No-Fault Case Law

The court considered the motion for summary judgment dismissing the complaint made by the defendant, Praetorian Insurance Company, in a case brought by Premier Health Choice, a/a/o Jessica Calderon, regarding no-fault claims for physical therapy treatment. The defendant submitted independent medical examination (IME) reports from an orthopedic doctor and neurologist, which concluded that the injuries were resolved and further physical therapy was not needed. The plaintiff submitted an unsworn doctor's report with their attorney's affirmation, which the court deemed to be without probative value and insufficient to raise a triable issue. Ultimately, the court reversed the lower court's decision and granted the defendant's motion for summary judgment, dismissing the complaint. The holding of the case was in favor of the defendant, Praetorian Insurance Company, based on the insufficient evidence provided by the plaintiff to support their claim for continued physical therapy treatment.

The relevant facts the court considered were that the defendant-insurer mailed notices for independent medical examinations (IMEs) to the plaintiff's assignor and his attorney, and the assignor failed to appear for the IMEs. The main issue decided was whether the defendant was entitled to summary judgment dismissing the plaintiff-provider's claim for first-party no-fault benefits. The holding of the case was that the defendant-insurer made a prima facie showing of entitlement to summary judgment and that the plaintiff did not raise a triable issue with respect to the assignor's nonappearance or the mailing and reasonableness of the underlying notices. Therefore, the motion for summary judgment was granted and the complaint was dismissed.

The relevant facts considered by the court were that Compas Medical, P.C. was seeking to recover first-party no-fault benefits as an assignee of Clarence Dupiton. The main issue decided was whether the defendant had failed to deny the claim within the requisite 30-day period or issued a timely denial of claim that was conclusory, vague, or without merit as a matter of law. The holding of the case was that plaintiff failed to establish either that the defendant had failed to 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, and therefore plaintiff failed to demonstrate its prima facie entitlement to summary judgment. The order denying plaintiff's motion for summary judgment was affirmed by the court.

The court considered the fact that the plaintiff, Compas Medical, P.C., was seeking to recover assigned first-party no-fault benefits, but the defendant, Praetorian Ins. Co., had denied the claims due to lack of verification and failure of the plaintiff's assignor to comply with independent medical examinations (IMEs) and examinations under oath (EUOs). The main issue decided was whether the defendant had timely requested verification and scheduled IMEs and EUOs, and whether the plaintiff's assignor had complied with these requests. The holding of the court was that the defendant had demonstrated that it had timely requested verification and scheduled IMEs and EUOs, and that the plaintiff's assignor had failed to comply with these requests. 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.

The main issues decided in this case were whether the defendant had timely and properly denied the plaintiff's claims based on the failure of the plaintiff's assignor to appear for scheduled independent medical examinations (IMEs). The court considered the evidence submitted by the defendant, which demonstrated that the denial of claim forms and the IME scheduling letters had been timely mailed, and that the assignor had failed to appear for the scheduled IMEs. The court found that the assignor's appearance at a duly scheduled IME is a condition precedent to the insurer's liability on the policy, and therefore granted the defendant's motion for summary judgment dismissing the second through seventh causes of action. However, the court also found that the defendant had failed to establish, as a matter of law, that it had timely denied the claim, so the branch of the defendant's motion seeking summary judgment dismissing the first cause of action was denied. Therefore, the holding of the court was that the order was modified to deny the branch of the defendant's motion seeking summary judgment dismissing the first cause of action.

The relevant facts in the case include an action by a provider to recover assigned first-party no-fault benefits, in which the defendant appealed from an order that granted the plaintiff's motion for summary judgment and denied the defendant's cross motion for summary judgment dismissing the complaint. The defendant submitted proof that independent medical examination (IME) scheduling letters and denial of claim forms, which denied the claims on the ground that the plaintiff's assignor had failed to appear for duly scheduled IMEs, had been timely mailed. The defendant also demonstrated that the plaintiff's assignor had not appeared for the duly scheduled IMEs, indicating a failure to comply with a condition precedent to coverage. As a result, the court reversed the judgment, vacated the order, denied the plaintiff's motion for summary judgment, and granted the defendant's cross motion for summary judgment dismissing the complaint. The main issue decided in this case was whether the plaintiff had complied with the conditions precedent to coverage, specifically in relation to appearing for scheduled IMEs, and whether there was sufficient proof to establish this non-compliance. The holding of the case was that the plaintiff had not raised a triable issue of fact, and therefore the defendant's cross motion for summary judgment dismissing the complaint was granted.

The relevant facts in this case involved a disagreement between Metro Health Products, Inc. and State Farm Mutual Automobile Insurance Co., with Metro Health Products seeking to recover assigned first-party no-fault benefits. State Farm had denied the claims on the basis that Metro Health had failed to comply with a condition precedent to coverage, specifically failing to attend scheduled examinations under oath (EUOs). The main issue decided by the court was whether State Farm's denial of the claims was justified, and whether Metro Health's objections to the EUO requests were valid. The holding of the case was that State Farm had timely and properly denied the claims, as they had demonstrated that the EUO scheduling letters and denial of claim forms had been timely mailed according to their standard office practices, and that Metro Health had failed to appear for the scheduled EUOs, therefore affirming the lower court's decision to grant State Farm's motion for summary judgment.

The court considered the fact that the plaintiff, Sunlight Medical Care, P.C., was seeking to recover first-party no-fault benefits as an assignee of Jazmin Ford-Campbell. Defendant Esurance Insurance Company argued that the assignor had failed to appear for scheduled examinations under oath (EUOs). The main issue decided was whether Esurance had properly notified the assignor of the EUOs. The court held that Esurance had indeed mailed the EUO scheduling letters to the address provided by the plaintiff and the assignor on their prescribed application for no-fault benefits and signed assignment of benefits. Therefore, the court denied plaintiff's motion for summary judgment and granted Esurance's cross motion for summary judgment dismissing part of the complaint. The court also noted that plaintiff's claim against its assignor was not properly based upon the assignment, and affirmed the lower court's decision.

The court considered the fact that the defendant's claims adjuster's affidavit established that the defendant did not receive the claims at issue. However, the affidavit by the plaintiff's billing manager demonstrated that the claim forms had been mailed to the defendant, leading to an issue of fact as to whether the defendant's time to pay or deny these claims ever began to run. The main issue decided was whether the defendant had received the claims at issue and whether their time to pay or deny the claims had begun. The holding of the case was that there was an issue of fact as to whether the defendant's time to pay or deny the claims ever began to run, and the Civil Court properly denied the defendant's motion for summary judgment dismissing the complaint.

The relevant facts the court considered were that Compas Medical, P.C., as assignee of Mitchelle Paul, brought an action to recover assigned first-party no-fault benefits from Praetorian Ins. Co. Plaintiff moved for summary judgment, which was denied by the Civil Court. The court granted defendant's cross motion for summary judgment dismissing the complaint, as plaintiff had failed to provide requested verification and failed to comply with a condition precedent to coverage. Plaintiff's assignor also failed to appear for independent medical examinations and examinations under oath. The main issue decided was whether plaintiff had provided the requested verification and complied with the conditions precedent to coverage, and whether the assignor had failed to attend scheduled examinations. The holding of the case was that the order denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment dismissing the complaint was affirmed.