No-Fault Case Law
Alleviation Med. Servs., P.C. v Geico Ins. Co. (2015 NY Slip Op 50396(U))
March 16, 2015
The relevant facts the court considered in this case were that the plaintiff, Alleviation Medical Services, P.C., was seeking to recover first-party no-fault benefits from the defendant, Geico Ins. Co., as an assignee of Rayvon Freeman. The main issue decided was whether the plaintiff was entitled to summary judgment in their favor. The court held that the plaintiff's motion for summary judgment was properly denied, as their papers failed to establish that the defendant had failed to pay or deny the claim within the required 30-day period, as mandated by Insurance Law. Additionally, the court found that the plaintiff had not proven that the defendant issued a timely denial of claim that was conclusory, vague, or without merit as a matter of law. Therefore, the court affirmed the lower court's decision to deny plaintiff's motion for summary judgment.
Cortland Med. Supply, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 50394(U))
March 16, 2015
The relevant facts considered by the court were that the plaintiff, Cortland Medical Supply, P.C., was seeking to recover assigned first-party no-fault benefits from the defendant, Praetorian Ins. Co. The defendant had moved for summary judgment to dismiss the complaint, arguing that the plaintiff's assignor had failed to appear for scheduled independent medical examinations (IMEs), which is a condition precedent to the insurer's liability under the policy. The main issue decided by the court was whether the defendant had sufficiently established that the IME requests had been timely mailed and that the assignor had failed to appear for the scheduled IMEs. The holding of the case was that the court reversed the order and granted the defendant's motion for summary judgment dismissing the complaint, ruling that the defendant had indeed established the timely mailing of IME requests and the assignor's failure to appear for the IMEs, which justified the denial of the claims.
Longevity Med. Supply, Inc. v Praetorian Ins. Co. (2015 NY Slip Op 50393(U))
March 16, 2015
The court considered the motion for summary judgment by the plaintiff and the cross-motion for summary judgment by the defendant in a case brought by a provider to recover assigned first-party no-fault benefits. The main issue was whether the defendant was entitled to summary judgment dismissing the plaintiff's first and second causes of action. The court held that the defendant was entitled to summary judgment dismissing the second cause of action because the plaintiff's assignor had failed to appear for independent medical examinations (IMEs) as scheduled, which was a condition precedent to the insurer's liability. The court also awarded summary judgment to the defendant dismissing the plaintiff's first cause of action, as the record established that the assignor had failed to appear for the scheduled IMEs. Therefore, the court affirmed the lower court's order and awarded summary judgment to the defendant dismissing both of the plaintiff's causes of action.
Longevity Med. Supply, Inc. v Geico Ins. Co. (2015 NY Slip Op 50392(U))
March 16, 2015
The relevant facts of this case involve Longevity Medical Supply, Inc. seeking to recover first-party no-fault benefits from Geico Ins. Co. On appeal from the Civil Court of the City of New York, Longevity argued that Geico failed to establish that Longevity's assignor had failed to appear for scheduled examinations under oath (EUOs), and therefore Longevity's motion for summary judgment should have been granted and Geico's cross motion for summary judgment should have been denied. However, the affidavits submitted by Geico were deemed sufficient to establish that Longevity's assignor had failed to appear for the scheduled EUOs. The court held that since the assignor's appearance at the EUO is a condition precedent to the insurer's liability on the policy, the order denying Longevity's motion and granting Geico's cross motion for summary judgment was affirmed.
Rainbow Supply of NY, Inc. v Geico Gen. Ins. Co. (2015 NY Slip Op 50391(U))
March 16, 2015
The court considered the motion for summary judgment by the plaintiff, Rainbow Supply of NY, Inc., as assignee of Georgia Brown and Vanessa Thompson, and the cross motion for summary judgment by the defendant, Geico General Ins. Co., in a case involving the recovery of assigned first-party no-fault benefits. The main issue decided was whether the defendant had timely and properly denied the claims based on a lack of medical necessity for the supplies at issue. The court held that the defendant's cross motion for summary judgment dismissing the complaint was granted, as the plaintiff's affidavit failed to rebut the conclusions set forth in the peer review reports submitted by the defendant. The court found that defendant was otherwise entitled to judgment and reversed the decision of the Civil Court, vacating the findings in plaintiff's favor and granting defendant's cross motion for summary judgment.
A.M. Med., P.C. v Continental Ins. Co. (2015 NY Slip Op 50389(U))
March 16, 2015
The relevant facts considered in this case were that A.M. Medical, P.C. was seeking to recover no-fault benefits from Encompass Insurance Company, and the claim forms at issue were received by Encompass on or before February 8, 2001. The main issue decided was whether the action, commenced in June 2007, was untimely based on the six-year statute of limitations for contract actions. The court held that Encompass had established that the claim forms were received by them on or before February 8, 2001, and thus the action, commenced in June 2007, was untimely. Therefore, the court reversed the order and granted Encompass' motion for summary judgment dismissing the complaint insofar as asserted against them.
Compas Med., P.C. v 21st Century Ins. Co. (2015 NY Slip Op 50388(U))
March 16, 2015
The main issue in this case was whether defendant failed to pay or deny the claim within the requisite 30-day period as required by Insurance Law § 5106. Plaintiff's motion for summary judgment was denied, as they failed to establish that defendant had issued a timely denial of claim, or that defendant had not received the claim in question. An affidavit by the defendant's claims representative was sufficient to establish that the defendant did not receive the claim underlying the plaintiff's third cause of action, but the plaintiff's owner demonstrated that the claim form had been mailed to defendant. As a result, there was an issue of fact as to whether defendant's time to pay or deny the claim began to run. Therefore, the court modified the order to deny the defendant's cross motion for summary judgment.
Acupuncture, Approach, P.C. v Allstate Ins. Co. (2015 NY Slip Op 50318(U))
March 16, 2015
The case involved Acupuncture, Approach, P.C. suing Allstate Insurance Company for recovery of assigned first-party no-fault benefits. Allstate appealed from an order entered by the Civil Court of the City of New York, which denied its motion for summary judgment dismissing the complaint. The main issue decided was whether the action was ripe for summary dismissal based on Allstate's claim that the assignor failed to appear for two scheduled independent medical examinations. The court held that the action was not ripe for summary dismissal because Allstate failed to establish "that it requested IMEs in accordance with the procedures and time frames set forth in the no-fault implementing regulations." Therefore, the order was affirmed and the case was allowed to proceed.
Top Choice Med., P.C. v Clarendon Natl. Ins. Co. (2015 NY Slip Op 50384(U))
March 12, 2015
The main issue in the case was whether the court should grant summary judgment dismissing the plaintiff's second cause of action. The court considered conflicting medical expert opinions regarding the medical necessity for the services at issue. The defendant had established the timely mailing of the denial of claim form, but the conflicting medical expert opinions presented by the parties demonstrated the existence of a triable issue of fact. As a result, the court held that the branch of the defendant's motion seeking summary judgment dismissing the plaintiff's second cause of action was properly denied. The court affirmed the order, ruling in favor of the plaintiff.
Metropolitan Diagnostic Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co. (2015 NY Slip Op 50383(U))
March 12, 2015
The court considered the case of Metropolitan Diagnostic Medical Care, P.C. as the assignee of Tareshe Allison, seeking to recover assigned first-party no-fault benefits from New York Central Mutual Fire Insurance Company. The main issue was whether the services provided were medically necessary. The court held that the physician's affirmation submitted by the plaintiff demonstrated the existence of a triable issue of fact as to the medical necessity of the services provided, and therefore, the defendant's motion for summary judgment dismissing the complaint should have been denied. Consequently, the order granting the defendant's motion for summary judgment was reversed, and the defendant's motion was denied.