No-Fault Case Law

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.

The court considered the defendant's motion for summary judgment to dismiss the complaint by the plaintiff, a medical care provider, seeking to recover first-party no-fault benefits. The defendant argued that the insured had fraudulently procured the insurance policy. The main issue was whether the defendant had provided sufficient evidence to establish entitlement to judgment as a matter of law. The court held that the defendant did not submit enough evidence to support its motion, as the insured's testimony at an examination under oath did not eliminate all material issues of fact regarding his actual residence at the time he procured the policy, and the investigative report submitted by the defendant was based on inadmissible hearsay. As a result, the court affirmed the order denying the defendant's motion for summary judgment.

The main issue in the case was whether the provider had failed to appear for duly scheduled examinations under oath (EUOs) as claimed by the defendant. The court considered the evidence and found that the defendant had failed to establish, as a matter of law, its defense that the plaintiff had failed to appear for properly scheduled EUOs. Therefore, the court held that the defendant's motion for summary judgment dismissing the complaint should have been denied. The court reversed the order and granted the provider's appeal, denying the defendant's motion for summary judgment.

The relevant facts the court considered were that defendant-insurer made a prima facie showing that it timely and properly mailed notices for independent medical examinations (IMEs) to plaintiff's assignor, who then failed to appear. The main issue decided was whether the defendant-insurer was entitled to summary judgment dismissing the plaintiff-provider's claim for first-party no-fault benefits. The holding of the case was that the defendant's motion for summary judgment dismissing the complaint was granted, as they had provided competent evidence of the assignor's nonappearance and the mailing of the IME notices, and the plaintiff did not raise a triable issue with respect to these facts.

The court considered an appeal from an order denying defendant's motion for summary judgment in a case seeking recovery of first-party no-fault benefits. The main issue decided was whether the defendant-insurer established the proper and timely mailing of the denial of claim forms at issue, which would warrant summary dismissal. The court held that the action was not ripe for summary dismissal because the defendant failed to establish the proper and timely mailing of the denial of claim forms, as the affidavit submitted by the defendant lacked probative value and failed to set forth the basis of the affiant's personal knowledge of the internal mailing practices and procedures of the defendant during the pertinent period. Therefore, the court affirmed the order denying defendant's motion for summary judgment.

The relevant facts considered by the court were that the defendant, an insurance company, had denied the plaintiff's claim for first-party no-fault benefits on the ground of lack of medical necessity. The insurance policy's coverage limits had been exhausted through payment of no-fault benefits in satisfaction of arbitration awards rendered in favor of other healthcare providers, in compliance with the priority of payment regulation. The main issue decided by the court was whether the defendant was entitled to summary judgment dismissing the action for first-party no-fault benefits. The holding of the court was that the defendant-insurer made a prima facie showing of entitlement to summary judgment, and the plaintiff failed to raise a triable issue in opposition. Therefore, the defendant's motion for summary judgment dismissing the complaint was granted.