No-Fault Case Law

The court considered an appeal from an order of the Civil Court which granted the defendant's motion for summary judgment dismissing the complaint in an action by a provider to recover assigned first-party no-fault benefits. The main issue was whether the denial of claim form had been timely mailed, and the plaintiff contended that the affidavits and documents submitted by the defendant were not sufficient to establish this. However, the court held that the affidavits and documents submitted by the defendant were indeed sufficient to establish that the denial of claim form had been timely mailed. The judgment was affirmed.

The case involved the New York University Hospital-Tisch Institute filing a lawsuit to recover no-fault benefits from the Government Employees Insurance Company under two insurance contracts. The Supreme Court initially denied the plaintiffs' motion for summary judgment on the first cause of action. Upon reargument, the court vacated its determination and granted summary judgment for the plaintiffs. The main issue to be decided was whether the defendant raised a triable issue of fact in opposition to the plaintiffs' motion for summary judgment. The court held that the defendant did raise a triable issue of fact, as the evidence submitted demonstrated that it received the responses to its requests for additional verification within the requisite time period and subsequently denied the claim within the 30-day period after issuing the last verification request. Therefore, the Supreme Court's initial denial of that branch of the plaintiffs' prior motion for summary judgment on the first cause of action was adhered to.

The relevant facts considered by the court were that the plaintiff, New Way Medical Supply Corp., was seeking to recover first-party no-fault benefits from defendant GEICO Insurance Co. The plaintiff moved for summary judgment, while the defendant cross-moved for summary judgment dismissing the complaint, based on a lack of medical necessity. The main issue decided by the court was whether there was a lack of medical necessity for the supplies at issue. The holding of the court was that the defendant's cross-motion for summary judgment dismissing the complaint was granted, as the plaintiff did not rebut the defendant's showing of lack of medical necessity, and did not submit any medical evidence in support of its motion for summary judgment. Therefore, the CPLR 3212 (g) findings in favor of the plaintiff were vacated and the defendant's cross-motion was granted.

The court considered an action by a provider to recover assigned first party-no-fault benefits. Defendant appealed from an order of the Civil Court that denied defendant's cross motion for summary judgment dismissing the complaint. The court decided that the branches of defendant's cross motion seeking summary judgment dismissing claims based on the workers' compensation fee schedule should have been granted as defendant timely denied the claims at issue and demonstrated that its denial was based on the fee schedule. Additionally, the court found that defendant had properly denied plaintiff's claim in accordance with the workers' compensation fee schedule because the claim was contrary to Physical Medicine Ground Rule 11. However, the court also held that plaintiff had raised a triable issue of fact as to the medical necessity of the remaining claims, thus modifying the order to provide that the branches of defendant's cross motion seeking summary judgment dismissing the unpaid portion of plaintiff's $1,291.96 claim should also be granted.

The relevant facts that the court considered in this case were that Eagle Surgical Supply, Inc. was seeking to recover first-party no-fault benefits from Allstate Insurance Company. The parties had entered into a stipulation where Allstate was to serve responses to Eagle Surgical Supply's discovery demands within 30 days, or be precluded from offering items not provided in the action. Eagle Surgical Supply moved for an order of preclusion, alleging that Allstate had failed to comply with the discovery stipulation. Despite not submitting written opposition to the motion within the stipulated time frame, the Civil Court denied Eagle Surgical Supply's motion based on Allstate's claim that it had served discovery responses in May 2011. The main issue decided in this case was whether Eagle Surgical Supply's motion for an order of preclusion should have been granted based on Allstate's failure to comply with the discovery stipulation and the lack of written opposition to the motion. The court held that Eagle Surgical Supply's motion for an order of preclusion should have been granted, as it was established that Allstate had not served the discovery responses within the stipulated time period and failed to submit written opposition to the motion within the stipulated time frame, or at all. Therefore, the court reversed the order and granted Eagle Surgical Supply's motion for an order of preclusion.

The case involved a dispute between Bronze Acupuncture, P.C., as the assignee of Dawn Barrington, and Travelers Ins. Co. over first-party no-fault benefits. The issue was whether Travelers Ins. Co. properly applied a $200 deductible to the claims in question. Plaintiff moved for summary judgment, but defendant cross-moved for summary judgment dismissing the complaint, arguing that the deductible had been properly applied and the claims were denied accordingly. The court found that the affidavits submitted by the defendant established the timely mailing of the denial of claim forms and the application of the $200 deductible as per the insurance policy. The court also rejected the plaintiff's contention that defendant improperly based its motion on an out-of-state affidavit, as the out-of-state affidavit was accompanied by a proper certificate of conformity. Therefore, the court reversed the order, denied plaintiff's motion for summary judgment, and granted defendant's cross motion for summary judgment dismissing the complaint.

The court considered the motion for summary judgment made by the plaintiff to recover assigned first-party no-fault benefits, as well as the cross-motion for summary judgment made by the defendant to dismiss the complaint on the grounds of a lack of medical necessity. The main issue decided was whether the supplies at issue were medically necessary, and the court held that the only remaining issue for trial was medical necessity. The court affirmed the denial of the plaintiff's motion for summary judgment and the denial of the defendant's cross motion, finding that there was a triable issue of fact as to whether the supplies were medically necessary. The court also found that the defendant failed to articulate a sufficient basis to strike the Civil Court's implicit findings in the plaintiff's favor.

The court considered a case involving Avicenna Medical Arts, P.L.L.C. seeking to recover first-party no-fault benefits from GEICO Insurance Company. The main issue was whether the services at issue were medically necessary. The court held that the only remaining issue for trial was medical necessity. The defendant submitted two sworn reports of independent medical examinations (IMEs) which determined that there was a lack of medical necessity for the services at issue. In opposition, the plaintiff submitted an affidavit from a doctor which failed to sufficiently rebut the conclusions set forth in the IME reports. As a result, the court reversed the order, vacated the findings in favor of the plaintiff, and granted the defendant's cross motion for summary judgment dismissing the complaint.

The main issue in this case was whether the defendant, Allstate Ins. Co., was required to produce its Special Investigation Unit (SIU) file in response to a discovery demand by the plaintiff, All Boro Psychological Services, P.C. The court held that the contents of the defendant's SIU file were not privileged and were discoverable, as the defendant failed to demonstrate that it had decided to deny the plaintiff's claims prior to commencing its investigation. The court also decided that the defendant was entitled to discovery regarding whether the plaintiff was in compliance with applicable state and local licensing laws, and that the defendant had the right to depose certain individuals related to the case. Therefore, the defendant was ordered to produce its SIU file in response to the plaintiff's demand, and the order was affirmed with modifications.

The court considered the fact that the provider was seeking to recover assigned first-party no-fault benefits from the insurance company. The insurance company had denied the claims based on a lack of medical necessity and submitted affirmed peer review reports to support their determination. The main issue decided was whether the denial of the claims by the insurance company was justified based on the lack of medical necessity. The court held that the insurance company's showing that the services were not medically necessary was not rebutted by the plaintiff, and therefore, the insurance company's cross motion for summary judgment dismissing the complaint should have been granted. The court reversed the lower court's order and granted the insurance company's cross motion for summary judgment dismissing the complaint.