No-Fault Case Law

The court considered a case brought by Avicenna Medical Arts, PLLC as assignee of Samuel Darwa, seeking to recover assigned first-party no-fault benefits from Unitrin Advantage Insurance Company. Avicenna Medical Arts moved for summary judgment, and Unitrin Advantage Insurance Company cross-moved for summary judgment, arguing that the bills at issue had been timely and properly denied based on the assignor's failure to appear for scheduled examinations under oath (EUOs). The Civil Court granted the branches of Avicenna's motion, awarding them the principal sum of $2,903. The main issue decided was whether Avicenna demonstrated its prima facie entitlement to summary judgment, and the court held that Avicenna was properly granted judgment on its first six causes of action as the defendant's follow-up EUO requests were untimely, precluding them from asserting their defense. The judgment was affirmed by the court.

The court considered the motion for summary judgment brought by the defendant, who denied the claims at issue based on the failure of the plaintiff's assignor to appear for independent medical examinations (IMEs). The main issue decided was whether the IME scheduling letters had been timely and properly mailed, and whether the plaintiff's assignor had failed to appear for the IMEs. The court held that the defendant's denial of claim forms were timely and proper, and that the IME requests had been timely mailed. Affidavits from the chiropractors who were to perform the IMEs were also submitted and were found to be sufficient to establish that the plaintiff's assignor had failed to appear for the IMEs. Therefore, the court reversed the order and granted the defendant's motion for summary judgment dismissing the complaint.

The court considered a case involving a provider seeking to recover assigned first-party no-fault benefits from an automobile insurance company. The main issue decided was whether the insurance company had properly reduced the billed amount for a medical procedure in accordance with the workers' compensation fee schedule. The court held that the insurance company's affidavits were sufficient to demonstrate that the fee schedule was appropriately applied, and that the company had mistakenly overpaid for the procedure. The court also found that the insurance company's defense was properly set forth in its denial of the claim, and that the provider had not rebutted the company's showing that it had overpaid. As a result, the court affirmed the lower court's decision to grant the insurance company's motion for summary judgment and to deny the provider's motion for summary judgment.

The court considered the fact that the plaintiff, a healthcare provider, failed to appear at scheduled examinations under oath (EUOs) and that the denial of claim forms had been timely mailed by the insurer. The main issue decided was whether the failure to appear at the EUOs was a condition precedent to the insurer's liability on the policy. The court held that the appearance at an EUO is indeed a condition precedent to an insurer's liability on a policy, as established in prior case law. As a result, the court granted the insurer's motion for summary judgment dismissing the complaint and denied the plaintiff's cross motion for summary judgment. The order was affirmed by the court.

The court considered the defendant-insurer's motion for summary judgment to dismiss the complaint by the plaintiff-provider for first-party no-fault benefits. The main issue decided was whether the defendant made a prima facie showing of entitlement to summary judgment by establishing that it timely and properly mailed notices for independent medical examinations (IMEs) to the plaintiff's assignor, and that the assignor failed to appear. The holding of the court was that the defendant-insurer did make a prima facie showing of entitlement to summary judgment, and the plaintiff did not specifically deny the assignor's nonappearance or otherwise raise a triable issue with respect to the mailing or reasonableness of the underlying notices. Therefore, the defendant's motion for summary judgment dismissing the complaint was granted.

The main issue in the case of Auto One Ins. Co. v Hillside Chiropractic, P.C. was whether the no-fault arbitrator erred in giving no weight to an independent medical examination (IME) report because it was not notarized, and whether the Master Arbitrator and IAS court were correct in deferring to the arbitrator's determination. The court considered the fact that the no-fault arbitrator's decision was based on CPLR 2106, which requires notarization for certain documents, but found that strict conformity to legal rules of evidence is not necessary in arbitration proceedings. The holding of the court was to reverse the denial of the petition seeking to vacate the arbitrator's determination, affirm the award of the lower arbitrator, vacate the arbitration award, and remand the matter for a new arbitration hearing before a different arbitrator.

The court considered the issue of whether or not the plaintiff was obligated to submit to examinations under oath (EUOs) in order to recover assigned first-party no-fault benefits. The main issue was whether the recipient of an authorization to pay or an assignment of benefits was obligated to submit to an EUO and whether or not the defendant demonstrated that the plaintiff had failed to appear for these scheduled examinations under oath. The court held that both the recipient of a properly executed prescribed authorization and a properly executed prescribed assignment were required to submit to a duly scheduled EUO. They also held that the plaintiff was obligated to submit to an EUO whether viewed as the patient's assignee or as the patient's representative. The order was affirmed and the court found that the plaintiff's remaining argument, which was raised for the first time on appeal, was without merit.

The court considered the plaintiff's appeal from an order granting the defendant's motion for summary judgment dismissing the complaint. Defendant's submissions established that they timely and properly denied plaintiff's no-fault claims due to excessive fees. Plaintiff failed to raise a triable issue regarding the denial forms or fee calculations. The court held that the denial of one of plaintiff's claims was timely, but there were remaining triable issues regarding other claims. Defendant's argument about reimbursement for moxibustion and infrared treatment was found unpersuasive. The court ultimately modified the order by reinstating plaintiff's claim for first-party no-fault benefits billed under specific CPT codes, and affirmed the order with this modification.

The Appellate Division, Second Department, reviewed a trial court's judgment in a case involving an automobile accident wherein a claim for no-fault benefits was filed with Hereford Insurance Company. The court held that the plaintiff was eligible for unpaid basic no-fault benefits in the amount of $50,000, but that the defendant's contention regarding the plaintiff's eligibility for excess no-fault coverage was not properly preserved for appellate review. The court also noted that the judgment awarding compound interest on the unpaid no-fault benefits was in error. The case was remitted to the trial court for recalculation of interest by applying simple interest at the rate of 2% per month. The main issues decided revolved around whether the plaintiff was eligible for basic and excess no-fault benefits, as well as the type of interest that should accrue on the unpaid benefits. The court ultimately decided that the plaintiff was eligible for $50,000 in unpaid basic no-fault benefits, but that the defendant did not preserve its contention regarding excess no-fault coverage. The court also held that compound interest was awarded in error, and instructed the trial court to recalculate interest on the unpaid benefits.

The main issue in the American Commerce Insurance Company v Francois case was whether the plaintiff was entitled to a temporary restraining order and preliminary injunction in order to prevent all no-fault actions arising from a car accident involving its insured. The court considered the plaintiff's argument that it would suffer imminent harm and that the injuries it would sustain would not be compensable by money damages. Additionally, the plaintiff claimed that it had a likelihood of success on the merits of its cause of action. The court found that the plaintiff failed to establish a likelihood of success on the merits, failed to demonstrate imminent harm, and did not show that its injuries would not be compensable by money damages. Therefore, the holding of the court was that the plaintiff's motion for a temporary restraining order and a preliminary injunction was properly denied.