No-Fault Case Law

Prestige Med., P.C. v Metropolitan Prop. & Cas. Ins. Co. (2022 NY Slip Op 50591(U))

The relevant facts of the case were that Prestige Medical, P.C. was seeking to recover assigned first-party no-fault benefits from Metropolitan Property and Casualty Insurance Co. The main issue decided by the court was whether the plaintiff failed to appear for duly scheduled examinations under oath (EUOs) and if the EUO scheduling letters had been properly mailed. The holding of the court was that the defendant established that the EUO scheduling letters had been properly mailed, and that the plaintiff had failed to appear for the scheduled EUOs. As a result, the court reversed the order of the Civil Court and granted the defendant's motion for summary judgment, dismissing the complaint.
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Sutphin Complete Med. Care, P.C. v Tri-State Consumer Ins. Co. (2022 NY Slip Op 50586(U))

The relevant facts in this case involved a medical provider seeking to recover assigned first-party no-fault benefits from an insurance company. The insurance company had sought summary judgment to dismiss the complaint on the grounds that the plaintiff's assignor failed to appear for scheduled independent medical examinations (IMEs) and that the amount charged by the medical provider exceeded the amounts permitted by the workers' compensation fee schedule. The defendant failed to establish its entitlement to summary judgment because it did not sufficiently establish that the IME scheduling letters were timely generated and properly addressed. Additionally, the affirmations from the doctors who were scheduled to perform the IMEs did not establish their personal knowledge of the nonappearance of the plaintiff's assignor. Therefore, the court held that the defendant was not entitled to summary judgment to dismiss the complaint and affirmed the order in favor of the medical provider.
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Veraso Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2022 NY Slip Op 50584(U))

The relevant facts the court considered in Veraso Medical Supply Corp. v State Farm Mutual Automobile Ins. Co. were that the plaintiff, Veraso Medical Supply Corp., was seeking to recover assigned first-party no-fault benefits from the defendant, State Farm Mutual Automobile Ins. Co. The main issue decided was whether the affidavit submitted by the plaintiff in opposition to the defendant's motion for summary judgment was sufficient to demonstrate the existence of an issue of fact. The holding of the court was that the affidavit submitted by the plaintiff was insufficient, and therefore the order granting the defendant’s motion for summary judgment and denying the plaintiff's cross motion for summary judgment was affirmed.
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Veraso Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2022 NY Slip Op 50583(U))

The case involved Veraso Medical Supply Corp. bringing an action to recover assigned first-party no-fault benefits from State Farm Mutual Automobile Insurance Co. The appellate court affirmed the lower court's order, which granted State Farm's motion for summary judgment dismissing the complaint and denied Veraso's cross motion for summary judgment. Veraso's main contention on appeal was that its affidavit was sufficient to demonstrate the existence of an issue of fact, but the court disagreed. The court cited previous cases to support its decision and ultimately held that the order was affirmed.
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Charles Deng Acupuncture, P.C. v Nationwide Ins. (2022 NY Slip Op 50580(U))

The relevant facts of this case involved an action by a provider to recover assigned first-party no-fault benefits. The court considered the defendant's motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant's motion for summary judgment should have been denied, based on the plaintiff's arguments. The court held that the plaintiff's arguments as to why the defendant's motion for summary judgment should have been denied were not properly before the court, as they were being raised for the first time on appeal, and therefore declined to consider them. As a result, the court affirmed the order granting defendant's motion for summary judgment dismissing the complaint.
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Mega Aid Pharm. I, Inc. v A. Cent. Ins. Co. (2022 NY Slip Op 50579(U))

The main legal issue in this case was whether the complaint against an insurance company seeking to recover assigned first-party no-fault benefits should be dismissed. The insurance company argued that the claims were submitted more than 45 days after the supplies had been furnished, lacked medical necessity, and that the fees sought exceeded the amounts permitted by the workers' compensation fee schedule. The court considered the affidavit of the insurance company's claims representative, which established that the claims had been submitted late and that the denial of claim form had been timely mailed. The court found that the plaintiff failed to raise a triable issue of fact in response to the insurance company's showing, as the claim forms were dated more than 45 days after the supplies at issue were furnished. Ultimately, the court held that the insurance company's motion for summary judgment dismissing the complaint should have been granted, reversing the lower court's order and granting the insurance company's motion.
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Lida’s Med. Supply, Inc. v Personal Serv. Ins. Co. (2022 NY Slip Op 50578(U))

The relevant facts considered in this case include the provider's attempt to recover assigned first-party no-fault benefits and the method of service of the summons and complaint, which alleged service by mail but did not contain an acknowledgment of service. The main issue decided was whether the provider had obtained personal jurisdiction over the defendant. The holding of the case was that the order denying the defendant's motion to dismiss the complaint was reversed, and the defendant's motion to dismiss the complaint was granted. The court cited a similar case, Longevity Med. Supply, Inc. v American Ind. Ins. Co., in which the order to dismiss the complaint was reversed based on similar circumstances.
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Sanford Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2022 NY Slip Op 50576(U))

The court considered the plaintiff's failure to appear for scheduled examinations under oath (EUOs) and the sufficiency of the affirmation submitted by the defendant's attorney in establishing this failure. The main issue decided was whether the affirmation was sufficient to demonstrate that the plaintiff failed to appear for the EUOs. The holding of the court was that the affirmation submitted by the defendant's attorney was deemed sufficient to demonstrate prima facie that the plaintiff failed to appear for the EUOs, and the plaintiff failed to raise a triable issue of fact in response. Therefore, the court affirmed the order granting the defendant's motion for summary judgment and dismissing the complaint.
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Masigla v Nationwide Ins. (2022 NY Slip Op 50575(U))

The court considered an appeal from an order granting the defendant's motion for summary judgment dismissing the complaint and denying the plaintiff's cross motion for summary judgment. This case involved a provider seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the lower court's decision to grant the defendant's motion for summary judgment and deny the plaintiff's cross motion for summary judgment should be affirmed. The holding of the court was that the order was affirmed, with $25 costs, and the decision was based on the reasons stated in a similar case decided simultaneously.
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Energy Chiropractic, P.C. v Nationwide Ins. (2022 NY Slip Op 50572(U))

The court considered the case of Energy Chiropractic, P.C., as Assignee of Reid, Shamel W. v Nationwide Ins., in which the plaintiff appealed from an order granting the defendant's motion for summary judgment and denying the plaintiff's cross motion for summary judgment. The main issue decided was whether the provider was entitled to recover assigned first-party no-fault benefits. The court affirmed the order, with the reasoning stated in the case of MSB Physical Therapy, P.C., as Assignee of Reid, Shamel W. v Nationwide Ins. The holding of the case was that the order granting the defendant's motion for summary judgment and denying the plaintiff's cross motion for summary judgment was affirmed.
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