No-Fault Case Law

The main issue in this case was whether the insurance company was justified in denying the plaintiff's claims for first-party no-fault benefits based on the plaintiff's failure to comply with a condition precedent to coverage, which was to appear for duly scheduled examinations under oath (EUOs). The court held that an appearance at an EUO is a condition precedent to the insurer's liability on the policy, and the insurance company was entitled to request the EUOs without specifying the reason for the request. The court also found that the opposing affirmation submitted by plaintiff's counsel was insufficient to raise a triable issue of fact in opposition to defendant's motion for summary judgment. Therefore, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The court considered a case where Meridian Psychological Services, PC provided psychological services to Kenroy Palmer after a motor vehicle accident. Meridian submitted the claim to Government Employees Insurance Co. (Geico) for payment, and Geico did not respond to the claim or pay or deny it. The main issue decided in the case was whether Geico was required to pay or deny the claim within 30 days of receipt, and whether Geico had properly followed up on the request for additional verification. The holding of the court was that Geico did not have a defense to the action brought by Meridian, as the claim had been timely submitted and Geico did not properly or timely follow up on its request for additional verification. Therefore, the court found in favor of the plaintiff, Meridian.

The court considered the provider's failure to comply with discovery requests, including the refusal to adequately comply with requests even after being directed to do so by court order. The main issue decided was whether the court should dismiss the complaint pursuant to CPLR 3126 due to plaintiff's willful and contumacious conduct in failing to comply with discovery requests and the absence of a reasonable excuse for its failure to comply. The holding of the court was that the order granting defendant's motion to dismiss the complaint with prejudice was affirmed, as the plaintiff's conduct was willful and in bad faith, warranting the drastic remedy of dismissal. The court also held that the remaining contention raised by the plaintiff for the first time on appeal was not properly before the court and therefore not considered.

In this case, the plaintiff sought to recover assigned first-party no-fault benefits for medical services provided to an assignor from October 19, 2000 through April 10, 2001. The defendant moved for summary judgment, claiming that the six-year statute of limitations had expired prior to the commencement of the action. The defendant's motion was denied, as the plaintiff provided evidence that the summons and complaint had been properly served on the defendant on March 25, 2003, within the statute of limitations period. The court found that the defendant's claim that the action had been previously dismissed was not substantiated by the record. Additionally, the defendant's submission of an answer in 2008 and service of discovery demands acted as a waiver of any right to dismiss the 2003 complaint. Therefore, the court affirmed the denial of the defendant's motion for summary judgment.

The relevant facts considered by the court in Forest Rehabilitation Medicine PC v Allstate Ins. Co. were that the plaintiff sought reimbursement for a relatively new and controversial form of pain management known as Calmare pain therapy, which had been administered to their assignor, Tracy Fertitta, after a motor vehicle accident. The court heard expert testimony from both the plaintiff and defendant, with the plaintiff's expert asserting that the therapy was reliable, had gained wide acceptance in the medical community, and had received FDA approval. The defendant's expert, however, argued that the treatment was not medically necessary and was not cost-effective. The main issue decided by the court was whether Calmare pain therapy was medically necessary and generally accepted as reliable science. The court ultimately held in favor of the plaintiff, finding that there was insufficient evidence to establish a lack of medical necessity for the Calmare pain therapy. The court concluded that, based on expert testimony and independent testing, the treatment was a medical necessity for the management of the patient's pain. Therefore, the court awarded judgment in favor of the plaintiff in the amount of $3,490, in addition to attorney's fees and statutory interest.

The main issue in the case was whether a no-fault provider had established its entitlement to judgment as a matter of law in a lawsuit to recover assigned first-party no-fault benefits. The provider sought summary judgment, claiming that the defendant insurer had failed to pay or deny the claims within the prescribed 30-day period. The court found that while the provider's affidavit established that the claim forms had been mailed to the defendant and that the defendant had failed to pay the claims within the 30-day period, the affidavit did not demonstrate that the defendant had failed to deny the claims within the 30-day period or that the defendant had issued timely denial of claim forms which were conclusory, vague, or without merit as a matter of law. As a result, the court denied the provider's motion for summary judgment, affirming the order without costs.

The main issue in the case was whether the defendant-insurer was entitled to summary judgment dismissing the action for first-party no-fault benefits. The court considered the defendant's submission of competent evidence establishing the proper and timely mailing of notices scheduling the assignor's independent medical examinations and examinations under oath, as well as the assignor's failure to appear. The defendant-insurer made a prima facie showing of entitlement to summary judgment. The plaintiff medical provider did not offer a persuasive explanation for why the notices were returned to the defendant as "unclaimed." The Appellate Term, First Department reversed the order of the Civil Court, denied plaintiff's cross motion for summary judgment, and granted defendant's motion for summary judgment dismissing the complaint.

The court considered a motion for summary judgment made by the defendant, an insurance company, to dismiss a complaint brought by the plaintiff, an acupuncture clinic, for first-party no-fault benefits. The insurance company established that it had timely and properly mailed notices for independent medical examinations (IMEs) to the plaintiff's assignor, and that the assignor failed to appear for the examinations. The plaintiff did not specifically deny the assignor's nonappearance or raise a triable issue with respect to the mailing or reasonableness of the notices. Therefore, the court held that the insurance company had the right to deny all claims retroactively to the date of loss, regardless of whether the denials were timely issued, and affirmed the lower court's decision to grant the insurance company's motion for summary judgment.

The Court considered the appeal from an order and subsequent judgment of the Civil Court which granted the plaintiff's motion for summary judgment and denied the defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was that the branches of plaintiff's motion seeking summary judgment on the first through thirteenth causes of action should have been denied, and the branches of defendant's cross motion for summary judgment seeking to dismiss those causes of action should have been granted. However, the Court did not disturb the branches of the order that granted the branch of plaintiff's motion seeking summary judgment on the 14th cause of action and denied the branch of defendant's cross-motion seeking summary judgment dismissing that cause of action. The holding of the case was that the judgment was reversed and the matter was remitted to the Civil Court for the entry of judgment in favor of the defendant dismissing the first through thirteenth causes of action and in favor of the plaintiff on the fourteenth cause of action following a calculation of statutory interest and an assessment of attorney's fees.

The court considered the appeal from an order of the Civil Court of the City of New York, Kings County. The order denied the defendant's cross motion for summary judgment dismissing the complaint brought by Clinton Place Medical, P.C. as the assignee of Jorge Done, seeking to recover assigned first-party no-fault benefits from New York Central Mutual Fire Insurance Company. The main issue was whether the denial of claim forms had been timely mailed in accordance with defendant's standard mailing practices and procedures, as the plaintiff's assignor had failed to appear for scheduled independent medical examinations. The court held that the denial of claim forms had been timely mailed in accordance with the defendant's mailing practices, and as the plaintiff had not challenged the finding that the defendant was otherwise entitled to judgment, the order was reversed and the defendant's cross motion for summary judgment dismissing the complaint was granted.