No-Fault Case Law

The main issues in this case were whether the defendant had timely denied the claims at issue based upon the plaintiff's assignor's failure to appear for scheduled independent medical examinations (IMEs) and whether the IME scheduling letters had been timely mailed in accordance with the office's standard mailing practices and procedures. The court noted that the only issue for trial was "the mailing of the IME scheduling letters." In support of its motion, the defendant submitted an affidavit by an employee of the company which had been retained by defendant to schedule IMEs, establishing that the IME scheduling letters had been timely mailed. The court found that as the plaintiff had not challenged the Civil Court's finding, in effect, that defendant is otherwise entitled to judgment, the order was reversed and defendant's motion for summary judgment dismissing the complaint was granted.

The main issue in this case was whether the defendant had timely mailed and properly scheduled independent medical examinations (IMEs) for the plaintiff. The court considered whether the initial scheduling letters had been timely mailed to the plaintiff, as required by Insurance Department Regulations. Defendant alleged that it had timely denied the claims at issue based upon plaintiff's assignor's failure to appear for duly scheduled IMEs. In support of its motion, defendant submitted an affidavit by an employee of the company which had been retained by defendant to schedule IMEs, which established that the IME scheduling letters had been timely mailed to plaintiff's assignor. The court decided that it was not necessary to mail the initial scheduling letters to plaintiff, and reversed the Civil Court's order, granting the defendant's motion for summary judgment dismissing the complaint.

The main issue in this case was whether the insurance company, NY Central Mutual Fire Ins. Co., had timely denied claims for first-party no-fault benefits based on the plaintiff's assignor's failure to appear for independent medical examinations (IMEs). The court considered affidavits from the company employee who scheduled the IMEs and the healthcare professionals who were to perform the IMEs, as well as an affidavit from the defendant's litigation examiner describing the standard mailing practices and procedures for verification requests and denial of claim forms. The court held that the assignor's appearance at the IMEs was a condition precedent to the insurer's liability on the policy, and as a result, the defendant's motion for summary judgment dismissing the complaint was granted.

The relevant facts the court considered in this case were that SK Prime Medical Supply, Inc. sought to recover $201.96 in first-party no-fault benefits from State Farm Mutual Automobile Insurance Co. The issue before the court was whether State Farm's denial of $200 of the claim at issue due to a deductible was appropriate, and whether the remaining amount sought by SK Prime was accurate based on the Durable Medical Goods Fee Schedule for Workers' Compensation. The holding of the court was that State Farm demonstrated the timely mailing of the denial of claim form and that the denial of $200 of the claim due to the deductible was proper. Additionally, State Farm's submission of its claims representative's affidavit and a copy of the fee schedule was sufficient to demonstrate that SK Prime was only entitled to receive $22.04 for a specific medical code, not the $24.00 billed by SK Prime. Therefore, the order granting State Farm's motion for summary judgment dismissing the complaint was affirmed.

The court considered the denial of medical claims by the defendant on the grounds of lack of medical necessity and failure to comply with verification requests. The main issues decided were whether the provider had established medical necessity for the denied claims and whether they had complied with the defendant's verification requests. The holding of the case was that the defendant's cross motion for summary judgment dismissing the complaint was granted, except for claims totaling $114.33 and $82.89, which were not addressed adequately by the defendant. Therefore, the order was modified to reflect this decision.

The court considered the fact that Right Aid Medical Supply Corp. as Assignee of Doleres Wong moved for summary judgment to recover assigned first-party no-fault benefits, but the Civil Court denied the motion and limited the issues for trial to the timeliness and propriety of the defendant's denial of claim forms and to the defenses preserved in such denials. The main issue decided was whether the Civil Court, in effect, granted plaintiff's motion for summary judgment, and whether it should have made CPLR 3212 (g) findings in plaintiff's favor. The holding of the case was that the court did not grant plaintiff's motion for summary judgment, but rather limited the issues of fact for trial, which it is permitted to do when a motion for summary judgment is denied or partially denied. The order, insofar as appealed from, was affirmed.

The relevant facts the court considered in this case were that the plaintiff, a medical provider, moved for summary judgment to recover assigned first-party no-fault benefits from the defendant insurance company. The Civil Court denied the motion but limited the issues for trial to the timeliness and propriety of the defendant's denial of claim forms and to the defenses preserved in such denials. On appeal, the defendant argued that the Civil Court effectively granted the plaintiff's motion for summary judgment and should not have made findings in the plaintiff's favor under CPLR 3212(g). The main issue decided was whether the Civil Court erred in limiting the issues for trial and making findings in the plaintiff's favor, and the holding was that the order, insofar as appealed from, was affirmed because the court did not grant the plaintiff's motion for summary judgment and was permitted to limit the issues of fact for trial under CPLR 3212(g).

The case involved a dispute between healthcare providers and an insurance company over first-party no-fault benefits that had been assigned to the providers. The insurance company had timely denied the claims based on the assignor's eligibility for workers' compensation benefits, and argued that the matter should be submitted to the Workers' Compensation Board due to the issue of whether the assignor had been injured during the course of employment. The trial court found that there were mixed questions of law and fact regarding the availability of workers' compensation benefits, and held the action in abeyance pending a determination by the Workers' Compensation Board. The appellate court affirmed the decision of the trial court, holding that the healthcare providers did not demonstrate that a proper application for workers' compensation benefits had been made within the time provisions set forth in the court's order, and therefore affirmed the dismissal of the remaining claims asserted in the complaint. In summary, the main issues decided were whether the healthcare providers had made a proper application for workers' compensation benefits within the given time frame, and whether the claims asserted in the complaint should be dismissed. The holding was that the trial court's decision to hold the action in abeyance and subsequently dismiss the remaining claims was affirmed.

The main issues in this case were whether the New York City Civil Court had personal jurisdiction over the defendant, and whether the Michigan declaratory judgment had a collateral estoppel effect in New York. The court considered the defendant's contention that the Civil Court lacked jurisdiction over it, as the defendant is a Michigan insurance company and had not conducted any business in New York, delivered contracts of insurance to residents of New York, or provided goods or services in New York. The court also considered the plaintiff's argument that the defendant had failed to establish that the Civil Court lacked jurisdiction. The holding of the court was that the defendant demonstrated its entitlement to summary judgment dismissing the complaint for lack of jurisdiction, as it had not done any of the acts necessary to fall under the Civil Court's long-arm jurisdiction. Additionally, the court determined that the defendant's failure to submit a certificate of conformity was not a fatal error. Therefore, the order granting the defendant's motion for summary judgment was affirmed.

The case involved a dispute over first-party no-fault benefits for medical services rendered after a motor vehicle collision. The main issue before the court was whether the collision was intentionally caused, which would impact the insurance coverage. The court considered the testimony of a witness from the defendant's Special Investigation Unit and found that it was relevant to the defense that there was no coverage due to the alleged injuries not arising from an insured incident. The jury unanimously returned a verdict in favor of the defendant, finding that the collision was the result of an intentionally caused event. The court affirmed the judgment, finding that the evidence presented at trial supported the jury's finding and that the motions for judgment as a matter of law and for a new trial were properly denied.