No-Fault Case Law

The relevant facts the court considered were whether the denial of claim forms had been timely and properly mailed, as well as established medical necessity for the services in question. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint should be granted based on lack of medical necessity. The holding of the case was that the order denying the defendant's motion for summary judgment was affirmed, as the plaintiff provided a sufficient doctor's affirmation in opposition to raise a triable issue of fact as to whether the services were medically necessary.

The relevant facts the court considered were that Geico General Insurance Company (Geico) initiated a subrogation action against Class 1 Transport and Laurel E. Stone to recover the amount paid for property damage and loss of use of the insured's vehicle due to an accident. Prior to the commencement of this action, Geico had sought to recoup benefits from Daily Underwriters of America (DUOA) through mandatory loss-transfer arbitration, but the arbitrator determined that Geico was not entitled to recover because they had not proven any negligence on the part of DUOA's insureds. Defendants then moved for summary judgment dismissing the complaint based on collateral estoppel, arguing that the arbitrator's decision precluded Geico from litigating the action. The main issue decided was whether the AFI rule limiting the preclusive effect of the arbitrator's decision should be given effect, and whether this ruled precluded Geico from bringing the action against the defendants. The holding of the case was that the AFI rule limiting the preclusive effect of the arbitrator's decision was clear and unambiguous, and should be given effect. Therefore, defendants' motion for summary judgment dismissing the complaint on collateral estoppel grounds should have been denied. As a result, the judgment was reversed, the order entered on March 22, 2013 was vacated, and defendants' motion for summary judgment was denied.

The main issue in this case was whether the Civil Court properly denied defendant's motion to dismiss the complaint based on plaintiff's failure to prosecute the action. The court considered the fact that the plaintiff, a provider seeking to recover no-fault benefits, failed to comply with a 90-day demand and did not provide a justifiable excuse or demonstrate a meritorious cause of action. The court held that the plaintiff's failure to comply with the 90-day requirement warranted the dismissal of the case. The court also emphasized the importance of honoring the balance struck by the generous statutory protections built into CPLR 3216 and stated that plaintiff's lack of a valid excuse for non-compliance placed the culpability for the dismissal squarely at the plaintiff's door. As a result, the court reversed the order and granted the defendant's motion to dismiss the complaint.

The main issues in this case were whether the plaintiff had failed to timely provide the defendant with so-ordered discovery responses, and whether the defendant's motion to strike the complaint and dismiss the action should be granted. The court considered the fact that a conditional so-ordered stipulation becomes absolute upon a party's failure to timely comply, and that the plaintiff was required to demonstrate a reasonable excuse for its failure to do so. The court held that the plaintiff failed to meet this burden, as they did not present sufficient facts to establish a reasonable excuse for their failure to comply with the so-ordered stipulation. Therefore, the court reversed the order of preclusion and granted the defendant's motion to strike the complaint and dismiss the action.

The main issues considered by the court in this case were whether the plaintiff had properly established submission and receipt of its claim, and whether the defendant had a valid defense in denying payment. The court found that the plaintiff met its prima facie burden by proving submission and receipt of the bills through the testimony of the defendant's witness and the introduction of the denial into evidence. It was noted that the defendant failed to extend its time to pay or deny the claims by issuing timely requests for verification, and delay letters that did not timely request verification would not serve to toll the time to pay or deny a claim. The court held that the defendant failed to meet its burden of establishing a justiciable defense, and therefore the plaintiff was entitled to a judgment in the amount of $3,960.57 plus statutory costs, interest, and attorney's fees.

The court was considering an action to recover assigned no-fault benefits for chiropractic services allegedly rendered to plaintiff's assignor on February 20, 2013. The defendant sought an order dismissing the action, alleging that the plaintiff had violated the Insurance Department Regulations Implementing the Comprehensive Motor Vehicle Insurance Reparations Act by engaging in impermissible fee-splitting. The court reviewed precedent cases and regulatory provisions related to fee-splitting and licensing requirements for professional medical providers in New York. The main issue involved defining the term "licensing requirement" and determining if impermissible fee-splitting standing alone constitutes a violation of a licensing requirement and an available defense to a no-fault action. The court held that impermissible fee-splitting, standing alone, is not a violation of a licensing requirement and does not constitute an available defense to a no-fault action, and thus any action is solely within the purview of the appropriate state licensing board. Therefore, the defendant's motion for summary judgment was denied in its entirety.

The court considered the fact that Progressive Casualty Insurance Company sought a judgment declaring that they were not obligated to provide insurance coverage for any claims submitted by Infinite Ortho Products, Inc. The main issue that was decided was whether Progressive Casualty Insurance Company was entitled to summary judgment finding that they were not obligated to provide coverage for the no-fault claims submitted by Infinite Ortho Products, Inc. The holding was that the order granting Progressive Casualty Insurance Company's motion for summary judgment was reversed, and the motion for summary judgment on the complaint was denied, as the plaintiffs failed to establish that they timely and properly mailed the denial of claim forms to the defendant, and were not entitled to judgment as a matter of law on this issue.

The court considered the conflicting medical expert opinions regarding the medical necessity of orthopedic surgery underlying the plaintiff's no-fault claim. The main issue decided was whether the defendant was entitled to summary judgment dismissing the plaintiff's claim in the sum of $212.37 due to the claim being submitted beyond the 45-day time limit. The court held that the conflicting expert opinions raised a triable issue for the plaintiff's claim of $3,408.11, but the defendant made a prima facie showing of entitlement to summary judgment for the $212.37 claim as it was submitted beyond the time limit, and the plaintiff failed to raise any triable issue in response. As a result, the defendant's motion for summary judgment dismissing the $212.37 claim was granted, and the order was affirmed.

The court considered that the plaintiff, Pierre Jean Jacques Renelique, had filed a motion for summary judgement to recover first-party no-fault benefits which was opposed by the defendant, Allstate Insurance Company. The defendant argued that they did not provide insurance coverage for the vehicle in question on the date of the accident. The court found that the defendant's affidavit was sufficient to demonstrate that the plaintiff's claim did not arise out of a covered incident, and as the plaintiff failed to raise a triable issue of fact, the Civil Court correctly denied the plaintiff's motion and granted the defendant's cross motion for summary judgement. Therefore, the holding of the case was that the order denying the plaintiff's motion and granting the defendant's cross motion for summary judgement was affirmed.

The main issue in this case was whether the defendant, Praetorian Ins. Co., should be granted summary judgment to dismiss the complaint by Jamaica Dedicated Medical Care, P.C., as assignee of LALBACHAN SOOKLALL, seeking to recover first-party no-fault benefits. The defendant argued that the insurance policy was fraudulently procured by the plaintiff's assignor, the insured. However, the court denied the defendant's motion for summary judgment, and the Appellate Term, Second Department affirmed the lower court's decision. The court did not provide specific details about the facts of the case or the reasoning behind the decision, but it upheld the denial of the defendant's motion for summary judgment, with the decision dated April 16, 2015.