No-Fault Case Law

The court considered a dispute over a provider's attempt to recover assigned first-party no-fault benefits from an insurance company. The main issue to be decided was whether the insurance company timely denied the plaintiff's claims, after the plaintiff's assignor failed to appear for scheduled medical exams. The court held that there was a question of fact as to whether the insurance company timely denied the claims, and that such a defense is subject to preclusion if the denials were untimely. The court affirmed the lower court's order, which denied the insurance company's cross motion for summary judgment dismissing the complaint.

The main issue in this case is whether the defendant, GEICO General Insurance Company, properly denied a claim for first-party no-fault benefits based on a lack of medical necessity. The court considered the evidence presented by both parties and found that there is a triable issue of fact regarding the medical necessity of the services at issue. Therefore, the court reversed the order granting the defendant's cross motion for summary judgment and denied the motion to dismiss the complaint. The holding of the case is that there is a triable issue of fact regarding the medical necessity of the services, and as a result, the defendant's cross motion for summary judgment dismissing the complaint was denied.

The court considered the motion for summary judgment by the defendant to dismiss the complaint brought by a provider seeking first-party no-fault benefits. The defendant argued that the claims at issue were properly denied based on the plaintiff's failure to appear for scheduled examinations under oath (EUOs). The main issue decided was whether the defendant's motion for summary judgment should be granted. The court held that the defendant's motion was properly denied because they failed to submit proof by someone with personal knowledge of the plaintiff's nonappearance for the EUOs in question. Therefore, the order denying defendant's motion was affirmed.

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.