No-Fault Case Law

The court considered the issue of whether the medical devices provided to plaintiff's assignor were medically necessary in an action to recover assigned first-party no-fault benefits. After a nonjury trial, the Civil Court awarded plaintiff the principal sum of $1,809.20. However, the defendant appealed, arguing that the medical devices provided were not medically necessary. The defendant's doctor testified that the cervical and lumbar traction units provided by the plaintiff were not medically necessary, and the court found his testimony to be "wholly credible." As a result, 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 complaint. The holding of the case was in favor of the defendant, as the court determined that the defendant established that the medical devices at issue were not medically necessary.

The relevant facts of the case included an action to recover no-fault benefits under a policy of automobile insurance by Westchester Medical Center, as Assignee of Christine Tachaud, against Allstate Insurance Company. The plaintiff's appeal from an order of the Supreme Court, Nassau County was denied by the court on the complaint. The plaintiff made a showing of its entitlement to judgment as a matter of law by demonstrating that the necessary billing documents were mailed to, and received by, the defendant insurer, and that payment of no-fault benefits was overdue. The appellate division reversed the order, stating that the plaintiff's motion for summary judgment on the complaint is granted, and that the Supreme Court should have granted the plaintiff's motion for summary judgment on the complaint. The main issue decided was whether the plaintiff was entitled to summary judgment as a matter of law, and the holding of the case was that the Supreme Court should have granted the plaintiff's motion for summary judgment on the complaint.

The court considered the failure of Allstate Insurance Company to timely contest the adequacy of the claim forms used by the plaintiff Richmond University Medical Center to establish proof of claim. Allstate Insurance Company waived its right to rely on any deficiencies in those forms at the litigation stage. The plaintiffs established their prima facie entitlement to judgment as a matter of law on the second cause of action by submitting evidence in admissible form that the prescribed statutory billing form had been mailed to and received by the defendant insurer, which failed to either pay or deny the claim within the requisite 30-day period. The main issue decided was whether Allstate Insurance Company waived its right to contest the adequacy of the claim forms at the litigation stage by failing to do so at the claims stage. The holding of the case was that the judgment in favor of Richmond University Medical Center, as assignee of Arnold Sealey, for the total sum of $6,698.56 was affirmed.

The relevant facts in this case involved an action to recover no-fault benefits under a policy of automobile insurance. The plaintiffs submitted a postal receipt indicating that the prescribed NF-5 statutory billing form was received by the defendant on May 26, 2011. The plaintiffs' motion for summary judgment on the first cause of action was granted by the Supreme Court. The issue at hand was whether the defendant timely paid or denied the claim, or requested additional verification within the time frame set forth in the no-fault regulations. The decision was that the Supreme Court properly granted the plaintiffs' motion for summary judgment on the first cause of action, affirming insofar as appealed from, with costs.

The case involves an action to recover no-fault benefits under two separate policies of automobile insurance. The appellant, QBE Insurance Corporation, appealed from a judgment entered in favor of the plaintiffs, New York Hospital Medical Center of Queens, in the sum of $66,682.29. The Supreme Court denied the defendant's cross motion for summary judgment and granted the plaintiff's motion for summary judgment in connection with the first and second causes of action. The main issue of the case was whether the plaintiffs were entitled to recover no-fault benefits under both insurance policies. The court held that the plaintiffs were entitled to recover no-fault benefits on the second cause of action, related to the claim submitted by Westchester Medical Center. However, the court modified the judgment to dismiss the first cause of action, as the defendant, QBE Insurance Corporation, had established that payment on the claim made by the plaintiff New York Hospital Medical Center of Queens was not overdue due to outstanding verification requests.

The court considered the mandatory arbitration process as the sole available remedy to determine issues of coverage between insurance carriers and Motor Vehicle Accident Indemnification Corporation (MVAIC). The appellant, Farmers Insurance Company, failed to participate in the arbitration proceeding, seek an adjournment, or file a petition to vacate the arbitration award regarding the alleged cancellation of the insurance policy. The main issues decided were the obligation of Farmers Insurance Company to provide coverage for the accident and the preclusive effect of the arbitration decision. The holding of the court was that appellant had a full and fair opportunity to contest the decision, and failed to do so, therefore, the order finding Farmers Insurance Company obligated to provide coverage for the accident was affirmed.

The court considered the matter of two arbitration awards that were vacated and remanded for a new arbitration before a new arbitrator. The main issue decided was whether the arbitration awards, rendered in compulsory arbitration, were irrational or contrary to settled law, and therefore should have been confirmed. The court held that the arbitral awards were not irrational or contrary to settled law, and therefore should have been confirmed. It was also determined that the respondent insurer's disclaimer, based strictly upon primacy of coverage, was not so absolute or unequivocal as to constitute a repudiation of the policy. The court held that the petitioner failed to comply with the conditions precedent to coverage found in the implementing no-fault regulations.

The court in this case considered an action to recover no-fault benefits under a policy of automobile insurance. The plaintiff, Westchester Medical Center, as assignee of Arianna Thrasher, appealed from an order of the Supreme Court that denied its motion for summary judgment on its first cause of action. The court held that the plaintiff made a prima facie showing of entitlement to judgment by submitting evidence that the prescribed billing form was received by the respondent insurer and failed to pay or deny the claim within the requisite 30-day period. The court also held that the respondent failed to raise a triable issue of fact in opposition to the appellant's prima facie showing. The respondent's contention of a complete absence of coverage that could be asserted as a basis for disclaimer was deemed improper as it was raised for the first time on appeal. The court reversed the order, granting the plaintiff's motion for summary judgment on its first cause of action.

The court considered the fact that the plaintiff provider was seeking to recover assigned first-party no-fault benefits from the defendant insurance company. The main issue decided was whether the defendant had timely and properly denied the claims at issue on the ground that the plaintiff had failed to comply with a condition precedent to coverage by failing to appear for duly scheduled examinations under oath. The holding of the court was that the defendant had proven that it had mailed its EUO scheduling letters and denial of claim forms in accordance with its standard office practices and procedures, and that the plaintiff's objections regarding the EUO requests would not be heard since the plaintiff did not claim to have responded in any way to the EUO requests. Therefore, the court affirmed the order of the Civil Court granting the defendant's motion for summary judgment dismissing the complaint.

The court considered a case in which Alev Medical Supply, Inc., as the assignee of Kecia Daniely, appealed the dismissal of their complaint seeking first-party no-fault benefits from Government Employees Insurance Company. The trial was limited to the issue of the defendant's defense of lack of medical necessity, and ultimately, the court found in favor of the defendant, dismissing most of the plaintiff's claims. The only remaining claim was for the recovery of $330 for a massager and a Thermophore. On appeal, plaintiff raised evidentiary objections, specifically challenging the admissibility of defendant's doctor's testimony as hearsay. However, the court affirmed the judgment, ruling that the Civil Court properly overruled plaintiff's hearsay objection and that the plaintiff's remaining contentions lacked merit. Therefore, the judgment was affirmed in favor of the defendant.