No-Fault Case Law

In the case of Quality Health Products, Inc. v Geico Ins. Co., the main issue was whether the medical supplies at issue were medically necessary and therefore covered under the first-party no-fault benefits. Quality Health Products, Inc. as Assignee of the individuals involved, had moved for summary judgment to recover these benefits, while Geico Ins. Co. had cross-moved for summary judgment to dismiss the complaint, arguing that the claims had been denied due to a lack of medical necessity. The court considered the peer review reports submitted by Geico, which provided a factual basis and medical rationale for the determination that there was a lack of medical necessity for the supplies at issue. In opposition, Quality Health Products, Inc. submitted an affidavit from a doctor that did not sufficiently rebut the conclusions set forth in the peer review reports. As a result, the court held that the only remaining issue for trial was medical necessity, and reversed the order in favor of Geico, granting their motion for summary judgment dismissing the complaint.

The court considered the denial of plaintiff's motion for summary judgment in an action to recover assigned first-party no-fault benefits. The main issue was whether the plaintiff's moving papers established that the defendant had failed to pay or deny the claim within the requisite 30-day period, or that the defendant had issued a timely denial of claim that was conclusory, vague, or without merit as a matter of law. The court held that plaintiff's moving papers failed to establish either of these criteria, and therefore, the denial of the motion for summary judgment was affirmed. The decision was that plaintiff had failed to establish its entitlement to summary judgment, and the order was affirmed.

The relevant facts of the case were that Ortho Products & Equipment, Inc. was seeking to recover assigned first-party no-fault benefits, and the defendant, GEICO General Ins. Co., had denied the claim based on a lack of medical necessity. Plaintiff moved for summary judgment, and defendant cross-moved 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 supplies at issue. The court held that defendant failed to articulate a sufficient basis to strike the Civil Court's implicit findings in plaintiff's favor, and that there was a triable issue of fact regarding the medical necessity of the supplies at issue. Therefore, the court affirmed the order, with costs.

The relevant facts considered by the court in this case were that Promed Durable Equipment, Inc. as Assignee of ALLI SHAVANNA was seeking to recover assigned first-party no-fault benefits from GEICO Insurance. GEICO had timely mailed denial of claim forms which denied the claims on the ground of lack of medical necessity and also submitted two affirmed peer review reports. The main issue decided was whether GEICO had provided sufficient evidence to establish the lack of medical necessity for the supplies at issue. The holding of the court was that GEICO had made a prima facie showing and the plaintiff did not rebut this showing, therefore the court granted GEICO's cross motion for summary judgment dismissing the complaint.

The relevant facts the court considered were that plaintiff Compas Medical, P.C. was seeking to recover first-party no-fault benefits from defendant GEICO Ins. Co. After plaintiff's motion for summary judgment was denied and defendant's cross motion for summary judgment to dismiss the complaint was granted in the Civil Court, the case was appealed. The main issue decided was whether plaintiff had established its entitlement to summary judgment, and whether defendant's cross motion for summary judgment should have been granted. The holding of the case was that plaintiff had failed to establish its entitlement to summary judgment, as it did not demonstrate that defendant had failed to pay or deny the claim within the 30-day period, or issued a timely denial of the claim that was conclusory, vague, or without merit as a matter of law. Additionally, the court held that defendant's cross motion for summary judgment dismissing the complaint should have been denied, as they failed to establish their entitlement to summary judgment on certain claims. As a result, the original order was modified to deny defendant's cross motion for summary judgment dismissing the complaint.

The main issues in this case relate to a provider seeking recovery of assigned first-party no-fault benefits. The court considered the denial of the plaintiff's motion for entry of a default judgment and the grant of the defendant's unopposed cross motion to vacate a prior order of the court, which had granted the plaintiff's motion for summary judgment on default. The court dismissed the portion of the appeal that was taken from the grant of the defendant's cross motion, as the plaintiff did not oppose it. The court affirmed the remainder of the order, as the vacatur of the prior order meant that the plaintiff's motion for the entry of a default judgment was properly denied. The holding of the case was that the denial of the plaintiff's motion for a default judgment was proper due to the vacatur of the prior order granting summary judgment on default.

The court considered a case in which medical providers were seeking to recover assigned first-party no-fault benefits, but the insurance company had denied the claims because the plaintiff's assignor had failed to appear for scheduled independent medical examinations (IMEs). The main issues decided were whether the insurance company had timely scheduled the IMEs, whether the plaintiff's assignor had failed to appear for the scheduled IMEs, and whether the insurance company had timely denied the claims at issue. The holding of the court was that the insurance company had timely scheduled the IMEs, the plaintiff's assignor had failed to appear for the scheduled IMEs, and the insurance company had timely denied the claims at issue. Therefore, the branch of the defendant's motion seeking summary judgment to dismiss the claims based on the plaintiff's assignor's failure to appear for scheduled IMEs was granted, and the branch of the plaintiff's cross motion seeking summary judgment on that portion of the complaint was denied.

The court considered the facts that the plaintiff, Quality Psychological Services, P.C., was seeking to recover first-party no-fault benefits on behalf of its assignor, Maria De La Rosa, from New York Central Mutual Fire Insurance Company. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint. The court held that the defendant had submitted sufficient evidence to establish that the scheduling letters for independent medical examinations (IMEs) had been timely mailed and that the plaintiff's assignor had failed to appear for the IMEs. The court also found that the denial of claim form had been timely mailed, and therefore, the defendant was entitled to summary judgment dismissing the complaint. The appellate term reversed the lower court's order and granted the defendant's motion for summary judgment.

The court considered the issue of a provider seeking to recover assigned first-party no-fault benefits and whether there was a lack of medical necessity for the supplies at issue. Plaintiff moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint. The Civil Court denied plaintiff's motion, made findings in plaintiff's favor, and held that the only remaining issue for trial was medical necessity. Defendant submitted an affirmed peer review report showing a lack of medical necessity for the supplies, which was unrebutted by plaintiff. The Appellate Term reversed the lower court's decision, vacated the findings in plaintiff's favor, and granted defendant's motion for summary judgment dismissing the complaint, based on the lack of medical necessity for the supplies at issue.

The court considered the motion for summary judgment by the defendant to dismiss the complaint brought by the plaintiff, Longevity Medical Supply, Inc. In this case, the defendant alleged that the claims had been properly denied due to the plaintiff's failure to appear at scheduled examinations under oath (EUOs). The main issue decided by the court was whether the defendant had established that its procedure for mailing denial of claim forms had been followed and if the requests for EUOs were timely. The court held that the defendant had provided sufficient evidence to establish that the mailing procedures for EUO scheduling letters and denial of claim forms had been followed, and that the requests for EUOs were timely. As a result, the court reversed the lower court's denial of the defendant's motion for summary judgment and granted the motion to dismiss the complaint.