No-Fault Case Law

The main issue in this case was whether defendant was liable to pay first-party no-fault benefits to the plaintiff, a medical supply company, as the assignee of a patient. The Court considered the evidence presented by the defendant regarding their standard mailing practices and procedures to establish timely mailing of requests for additional verification, as well as timely denial of claims on the grounds of the plaintiff's failure to appear for scheduled independent medical examinations. Defendant also demonstrated that they had timely mailed verification requests and follow-up verification requests for the plaintiff's first cause of action. As a result, the court reversed the judgment, vacated parts of the order, and denied the branches of the plaintiff's cross-motion seeking summary judgment while granting the branches of defendant's motion seeking summary judgment. Therefore, the defendant was not liable to pay the no-fault benefits to the plaintiff.

The court considered the facts that Coney Island Physician Care, P.C. sought to recover assigned first-party no-fault benefits from Praetorian Ins. Co. The main issue was whether defendant was required to pay the claims or not based on timely mailing of verification requests, scheduling letters for independent medical examinations (IMEs), and denial of claim forms. The holding of the case was that defendant's motion for summary judgment dismissing the complaint was granted, as they had established that they had timely mailed verification requests and follow-up verification requests, and that plaintiff's assignor had failed to appear for the scheduled IMEs, which are a condition precedent to the insurer's liability on the policy. Therefore, the denial of claim forms and the denial of plaintiff's claims should have been dismissed.

The relevant facts considered by the court in this case involved a dispute between Optimal Well-Being Chiropractic, P.C. and Ameriprise Auto & Home Insurance. The issue decided was whether the insurance company had properly denied the claims for first-party no-fault benefits due to the failure of the plaintiff to appear for scheduled EUOs. The court ultimately held in favor of Optimal Well-Being Chiropractic, P.C., ruling that the insurance company had failed to submit proof by someone with personal knowledge of the nonappearance of the plaintiff at the EUOs in question, and therefore affirming the judgment in favor of the plaintiff.

The court considered a medical provider's appeal from an order granting a motion for summary judgment dismissing its complaint. The main issue was whether the insurance company had properly tolled its time to pay or deny the claims, as required by law. The court held that the insurance company failed to establish, as a matter of law, that it had properly tolled its time to pay or deny the claims, and therefore was not entitled to summary judgment dismissing these causes of action. The court also held that the insurance company untimely denied the claim upon which another cause of action was based, and therefore was not entitled to summary judgment on this cause of action. Finally, the court held that the affidavits submitted by the insurance company were sufficient to demonstrate that certain scheduling letters and denial of claim forms had been timely mailed, and as such, the insurance company was entitled to summary judgment dismissing these causes of action.

The relevant facts considered in this case were that the plaintiff, EMC Health Products, Inc., was seeking to recover assigned first-party no-fault benefits from the defendant, Geico Ins. Co. Plaintiff moved for summary judgment, while defendant cross-moved for summary judgment dismissing the complaint, arguing that the action was premature because they had timely and properly requested verification and plaintiff had not responded. The main issue decided by the court was whether the 30-day period within which defendant was required to pay or deny the claims began to run, and whether plaintiff's action was premature. The holding of the case was that as defendant demonstrated that it had not received the verification requested, and plaintiff did not show that such verification had been provided to defendant prior to the commencement of the action, the 30-day period did not begin to run, and thus plaintiff's action was premature. Therefore, the appellate court reversed the lower court's decision, vacated the findings in favor of plaintiff, and granted defendant's motion for summary judgment dismissing the complaint.

The court considered the fact that the defendant had timely mailed requests and follow-up requests for verification related to the claim at issue, but had not received the requested verification from the plaintiff. The main issue decided was whether the 30-day period within which the defendant was required to pay or deny the claims began to run. The holding of the case was that the defendant had not received the requested verification, and the plaintiff did not show that the verification had been provided to the defendant prior to the commencement of the action, making the plaintiff's action premature. As a result, the court reversed the order and granted the defendant's motion for summary judgment dismissing the complaint.

The main issue in this case was whether the defendant insurance company was entitled to summary judgment dismissing the complaint brought by the plaintiff medical provider to recover assigned first-party no-fault benefits. The court considered the fact that the defendant had timely mailed a denial of claim form citing lack of medical necessity, and had submitted an affirmed peer review report to support this determination. The court held that the defendant had made a prima facie showing of lack of medical necessity for the services at issue, and the plaintiff had not provided any rebuttal evidence. Therefore, the court reversed the order denying the defendant's motion for summary judgment and granted the motion for summary judgment dismissing the complaint.

The court considered whether the defendant had properly paid the plaintiff for services in accordance with the workers' compensation fee schedule. The main issue was whether the plaintiff's motion for summary judgment should have been granted and the defendant's cross motion for summary judgment should have been denied. The court held that the defendant had fully paid the plaintiff for the services according to the workers' compensation fee schedule. However, the court also held that the plaintiff's motion for summary judgment on its first cause of action should have been granted, as the defendant did not demonstrate that it had timely denied the claim. Therefore, the court modified the order to grant the plaintiff's motion for summary judgment on its first cause of action and deny the defendant's cross motion seeking to dismiss that cause of action.

The Civil Court of the City of New York, Kings County granted the plaintiff's motion for summary judgment and denied the defendant's cross motion for summary judgment dismissing the complaint. The case involved a provider seeking to recover assigned first-party no-fault benefits. The defendant timely denied the claim based on a lack of medical necessity, but the court found a triable issue of fact regarding the medical necessity of the services at issue. As a result, the court modified the order to provide that the plaintiff's motion for summary judgment is denied. The decision was made on December 17, 2014.

The relevant facts considered by the court in this case were that Dr. Allen Cherkin was seeking to recover assigned first-party no-fault benefits from Praetorian Insurance Company. The insurance company had denied the claim, and argued that the denial was timely mailed. However, the court found that there was a triable issue of fact regarding the medical necessity of the services at issue, and therefore denied the insurance company's motion for summary judgment dismissing the complaint. The main issue decided was whether there was a triable issue of fact regarding the medical necessity of the services, and the holding of the court was that the denial of the claim forms were sufficiently established, but that there was indeed a triable issue of fact regarding the medical necessity. The court ultimately affirmed the order denying the insurance company's motion for summary judgment.