No-Fault Case Law

The relevant facts considered by the court in this case involved a dispute over first-party no-fault benefits between XVV, Inc. and Praetorian Ins. Co. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint based on the plaintiff's assignor failing to appear for independent medical examinations (IMEs). The court ultimately held that the defendant was entitled to summary judgment, as they had submitted sufficient evidence that the IME requests had been timely mailed and that the plaintiff's assignor had failed to appear for the IMEs. As a result, the court reversed the lower court's decision and granted the defendant's cross motion for summary judgment dismissing the complaint.

The court considered the timely mailing of independent medical examination (IME) scheduling letters, the failure of the plaintiff's assignors to appear for the scheduled IMEs, and the timely mailing of the denial of claim forms. The main issue decided was whether the insurer was liable for first-party no-fault benefits when the plaintiff's assignors failed to appear for scheduled IMEs. The court held that an assignor's appearance at an IME is a condition precedent to the insurer's liability on the policy, and therefore, the defendant's motion for summary judgment dismissing the complaint was granted.

The Court considered the denial of plaintiff's motion for summary judgment and the granting of defendant's cross motion for summary judgment, which were made by the Civil Court of the City of New York. The main issue decided was whether defendant's cross motion should have been denied and plaintiff's motion should have been granted. The holding of the case was that the order of the Civil Court denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment was affirmed. The court determined that defendant's affidavit, executed in Pennsylvania, was accompanied by a proper certificate of conformity, and that the absence of a certificate of conformity for an out-of-state affidavit was not a fatal defect. The court also held that defendant had timely denied the claims at issue, and plaintiff had provided no basis upon which to reverse the order of the Civil Court.

The main issue in this case was whether the provider had standing to receive reimbursement of first-party no-fault benefits without annexing a copy of the assignment of benefits form executed by its assignor. The court held that the provider did have standing, as the claim forms received by the defendant stated that the assignor had executed an assignment and defendant was advised that the signature was "on file.” The court also stated that the defendant’s remaining argument was not properly before the court and lacked merit. Therefore, the judgment granting the plaintiff’s motion for summary judgment and denying the defendant’s cross motion for summary judgment was affirmed.

The court considered the case of New York Diagnostic Medical Care, P.C. as the assignee of Kenneth Smith, who appealed from an order of the Civil Court of the City of New York, Kings County, which denied plaintiff's motion for summary judgment in an action to recover assigned first-party no-fault benefits. The main issue was whether the provider had established its prima facie entitlement to judgment as a matter of law. The court held that while the provider had submitted evidence in admissible form that the claim forms were mailed to the insurer, and that the insurer failed to pay those claims within the prescribed 30-day period, the affidavit failed to demonstrate that the insurer had either failed to deny the claims within the requisite 30-day period or issued timely denial of claim forms which were conclusory, vague, or without merit as a matter of law. Therefore, the court affirmed the order denying plaintiff's motion for summary judgment.

The relevant facts of the case are that Optimal Well-being Chiropractic, P.C., as the assignee of Prince Johnson, filed a lawsuit against Chubb Indemnity Insurance Company to recover first-party no-fault benefits. The issue at hand was whether the trial court correctly granted plaintiff's motion for summary judgment and denied defendant's cross-motion for summary judgment dismissing the complaint. The main issues considered were whether the insurance company had failed to pay or deny the claim within the requisite 30-day period and whether the no-fault plaintiff had demonstrated proof of the submission of the claim forms. The holding of the case was that the trial court's decision was modified to deny plaintiff's motion for summary judgment, while affirming the decision to deny defendant's cross-motion for summary judgment dismissing the complaint. The court concluded that the insurance company had not established a basis to disturb the decision as it pertained to the denial of the cross-motion for summary judgment.

The main issue in the case is whether the supplies at issue were medically necessary, as the defendant had denied the claims on the basis of a lack of medical necessity. The court considered the evidence presented by both parties and determined that there was a triable issue of fact regarding the medical necessity of the services at issue. Therefore, the court held that the defendant's cross motion for summary judgment dismissing the complaint is denied. The order denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment dismissing the complaint was modified to provide that defendant's cross motion for summary judgment dismissing the complaint is denied.

The court considered the motion for summary judgment by the defendant to dismiss the complaint, based on a lack of medical necessity for the claims in question. The Civil Court denied the defendant's motion and limited the issue for trial to medical necessity. The main issue decided was whether the defendant had sufficient basis to strike the Civil Court's implicit findings in favor of the plaintiff and whether there was a triable issue of fact regarding the medical necessity of the services at issue. The holding of the case was that the order, insofar as appealed from, was affirmed, with the court finding that there was a triable issue of fact regarding the medical necessity of the services at issue.

The court considered the case of City Chiropractic, P.C. as Assignee of Kamesha Campbell v. Eveready Ins. Co., which involved the plaintiff seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant had timely mailed its verification request and follow-up verification requests as required by law. The court held that the defendant had demonstrated that it had not received all of the verification requested, and the plaintiff did not provide evidence that such verification had been provided to the defendant prior to the commencement of the action. Therefore, the 30-day period within which the defendant was required to pay or deny the claims at issue did not begin to run, and the plaintiff's action was deemed premature. As a result, the judgment was reversed, and the defendant's cross motion for summary judgment dismissing the complaint was granted.

The court considered an appeal from an order of the Civil Court that denied the defendant's motion seeking summary judgment dismissing the complaint seeking to recover first-party no-fault benefits for medical services rendered by Arco Medical NY, P.C. The main issue decided was whether there was a triable issue of fact regarding the medical necessity of the services at issue. The holding of the court was that upon review of the record, it was found that there was indeed a triable issue of fact regarding the medical necessity of the services, and therefore the order denying the defendant's motion was affirmed.