to recover assigned first-party no-fault benefits from Chubb Indemnity Insurance Company. Plaintiff moved for summary judgment, while the defendant cross-moved for summary judgment, arguing that the assignor had failed to appear for properly scheduled independent medical examinations (IMEs). The main issue decided was whether the assignor was properly notified of the IMEs, as the scheduling letters were addressed to someone with a slightly different name than the assignor. The holding of the case was that the IME scheduling letters did not provide sufficient notice that the assignor was to appear for the IMEs, so the court affirmed the order denying the defendant's cross motion for summary judgment dismissing the complaint.

The relevant facts of the case were that Compas Medical, P.C. was seeking to recover assigned first-party no-fault benefits from Hartford Insurance Company. The court considered the denial of claim forms and the timely mailing of those forms. The main issues decided were whether defendant's denial of claim forms were timely mailed and whether plaintiff was entitled to summary judgment on certain causes of action. The holding of the case was that the court modified the order by providing that plaintiff's motion for summary judgment on the 4th, 5th, and 10th causes of action were granted, and defendant's cross motion for summary judgment dismissing the 5th and 10th causes of action were denied.