No-Fault Case Law

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.

The court considered the denial of a healthcare provider's motion for summary judgment and the granting of the insurance company's cross motion for summary judgment in a case to recover first-party no-fault benefits. The main issue was whether the insurance company adequately demonstrated that it had fully paid the provider for services in accordance with the workers' compensation fee schedule and whether there was a triable issue of fact as to the medical necessity of the services rendered. The holding was that the insurance company demonstrated it had fully paid the provider in accordance with the fee schedule, but there was a triable issue of fact regarding the medical necessity of the services, and therefore the insurance company was not entitled to summary judgment dismissing that claim. The court modified the order to deny the insurance company's cross motion seeking summary judgment dismissing the claim based on a lack of medical necessity.

The relevant facts considered by the court in the case of Eagle Surgical Supply, Inc. v Allstate Insurance Company included the plaintiff's failure to appear for scheduled examinations under oath (EUOs) as part of the process to recover assigned first-party no-fault benefits. Defendant moved for summary judgment to dismiss the complaint on this ground. The main issue decided was whether the EUO scheduling letters were defective and whether the plaintiff's objections regarding the EUO requests should be heard. The court held that the EUO scheduling letters advised the plaintiff that the EUO would concern plaintiff's eligibility to be reimbursed for assigned no-fault benefits, and the plaintiff's objections were not grounds for dismissal since the plaintiff did not respond in any way to the EUO requests. The court also held that the plaintiff's remaining contentions were improperly raised for the first time on appeal and therefore not properly before the court. The judgment granting defendant's motion for summary judgment was affirmed.

The court considered the facts that the timely mailing of examination under oath (EUO) scheduling letters had tolled the defendant's time to pay or deny the plaintiff's claim, and that the plaintiff's assignor had failed to appear for the properly scheduled EUOs. The main issue decided was whether the insurer's time to pay or deny the claim had been properly tolled, and if the claim had been timely and properly denied on that ground. The holding of the court was that the judgment was reversed, the order entered was vacated, and plaintiff's motion for summary judgment was denied, while the defendant's cross motion for summary judgment dismissing the complaint was granted. The court also determined that an assignor's appearance at an EUO is a condition precedent to the insurer's liability on the policy.